An e-bulletin created for healthcare systems working with patients to control their diabetes and high blood pressure

October 2018

An Iowa Story A journey from cardiac arrest to RAGBRAIHeart disease can render anyone powerless Even someone like my stepfather Growing up he was always a strong and physically capable role model He once raced three-wheelers professionally taught me how to race motocross and in middle school my friends joked that he looked like professional wrestler ldquoStone Coldrdquo Steve Austin The similarities were obvious since he had a bald head goatee and imposing statureBut heart disease is a brutal adversary One morning in June 2013 he collapsed into my car from cardiac arrest after we leftthe gym

Vital Signs Report Issued CDC calls for action to curb heart attacksThis study describes the burden in 2016 of nonfatal and fatal cardiovascular events targeted for prevention by Million Hearts 2022 a national initiative working to prevent one million cardiovascular events during 2017ndash2021 Heart attacks and strokes are taking a huge toll on adults across the US mdash and the CDC is calling on both patients and health care providers to take action Health officials report that heart attacks strokes and similar conditions caused 22 million hospitalizations and 415000 deaths in 2016 Those cases resulted in $327 billion in costs that year alone The CDC says that staggering number is driven in part by missed opportunities to treat the controllable causes of cardiovascular disease Case in point 9 million adults arenrsquot taking aspirin as recommended 54 million smoke and 39 million could benefit from better cholesterol management according to the CDC

Patient-Centered Care Awareness Monthwwwplanetreeorg

Pharmacists Monthwwwpharmacistcom

Talk About Your Medicines Monthwwwbemedwiseorg

Physician Assistants WeekOctober 6 ndash 12 2018wwwaapaorg

American Diabetes Monthwwwdiabetesorg

Diabetes Education MonthNovember 4 -10 2018wwwdiabeteseducatororg

Great American SmokeoutNovember 15 2018wwwcancerorg

Family Caregivers Monthwwwlungorg

What Makes This Program EffectiveIt is the process by which the program is taught Classes are highly participative where mutual support and success build the participantsrsquo confidence in their ability to manage their health and maintain active and fulfilling lives Better Choices Better Health workshops will not conflict with existing programs or treatments They are designed to enhance regular treatment and disease-specific education In addition many participants have more than one chronic condition The program is especially helpful for these individuals as it gives them skills to coordinate all the things needed to manage their health as well as to help keep them active To learn more and hear participant comments view the Health for a Lifetime Video

ABCS are continued on the next pagehellip

Priority Keeping People Healthy

Priority Optimizing Care

bull Visit the Million Heartsreg website for evidence-based resources tools and guides to help you target interventions to best meet the cardiovascular needs of the people you serve

bull Join the social media conversation by following Million Heartsreg on Facebook and Twitter (MillionHeartsUS)bull Get regular updates by signing up for the Million Heartsreg e-Updatebull Visit our Million Heartsreg Partner Toolkit for shareable content graphics and other resources

Find out how practice leaders in Chicago and Boulder used incentives to reach hypertension control goalsTwo 2017 Million Heartsreg Hypertension Control Champions achieved blood pressure control through participation in value-based performance reimbursement and other financial incentive programs in their practices Optimize Patient Care Using Incentives

Millions Hearts Elements Associated with Effective Adoption and Use of a Protocol Insights from Key Stakeholders (PDF)Simple evidence-based treatment protocols are an essential tool for improving blood pressure control among practices and health care systems To accelerate the adoption and implementation of protocols Million Heartsreg convened a group of stakeholders who recognize that the use of protocols is key to their success in blood pressure control Stakeholders consist of protocol owners key organizations and health care providers who have successfully used protocols within their system This document is a compilation of comments and insights gained from the stakeholder discussions in fall 2013 about adopting and using hypertension protocols

Who still smokes in the US - and whyThe divide between who puffs and who passes on traditional tobacco cigarettes today is largely drawn by often overlapping factors such as income education and geography Disparities in these areas are stark and are key to whether and how smokers try to quit the countryrsquos leading cause of preventable disease and death

Weight-Adjusted Aspirin Dosing Evidence Builds in Primary PreventionLow-dose aspirin intended for primary prevention typically 75 to 100 mg once daily doesnt protect against cardiovascular events in persons who weigh at least 70 kg (about 154 pounds) suggests a patient-level analysis of randomized trials that included more than 100000 patients

The CDC recently released a resource on promising policies and practices from several states on addressing tobacco use among individuals with mental health andor substance use disorders The states highlighted in the document are New York Oklahoma Hawaii Texas and Kentucky Some of the policies and practices described include having a smoke-free campus screening clients for tobacco use offering tobacco cessation counseling offering nicotine replacement therapy (NRT) and offering non-nicotine tobacco cessation medications

23 of US adults meet minimum recommended physical activity levelsJust 23 of US adults meet minimum recommended physical activity levels according to findings published in the National Health Statistics Reports Researchers studied more than 155000 Americans ages 18 to 64 and found that while 14 states and Washington DC had significantly greater percentages of adults who met the guidelines than the national average 13 states had significantly lower percentages than the national average HealthDay News (628)

Priority Improving Outcomes for Priority Populations

Educate Young Adults About Their Risk for StrokeStroke can happen to anyone at any time Stroke risk factors like hypertension and obesity are on the rise in younger adults This May during National Stroke Awareness Month Million Heartsreg helped educate younger adults about the risks and realities of stroke with stroke survivor stories an interactive quiz videos social media messages and more

New Institute for Clinical Systems Improvement toolkit helps clinics address tobaccouse The Tobacco Health Systems Change Starter Toolkit for Clinics provides a wealth of practical resources and tools to help clinics and health systems improve how they address tobacco use among patients Download Tobacco Toolkit for Clinics

Cholesterol levels associated with CVD-related premature death study showsLDL cholesterol levels ranging from 100 mgdL to 159 mgdL increase mortality risk from cardiovascular disease by up to 40 among adults with no history of diabetes or heart disease and a low 10-year risk for CV events like heart attacks or strokes compared with those who had LDL-C levels below 100 mgdL according to a study in Circulation Researchers evaluated 36375 individuals and found those with LDL-C levels of 100 mgdL to 129 mgdL died of CVD nearly 18 years sooner while those with LDL-C levels of 160 mgdL or higher died about four years sooner compared with those whose LDL-C levels were below 100 mgdL Reuters (820)

CDC Rates of Outpatient Rehab Post-stroke Low in Several States Including IowaFindings are based upon a 2013 survey of 20 states and the District of Columbia and a follow-up study of four of those states in 2015 (Main Georgia Oregon and Iowa)

AHA recommends switching from diet drinks to waterPeople should replace diet and sugary beverages with carbonated plain or unsweetened flavored water according to the American Heart Associations recommendations in the journal Circulation However children with diabetes who are eating a balanced diet could help keep their blood glucose levels in check by switching low-calorie drinks with sugary beverages when needed the report stated HealthDay News (730)

CARDIA Study IDs ldquoSoberingrdquo Rate of Hypertension in BlacksThree-quarters of black men and women develop hypertension by middle age compared with just over half of white men and two-fifths of white women warn US researchers in a study that nevertheless underlined the role of following a healthy diet in preventing high blood pressureData on over 3800 individuals from the Coronary Artery Risk Development in Young Adults (CARDIA) study showed that by age 55 years the cumulative incidence of hypertension was approximately 75 in black men and women compared with 55 in white men and 40 in white women

Exercise reduces cardiac risks regardless of air pollutionThe risk of a first or recurrent heart attack is reduced with exercise no matter the air quality a study in the Journal of theAmerican Heart Association found Researchers suggested however that people should avoid air pollution when possible by not actively commuting or exercising on busy roads MedPage Today (free registration) (718)

Researchers find morning vs evening preference tied to BMI in prediabetesA study published in the Frontiers in Endocrinology showed that people with prediabetes who wake eat and do activities earlier in the day had a lower body mass index and potentially a lower risk of developing type 2 diabetes compared with those who wake later and eat and sleep later in the evening Researchers used a cohort of more than 2000 prediabetes patients and also found an association between higher BMI and higher levels of social jet lag Diabetes (UK) (816)

Time to diabetes treatment intensification tied to glycemic control study showsA study in Diabetes Care showed that the earlier addition of one or more noninsulin diabetes drugs after the index date among patients with type 2 diabetes who received metformin or sulfonylurea monotherapy led to a shorter time to glycemic control compared with intermediate and late intensification Researchers used a cohort of 93515 adults aged 18 to 79 and found the intermediate intensification group was 22 less likely to achieve glycemic control and the late intensification group 28 less likely compared with the early intensification group Healio (free registration)Endocrine Today (829)

Third Edition of Diabetes in America Now AvailableThe third edition of the comprehensive reference book Diabetes in America has been published online by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) The book is divided into three main sections covering epidemiology of diabetes in the United States complications and related conditions and diabetes prevention and medical care The 42 chapters cover a wide range of specific topics under each heading with far more information than was provided in the second edition published as a printed book in 1995

Study ties painful diabetic peripheral neuropathy to low vitamin D levelsUK researchers found that levels of 25-hydroxyvitamin D were significantly lower among patients with type 2 diabetes with painful diabetic peripheral neuropathy compared with diabetes patients without peripheral neuropathy or with painless diabetic peripheral neuropathy and those without either condition The findings in Diabetic Medicine based on data from 59 individuals revealed that for each unit reduction in vitamin D the odds of painful diabetic peripheral neuropathy increased by a factor of 111 researchers wrote Healio (free registration)Endocrine Today (828)

Statins Diabetes and Glucose Metabolism Challenging Cases and Considerations CME ABIM MOC CEDo Electric Cars Affect Pacemakers amp Defibrillators CME ABIM MOC CE

Do Multivitamins Promote Heart Health CME ABIM MOC CE

Does Vegetarian Diet Improve HbA1c Cut CV Risk for Diabetes CME ABIM MOC CE

The Financial Burden of Heart Disease on Low-Income Families CME ABIM MOC CESimplifying Insulin Delivery for Better Patient Outcomes in T2D CME ABIM MOC CEAre There CV and Other Health Benefits With Saunas CME ABIM MOC CEIT Health Solutions Medication Errors Reduced CME ABIM MOC CEGreater Risk for Diabetes Among Non-heterosexual Youth CME ABIM MOC CEObesity and Dyslipidemia How Would You Treat CME ABIM MOC CEExploring the Latest Statin Clinical Data in CAD How to Treat High-Risk Patients CME ABIM MOC CEMetabolically Healthy Obese Women at Risk for Heart Disease CME ABIM MOC CEMetformin Use and Risk for Lactic Acidosis in T2 Diabetes CME ABIM MOC CESGLT2 Inhibitors and CV Outcomes A Year in Review CME CETreating Coronary Artery Disease Today Distilling the Latest DataDifference in HbA1C Drop - Intermittent Fasting vs Low-Cal Diet CME ABIM MOC CE

Suggested Resources from Million HeartsregDesign of EvidenceNOW Helps Balance Primary Care Implementation and Implementation Research (Ann Fam Med)8 Percent of US Deaths Are Associated with Inadequate Physical Activity but Rates Vary with Age (Pre Chronic Dis)Study Finds Limited Awareness of Air Quality Among People with Heart Disease (Am J Prev Med)Veterans Health Administration Implements Home-Based Cardiac Rehabilitation to Address Participation Barriers (JAMA Intern Med)The Great Recession Worsened Blood Pressure and Blood Glucose Levels in American Adults (PNAS)

Stroke the fifth leading cause of death in the United States can happen to anyone at any timeRead these survivor stories from CDCrsquos Division for Heart Disease and Stroke Prevention to learn more about stroke including how your patients may be at risk how you can educate them to recognize stroke and how they should respond if a stroke happens Promote New Stroke Survivor Stories from cdcgovstroke

Connecticutrsquos public health department uses electronic health records to identify hypertensive patientsConnecticutrsquos public health department worked with eHealthConnecticut its regional extension center to develop a centralized web-based dashboard where each health system can report and compare patient data to find people with undiagnosed hypertension Read Connecticutrsquos Success Story

Medicaid Expansion Curbs Uninsured Hospitalization for CV EventsIn the first year states that expanded Medicaid coverage under the Affordable Care Act (ACA) had fewer uninsured hospital admissions for acute myocardial infarction stroke and heart failure than states that opted not to expand Medicaid show results of a study by researchers at Northwestern University Feinberg School of Medicine in Chicago Illinois

Insurers want clarity on texting calling patientsA group of insurers led by the American Association of Healthcare Administrative Management wants the FCC to grant a 2016 petition seeking changes in the Telephone Consumer Protection Act to clarify how HIPAA-covered entities can use texts or phone calls to communicate with patients A legal challenge to the petition has been resolved so the FCC now can act on it FierceHealthcare (829)

Research links diet quality to CV mortality riskAdults from 21 countries whose diet quality -- measured with the PURE study healthy diet score -- fell in the highest quintile had a modest reduction in major cardiovascular events and a 25 reduced risk for non-CV mortality compared with those in the lowest diet score quintile and researchers said at the European Society of Cardiology Congress that the findings were echoed in other large international studies included in the analysis Recent cohort studies with all geographic regions of the world indicate that moderate intakes of whole fat dairy unprocessed meats fish and nuts are protective while a diet high in starch is harmful said researcher Andrew Mente Healio (free registration)Cardiology

Today (828)

More stroke survivors could afford medication after the ACATHE PERCENT OF STROKE SURVIVORS WHO SAID THEY DIDNT TAKE PRESCRIBED DRUGS DUE TO COST (JAMA NEUROLOGY)Fewer stroke survivors are skipping their medications due to cost since the ACA was put in place In a new analysis researchers looked at how often stroke survivors said they couldnrsquot afford prescribed medications between 2000 and 2016 Between 2006 and 2010 23 percent of stroke survivors said they couldnt pay for medications From 2014 to 2016 however more survivors had health insurance mdash and the share who said they couldnrsquot afford their drugs fell to 18 percent The authorsrsquo takeaway Further Medicaid expansion would likely be a good thing for stroke survivors and could cut costs since treatment could stave off future problems

Report Medicaid could save over $48B with fully electronic transactionsMedicaid could save over $48 billion per year if all of the programs claims processes were to become fully electronic according to a report from the Council for Affordable Quality Healthcare The move could save payers $684 per transaction the report estimates Healthcare Dive (817)

The Iowa Department of Public Health -- Health Promotion and Chronic Disease Control Partnership

Study links increasing BMI to higher stroke riskResearch published in Nutrition Metabolism and Cardiovascular Diseases linked increasing body mass index with a higher risk for stroke The analysis of data from 44 studies showed a J-shaped relationship with no link between BMI and stroke among adults with a BMI of less than 24 but a gradual increase in risk among those with a BMI of at least 25 Healio (free registration)Endocrine Today (731)

Terry Y MeekHealth Systems Coordinator

terrymeekidphiowagov

Laurene HendricksLinkage Coordinator

laurenehendricksidphiowagov

Editors

This e-Bulletin is supported by Cooperative Agreement Number 5U58DP004807-05 from the Centers for Disease Control and Prevention Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Iowa Department of Public Health

CDC looks at patient health data exchanged by physiciansCDC researchers found that referrals laboratory results and medication lists were the most common types of patient health information sent by office-based physicians while they most often received lab results imaging reports and medication lists The findings in National Health Statistics Reports based on 2015 National Electronic Health Records Survey data also showed that lab results were the most commonly electronically integrated data while medication lists were the most commonly searched data in the EHR Health Imaging online (817)

Study Adding support alerts to EHRs cuts spending boosts qualityIntegrating Choosing Wisely clinical decision support alerts into the Epic EHR system at Cedars-Sinai Medical Center resulted in lower spending shorter lengths of stay a lower 30-day readmission rate and fewer complications when clinicians followed the recommendations researchers reported in the American Journal of Managed Care Health care providers received immediate notification if they deviated from recommendations and were given an option to justify change or cancel the order Health Data Management (free registration) (817)

Obesity Drug Belviq Is Heart Safe in Cardiovascular Outcome StudyThe obesity drug lorcaserin (Belviq Eisai) does not increase the risk of any major adverse cardiac events (MACE) mdash

including cardiovascular death nonfatal myocardial infarction and nonfatal stroke mdash according to top-line results from a

12000 patient post-marketing safety study mandated by the US Food and Drug Administration (FDA)

Target BP Participant Webinar Using Self-Measured Blood Pressure to Diagnose and Manage High Blood Pressure that was held on April 26 2018A copy of the recording along with presentation slides will be forthcoming In the meantime if you would like to view our new SMBP video that was featured during todays presentation please visit httpstargetbporgtools_downloadsself-measured-blood-pressure-video If you would like additional information about the Target BP initiative or would like to share information with your colleagues please visit our targetbporg website

The New York Times Heart Failure May Be More Lethal In WomenThe incidence of heart failure has declined overall in both sexes in recent years and remains higher in men But women are

more likely to die from the disease A study in the Canadian Medical Association Journal included 90707 new diagnoses of

heart failure among Ontario residents from 2009 to 2014 Almost 17 percent of women died within a year of follow-up

compared with just under 15 percent of men Rates of hospitalization decreased over the study period in men and

increased in women (Bakalar 718)

NPR Keeping Blood Pressure Down Can Help Lower Dementia RiskEvery day Dr Walter Koroshetz 65 takes a pill as part of his effort to help keep his brain healthy and sharp The pill is his blood pressure medication And Koroshetz who directs the National Institute of Neurological Disorders and Stroke says controlling high blood pressure helps him reduce his risk of dementia He also keeps his blood pressure down by exercising and paying attention to his weight and diet Im a believer he says (Hamilton 716)