Cardiovascular Disease - Stroke Deaths

Why Is This Important?

In 2016, stroke was the fifth leading cause of death in New Mexico.

Definition

Stroke Deaths per 100,000 population in New Mexico Stroke deaths include deaths with underlying cause of cerebrovascular disease, include ICD-10 codes I60-I69.

Data Sources

• New Mexico Death Data: Bureau of Vital Records and Health Statistics (BVRHS), Epidemiology and Response Division, New Mexico Department of Health.
  (https://www.nmhealth.org/about/erd/bvrhs/vrp/)
• Centers for Disease Control and Prevention, National Center for Health Statistics, CDC WONDER Online Database
  (http://wonder.cdc.gov)
• New Mexico Population Estimates: University of New Mexico, Geospatial and Population Studies (GPS) Program.
  (http://gps.unm.edu/)

How the Measure is Calculated

How Are We Doing?

US and NM: In general, stroke death rates have decreased in the last 15 years in the US. In New Mexico, stroke mortality rates declined beginning in 2004 and remained relatively stable through 2011, with another slight decline in 2012 and 2013. Though the rate in most recent years, 2015 through 2017, was statistically significantly higher than that of 2012, the NM rate has essentially remained stable since 2013. Age and Sex, 2015-2017 combined: There was no statistically significant difference in stroke mortality rates by sex. Stroke mortality is strongly associated with age for both sexes. The stroke mortality rates were significantly higher for older age groups. For both sexes, from the age group 35-44, the stroke mortality rate for each age group was statistically significantly higher than that of the next younger age group. Race/Ethnicity, 2014-2017 combined: The stroke mortality rates for Black or African American and American Indian or Alaska Native populations were statistically significantly higher than that of the white population. The rate for the Black or African American population was statistically significantly higher than that of the Hispanic population, as well. Race/Ethnicity and Sex, 2014-2017 combined: Among males, the stroke mortality rate of White males was lower than that of American Indian and Hispanic males. There were no significant differences by Race/Ethnicity among females. Among American Indian/Alaska Natives, the stroke mortality rate for males was statistically significantly higher than that of females. There were no differences between the male and female rates of the other Race/Ethnic populations. County, 2015-2017: During the period 2015-2017, stroke mortality rate varied by county. The six counties with the highest rates were De Baca, Socorro, Luna, Eddy, Sandoval, and Lea. The six counties with the lowest rates that were sufficiently stable to report were Chaves, Cibola, Grant, Los Alamos, Sierra, and Catron. Urban and Rural, 2015-2017: The rate of Metropolitan counties, as a group, was statistically significantly higher than the rate of Rural counties. There was no statistically significant difference in stroke mortality rates between any other geographic urban/rural categories.

How Do We Compare With the U.S.?

2017 U.S. estimate of stroke mortality was not available at the time of publication. In 2016, the New Mexico age-adjusted stroke mortality rate was lower than that of the U.S. Of note, the New Mexico stroke mortality rate has been at or below the HP 2020 target for the U.S. of 34.8 deaths per 100,000 since 2009, with the exception of 2016 (35.0/100,000). However, US and NM rates are getting closer, since the US rates are decreasing faster than the NM rates.

What Is Being Done?

The NM Department of Health Heart Disease and Stroke Prevention (HDSP) Program works with health systems, health care providers, community partners, agencies and coalitions to provide awareness of and education about heart disease and stroke prevention strategies. Program strategies are focused on providing professional education to members of the health care team about the importance of reporting standardized hypertension and diabetes quality measures to reporting bodies using electronic health record (EHR) data; partnering with EHR data experts to provide technical assistance to health systems on how to extract necessary data from the EHR to be able to report quality measures; working with health systems to identify potential errors in entering EHR data that may affect quality reporting; using EHR data to identify patients with undiagnosed hypertension commonly referred to as those "hiding in plain sight;" partnering with the NM Department of Health Diabetes Prevention and Control Program (DPCP) to provide resources and programs for patients to manage their hypertension and diabetes; promoting the value of community health workers as members of the healthcare team; promoting and educating about the importance of using a team-based healthcare model; partnering with NM Medicaid to extract and analyze prescription fill data for diabetes and hypertensive medications; use Million Hearts and American Heart Association resources to promote and educate about self-measured blood pressure monitoring tied with clinical support. The HDSP program's partners support build environment improvements so people at risk for or with cardiovascular disease and stroke can be physically active and initiatives that increase access to healthy foods. The HDSP program consults with populations that are disproportionately affected by cardiovascular disease and stroke and/or those that serve them to develop education and services that are culturally appropriate to these populations.

Evidence-based Practices

Evidence-based community health improvement ideas and interventions may be found at the following sites: - The Guide to Community Preventive Services - Health Indicators Warehouse - County Health Rankings - Healthy People 2020 Website Heart Disease and its complications can be prevented and managed through these strategies: * Clinical decision-support systems designed to assist healthcare providers in implementing clinical guidelines at the point of care. * Reducing out-of-pocket costs (ROPC) for patients with high blood pressure and high cholesterol. * Team-Based Care to Improve Blood Pressure Control. * Interventions engaging community health workers/community health representatives/promotoras * Implementing self-measured blood pressure monitoring interventions * Interactive digital interventions for blood pressure self-management * Mobile Health (mHealth) interventions for treatment adherence among newly diagnosed patients CDC recommends specific major activities to implement these seven effective strategies: 1) Clinical decision-support systems (CDSS) designed to assist healthcare providers in implementing clinical guidelines at the point of care. * Implementation of CDSS at clinics and sites that provide healthcare services along with providing technical assistance on proper use of these systems. * CDSS for cardiovascular disease prevention (CVD) include one or more of the following: * Reminders for overdue CVD preventive services including screening for risk factors such as high blood pressure, diabetes, and high cholesterol * Assessments of patients' risk for developing CVD based on their medical history, symptoms, and clinical test results * Recommendations for evidence-based treatments to prevent CVD, including intensification of treatment * Recommendations for health behavior changes to discuss with patients such as quitting smoking, increasing physical activity, and reducing excessive salt intake * Alerts when indicators for CVD risk factors are not at goal[[br]] 2) Reducing out-of-pocket costs (ROPC) for patients with high blood pressure and high cholesterol: * Reducing out-of-pocket costs involves program and policy changes that make cardiovascular disease preventive services more affordable. These services include: * Medications * Behavioral counseling (e.g. nutrition counseling) * Behavioral support (e.g. community-based weight management programs, gym membership) * Encouraging the delivery of preventive services in clinical and non-clinical settings (e.g. worksite, community). * Promoting interventions that enhance patient-provider interaction such as team-based care, medication counseling, and patient education. * Increasing awareness of covered services to providers and to patients with high blood pressure and high cholesterol using targeted messages. * Work with diabetes management and tobacco cessation programs to coordinate coverage for blood pressure and cholesterol management. [[br]] 3) Team-Based Care to Improve Blood Pressure Control: * Team-based care to improve blood pressure control is a health systems-level, organizational intervention that incorporates a multidisciplinary team to improve the quality of hypertension care for patients. * Provide technical assistance to facilitate communication and coordination of care support among various team members including the patient, the patient?s primary care provider, nurses, pharmacists, dietitians, social workers, and community health workers. * Enhance the use of evidence-based guidelines by team members. * Actively engage patients and populations at risk in their own care by providing educational materials, medication adherence support, and tools and resources for self-management (including health behavior change). 4) Interventions engaging community health workers/community health representatives/promotoras: * Screening and health education. CHWs screen for high blood pressure, cholesterol, and behavioral risk factors recommended by the United States Preventive Services Task Force (USPSTF); deliver individual or group education on CVD risk factors; provide adherence support for medications; and offer self-management support for health behavior changes, such as increasing physical activity and smoking cessation. * Outreach, enrollment, and information. CHWs reach out to individuals and families who are eligible for medical services, help them apply for these services, and provide proactive client follow-up and monitoring, such as appointment reminders and home visits. * Team-based care. As care team members, CHWs partner with clients and licensed providers, such as physicians and nurses, to improve coordination of care and support for clients. * Patient navigation. CHWs help individuals and families navigate complex medical service systems and processes to increase their access to care. * Community organizers. CHWs facilitate self-directed change and community development by serving as liaisons between the community and healthcare systems. 5) Implementing self-measured blood pressure monitoring interventions: * One-on-one patient counseling on medications and health behavior changes (e.g., diet and exercise) * Educational sessions on high blood pressure and blood pressure self-management * Access to electronic or web-based tools (e.g., electronic requests for medication refills, text or email reminders to measure blood pressure or attend appointments, direct communications with healthcare providers via secure messaging) 6) Interactive digital interventions for blood pressure self-management: In these interventions, patients who have high blood pressure use digital devices to receive personalized, automated guidance on blood pressure self-management. Devices include mobile phones, web-based programs, or telephones. Interactive content does not require direct input from a health professional. 7) Mobile Health (mHealth) interventions for treatment adherence among newly diagnosed patients: mHealth interventions for treatment adherence use mobile devices to deliver self-management guidance to patients who have been recently diagnosed with cardiovascular disease. Content must be accessible through mobile-phones, smartphones, or other hand-held devices. Interventions must include one or more of the following: * Text-messages that provide information or encouragement for treatment adherence * Text-message reminders for medications, appointments, or treatment goals * Web-based content that can be viewed on mobile devices * Applications (apps) developed or selected for the intervention with goal-setting, reminder functions, or both * An interactive component (i.e., patients enter personal data or make choices) that gives patients personally relevant, tailored information and feedback * Mobile communication or direct contact with a healthcare provider * Web-based content to supplement text-message interventions

Other Objectives

New Mexico Community Health Status Indicator (CHSI)

More Resources

1. Chronic Disease Prevention Council (http://www.chronicdiseasenm.org) 2. American Heart Association (www.heart.org) 3. Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention (http://www.cdc.gov/dhdsp) 4. New Mexico Death Certificate Database, Bureau of Vital Records and Health Statistics, New Mexico Department of Health. Accessed via NM IBIS on 11/05/2018. 5. CDC Wonder, https://wonder.cdc.gov/controller/datarequest/D76;jsessionid=3465CD37C8748EEA5EFF750D862FC942