Posts Tagged ‘heart attack’

Acute Cardiac Care & Arizona’s EMS System – Setting the National Standard

December 4th, 2012

Sudden cardiac arrest is a leading cause of death in Arizona (7,600/year).  Because Arizona’s EMS agencies (including more and more 911 centers) have implemented key interventions, the survival rate from Sudden Cardiac Arrest in Arizona has increased by 300% since 2004.  Arizona’s pre-hospital and EMS system has become a model that has been adopted across the country- and now is shaping international models for cardiac arrest.  This success isn’t an accident – it is because our EMS System stakeholders made it happen. 

How did we get there?  Basically, it’s our unique Save Hearts in Arizona Registry and Education (SHARE) program- which is a public-private partnership bringing together the agencies in the Chain of Survival for Sudden Cardiac Arrest including the public, 9-1-1 dispatch centers, trained EMS providers and community hospitals.  Some of the system interventions that have enabled us to triple survival rates when compared to the rest of the country include: 

  1. Public training events to recognize cardiac arrest and how to perform bystander CPR;
  2. Implement new 9-1-1 dispatcher pre-arrival instructions to recognize cardiac arrest and start CPR more quickly;
  3. Data collection and analysis that guides quality improvement efforts;
  4. Extensive and on-going performance evaluation and competency training of EMS folks;
  5. On-going evaluation of resuscitation attempts along with participation in quality improvement initiatives;
  6. Seamless integration of care between first responders and EMS transporting entities;
  7. Involvement in numerous local, national, and international EMS care initiatives and training conferences; and
  8. Buying pre-hospital ECG and transmission equipment to facilitate early treatment within hospitals. 

Not only that- we’ve been measuring and publishing our results all along the way.  By publishing- we’re able to show the world what we’ve accomplished so that the pre-hospital systems all around the world can do what we’ve done.  Here’s a list of 16 peer-reviewed publications that highlight the significant improvements in cardiac arrest survival in Arizona.

Lower the Pressure

September 14th, 2012

About 1/3 of American adults have high blood pressure and more than half of them don’t have it under control.   The majority of people with high blood pressure are being treated with medicine and have seen a doctor at least twice in the past year…  but their pressure still isn’t under control, according to a new Vital Signs report from the CDC this week. 

High blood pressure means blood pressure greater than or equal to 140/90 mm- Hg…  and its direct health care cost is almost $131B per year.  To learn more about blood pressure, visit www.cdc.gov/bloodpressure/.   For more information on heart disease and stroke, visit http://www.cdc.gov/heartdisease/.  Controlling high blood pressure is also a key component of the Million Hearts initiative to prevent a million heart attacks and strokes by 2017.

 

Arizona Stroke Research

May 10th, 2010

Dr. Ben Bobrow, our EMS Medical Director is at it again, with yet another publication that positively measured the value and effectiveness of another public health intervention.  Ben and his team published this month in Stroke and demonstrated that telemedicine is incredibly valuable for saving lives in rural and remote communities, by giving rural and frontier health care providers critical access to specialists that can help the rural providers save lives- and quality of life.

The bottom line is that the rural provider needs good advice about whether to administer thrombolysis medication.  If given quickly and when appropriate, this kind of medicine can dramatically improve outcomes- but it requires very quick judgment and administration…  including deciding who needs it and who doesn’t.  making a bad call can be a real problem, and making a good call can save a life.  Good work Ben.

Salt Initiative

February 22nd, 2010


We launched our salt reduction initiative this week http://www.azdhs.gov/salt/.  The overall goal is to get Arizonans to reduce their salt intake by paying more attention to the Sodium line in the nutrition facts and being a better- by selecting foods for the family that are lower in sodium.

Sodium can increase your blood pressure and the chances of you having a heart attack or stroke… and heart disease is the leading cause of death in Arizona.  National dietary guidelines recommend that many adults eat no more than 2,300 milligrams of sodium each day.  For best health, some adults should eat no more than 1,500 milligrams of sodium each day, and you should really pay attention if you’re over 40, are African American or if you already have high blood pressure.

Most people think that they get their salt mostly from adding it with the shaker- but in reality, 80% of the salt that we get is from processed foods.  That’s the reason why it’s so important to read the label and buy foods that are lower in sodium.

 

Start today and become a “Champion for Change” to cut back on your sodium intake. A Champion for Change” is anyone that makes healthy changes in their home or community. Being a Champion is about being committed to keeping you and your family healthy.

You can begin today by looking at our salt education resources on the www.eatwellbewell.org web site, pledge to eat less salt, and signing up for email alerts and pledge to reduce your salt intake.

Salt, BPA, CCR & the Budget

January 22nd, 2010

NaCl
It’s been no secret that the U.S. (and Arizona) diet is high in salt- and almost 90% of that salt comes from pre-processed foods (as opposed to the salt that you might add while cooking or eating).  Reducing dietary salt is an important public health target- and it’s among one of the cheapest and easiest public health interventions.  In fact, the cardiovascular benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels.

A new study this week in the New England Journal of Medicine http://content.nejm.org/cgi/content/full/NEJMoa0907355 found that reducing dietary salt by 3 g per day would reduce the annual number of new cases of coronary heart disease in Arizona by up to 2,400 per year, reduce the number of strokes in AZ by up to 1,300, heart attacks by up to 2,000 and reduce the annual number of deaths from any cause by between 880 and 1,800.  All from a modest reduction in salt intake.

In fact, Japan, the UK, Finland, & Portugal have successfully reduced population-wide salt intake by using a combination of regulations on the salt content in processed foods, labeling of processed and prepared foods, public education, and by collaborating with the food industry to reduce the amount of salt that is added to foods.

The New York City Health Department has been coordinating a nationwide effort to reduce the salt in both packaged and restaurant foods by 25% over five years http://www.nyc.gov/html/doh/html/cardio/cardio-salt-initiative.shtml. Our nutrition team is exploring whether and how we can sign-on to this growing national initiative…  15 state health departments are already among the supporters.  More on this soon.

BPA
On the other end of the risk spectrum is recent concern about a chemical called bisphenol a, which is a plasticizer that’s used in some kinds of water bottles and in plastics that cover processed foods.  Previous studies have found a slight association between urinary BPA concentrations and heart disease, diabetes and liver enzymes in adult participants of the National Health and Nutrition Examination Survey.  A new study out this week published at: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0008673 concluded that “Higher BPA exposure, reflected in higher urinary concentrations of BPA, is consistently associated with reported heart disease in the general adult population of the USA.”

When I heard about this new study I didn’t think much of it, because the association is weak and the risk increase is slight- and because the studies that have been conducted have shown as association- not causation.  But, when I saw my wife throwing away all of our perfectly good plastic water jugs this morning because of something she heard on the radio- I thought I should include something in this week’s update.

You can read the study yourself and do your own research, but I’m not convinced that the low levels that we’re exposed to from containers is a problem.  So, if you see me in the elevator, you will still see me with my bisphenol A containing refillable water bottle (that I fill up with tap water).

CCR
There was a very good article in the paper this week about our efforts to convert the world to using the new CCR to resuscitate adults that have a cardiac arrest.  You can read the full article at: http://www.azcentral.com/news/articles/2010/01/19/20100119cardiacdoc0119.html and you can review the new CCR method at www.azshare.gov.

Extraordinary Measures
A new movie called Extraordinary Measures will be released today.   The film is about a family’s efforts to find a cure for Pompe disease http://en.wikipedia.org/wiki/Pompe_disease (a metabolic disorder), which affects their two children.  In a sense, it’s a public health film, because it’s directly related to our newborn screening program.  There is currently no reliable newborn screening test for this disorder yet (so we don’t test for it yet), but Illinois and Missouri have been mandated to implement the test.   You can read more about Arizona’s Newborn Screening Program on our website.

Budget Requests and Bill Inquiries
Please respond quickly to any request that comes from Duane regarding budgetary or bill information.  The Legislature is now in session, and bills that impact our programs are coming out daily.  It’s critical that we look over the bills and get any feedback to Duane right away so that we can relay and suggestions to the appropriate place quickly.

As I mentioned last week, the Governor recently released her budget for FY ’11 (the fiscal year that begins on July 1, 2010).  The Agency Detail Book contains the budget proposal for the ADHS starting on Page 80.

Congrats…
…  to our team from the Arizona State Hospital that completed the PF Chang’s half marathon.  They got together last summer and started planning and training, with group runs at Papago and South Mountain Parks.  Team Captain Crystal Gilbert led the pack on Sunday when the team took off.  17 people crossed the finish line 13.1 miles later.  Team AzSH placed second in the municipal team category!

Salt, BPA, CCR & the Budget

January 22nd, 2010

NaCl
It’s been no secret that the U.S. (and Arizona) diet is high in salt- and almost 90% of that salt comes from pre-processed foods (as opposed to the salt that you might add while cooking or eating).  Reducing dietary salt is an important public health target- and it’s among one of the cheapest and easiest public health interventions.  In fact, the cardiovascular benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels.

A new study this week in the New England Journal of Medicine http://content.nejm.org/cgi/content/full/NEJMoa0907355 found that reducing dietary salt by 3 g per day would reduce the annual number of new cases of coronary heart disease in Arizona by up to 2,400 per year, reduce the number of strokes in AZ by up to 1,300, heart attacks by up to 2,000 and reduce the annual number of deaths from any cause by between 880 and 1,800.  All from a modest reduction in salt intake.

In fact, Japan, the UK, Finland, & Portugal have successfully reduced population-wide salt intake by using a combination of regulations on the salt content in processed foods, labeling of processed and prepared foods, public education, and by collaborating with the food industry to reduce the amount of salt that is added to foods.

The New York City Health Department has been coordinating a nationwide effort to reduce the salt in both packaged and restaurant foods by 25% over five years http://www.nyc.gov/html/doh/html/cardio/cardio-salt-initiative.shtml. Our nutrition team is exploring whether and how we can sign-on to this growing national initiative…  15 state health departments are already among the supporters.  More on this soon.

BPA
On the other end of the risk spectrum is recent concern about a chemical called bisphenol a, which is a plasticizer that’s used in some kinds of water bottles and in plastics that cover processed foods.  Previous studies have found a slight association between urinary BPA concentrations and heart disease, diabetes and liver enzymes in adult participants of the National Health and Nutrition Examination Survey.  A new study out this week published at: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0008673 concluded that “Higher BPA exposure, reflected in higher urinary concentrations of BPA, is consistently associated with reported heart disease in the general adult population of the USA.”

When I heard about this new study I didn’t think much of it, because the association is weak and the risk increase is slight- and because the studies that have been conducted have shown as association- not causation.  But, when I saw my wife throwing away all of our perfectly good plastic water jugs this morning because of something she heard on the radio- I thought I should include something in this week’s update.

You can read the study yourself and do your own research, but I’m not convinced that the low levels that we’re exposed to from containers is a problem.  So, if you see me in the elevator, you will still see me with my bisphenol A containing refillable water bottle (that I fill up with tap water).

CCR
There was a very good article in the paper this week about our efforts to convert the world to using the new CCR to resuscitate adults that have a cardiac arrest.  You can read the full article at: http://www.azcentral.com/news/articles/2010/01/19/20100119cardiacdoc0119.html and you can review the new CCR method at www.azshare.gov.

Extraordinary Measures
A new movie called Extraordinary Measures will be released today.   The film is about a family’s efforts to find a cure for Pompe disease http://en.wikipedia.org/wiki/Pompe_disease (a metabolic disorder), which affects their two children.  In a sense, it’s a public health film, because it’s directly related to our newborn screening program.  There is currently no reliable newborn screening test for this disorder yet (so we don’t test for it yet), but Illinois and Missouri have been mandated to implement the test.   You can read more about Arizona’s Newborn Screening Program on our website.

Budget Requests and Bill Inquiries
Please respond quickly to any request that comes from Duane regarding budgetary or bill information.  The Legislature is now in session, and bills that impact our programs are coming out daily.  It’s critical that we look over the bills and get any feedback to Duane right away so that we can relay and suggestions to the appropriate place quickly.

As I mentioned last week, the Governor recently released her budget for FY ’11 (the fiscal year that begins on July 1, 2010).  The Agency Detail Book contains the budget proposal for the ADHS starting on Page 80.

Congrats…
…  to our team from the Arizona State Hospital that completed the PF Chang’s half marathon.  They got together last summer and started planning and training, with group runs at Papago and South Mountain Parks.  Team Captain Crystal Gilbert led the pack on Sunday when the team took off.  17 people crossed the finish line 13.1 miles later.  Team AzSH placed second in the municipal team category!