Just as it is in the rest of the United States, heart disease is the leading cause of death in Delaware, according the latest CDC mortality statistics(www.cdc.gov). But in 2012, when current Delaware AFP (DAFP) President Margot Savoy, M.D., M.P.H., was chair of the chapter's community outreach committee, the group noted that although the DAFP had been active across the state in immunizations and tobacco cessation, it was not involved in fighting cardiovascular disease.
Christiana Care nurse Bernadette Baker, R.N., provides free blood pressure screenings to customers at ShopRite during a Million Hearts Delaware outreach event.
"We reached out to see what was being done at the state level (with cardiovascular disease), and it turned out there was a small group just getting started," Savoy told AAFP News. That small group is what is now known as Million Hearts Delaware (MHDE)(millionheartsde.com).
Spearheaded by Edward Goldenberg, M.D., and Elisabeth Bradley, A.P.N., of Christiana Care Health System, the initiative hit close to home for Savoy, who, as it happens, is medical director of family medicine centers and youth rehabilitative services at Christiana Care. "We hopped onboard from the start, and I took on the role of chair of the clinical prevention arm of the initiative," she explained. For its part, the chapter has taken primary responsibility for the MHDE website, including developing and maintaining it, Savoy added.
With 12 founding member organizations signed up from around the state, MHDE set out to promote the national Million Hearts initiative. Launched by HHS in September 2011, the goal of the Million Hearts campaign is to prevent 1 million heart attacks and strokes by 2017.
- In 2012, the Delaware AFP became one of a dozen founding member organizations of the Million Hearts Delaware initiative to help fight cardiovascular disease in the state.
- Launched by HHS in September 2011, the national Million Hearts initiative intends to prevent 1 million heart attacks and strokes by 2017.
- Million Hearts Delaware aligns the efforts of hospitals, government agencies, major employers and health care professionals to combat cardiovascular disease.
According to its website, MHDE aligns the efforts of hospitals, government agencies, major employers and health care professionals to combat cardiovascular disease through two specific avenues: public awareness and clinical prevention.
Public Awareness Efforts
Through its public awareness initiative, MHDE focuses on helping the state's residents improve their blood pressure levels and shrink their waist size, because controlling these two factors has been shown to reduce heart attacks and strokes. For example, in recognition of February as American Heart Month, Nanticoke Health Services and the DAFP collaborated to hold The Heart of Good Health health fair in the small town of Laurel, and MHDE was there to lend a hand.
"Nanticoke Health Services hosted more than 80 tables, with the majority providing health screenings focused on cardiovascular (disease) prevention, such as glucose checks, lipid checks, ankle-brachial index screening, blood pressure checks and BMI (body mass index)," said Joseph Kim, D.O., president of medical staff at Nanticoke Health Services in Seaford and immediate past president of the DAFP.
Denise Taylor, project manager for MHDE, said both MHDE and the DAFP hosted tables at the event, offering blood pressure screenings, interactive games, and information about obesity and weight loss for adults and kids. Among resources the DAFP offered were nutrition and fitness tools and information from the AAFP.
"We had more than 1,000 people come through," Kim said. "The purpose was to increase awareness of cardiovascular and related diseases and provide free screenings to the public. We have a lower socio-economic population; therefore, events like health fairs are able to help prevent and catch potential problems."
Up next, MHDE will be a major sponsor and participant in Wilmington Wellness Day on April 26. Taylor said the group will perform blood pressure screenings during the event and offer attendees free tape measures to help them track their waist circumference.
Clinical Prevention Suggestions
As part of the clinical prevention arm of the initiative, MHDE recommends physicians make use of an easy-to-remember acrostic saying when formulating the care plan for patients who have or are at risk for heart disease.
"We encourage family docs to focus on the ABCS of cardiovascular disease," Savoy said.
"A: Make sure patients who would benefit from Aspirin are taking it, and those who should not be, aren't.
B: Ensure patients know their Blood pressure and are at goal.
C: Ensure patients know their Cholesterol and are at goal.
S: Encourage patients to quit Smoking (or never start)."
Delaware AFP President Margot Savoy, M.D., poses after completing the 2013 Wilmington Heart Walk. The chapter sponsored the American Heart Association event.
Although Savoy characterized these four areas as the major risk factors for cardiovascular disease, she also noted that "given the increasing prevalence of obesity in Delaware and across the U.S., we encourage patients to know their BMI and waist circumference."
Whatever management strategies physicians offer patients to prevent cardiovascular disease, according to Savoy, the most important steps to reduce risk occur at home. It's a topic she discussed in an article published in the Wilmington News Journal(millionheartsde.files.wordpress.com) last fall.
"Starting early is important," she said in the story. "Parents play a big role in preventing their kids from developing heart disease in the first place. Children as young as 8 have been found to already have fatty deposits in their arteries."
Savoy said that parents need to act as heart-healthy role models for their children by providing a smoke-free home and fruits and vegetables in their meals. She also suggested having children read the nutritional content on food labels and then letting them make some of the grocery shopping decisions. Portion control and simple exercise also should be introduced.
Groups involved with MHDE tackle cardiovascular disease from other perspectives, as well. For example, two years ago, Nanticoke Health Services and the DAFP partnered in a Sussex County CME conference to educate physicians about the importance of identifying and treating heart disease.
"We discussed the new anticoagulants; identification and treatment of atrial fibrillation, diabetes and heart disease; and the association between rheumatologic disorders and heart disease," said Kim. "One interesting point (covered) was the increased risk of cardiovascular disease in people with rheumatoid arthritis."
Facts About the Delaware AFP
Chapter executive director: Katie Hamilton
Number of chapter members: 336
Year chapter was chartered: 1950
Location of chapter headquarters: Newark
2014 Annual Scientific Assembly: June 7, John H. Ammon Medical Education Center at Christiana Hospital, Newark
Now three years in, MHDE has already been recognized for its work in educating Delaware residents about preventing heart disease. Just last year, MHDE received the Focus on Excellence Award in Community Health from Christiana Care Health System, said Taylor.
"The Focus on Excellence Awards recognize teams who enter projects demonstrating improvement in process or outcomes using the PDCA (Plan-Do-Check-Act) model," she said.
According to Taylor, the DAFP and MHDE plan to continue building on their mutual success, and the hope is that funding for MHDE provided by Christiana Care, the DAFP and others can be maintained until the program's goal is reached. Savoy said the DAFP also will continue to provide additional resources for MHDE moving forward.
"We plan to continue providing exhibit space to MHDE at our annual meetings and large conferences, providing education articles in our journal, supporting the heart walk again, and, hopefully, assisting in creating some educational content for YouTube for patients and providers," she said. "I am confident DAFP will be partners with Million Hearts for the long haul. Cardiovascular disease is just too important to be ignored."