Individualized Risk Communication and Outreach for Primary Cardiovascular Disease Prevention in Community Health Centers

AbstractObesity increases the risk of developing cardiovascular disease and other metabolic diseases. We intended to compare three different anthropometric indicators of obesity, in predicting the incidence of cardiovascular events in Chinese type 2 diabetes. Beijing Community Diabetes Study was a prospective multi-center study conducted in Beijing community health centers. Type 2 diabetes patients from fourteen community health centers were enrolled at baseline. The primary endpoint was cardiovascular events. The upper quartile of neck circumference (NC) was set as greater NC. A total of 3299 diabetes patients were enrolled. In which, 941 (28.52%) had cardiovascular disease at baseline. Logistic analysis showed that central obesity (waist circumference (WC) above 90 cm in men and 85 cm in women) and greater NC were all related to baseline cardiovascular disease (adjusted OR = 1.49, and 1.55). After 10-year follow-up, 340 (10.31%) had cardiovascular events. Compared with patients without cardiovascular events, those having cardiovascular events had higher BMI, larger WC and NC. Cox regression analysis showed that greater WC and NC were all associated with the occurrence of cardiovascular events (adjusted HR = 1.41, and 1.38). A higher NC and WC might increase the risk of cardiovascular events by about 40% in type 2 diabetes patients in Beijing communities.

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THE HEALTH PROMOTION OF CARDIOVASCULAR DISEASE PREVENTION BY COMMUNITY HEALTH NURSE IN PRIMARY HEALTH CARE: A SYSTEMATIC REVIEW

International Journal of Nursing and Health Services (IJNHS) ◽

10.35654/ijnhs.v2i3.113 ◽

2019 ◽

Vol 2 (3) ◽

pp. 22-31

Author(s):

Rizkiyani Istifada ◽

Etty Rekawati

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Health Care ◽

Health Promotion ◽

Primary Health Care ◽

Disease Prevention ◽

Community Health ◽

Cardiovascular Disease Prevention ◽

Systematic Analysis ◽

Primary Health

Health promotion is a method to increase awareness of healthy behavior in public. Unhealthy lifestyles cause increases the risk of cardiovascular disease. Community health nurses have a responsibility to increase the motivation of healthy practice with the health promotion’s method. This research method used a systematic review, using online databases on Cambridge Core, Wiley Online, and Science Direct e-resources when the articles published from 2006-2018. The selection of literature used the Critical Capability Program (CASP) tool and got eight relevant articles. The systematic analysis used the Cochrane Collaboration. The themes of this article are 1) nurses’ knowledge about health promotion, 2) the meaning of health promotion, and 3) the implementation health promotion of cardiovascular disease prevention by nurses. The themes identified some categories, such as nurse responsibilities, the essence of health promotion, support and barriers, and health promotion’s method. The nurse’s perception of health promotion is the core of their work to decrease the prevalence of the cardiovascular disease. Keywords: cardiovascular disease, health promotion, nurses, primary health care

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Abstract P324: Implications of ACC/AHA Cholesterol Guidelines on Statin Underutilization for Prevention of Cardiovascular Disease in Diabetes Mellitus among Several U.S. Networks of Community Health Centers

Circulation ◽

10.1161/circ.135.suppl_1.p324 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Ehimare Akhabue ◽

Sarah S Rittner ◽

Joseph E Carroll ◽

Philip M Crawford ◽

Lydia Dant ◽

...

Keyword(s):

Cardiovascular Disease ◽

Community Health ◽

Community Health Centers ◽

Heart Association ◽

Female Gender ◽

Statin Treatment ◽

Health Centers ◽

Research Network ◽

High Risk Population ◽

Care Gaps

Introduction: Little is known about statin underuse among diabetes (DM) patients cared for in community health centers (CHCs), which tend to serve socioeconomically disadvantaged populations. Implications of the recent American College of Cardiology/American Heart Association (ACC/AHA) guidelines on preexisting gaps in statin treatment in this population are unclear. Hypothesis: Substantial statin underutilization will exist regardless of differences between guidelines. Methods: We included 32,440 adults (45% male, 63% non-white, 28% uninsured/Medicaid) with DM aged 40 to 75 years who received care within 16 CHC groups in eleven states in the Community Health Applied Research Network (CHARN) during 2013. Statin prescribing was analyzed as a function of concordance with the National Cholesterol Education Program Adult Treatment Panel (ATPIII) 2001 guideline and ACC/AHA 2013 guideline. Results: More patients were concordant with the ACC/AHA (52.8%) versus ATPIII (36.2%) guideline. Female gender was independently associated with lower concordance for both guidelines [OR 0.90 CI (0.85-0.94) and OR 0.84 CI (0.80-0.88) respectively]. Black race was associated with lower concordance with ATPIII but not ACC/AHA. Being insured, Asian/Pacific Islander or primarily Spanish speaking were associated with greater concordance for both guidelines. 35% (11526/32440) of the cohort were concordant with neither guideline (Figure), the majority (80%) having no statin prescribed. 28% (9168/32440) were concordant with ACC/AHA guidelines but not ATPIII guidelines. 8.5% of these patients had an LDL >160 despite having a medium or high intensity statin prescribed. 12% (3772/32440) were concordant with ATPIII but not ACC/AHA guidelines. Most of these patients had an LDL between 70-99 mg/dl with no or a low intensity statin prescribed. Conclusions: Opportunities exist to improve cholesterol management in DM patients in CHCs. Addressing care gaps could improve cardiovascular disease prevention in this high risk population.

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