State Level Efforts to Improve CV Health

Partners in Innovation | As part of its five-year Strategic Plan, the ACC has set priorities to ensure that it is a leader in efforts to reduce the burden of cardiovascular disease in U.S. and global populations. This focus on population health cascades down through the College’s state chapters. However, many states have been working on prevention and health education efforts for years prior to the College’s formalized focus. Some of the hottest topics in the states center on mandatory high school cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) training, school athlete screening, statewide weight loss initiatives, smoking cessation and pulse oximetry screening to diagnose critical congenital heart defects (CHDs) in newborns.

Throughout the past year, ACC’s state chapters have made immense strides in local, state-level efforts to improve cardiovascular health of residents. Here are just a few stories from states that have been making positive waves:

Statewide Weight Loss Initiative

According to the Centers for Disease Control and Prevention, Kansas ranks 13 in the U.S. for obesity with an adult obesity rate of more than 31 percent. Championed by Dhanunjaya R. Lakkireddy, MBBS, FACC, governor of the ACC’s Kansas Chapter, the Chapter has been busy planning and implementing the One Million Pounds and 10 Million Miles initiative to promote a “leaner and fitter Kansas.” Read More >>>

The initiative is focused on creating a healthier and more active Kansas by tackling the obesity epidemic of the state’s citizens head on. The program requires active collaboration amongst a number of groups including the state government, hospitals, physicians, insurance companies, technology partners and citizens of Kansas, all of whom are working toward the goal of losing one million pounds and walking 10 million miles in a span of one year. “To lead a happy and healthy life is the fundamental right of every human being,” says Lakkireddy. “The One Million Pounds and 10 Million Miles initiative is a step in the right direction to motivate people of Kansas to take ownership of their right for healthy living.” He adds that the Chapter is working on the logistics and collaborating with other organizations with a kick off planned for early 2016.

Mandatory High School CPR and AED Training

hen an individual goes into cardiac arrest, prompt and effective bystander CPR may double or triple their chance of survival. However, 70 percent of Americans report feeling “helpless to act” during an emergency because they do not know how to perform CPR. The West Virginia Chapter of the ACC this year helped pass legislation mandating CPR and AED training as a high school graduation requirement. Read More >>>

Several chapters have also made this issue a priority, including Ohio and Connecticut where Laxmi S. Mehta, MD, FACC, governor of the Ohio Chapter, and Gilead I. Lancaster, MD, FACC, governor of the Connecticut Chapter, have testified and remain vocal advocates in their respective states.

In recent testimony, Mehta emphasized the impact that the lack of timely and effective CPR has on Americans. “Every year nearly 424,000 people in the U.S. suffer out-of-hospital sudden cardiac arrest and only 10.4 percent survive, making it one of the leading causes of death in the country,” she said. “Five minutes makes the difference in survival.” She cites the support of the cardiovascular community as a key component in helping to find cost-effective ways of implementing this mandatory graduation requirement. “We are ready to help implement [this legislation] and help put thousands of potential lifesavers into the community each year,” she said. While there has not been a decision in Ohio on this legislation, the Ohio Chapter continues to actively support the effort to make CPR training a graduation requirement.

In early October, Charles I. Berul, MD, FACC, the ACC’s Board of Governors representative for Washington, DC, testified during a DC City Council hearing on a bill requiring the placement of AEDs and training personnel in all schools in the city. According to Berul, “This bill will save lives! However, AED training should not be limited to coaches and school nurses. Equipping these students with vital AED and CPR skills would put thousands of potential lifesavers in the community each year.”

The ACC has been a longtime supporter of AED and CPR training requirements for high school students. Furthering this effort, ACC staff has worked with the National Lieutenant Governor’s Association to pass a policy resolution recommending that students are trained in CPR and AED before graduating from high school. As of October, the total number of states with similar legislation is 26, with New York and North Dakota being the latest states to mandate CPR training as a high school graduation requirement.

School Athlete Screening

This year, Texas and South Carolina introduced legislation that would have required those participating in school athletics to have an electrocardiogram (EKG) as part of their pre-participation physicals. The ACC Sports and Exercise Cardiology Section Leadership Council played a pivotal role in both instances. Chapter leaders presented alternative plans focused on obtaining patient and family health information and developing emergency care plans for sports venues that include CPR-trained volunteers and AED availability. Interactions with legislators in the form of personal meetings, hearing testimony, letters and press interviews made the difference in defeating bills mandating EKGs in these states. Read More >>>

Meanwhile, the New Jersey Chapter of the ACC was instrumental in arming health care providers with training and professional development to aid in the pre-participation assessment of student athletes. The training, among the first of its kind in the U.S., comes in the form of an educational and instructional video known as a professional development module. It came about after New Jersey Governor Chris Christie in 2013 signed the Scholastic Student-Athlete Safety Act which established measures to ensure the health of student athletes. The bill served as a response to the recommendations drafted by the New Jersey Task Force on Screening of High School Athletes for cardiovascular disease, led by Lou E. Teichholz, MD, FACC, past New Jersey ACC Chapter Governor.

The state law requires that the New Jersey Departments of Education and Health develop the module in consultation with not only the New Jersey Chapter of the ACC, but also working in concert with the New Jersey Chapter of the American Academy of Pediatrics, the New Jersey Academy of Family Physicians and the American Heart Association. The collaboration resulted in the Student Athlete Cardiac Screening Professional Development Module, which was funded by ACC’s New Jersey Chapter, and sets out to increase the assessment skills of those medical professionals such as physicians, physician assistants and nurse practitioners who perform student-athlete assessments and screenings.

“Members of the ACC are committed to dramatically reducing the incidence, severity and complications of cardiovascular disease, and this training program will go a long way in promoting prevention, reducing disparities in health care, and improving personal and population-based cardiovascular health,” says Joel S. Landzberg, MD, FACC, president and governor of ACC’s New Jersey Chapter. “It’s an honor to assist the state in developing and rolling out this important public health and education program.

To date, the New Jersey module has equipped more than 5,000 professionals with pre-participation assessment training.

Pulse Oximetry Screening

CHDs are the most common cause of infant death due to birth defects, and upwards of 200 infants with undetected critical CHDs are discharged each year from hospitals in the U.S. Pulse oximetry newborn screening, a simple, inexpensive bedside test to determine the amount of oxygen in a newborn’s blood and the pulse rate, can identify some infants with a critical CHD before they show any signs. The ACC has long advocated for the universal coverage of these screenings for newborns, as studies have shown that this approach to early detection of more subtle forms of congenital heart disease can prevent related complications and promote early diagnosis and treatment. Read More >>>

To date, 46 states and the District of Columbia have enacted pulse oximetry screening requirements, with Washington, Colorado and Hawaii approving bills in the first half of 2015. The District of Columbia is the most recent addition to the list with the law taking effect in September. Vermont is proceeding with regulation as well, leaving only Wyoming, Idaho and Kansas without laws in place. ACC Chapters have been instrumental in grassroots efforts to advocate for these bills through hearing testimony, meetings with legislators and by joining forces with stakeholders such as the American Heart Association.

Tackling NCDs at the State Level

Under the leadership of Michael Mansour, MD, FACC, immediate past chair of the BOG, the Delta Medical Society adopted a resolution pledging support of the United Nations campaign to reduce mortality and morbidity from non-communicable diseases 25 percent by 2025. The resolution indicates that “the Mississippi Delta has the highest incidence of cardiovascular disease and death in Mississippi,” and that the state “closely reflects the high incidence and death from cardiovascular disease and death as seen in low- and middle-income countries.” Read More >>>

Mansour offered the resolution at the Mississippi State Medical Association annual meeting. It was accepted and will be used to educate state lawmakers on the importance of smoking cessation, diabetes awareness and wellness-education improvements. Other states are considering similar efforts.

What’s Next For the States?

As part of the College’s Population Health Retreat held this past summer, the ACC Population Health Policy and Health Promotion Committee identified state advocacy and patient education as key components of its agenda. Thanks to this focus, the ACC will be working closely with leaders of ACC Chapters as well as external partners to add physical education, nutrition and diet programs to its state advocacy agenda. Read More >>>

These stories from the states are just a handful of examples of how ACC’s chapters are working at a grassroots level to advocate for state-level changes to improve the cardiovascular health of their residents. Look for more on successes and progress around population health and prevention efforts in the states in upcoming issues of Cardiology, as well as on the ACC in Touch Blog.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, SCD/Ventricular Arrhythmias, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention

Keywords: ACC Publications, Cardiology Magazine, Health Education, Cardiopulmonary Resuscitation, State Government, Oximetry, Adolescent, Adolescent Behavior, Obesity, Abdominal, Pediatric Obesity, Cardiopulmonary Resuscitation

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