Population Health, Epidemiology and Statistical Principles

POPULATION HEALTH, EPIDEMIOLOGY AND STATISTICAL PRINCIPLES 13

Coronary artery disease is the primary cause of mortality in UnitedStates. Although there has been a decline over the decades in CADrelated fatality, the disease still surpasses other illnesses incausing death. Hence, there is a need for more widespread healthintervention in coming up with more effective approaches aimed atreducing the occurrence of the disease.

Background and Significance of the Disease

Definition

Coronary artery disease (CAD) refers to the tightening or cloggingof the arteries as well as vessels, supplying nutrients and oxygen tothe heart (Rimmerman, 2015). It derives from atherosclerosis, whichis a buildup of fatty materials within the inner arteries linings.The outcome is blockage that inhibits the flow of blood to the heart.Once, there is a total cut-off of blood flow, the outcome is a heartattack.

Description

CAD also referred to as coronary heart illness, is the major causeof death for males and females in America. The American HeartAssociation notes that deaths due to CAD have dropped from 1990, yetabove more individuals still passed away due to the illness in 2000(Institute of Medicine, 2011). Close to 82.6 millioncivilians, depict active symptoms of the disease (Institute ofMedicine, 2011). Coronary artery disease comes about followingthe partial clogging or blocking of coronary arteries. The cloggingrestricts the movement of blood from the coronary arteries that actas the main oxygen-rich suppliers of blood to the heart. The coronaryarteries inflate in instances when the heart is working more andrequires extra oxygen, for instance, when an individual is climbing amountain, running or exercising. In case the arteries fail toinflate, the heart lacks ample oxygen supply referring to myocardialischemia. If the clogging is limited angina occurs, which is a formof chest pain. However, if the clogging restricts blood movements,the outcome is a heart attack. Healthy coronary arteries must besmooth and clean. Artery walls ought to be flexible and expandable toallow more blood flow when the heart is working harder.

Signs and Symptoms

The hardening of arteries or atherosclerosis mainly causes coronaryartery disease. Fatty substances and cholesterol build up within theinner arteries’ wall, attracting fibrous tissue, calcium and bloodconstituents, which harden to form artery-blocking plaques.Atherosclerotic plaques frequently result in blood clots thatobstruct the coronary arteries causing coronary thrombosis (Instituteof Medicine, 2011). The plaque clogging often results in severenarrowing of arteries, leading to insufficient blood movement to theheart. This results in the development of symptoms of inadequateblood flow, referred to angina. Angina is signified by chest painarising from lack of oxygen supply to the heart (Institute ofMedicine, 2011). Additionally, arteriosclerosis may result infatigue, unusual heart beat and breathe shortness (Institute ofMedicine, 2011). Plaque might as well tear artery walls leadingto blood clots, resulting in a heart attack.

Current prevalence statistics

The National Center for Health Statistics notes that cardiovasculardisease progresses to be the major cause of death in America. Theimpact is on both men and women from all ethnicities and coronaryartery disease is the most widespread kind of heart disease. CADkills more than 370,000 individuals every year (CDC, 2015). Close to735,000, US citizens have a heart attack annually (CDC, 2015). Of theannual figure, 525,000 derive from a first time heart attack whereas210,000 occur in individuals that had previously experienced a heartattack (CDC, 2015). CAD is also a major cause of death in Texas. Thestate has a 22nd highest fatality rate due to cardiovascular illnessin the United States (American Heart Association, 2010). CADprogresses to record a higher prevalence even in counties. In HoustonCounty, 5.1% adults have had positive diagnosis of cardiovascularillness (The State of Health, 2012). The table below shows theprevalence rates of CAD for 2013. Rates for national statistics andevery state are founded on age-adjusted rates for every 100,000America standard populations. Because death rates are impacted by thepopulation composition of a specific region, age-adjusted rates areapplied for comparisons amid areas since they regulate fordisparities in population composition (Kaiser Family Foundation,2015).

Prevalence rate by:

Mortality rate per 100,000 population

Geographic county Houston

102.5 male

40.9 female

State Texas

214.4 male

135.3 female

National statistics United States

214.5 male

134.3 female

Current Surveillance Methods

Surveillance is a basic tool, which supports most public healthactions. Tracking CAD and its risk factors is crucial in planning,implementing and accessing programs as well as guidelines forpreventing the disease (CDC, 2014). Data is required in thesurveillance of trends and sequences, creating study priorities,scrutinizing the quality of care in addition to patient results,determining populations that are underserved and arranging how toplace services.

The “National Cardiovascular Disease Surveillance System” is oneof the surveillance methods used nationally, at state andcounty-level. The system puts together numerous indicators fromdifferent information sources to produce an all-inclusive outlook ofthe public health burden of cardiovascular illnesses (CDC, 2014).Additionally, the system collects data on associated risk factors ofcardiovascular diseases in America. The interactive “Data Trendsand Maps Web site” is a major facet of the system that displays theinformation collected. Data is arranged by location that is nationalstatistics, county and state, by indicator, biomarkers and riskfactors. It is also possible to plan the information 10-year trends,stratified in reference to gender, age and ethnicity (CDC, 2014).

The community surveillance “Atherosclerosis Risk in Communities(ARIC)” approximates sequences and trends of CAD case casualty,incidence and death in four American communities (Luscher, 2007). Thesurveillance method entails ongoing evaluation of death certificatesand discharge information from hospitals to determine CHD happeningsin community inhabitants. Community surveillance plans use aretrospective design, depend on diagnosis codes for finding cases,and possible cases are authenticated via standardized strategies.

The MONICA project “Monitoring Trends and Determinants inCardiovascular Disease” is a surveillance method created by theWorld Health Organization (Luscher, 2007). It calculates theoccurrence as well as determinants of critical and non-criticalcoronary heart disease in specific populations over a specifiedperiod. From 1979, the method concentrated on assessing these trendsfor a population of 15 million males and females from the age to 25to 64 (Luscher, 2007). The MONICA project focuses on determiningsurvival trends and CAD rates, the relevance of alterations inclassic risk factors to the trends in CAD rates, the significance ofalterations in CAD care to survival and death rate.

Providers report the disease by publishing hospital-specific reportcards (McLean, 2010). Not all states in America are mandated topublish report cards. The report cards are published when care isprovided to an individual that has signs and symptoms that may resultin CAD. The report also comprises published information when theprovider is dealing with a high-risk patient.

Epidemiological Analysis

According to the American Heart Association, close to 82.6 millionindividuals in America presently have one or many kinds ofcardiovascular disease (Institute of Medicine, 2011). Thismakes it the major cause of fatality amid men and women. Anapproximated 16.3 million US citizens from the age of 20 and abovehave CAD (Institute of Medicine, 2011). The prevalence rate ishigher in males with 8.3% while it is 6.1% in women (Institute ofMedicine, 2011). Non-Hispanic white males have the highestprevalence of CAD at 8.5% non-Hispanic African Americans at 7.9%,and latter Mexican American males at 6.3% follow them (Instituteof Medicine, 2011). In women, the rate is highest fornon-Hispanic African American females at 7.6%, then non-Hispanicwhite females at 5.8% and Mexican Americans at 5.6% (Institute ofMedicine, 2011).

Characteristics of at-risk population

CAD arises from numerous factors. It may be a result of theinteraction amid genetic, lifestyle and surrounding factors. Thereare risk factors that can be changed while others cannot. Those thatare not possible to modify include age, gender, and heredity(Institute of Medicine, 2011). Those possible to modifyinclude diet, smoking, hypertension, exercise, obesity, diabetesmellitus and high blood cholesterol. Extreme alcohol intake andstress might also result in CAD risk.

Non-modifiable factors

The risk of coronary artery disease increases with age. This impliesthat older people are at a higher risk of getting the illness whencompared to younger people (Institute of Medicine, 2011). Itis mainly attributed to increased inactivity. The disease has ahigher prevalence rate amid men than women. Although there are highfatality rates for both men and women, men record a higher incidence(Institute of Medicine, 2011). It is also possible for peopleto get the disease through genetics. In case and individual comesfrom a family where most of the family members have CAD, it is highlylikely that the individual may also develop CAD.

Modifiable factors

The death rate of CAD due to smoking is 60% more among smokers whencompared to non-smokers. Habitual exposure to secondary smokeenhances the risk by 25-30% (Institute of Medicine, 2011).Hence, individuals that smoke expose themselves to the risk of CAD,while at the same time exposing none smokers to the illness throughsecondary smoking. People that engage in physical activity reduce thepossibility of developing coronary artery disease (Rimmerman, 2015).A large percent of Americans do not engage in physical activity,which explains why CAD is the major cause of fatality in the nation.People that have higher blood cholesterol are at a greater risk ofCAD, especially when combined with different risk factors such ashypertension, smoking, gender or age. Obesity is a different riskfactor for CAD. Information from the American Health Associationnotes that overweight persons are more probable to develop coronaryartery disease. Subsequently, wait reduction through engaging inphysical activity minimizes the risk. Close to 75% of people thathave diabetes pass away because of some kind of cardiovasculardisease (Institute of Medicine, 2011). Diabetic adults recordtwo to four times’ higher death rates owing to CAD when compared toadults that are not diabetic.

Costs

CAD results in both financial and social costs. Financial costs areincurred when paying physicians and different health care providers,paying for hospital or nursing home services and buying medicine (Rao&amp Thanikachalam, 2005). When the disease results inhospitalizations, specifically in case of a heart attack, theexpenses are extremely high. Other financial expenses are ambulancerides, urgent treatment that may involve surgery and paying fordiagnostic tests. Social costs include lost productivity (Rao &ampThanikachalam, 2005). When an individual is admitted because of CAD,they are unable to work, which means they are not as productive asexpected. Another problem is that one is compelled to change theirsocial habits, like feeding on high cholesterol foods to reduce asecond incidence. In serious cases, CAD results in the loss of aloved one.

Screening and Diagnosis

Diagnosis

The disease is normally diagnosed following a risk evaluation andmore tests (Rimmerman, 2015). The health care provider diagnoses theillness depending on the patient’s medical as well as familyrecords, risk factors for CAD, physical assessment, and the outcomesfrom tests. Diagnosis is done using a number of the differentscreening tests.

Current guidelines for screening and diagnosis

When making any CAD diagnostic attempt, it is mandatory to have adetailed patient history, which includes a complete list of the riskfactors associated with the disease, a detailed physical analysis ofall secondary pulses that when abnormal, might indicate the presenceof causal peripheral arterial illness, as well as anelectrocardiogram (Rimmerman, 2015). Following the first evaluation,providers are supposed to perform laboratory blood examinations,stress tests, in addition to a cardiac catheterization important ingaining insight that is more indicative (Rimmerman, 2015). Thepatient history ought to involve any current signs and a conclusiveinventory of comorbid situations. In addition, history must entaildata concerning the character and area of discomfort, discomfortradiation, linked symptoms and alleviating aspects. Family historymust not be underestimated, because it is relevant when assessing asick person’s risk factor profile.

The results from a patient’s physical examination could be normal.Hence, health care providers are supposed to conduct furtherassessments, which involve measuring the blood pressure or anklebrachial index (Rimmerman, 2015). Other assessments are to thecarotid arteries entailing bruits auscultation, chest wall, checkingshoulders for deformities or tenderness, which might be relevant inthe diagnosis of musculoskeletal discomfort of the chest (Rimmerman,2015).

Screening test

Stress testing is a screening test employed in validating theavailability of flow-limiting, functionally relevant CAD (Rimmerman,2015). The test entails blood pressure screening andelectrocardiography. It takes two forms, pharmacologic as well asexercise administration (Rimmerman, 2015). The ideal technique isexercise employing a treadmill or bicycle. The aerobic exerciseresults in a greater rate pressure and hence more cardiovascularstress is achieved. This allows the analysis of a sick person’sfunctional ability, providing prognostic information through the onlyparameter of acquired metabolic equivalents. The rate at which theheart rate reduces following exercise is as well as an establishedprognostically relevant factor. Using imaging andelectrocardiographic stress tests together increases close to 15%points towards the sensitivity as well as specificity of stresstesting.

Plan of Action

The plan involves working towards reducing prevalence of thedisease. This involves ensuring that more people are aware ofcoronary heart disease risk factors, and manners of preventing theillness.

The first action plan is public health education and outreach. Theplan involves informing members of the county and state about CAD.Many people are aware that CAD is the main cause of death in America.However, few realize that the fatality rate can be reduced throughlifestyle changes that minimize the risk of coronary artery disease.Through public education and outreach, it is possible to educatepeople on healthy living and ensure that more people join in thecampaign to reduce CAD related fatalities (Texas Department ofState Health Services, 2008). Measurement is by checkingstatistics to determine if there has been a decline in the incidenceof CAD for specific communities.

The second action plan is empowering people on how to respond to anindividual suffering from CAD. Research demonstrates that the diseasekills fast especially in the case of acute CAD. In case of a cardiacarrest, CPR should start instantly (Texas Department of StateHealth Services, 2008). Empowering people will ensure that theyare able to perform such procedures as soon as possible, in turnsaving more lives. It also makes it possible for civilians to detectin time the signs and symptoms of CAD and call 911 immediately.Measurement is by determining whether there is a reduction infatality rate due to timely and instant response to administeringfirst aid in cases of cardiac arrest, within a specific region.

Third is fostering research on programs that can be used at thecommunity level to prevent CAD. Research makes it possible to come upwith advent manners of assessing public health interventions,specifically those linked to promoting health. Research may alsoresult in the discovery of new approaches on reducing CAD fatality(Texas Department of State Health Services, 2008). Measurementis by assessing the level to which the new research is integrated inalready established health intervention approaches.

Conclusion

CAD arising from the tightening of arteries supplying blood to theheart has a high fatality rate. Common signs include unexplainedfatigue, chest pain and shortness of breath. There are individuals atrisk of getting CAD than others, these are smokers, people withhypertension, obesity and high cholesterol levels, in addition tolack of physical exercise. Other factors include age, gender andgenetics. To determine if an individual is at risk of a coronaryartery disease, screening like stress testing is conducted. The highfatality due to CAD is a call to action for more effective plans todeal with the disease.

References

American Heart Association. (2010). Texas state fact sheet,1-1. Retrieved from: http://www.heart.org/idc/groups/heartpublic/@wcm/@adv/documents/downloadable/ucm _307214.pdf

CDC. (2014). National Cardiovascular Disease Surveillance.Retrieved from: http://www.cdc.gov/dhdsp/ncvdss/

CDC.(2015). Heart disease facts. Retrieved from:http://www.cdc.gov/heartdisease/facts.htm

Institute of Medicine. (2011). A nationwide framework forsurveillance of cardiovascular and chronic lung diseases.Washington: National Academies Press.

Kaiser Family Foundation. (2015). Number of heart diseasedeaths per 100,000 population by gender. Retrieved from:http://kff.org/other/state-indicator/heart-disease-death-rate-by- gender/

Luscher, T. F. (2007). Coronary disease surveillance: A public healthimperative. European Heart Journal, 28(17), 2051-2052.

McLean, T. R. (2010). The impact of provider-specific report cards oncoronary artery bypass graft volume. American Heart HospitalJournal, 8(1), 14-8.

Rao, G. H. R., Thanikachalam, S., &ampSouth Asian Society on Atherosclerosis and Thrombosis. (2005).&nbspCoronaryartery disease: Risk promoters, pathophysiology, and prevention.New Delhi:Jaypee Brothers Medical Publishers.

Rimmerman, C. M. (2015). Coronary artery disease. Cleveland ClinicCenter for Continuing Education, 1-1.

Texas Department of State HealthServices. (2008). Texasplan to reduce cardiovascular disease and stroke, 1-62.

The State of Health. (2012). Houston/Harris county: Executivesummary. Retrieved from: http://houstonstateofhealth.org/hshcms/wp-content/uploads/2013/04/State-of-Health- 2013-Ex-Summary-Final.pdf