An Institute of Medicine report titled U.S. Health in International Perspective: Shorter Lives, Poorer Health documents the decline in the health status of Americans relative to people in other high-income countries, concluding that “Americans are dying and suffering from illness and injury at rates that are demonstrably unnecessary.”1 The report blames many factors, “adverse economic and social conditions” among them. In an editorial in Science discussing the findings of the Institute of Medicine report, Bayer et al2 call for a national commission on health “to address the social causes that have put the USA last among comparable nations.”

Although mortality from cardiovascular disease (CVD) in the United States has been on a linear decline since the 1970s, the burden remains high. It accounted for 31.9% of deaths in 2010.3

There is general agreement that the decline is the result, in equal measure, of advances in prevention and advances in treatment. These advances in turn rest on dramatic successes in efforts to understand the biology of CVD that began in the late 1940s.4,5 It has been assumed that the steady downward trend in mortality will continue into the future as further breakthroughs in biological science lead to further advances in prevention and treatment. This view of the future may not be warranted.

The prevalence of CVD in the United States is expected to rise 10% between 2010 and 2030.6 This change in the trajectory of cardiovascular burden is the result not only of an aging population but also of a dramatic rise over the past 25 years in obesity and the hypertension, diabetes mellitus, and physical inactivity that accompany weight gain. Although there is no consensus on the precise causes of the obesity epidemic, a dramatic change in the underlying biology of Americans is …

/pdf/social-determinants-of-risk-and-outcomes-for-cardiovascular-32xag7l2hs.pdf

Social Determinants of Risk and Outcomes for Cardiovascular Disease A Scientific Statement From the American Heart Association

/pdf/triglycerides-and-cardiovascular-disease-a-scientific-25jmfgszcb.pdf

Triglycerides and Cardiovascular Disease : A Scientific Statement From the

Outcomes research examines the effects of medical care interventions and policies on the health outcomes of individuals and society.1 Investigators conducting outcomes research seek to inform the development of clinical practice guidelines, to evaluate the quality of medical care, and to foster effective interventions to improve the quality of care.2 Outcomes research has traditionally used quantitative sciences to examine the utilization, cost, and clinical effectiveness of medical care through randomized and nonrandomized experimental designs. Quantitative methods are not as well suited to measure other complex aspects of the healthcare delivery system, such as organizational change, clinical leadership in implementing evidence-based guidelines, and patient perceptions of quality of care, which are also critical issues in outcomes research.3–7 These more nuanced aspects of healthcare delivery may be most appropriately examined with qualitative research methods.8–10

Qualitative approaches are becoming more common in clinical medicine and health services research.5,11–15 Federal encouragement of qualitative research is regularly reflected in funding program announcements issued by the National Institutes of Health.16 For more than a decade, federal agencies and foundations such as the National Science Foundation have demonstrated a commitment to supporting qualitative research through funding scientific conferences, workshops, and monographs on this field of inquiry.17–20 Despite this steady growth in qualitative research, outcomes investigators in cardiology have relatively little guidance on when and how best to implement these methods in their investigations.

The purpose of the present report is to introduce qualitative methods as providing unique and critical contributions to outcomes research. This report will describe the situations in which qualitative approaches are most helpful; summarize the primary principles and practices in study design, sampling, data collection, and data analysis for qualitative studies; present representative examples of cardiovascular outcomes research that uses qualitative methods; and synthesize current standards for …

Qualitative and Mixed Methods Provide Unique Contributions to Outcomes Research

The goal of this American Heart Association Guide for Improving Cardiovascular Health at the Community Level (AHA Community Guide) is to provide a comprehensive inventory of evidence-based goals, strategies, and recommendations for cardiovascular disease (CVD) and stroke prevention that can be implemented on a community level. This guide advances the 2003 AHA Community Guide1 and the 2005 AHA statement on guidance for implementation2 by incorporating new evidence for community interventions gained over the past decade, expanding the target audience to include a broader range of community advocates, aligning with the concepts and terminology of the AHA 2020 Impact Goals, and recognizing the contributions of new public and private sector programs involving community interventions.

In recent years, expanding arrays of programs and policies have been implemented in increasingly diverse communities to provide tools, strategies, and other best practices to potentially reduce the incidence of initial and recurrent cardiovascular events. The AHA Community Guide complements the AHA statement entitled “Population Approaches to Improve Diet, Physical Activity, and Smoking Habits”3 and supports the AHA 2020 goal4 to “improve the cardiovascular health of all Americans by 20%, while reducing deaths from CVDs and stroke by 20%.” The present AHA Community Guide supports the AHA 2020 goal by identifying exemplary regional or national programs that encourage cardiovascular health behaviors and health factors (formerly addressing risk behaviors and risk factors) from which communities might acquire proven strategies, expertise, and technical assistance for improving cardiovascular health.

The AHA Community Guide seeks to prevent the onset of disease (primary prevention) and to maintain optimal cardiovascular health (primordial prevention) among broader segments of the population. Prior research indicates that using public health strategies such as sodium reduction in processed foods to lower blood pressure,5–8 tobacco laws to promote smoking cessation,9–11 and modification of …

American Heart Association Guide for Improving Cardiovascular Health at the Community Level, 2013 Update A Scientific Statement for Public Health Practitioners, Healthcare Providers, and Health Policy Makers

Cardiovascular disease (CVD) is estimated to cause 46% of all mortalities in Kuwait. To design effective primary and secondary prevention programs, an assessment of a population’s prior CVD knowledge is of paramount importance. There is scarcity of data on the existing CVD knowledge among the general Kuwaiti population. Hence, this study was performed to assess the level of knowledge towards CVD types, warning symptoms of heart attack or stroke, and CVD risk factors. It also explored public views on the community pharmacists’ role in CVD prevention and management. A descriptive cross-sectional survey was performed using a pretested self-administered questionnaire on a sample of 900 randomly selected Kuwaiti individuals. Descriptive and multivariate logistic regression analysis were used in data analysis. The response rate was 90.7%. Respondents’ knowledge about types of CVD, heart attack or stroke symptoms was low. Almost 60% of respondents did not know any type of CVD, and coronary heart disease was the commonest identified type (29.0%). Two-fifths of participants were not aware of any heart attack symptoms, and the most commonly known were chest pain (50.4%) and shortness of breath (48.0%). Approximately half of respondents did not recognize any stroke symptoms, and the most commonly recognized were ‘confusion or trouble speaking’ (36.4%) and ‘numbness or weakness’ (34.7%). Respondents’ knowledge regarding CVD risk factors was moderate. The commonest factors identified by over four-fifths of participants were smoking, obesity, unhealthy diet and physical inactivity. In the multivariate logistic regression analysis, independent predictors of better level of CVD knowledge were females, age 50–59 years, high level of education, regular eating of healthy diet, and had a family history of CVD. Most of respondents only identified the role that pharmacists had to play is to help patients manage their medications, with a minimal role in other aspects of CVD prevention and management. There are deficiencies in CVD knowledge among Kuwaiti population, which could turn into insufficient preventative behaviours and suboptimal patient outcomes. There is an apparent need to establish more wide-spread and effective educational interventions, which should be sensitive to the perceptions, attitudes, and abilities of targeted individuals.

/pdf/public-knowledge-of-cardiovascular-disease-and-its-risk-1vcmcle67q.pdf

Public knowledge of cardiovascular disease and its risk factors in Kuwait: a cross-sectional survey

Taking the initiative Implementing the American Heart Association Guide for improving cardiovascular health at the community level

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Taking the initiative Implementing the American Heart Association Guide for improving cardiovascular health at the community level