On September 26, 2018

Vermont fares well in heart attack, stroke study

By Mike Faher/VTDigger

Vermont earned high marks on a new federal study of hospitalizations and deaths due to cardiovascular events like heart attack and stroke.

The state had the nation’s lowest death rate in 2016 for cardiovascular events deemed “preventable” in the study, issued by the Centers for Disease Control and Prevention. Vermont also fared well in hospitalization rates for those same conditions.

One expert said Vermont’s reputation as a “health-conscious” state may play a role in such numbers. But state officials said they couldn’t draw any firm conclusions from the CDC study, given that cardiovascular disease still is one of the state’s leading causes of death.

“Even though we are one of the healthiest states, we still have a lot of work to do in terms of risky behaviors and the impact they have on chronic diseases,” said Nicole Lukas, health systems director at the Vermont Department of Health.

The CDC report is framed by the federal government’s Million Hearts 2022 campaign, which aims to prevent 1 million heart attacks, strokes and other “acute cardiovascular events” by 2022.

Within that context, the report examined state-by-state cardiovascular-related hospital visits and deaths along with underlying clinical diagnoses. The study found that there were more than 2.2 million preventable hospitalizations and 415,480 deaths in 2016.

There were $32.7 billion in costs associated with the hospitalizations.

The study’s authors expressed particular concerns about the 35-64 age group, where there were nearly 775,000 hospitalizations and 73,400 deaths.

“Many of these cardiovascular events are happening to middle-aged adults, who we wouldn’t normally consider to be at risk,” Dr. Anne Schuchat, the CDC’s principal deputy director, said in a statement accompanying the report’s release. “Most of these events can be prevented through daily actions to help lower risk and better manage medical conditions.”

Vermont did well in some important rankings in the CDC study. While the state was in the middle of the pack for emergency department visit rates, Vermont ranked sixth-lowest in “acute hospitalization” rates and lowest in mortality rates for preventable cardiovascular conditions.

Vermont’s mortality rate was 111.2 per 100,000 people. The next-lowest state was Minnesota, with a 113.1 rate. The highest rate was in Mississippi, with 267.3 deaths per 100,000 people.

Dr. David Schneider, medical director for cardiovascular services at the University of Vermont Health Network, said one possible explanation for the low death rate is a relatively healthy population.

“Vermont is populated by individuals who tend to be more health-conscious. And so our prevention efforts … are more likely to be adhered to in Vermont than in other parts of the country,” Schneider said.

As one example, he cited patients who have a heart attack and receive a stent. Those patients are at higher risk for having a second heart attack – and at a higher risk for death – if they don’t take their medication after they return home from the hospital, Schneider said.

“My personal experience has been that, in Vermont, if you do a good job of communicating to your patient why you want them to take their medication, you have a reasonably good chance that they will take their medications,” he said.

Vermont’s low uninsured rate might be another factor, Schneider said. State statistics earlier this year showed that only 3.7 percent of the population lacks health insurance.

Schneider also said the health network “has really strong systems in place to ensure that we are giving patients appropriate treatment and doing the appropriate prevention.” That includes clear discharge instructions and prompt follow-up care for heart attack patients.

Still, Schneider said, there’s “not a simple answer” for Vermont’s performance in the CDC study.
State officials agreed.

“It’s hard to take any specific Vermont message away” from the study, said Paul Meddaugh, an epidemiologist and data analyst for the state Health Department.

Meddaugh said state officials have not yet analyzed Vermont’s cardiovascular data for 2016 – the year cited in the CDC report. Prior years showed some positive trends, albeit with a potentially troubling result in 2015.

“The rates for both coronary heart disease mortality and stroke mortality have been declining (in Vermont),” Meddaugh said. “But in the last full year of reportable data that we had, which is 2015, it did do a slight upturn. It’s impossible at the moment to really say what that means.”

State data also show that the rate of adults with cardiovascular disease stayed steady at 7 percent to 8 percent from 2006 to 2015.

However, statewide statistics don’t tell the whole story. The CDC noted “considerable disparities” in cardiovascular data among demographic groups. And Schneider, from the perspective of his work in Vermont, said he has seen disparities related to factors like obesity and socioeconomic status.

“Any hospital in the country does the right thing when someone shows up with an acute event. But what you want to do is try to prevent that acute event,” Schneider said. “And the prevention is actually less expensive, but harder to do when you have these socioeconomic disparities.”

Prevention is the focus of the federal Million Hearts campaign. Officials say that goal could be reached if each state cut its rate of cardiovascular events by 6 percent every year.

The campaign promotes initiatives like reducing sodium intake and tobacco use while boosting physical activity in the general population and rehabilitation participation for cardiac patients. Federal officials also are promoting what’s called “ABCS” measures in cardiovascular care – aspirin use when appropriate, blood pressure control, cholesterol management and smoking cessation.

Vermont isn’t participating directly in the current Million Hearts campaign but did participate in an earlier iteration, Lukas said. That spurred extensive work on hypertension – described as a “core contributor to fatal cardiac events” and a prevalent risk factor for cardiovascular disease in a new state data brief.

The state also is addressing risk factors in its 3-4-50 campaign, which links three behaviors – lack of physical activity, poor diet and tobacco use – with more than half of all deaths in Vermont.

Lukas said officials continue to target their prevention programs where they are most needed. The state recently identified low-income residents and Vermonters living with disabilities as “priority populations,” she said.
The stakes for that work are high: The CDC study predicts that, if 2016 rates stay constant, there will be 2.2 million emergency department visits, 11.8 million hospitalizations and 2.2 million deaths from preventable cardiovascular events through 2021.

For Vermont, the CDC’s predicted totals through 2021 are 4,900 emergency visits, 17,500 acute hospitalizations and 3,400 deaths – along with $300 million in associated costs.

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