 |
 |
National Center for Chronic Disease Prevention and Health Promotion
Chronic Disease Prevention
Home | Contact Us
|
||||||||
|
|
|
|
|
|
|
||
National Center for Chronic Disease Prevention and Health Promotion Chronic Disease Prevention Home | Contact Us |
|
|
||||||
|
|
|
CENTERS FOR
DISEASE CONTROL AND PREVENTION Registries Play an Important Role in Helping Understand and Prevent Cardiovascular Disease CDC and its partners are actively developing data systems designed to improve the quality of cardiovascular care and survival. These systems, called disease registries, provide data used to improve care of patients who have strokes, high blood pressure, and heart attacks. Registries often play an important role in helping researchers understand the burden of cardiovascular disease and identify related health disparities and prevention strategies. “The registry activities are part of our efforts to improve the public health surveillance in heart disease and stroke,” said Zhi-Jie Zheng, MD, PhD, a CDC senior epidemiologist. “Our vision is to establish an integrated national surveillance system that will track and measure the population burden of cardiovascular diseases and quality of cardiovascular care.” The Paul Coverdell National Acute Stroke Registry Stroke is the country’s third leading cause of death and a major cause of serious, long-term disability. The burden of disease is substantially higher among African Americans than among whites; in 2000, the stroke death rate was 87 per 100,000 for black men and 79 per 100,000 for black women, compared with 59 per 100,000 for white men and 58 per 100,000 for white women. Approximately 50% of stroke sufferers die before they reach a hospital. Additionally, an estimated 4.5 million Americans and their families live with the disabling effects of stroke. Researchers have found that certain drugs—called thrombolytic medications or “clot busters”—can improve stroke outcomes in eligible patients, yet only about 3% of patients with stroke are being appropriately treated with these medications. In addition, far too few stroke patients arrive at the hospital in time to receive treatment that could lead to full recovery, and far too many become needlessly disabled. To help overcome these deficiencies, CDC established The Paul Coverdell National Acute Stroke Registry. This registry, initiated in 2001 and still in the developmental phase, has as its primary goal to help hospitals improve their delivery of the critical emergency care that can prevent permanent disabilities from stroke. CDC first convened an expert panel to make recommendations about the specific kinds of quality improvement data that should be collected for the registry. This panel included representatives from Brain Attack Coalition, National Stroke Association, American Heart Association /American Stroke Association, National Institute for Neurologic Disorders and Stroke, and Centers for Medicare and Medicaid Services.
The long-term goal of this important project is to establish state registries nationwide and a clearinghouse to provide information and educational materials on stroke to health care professionals and the public. Data from the registries will be instrumental in helping states reduce death and disability from stroke and improve the quality of life for stroke survivors. The program’s namesake, Paul Coverdell, was a U.S. Senator from Georgia who died after a stroke in July 2000 at the age of 61. For additional information on the registry, visit http://www.cdc.gov/programs/chronic5.htm. Cardiovascular Surveillance via a Hypertension Registry The Wake Forest University School of Medicine is conducting a 3-year pilot project to establish an emergency department–based hypertension (high blood pressure) registry at the Wake Forest University Baptist Medical Center. In collaboration with a CDC technical advisor, investigators at the medical center developed an active database that tracks information on the emergency care of hypertensive patients, referrals and recommendations for follow-up, and follow-up care. After preliminary data have been analyzed and interpreted, findings from the registry will help in the design and targeting of programs for improving the state and local infrastructure of medical care for high blood pressure. The project’s primary goals are to
Of the approximately 67,000 annual emergency room visits at this medical center, almost half (45%) are made by African Americans and members of other minority groups. All adult patients seen in the emergency department have blood pressure readings taken, and their records are screened for inclusion in the registry. Patients who have sustained blood pressure values above 140/90 mmHg, a history of hypertension, or who are currently taking antihypertensive medication are included. Already, policies and quality of care for these emergency department patients have been improved by some of the registry’s preliminary findings. CDC and its partners at the Wake Forest University School of Medicine hope to find that within 3 years from the time this demonstration project started (1) the number of emergency room visits for symptoms related to cardiovascular or cerebrovascular problems (those assigned related ICD-9 codes) will drop by 5%; (2) the number of people who come to the emergency room with no history of high blood pressure or current usage of hypertension medication, yet are shown to have elevated blood pressure, will decline by 10%; and (3) the number of people who are found to have high blood pressure, regardless of history or diagnoses, will drop 10% overall. For more information about the Hypertension Registry, contact Carma Ayala, PhD, MPH, at CDC by e-mail at cayala@cdc.gov. A Community-Based Cardiac Arrest Registry Project: The Study of Sudden Unexplained Death in Multnomah County, Oregon An estimated 400,000 people die annually of sudden cardiac death (SCD), a major clinical and public health problem. For about 5% to 15% of all SCD cases, a definitive cause cannot be determined. In collaboration with CDC, the Heart Rhythm Research Laboratory at the School of Medicine, Oregon Health & Science University, is conducting a prospective study using a novel, comprehensive approach to uncover “hidden” causes of sudden and previously unexplained cardiac deaths in the community. The study’s principal investigator, Sumeet Chugh, MD, said that although the phenomenon of sudden cardiac death has been studied for many years, it has only infrequently been done in a systematic manner in communities where it actually happens. According to Dr. Chugh, this is much more than just a registry. The project’s ultimate goal is to discover risk factors and novel methods for preventing such deaths, which could be very significant if you consider that, nationally, only about 5% of people experiencing sudden cardiac arrest survive long enough to get to a hospital. Many of these deaths (25% to 40%) occur without warning among people under the age of 65. Therefore, finding ways to identify persons at high risk is extremely important. This project has three elements. First, researchers sought to understand the magnitude of the problem in the community. They identified all cardiac arrest deaths in Multnomah County (population 660,486) through emergency medical services, the medical examiner, and 16 area hospitals, then ascertained which of those cases met their criteria for sudden death. Using a retrospective review of death certificates, they also identified cases of cardiac deaths that had occurred outside of hospitals. Findings from this research have yielded an estimate of annual incidence in this community. Second, the investigators are looking at possible “hidden” risk factors in people with outwardly normal hearts. Two recent studies have shown that sudden unexplained cardiac death (SUD, for short) tends to run in families—if one parent had SUD, a person’s risk increases twofold, but if both parents had SUD, a person’s risk increases ninefold. This tells researchers that genes could be an important risk factor. The genetic analysis portion of the research is expected to begin soon. Third, the research team is exploring the possible significance of common heart defects that normally do not result in disease per se, including thickening of the heart wall (left ventricular hypertrophy) and mitral valve prolapse. Because such conditions are so common, they cannot be the only determining factor in triggering sudden death. However, researchers hypothesize that these conditions may interact with other factors, perhaps genetic, to play a role. “Our work with CDC has not only made it possible for us to conduct this important research, but also to disseminate critical information to the community,” Dr. Chugh said. In March 2004, his department hosted the first-ever statewide symposium on cardiac arrest management, where more than 150 EMS physicians, medical directors, system managers, cardiologists, emergency room nurses, and field paramedics gathered to learn about
For further information about the Oregon Sudden Unexplained Death Study, visit its Web site at http://www.oregonsuds.org.* * Links to non-Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organization Web pages found at this link. |
|
|
|
|
|
|
||||||||||||||
|
|
|
Privacy
Policy | Accessibility This page last reviewed September 08, 2004 United
States Department of Health and Human Services |
|
The first CDC funding
went to four sites in Georgia, Ohio, Michigan, and Massachusetts for the
design and testing of prototypes to measure the delivery of acute stroke
care to patients in their states. In 2002, an additional four sites in
California, Illinois, North Carolina, and Oregon were funded for the same
purposes. By late 2002, these eight sites had yielded data from 7,333
patients at 109 hospitals. On the basis of these findings, the registry, in
collaboration with state health departments and hospitals, developed plans
that focused on quality improvements in emergency room diagnosis, inpatient
management, and secondary stroke prevention (helping patients control high
blood pressure and cholesterol levels and stop smoking).