Heart Disease and Stroke

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Policies & Practices
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The Problem

Cardiovascular disease—including heart disease, stroke, and other vascular diseases—is the leading cause of death in the United States.⁴

Policies & Practices

Implementation of electronic health records

An electronic health record (EHR) is a real-time, digital, patient-centered record that replaces paper charts. The US Department of Health and Human Services recommends that healthcare providers use government-certified EHR systems “meaningfully” by focusing on such aspects as engaging patients in their own care, sharing information among healthcare organizations, and providing support for decisions on national high-priority conditions.⁵

It is hoped that if healthcare providers meet such “meaningful use” criteria, it will lead to 1) creation of tools that measure healthcare quality to improve clinical and population health, 2) increased transparency and efficiency, 3) individuals empowered to access clinical information, and 4) more robust research data on health systems.⁵

EHRs should include clinical decision supports, such as alerts for elevated blood pressure and cholesterol levels based on laboratory results, to support guidelines-based clinical decision making.^6–9 Implementation of EHRs that meet meaningful use capabilities allows healthcare providers (e.g., physicians, nurses, pharmacists) to monitor the health of their patients proactively by tracking, in electronic form, heart disease and stroke risk factors.

Status of state implementation of electronic health records, United States (as of December 2012)

(State count includes the District of Columbia.)

States were rated green, yellow, or red according to the following criteria:

Green	As of December 2012, 31.0%–45.0% of office-based physicians in the state were meeting meaningful use criteria.
Yellow	As of December 2012, 16.0%–30.9% of office-based physicians in the state were meeting meaningful use criteria.
Red	As of December 2012, 0%–15.9% of office-based physicians in the state were meeting meaningful use criteria.

Pharmacist collaborative drug therapy management policy

Collaborative drug therapy management (CDTM) is team-based care managed by both a pharmacist and prescribing provider. Evidence shows that pharmacists are effective team members in managing control of chronic disease risk factors such as high blood pressure and low-density lipoprotein (LDL) cholesterol.^1,2,9 A CDTM policy is a state legislative, regulatory, or other written policy that authorizes qualified pharmacists working within the context of a defined protocol to perform patient assessments; order drug therapy-related laboratory tests; administer drugs; and select, initiate, monitor, continue, and adjust drug regimens.¹⁰

State CDTM policies can increase medication adherence rates and improve health outcomes (e.g., reduced hemoglobin A1c, lower LDL cholesterol and blood pressure, fewer adverse drug events).^1,2,9

Status of state pharmacist CDTM policies, United States (as of December 31, 2012)

(State count includes the District of Columbia.)

The rating levels were selected based on the variability of state CDTM policies that existed in the United States in 2012. State policies that cover chronic disease risk factors, including heart disease and stroke risk factors such as hypertension and cholesterol, meet the highest standards.

States were rated green, yellow, or red according to the following criteria:

Green	As of December 31, 2012, the state had a statewide legislative, regulatory, or other written policy authorizing pharmacists in any practice setting (e.g., community retail pharmacy, healthcare setting) to enter into collaborative practice agreements with prescribing providers for drug therapy management of any health condition, as agreed to under protocol.
Yellow	As of December 31, 2012, the state had a statewide legislative, regulatory or other written policy authorizing pharmacists to enter into collaborative practice agreements with prescribing providers for drug therapy management in all practice settings, but the policy did not cover chronic diseases (e.g., hypertension), or collaboration was limited to specified hospital, medical, or clinical practice settings.
Red	As of December 31, 2012, the state had no statewide legislative, regulatory, or other written CDTM policy.

Prevention Status Reports: Heart Disease and Stroke, 2013

The files below are PDFs ranging in size from 100K to 500K.

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References

Community Preventive Services Task Force. Cardiovascular Disease Prevention and Control: Team-Based Care to Improve Blood Pressure Control. In: Guide to Community Preventive Services. Updated Apr 2012.
Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. A Report to the U.S. Surgeon General[PDF 1.2M] 2011. Rockville, MD: US Public Health Service; 2011.
Institute of Medicine. Primary Care and Public Health: Exploring Integration to Improve Population Health. Washington, DC: National Academies Press; 2012.
Kochanek KD, Xu JQ, Murphy SL, et al. Deaths: final data for 2009[PDF 3.2M]. National Vital Statistics Report 2011;60(3).
US Department of Health and Human Services. EHR Incentives & Certification: Meaningful Use Definition & Objectives. Accessed Dec 7, 2012.
Kinn JW, Marek JC, O’Toole MF, et al. Effectiveness of the electronic medical record in improving the management of hypertension. Journal of Clinical Hypertension 2002;4(6):415-9.
Ross SE, Moore LA, Earnest MA, et al. Providing a web-based online medical record with electronic communication capabilities to patients with congestive heart failure: randomized trial. Journal of Medical Internet Research 2004;6:e12.
Rossi RA, Every NR. A computerized intervention to decrease the use of calcium channel blockers in hypertension. Journal of General Internal Medicine 1997;12:672–8.
Toth-Pal E, Nilsson GH, Furhoff AK. Clinical effect of computer generated physician reminders in health screening in primary health care—a controlled clinical trial of preventive services among the elderly. International Journal of Medical Informatics 2004;73:695-703.
American College of Clinical Pharmacy. ACCP position statement: collaborative drug therapy management by pharmacists—2003[PDF 141K]. Pharmacotherapy 2003;23(9):1210–25.