Take Heart Alaska Heart Disease And Stroke Prevention Plan .
TAKE HEART ALASKAHEART DISEASE AND STROKE PREVENTION PLAN2020-2025
This page intentionally left blank.Take Heart Alaska 2020-2025 Strategic Plan2
Table of ContentsIntroduction Background .4Development of the Strategic Plan . 4Acknowledgments . 4Coalition Members (2019) . 4Strategic Plan Framework Coalition Structure . 6Burden of Heart Disease Stroke in Alaska .7What is Heart Disease Stroke? . 7Why Heart Disease Stroke are Public Health Concerns? . 7Alaska Heart Disease Prevalence, Mortality Hospitalization . 8Alaska Stroke Prevalence, Mortality Hospitalization . 9Alaska Heart Disease Stroke Disparities . 10Economic Cost . 14Data Gaps . 14Solutions to Heart Disease Stroke . 15Risk Protective Factors . 15Screening . 17Key Activities to Prevent Heart Disease Stroke in Alaska. 17Health Equity . 18Strategic Plan Goals, Strategies Objectives . 19Increase Education Engagement . 19Promote Early Detection (of cardiovascular disease) . 19Support Quality Management Treatment. 19Strengthen Statewide Community Partnerships. 19Performance Indicators . 20Take Heart Alaska 2020-2025 Strategic Plan3
Introduction BackgroundDevelopment of the Strategic PlanThis plan was developed by members of the Take Heart Alaska coalition, with leadership from the SteeringCommittee and assistance from a local contractor, Agnew::Beck Consulting. The Alaska Division of PublicHealth’s Section of Chronic Disease Prevention and Health Promotion received a grant from the Centers forDisease Control and Prevention (CDC) in 2018 to carry out work to prevent and manage diabetes, heartdisease, and stroke. The section’s Heart Disease and Stroke Prevention program used part of this funding todevelop a statewide heart disease and stroke prevention plan. The plan’s vision, mission, guiding principles,goals, objectives, and strategies were identified--drawing from members’ expertise, existing data, andevidence-based practices—during multiple coalition working sessions, teleconferences, and online surveys.The coalition approved the final plan in April 2020.This plan is a living document comprised of four broad goal areas aimed at reducing the burden of heartdisease and stroke in Alaska. To meet these aims, it includes specific strategies and objectives to focus on forthe next five years. Guided by these goals, strategies, and objectives; specific activities—in the form of annualwork plans—have been developed by the three Take Heart Alaska Work Groups:(1) Increase Education Engagement Work Group;(2) Promote Early Detection Work Group; and the(3) Support Quality Management Treatment Work Group.The Take Heart Alaska coalition collaborates with stakeholders and healthcare and community partners toimprove cardiovascular health while reducing the overall burden of cardiovascular diseases in theircommunities. To join the coalition effort or for more details about Work Groups and annual work plans, pleasereach out to the State of Alaska’s Heart Disease and Stroke Prevention Program at heart@alaska.gov.AcknowledgmentsWe wish to acknowledge and thank those who helped create the Take Heart Alaska 2020-2025 Strategic Planand who continue to work toward a heart disease and stroke free Alaska. Members with an asterisk next totheir name are Steering Committee members.Coalition Members (2019)NameOrganizationErin AlkestadMountain-Pacific AlaskaMarcia AndersonAlaska Native Tribal Health ConsortiumApril ArbuckleSouthcentral Foundation, St. PaulAlida BusSOA-Div. of InsuranceAngela ColburnAlaska Regional HospitalJessica DavisSouthcentral FoundationRachel DeMarceAlaska Native Tribal Health ConsortiumTake Heart Alaska 2020-2025 Strategic Plan4
NameOrganizationTara Ferguson-GouldAlaska Primary Care AssociationAmanda GagnonSouthcentral Foundation*Preston GrooganMountain-Pacific Quality HealthKen HelanderAmerican Association of Retired Persons (AARP – Alaska)Elly HendersonAmerican Heart Association*Paula HudsonAmerican Heart Association*Emma KleinSoutheast Alaska Regional Health ConsortiumJessica LeystraAlaska Diabetes AssociationKrista MalevichAlaska Regional HospitalJuliette MartinezAmerican Heart AssociationCathy McVeyAlaska Heart Vascular InstituteTammi MeissnerSoutheast Alaska Regional Health Consortium*Ashley MinaeiState of Alaska Division of Public HealthJessica NewmyerAmerican Heart AssociationSuzie NunnBristol Bay Area Health CorporationGeorgiana PagehealtheConnect AlaskaAmy PaulProvidence AlaskaBill PeachhealtheConnect AlaskaErin PetersonAlaska Native Tribal Health ConsortiumEllen ProvostAlaska Native Tribal Health Consortium*Renee RobinsonUniversity of Alaska AnchorageLeslie ShallcrossUAF Cooperative Extension ServiceErika ShedlarskiSouthcentral FoundationClaire SiekaniecAlaska Native Tribal Health ConsortiumAmber SimonettiMat-Su Regional Medical CenterPam SloperSoutheast Alaska Regional Health ConsortiumJanelle SolbosUAA/ISU Doctor of Pharmacy ProgramRuth TownsendAlaska Regional HospitalRayna UsonSouthcentral FoundationHeidi WailandAlaska Native Tribal Health ConsortiumJamie WestenskowAlaska Regional HospitalLaura YounghealtheConnect Alaska*JoAnne Zito-BrauseState of Alaska Division of Public Health*Steering Committee members.Take Heart Alaska 2020-2025 Strategic Plan5
Strategic Plan Framework Coalition StructureVisionStatewide collaboration for aheart healthy Alaska.MissionTake Heart Alaska collaborates withstakeholders and healthcare andcommunity partners to improvecardiovascular health while reducing theoverall burden of cardiovascular diseasesin their community.Guiding Principles Patient Self-Advocacy EmpowermentCollaboration PartnershipHealth Literacy EducationPreventionHigh Value Quality HealthcareOptimum Health for AlaskansTake Heart Alaska 2020-2025 Strategic Plan6
Burden of Heart Disease Stroke in Alaska1What is Heart Disease Stroke?The term “heart disease” refers to several different heart conditions including ischemic heart disease (alsocalled coronary artery disease [CAD] or coronary heart disease [CHD]), which can lead to a heart attack,angina, heart failure, and other serious health problems.Stroke occurs when a blood vessel that feeds the brain either bursts (hemorrhagic stroke) or is blocked(ischemic stroke) causing that part of the brain, and the part of the body it controls, to not work properly.Why Heart Disease Stroke are Public Health Concerns?Heart disease and stroke are among Alaska’s leading causes of death and are critical public health priorities. In2016, heart disease was the second most common cause of death in Alaska and stroke was the fifth (see Table1). Heart disease and stroke cause about one-third of the deaths in Alaska (see Figure 1). Heart disease is oftencalled the “silent killer” because there are commonly no warning signs or symptoms, and many people do notknow they have it.Table 1: Cause of Death by Rank in Alaska the U.S. (2016)Cause of Death by Rank in AlaskaAlaska DeathsUS DeathsAge-AdjustedAge AdjustedRankNumber%RateRateRank1. Cancer97422%152.5155.822. Diseases of the Heart81418%136.3165.513. Unintentional Injuries4299%61.947.434. Chronic Lower Respiratory Disease2365%40.440.645. Stroke1934%38.237.356. Suicide1864%25.313.5107. Chronic Liver Disease and Cirrhosis1233%15.910.7128. Diabetes1223%18.621.079. Alzheimer’s Disease1092%25.430.3610. Influenza and Pneumonia601%12.413.58Source: Reproduced from State of Alaska, DHSS. Alaska Vital Statistics 2016 Annual Report. Available PDFs/VitalStatistics AnnualReport 2016.pdf. Accessed 2-17-2020.Alaska DHSS, Section of Chronic Disease Prevention and Health Promotion Alaska Department of Health and Social Services. TheBurden of Heart Disease and Stroke in Alaska (2019). Accessed February 17, Cardiovascular/pubs/2019HDSP BurdenReport.pdf.1Take Heart Alaska 2020-2025 Strategic Plan7
Figure 1: Heart Disease Stroke Contributions to DeathAmong Alaskans (2007-2016 combined)7%28%65%All Other CausesHeart DiseaseStrokeSource: Reproduced from The Burden of Heart Disease and Stroke in Alaska (2019) report.Alaska Heart Disease Prevalence, Mortality HospitalizationPrevalence in Alaska. According to the most recently available data (2016), 4.3% of adults in Alaska reportbeing diagnosed with heart disease, meaning they have had been diagnosed with a heart attack, coronaryheart disease, or both. This translates to more than 24,000 Alaska adults who have been diagnosed with heartdisease. The prevalence of heart disease has significantly declined during the past 10 years. This is similar tonational trends (see Figures 2 and 3). Note that because heart disease is often asymptomatic andundiagnosed, prevalence rates are based on self-report and are likely underestimated.Figure 2: Prevalence of Adults Diagnosed with HeartDisease (Heart Attack) in Alaska a201120122013201420152016U.S.Source: Reproduced from The Burden of Heart Disease and Stroke in Alaska (2019) report.Take Heart Alaska 2020-2025 Strategic Plan8
Figure 2: Prevalence of Adults Diagnosed with Heart Disease(Coronary Heart Disease) in Alaska laska201120122013201420152016U.S.Source: Reproduced from The Burden of Heart Disease and Stroke in Alaska (2019) report.Heart disease-related deaths (mortality). Heart disease is the second leading cause of death in Alaska. It wasa cause of death for 21,914 Alaskans between 2007 and 2016. For 7,182 Alaskans, it was the underlying causeof death (i.e., direct cause), and for 14,732 it was a contributing cause of death. Death rates have declinedsignificantly during recent years.Heart disease-related hospitalizations and outpatient treatment. In total, during 2016, heart diseasecontributed to 70,782 hospital visits. Of those visits, 12,288 were inpatient visits, where the person wasadmitted to a hospital. Heart disease was the primary diagnosis (or reason care was needed) for 31% ofinpatient visits. The remaining 58,494 cases were outpatient visits (i.e., emergency department, outpatientsurgery, outpatient observation, imaging labs, or other services), and for about half of these (51%) heartdisease was the primary diagnosis.Alaska Stroke Prevalence, Mortality HospitalizationPrevalence in Alaska. According to 2016 data, 2.2% of adults in Alaska report having had a stroke at somepoint during their lives. This translates to about 15,000 Alaska adults who have suffered from a stroke. Theprevalence of stroke in Alaska has not changed during recent years. Prevalence over recent years has beensimilar to the U.S. See Figure 3.Take Heart Alaska 2020-2025 Strategic Plan9
Figure 3: Prevalence of Adults Ever Being Diagnosed withStroke in Alaska U.S. Alaska201120122013201420152016U.S.Source: Reproduced from The Burden of Heart Disease and Stroke in Alaska (2019) report.Stroke-related deaths. Stroke is the fifth leading cause of death in Alaska. It was a cause of death for 4,793Alaskans between 2007 and 2016: 1,720 as the underlying cause of death (i.e., direct cause), and 3,073 as acontributing cause of death. Despite the unchanged stroke prevalence, stroke-related death rates havedeclined significantly during recent years.Stroke-related hospitalizations and outpatient treatment. In total, during 2016 strokes contributed to 10,021hospital visits – 2,725 of these were inpatient visits, where the person was admitted to a hospital, and 7,296were outpatient visits (i.e., emergency department, outpatient surgery, outpatient observation, imaging labs,or other services). Stroke was the primary diagnosis in about half of cases for each type of visit.Alaska Heart Disease Stroke DisparitiesComparisons by race. Despite similar prevalence, both heart disease and stroke-related death andhospitalization rates were higher for Alaska Native people in comparison to Whites. Heart disease-relatedhospitalization rates were also higher among Pacific Islander people than among Whites.Other demographic comparisons. Prevalence of heart disease and stroke, as well as related hospitalizationand death, increased with age: less than 1% of adults ages 18-44 have heart disease or have had a stroke,compared to 19.0% with heart disease and 11.7% who have had a stroke among adults ages 75 and older.Heart disease and stroke-related hospitalization rates were both higher for men than women. Heart diseaseprevalence and related death rates were higher for men than women, but stroke prevalence and death rateswere similar by gender. Prevalence of heart disease was higher among people with fewer economic resourcesthan among those with more resources.Regional comparisons. The prevalence of heart disease was greater in the Southeast-southern region andKenai Peninsula region than in the state overall; stroke prevalence was similar across the state’s regions. Bothheart disease and stroke-related death rates were higher in the Northwest and Yukon-Kuskokwim Deltaregions than in the state overall. See Figures 4-6.Take Heart Alaska 2020-2025 Strategic Plan10
Figure 4: Prevalence of Ever Being Diagnosed with Heart DiseaseAmong Adults by Behavioral Health Systems RegionAlaska, 2012-2016Prevalence of Heart Disease by Behavioral Health Systems RegionAlaska adults, 2012-2016PrevalenceLowerCIUpperCIState of 6%3.7%5.6%Juneau3.2%2.4%4.4%Kenai .2%1.9%5.2%Other hern*7.0%5.1%9.6%Southwest3.6%2.6%5.0%Y-K Delta2.8%1.8%4.3%Data source: Alaska BRFSS Standard File.*indicates significant difference between region and state overall.Take Heart Alaska 2020-2025 Strategic Plan11
Figure 5: Heart Disease-related Death Rates Among Adults, by Behavioral Health Systems RegionAlaska, 2007-2016, age-adjusted, underlying, and contributing causes of death combinedHeart disease death rate (underlying and contributing causes combined) by Alaska Behavioral Health SystemsRegion 2007-2016:RateLowerCIUpperCICountState of .2311.0663Kenai 11,876Northwest*497.4452.7542.2617Other 7.6361.6548Y-K Delta*437.1395.3478.8507Rates are per 100,000 and age-adjusted to the 2000 U.S.Standard Population (19 age groups - Census P25-1130).Source: Alaska Division of Public Health, Health Analytics and Vital Records Section, Mortality Data. Underlying andcontributing cause. Only Alaska residents are included.*indicates significant difference between region and state overall.Take Heart Alaska 2020-2025 Strategic Plan12
Figure 6: Stroke-related Death Rates, by Behavioral Health Systems RegionAlaska, 2007-2016, age-adjusted, underlying and contributing causes of death combinedStroke death rate (underlying and contributing causes) by Behavioral Health Systems RegionAlaska residents, 2007-2016RateLowerCIUpperCICountState of airbanks63.355.970.7316Juneau62.351.173.6130Kenai 185.1129.1110Other K Delta*120.597.9143.0126Northwest*Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population (19 age groups - Census P25-1130).Source: Alaska Division of Public Health, Health Analytics and Vital Records Section, Mortality Data. Underlying andcontributing causes of death combined. Only Alaska residents are included.*indicates significant difference between region and state overall.Take Heart Alaska 2020-2025 Strategic Plan13
Screening for hypertension, cholesterol, and diabetes. Most Alaska adults (92%) were current with screeningfor hypertension, 84% met cholesterol screening recommendations, and 52% have been screened for diabetesin the past three years. Screening rates for all three conditions were lower in the Northwest and YukonKuskokwim Delta regions than in the state overall. Alaska Native adults, rural Alaska residents, and peoplewith fewer economic resources were less likely than the state average to be current with any of the threescreenings.Economic CostHospital stays due to a heart attack or other outcome of heart disease or stoke places a burden on individuals,families, and society. The CDC reports that heart disease costs the United States about 200 billion each yearin terms of health care services, medications, and lost productivity. 2 Heart attacks ( 11.5 billion) and coronaryheart disease ( 10.4 billion) are two of the ten most expensive hospital primary discharge diagnoses.The impact of heart disease and stroke is also costly in Alaska. In fiscal year 2016, Alaska Medicaid recipientswith heart disease alone or in combination with other chronic diseases (9,527 people) needed more than 300million in health care paid by Medicaid, with an average per-person cost of more than 34,000. 3Data GapsData gaps. Currently available information about the prevalence of heart disease in Alaska is based on selfreport. The true number of people in Alaska suffering from heart disease is likely to be much greater, becauseheart disease is often undiagnosed. In the future, health information exchanges that include informationabout clinical outcomes may help to fill this gap.For more detailed information regarding the overall burden of heart disease and stroke in Alaska, please seethe complete The Burden of
Burden of Heart Disease Stroke in Alaska. 7 What is Heart Disease Stroke . Health’s Section of Chronic Disease Prevention and Health Promotion received a grant from the Centers for Disease Control and Prevention (CDC) in 2018 to carry out work to prevent and manage diabetes, heart disease, and stroke. The section’s Heart Disease and St roke Prevention program used part of this .
Judge Larry Zervos Alaska Superior Court, Sitka Rural Access Subcommittee Judge Dale Curda, co-chair Alaska Superior Court, Bethel Judge Roy Madsen (retired), co-chair Alaska Superior Court, Kodiak Louise Brady Sitka Tribe of Alaska, Sitka James Jackson Alaska Court Magistrate, Galena Judge Michael Jeffery Alaska Superior Court, Barrow
Alaska Airlines Inflight Magazine. Economics 300: Economy of Alaska, Notes-Introduction to Alaska Geography, page 9 Alaska Census Areas For purposes of collecting and reporting economic and social Alaska data, Alaska is divided into 27 “census areas.” These census areas are shown in the map below.
Wholesale Trade, and Construction. Source: Alaska Department of Labor, . employment pie. 2 ALASKA ECONOMIC TRENDS AUGUST, 1998 Alaska Economic Trends is a monthly . the Employment Security Division and published by the Alaska Department of Labor, P.O. Box 21149, Juneau, Alaska 99802-
Alaska Native Language Materials . in the . Alaska State Library . Historical Collections . Compiled by . James Simard . Alaska State Library - Historical Collections . Alaska Department of Education & Early Development Division of Libraries, Archives & Museums . P.O. Box 110571 Juneau Alaska 99811-0571 (907) 465-2925 Fax: (907) 465-2990
All National Banner Unified Champion Schools 518 schools *Denotes a school with 4-year renewal recognition STATE City School Name ALASKA Anchorage Robert Service High School ALASKA Anchorage East High School ALASKA Anchorage West Anchorage High School ALASKA Chugiak Chugiak High School ALASKA Eagle River Eagle River High School ALASKA Eagle River Homestead Elementary School
In addition to DEC, the slate agencies named as Defendants are: Alaska Department of Natural Resources, Alaska Oil and Gas Conservation Commission, Alaska Energy Authority, and Regulatory Commission of Alaska. 2 Kanuk v. State, 335 P.3d 1088, 1090 (Alaska 2014). 3 4 Id. at 1103. Id. at 1097. 1
Atherosclerotic Disease is a Pan Vascular Process Coronary Artery Disease (CAD) Non-coronary Atherosclerosis -Peripheral Artery Disease (PAD) -Lower extremity -Upper extremity (subclavian stenosis) -Carotid artery disease -Renal artery disease -Mesenteric artery disease -Aortic aneurysm -Vasculogenic Erectile Dysfunction Vascular disease is
American Revolution were the same white guys who controlled it after the American Revolution. And this leads us to the second, and more important way that as a revolution, the American one falls a bit short. So, if you've ever studied American history, you're probably familiar with the greatest line in the Declaration of Independence: “We hold these truths to be self-evident, that all men .
