Cardiovascular Disease and Stroke August 9, 2019 Overview of - PowerPoint PPT Presentation

Presentation to the Texas Council on Cardiovascular Disease and Stroke August 9, 2019

Overview of Presentation Part 1: Karen Nunley, PhD • Summary of Heart Attack and Stroke Care Hospital Performance Measures 2018 Reports Part 2: Elizabeth Harker, MPH • Results from DSHS’ Self -Measured Blood Pressure (SMBP) Project

Adult Stroke Prevalence, by Public Health Region (PHR), Texas, 2017 Overall Stroke Prevalence in Texas = 3.5% (95% CI: 2.8 - 4.2) Data Classification: Quantiles. Data Source: 2017 Texas Behavioral Risk Factor Surveillance System (BRFSS), Center for Health Statistics, Texas Department of State Health Services. Stroke is defined as "Yes" responses to the survey question, "Have you ever been told by a doctor or health professional that you have a stroke?"

Stroke Prevalence among Adults by Age Group (Years), Sex, and Race/Ethnicity, Texas, 2017 Title (hide) 10 7.7% 8 PERCENT % 5.8% 6 4.5% 4.2% 4 3.5% 3.3% 2.1% 2 n/a n/a n/a 0 18-29 30-44 45-64 ≥65 Male Female White Black Hispanic Other Age Group (years) Sex Race/Ethnicity Data source: Texas Behavioral Risk Factor Surveillance System (BRFSS), 2017, Center for Health Statistics, Texas Department of State Health Services. n/a: Insufficient data, statistically unreliable to report at the indicated levels.

Stroke Prevalence among Adults by Age Group (Years), Sex, and Race/Ethnicity, Texas, 2017 Title (hide) 10 7.7% 8 PERCENT % 5.8% 6 4.5% 4.2% 4 3.5% 3.3% 2.1% 2 n/a n/a n/a 0 18-29 30-44 45-64 ≥65 Male Female White Black Hispanic Other Age Group (years) Sex Race/Ethnicity Data source: Texas Behavioral Risk Factor Surveillance System (BRFSS), 2017, Center for Health Statistics, Texas Department of State Health Services. n/a: Insufficient data, statistically unreliable to report at the indicated levels.

Stroke Prevalence among Adults by Age Group (Years), Sex, and Race/Ethnicity, Texas, 2017 Title (hide) 10 7.7% 8 PERCENT % 5.8% 6 4.5% 4.2% 4 3.5% 3.3% 2.1% 2 n/a n/a n/a 0 18-29 30-44 45-64 ≥65 Male Female White Black Hispanic Other Age Group (years) Sex Race/Ethnicity Data source: Texas Behavioral Risk Factor Surveillance System (BRFSS), 2017, Center for Health Statistics, Texas Department of State Health Services. n/a: Insufficient data, statistically unreliable to report at the indicated levels.

Stroke Prevalence among Adults by Education And Annual Household Income, Texas, 2017 Title (hide) 8 6 5.4% 4.6% PERCENT % 3.7% 3.7% 4 2.4% 2 1.6% n/a n/a 0 <HS Grad HS Grad Some ≥College <$35K $35K - $50K - ≥$75K College Grad <$50K <$75K Education Annual Household Income Data source: Texas Behavioral Risk Factor Surveillance System (BRFSS), 2017, Center for Health Statistics, Texas Department of State Health Services. n/a: Insufficient data, statistically unreliable to report at the indicated levels.

Stroke Prevalence among Adults by Education And Annual Household Income, Texas, 2017 Title (hide) 8 6 5.4% 4.6% PERCENT % 3.7% 3.7% 4 2.4% 2 1.6% n/a n/a 0 <HS Grad HS Grad Some ≥College <$35K $35K - $50K - ≥$75K College Grad <$50K <$75K Education Annual Household Income Data source: Texas Behavioral Risk Factor Surveillance System (BRFSS), 2017, Center for Health Statistics, Texas Department of State Health Services. n/a: Insufficient data, statistically unreliable to report at the indicated levels.

Stroke Prevalence among Adults by Select Comorbidities, Texas, 2017 Title (hide) 14 13.2% 12 10.6% 10 PERCENT % 7.7% 8 7.1% 6.1% 6 5.0% 4 3.1% 3.1% 2.9% 2.8% 2.5% 2 1.4% 0 Yes No Yes No Yes No Yes No Yes No Yes No Diabetes Hypertension Kidney Disease Current Smoker Obesity Depression Data source: Texas Behavioral Risk Factor Surveillance System (BRFSS), 2017, Center for Health Statistics, Texas Department of State Health Services.

Stroke Prevalence among Adults by Select Comorbidities, Texas, 2017 Title (hide) 14 13.2% 12 10.6% 10 PERCENT % 7.7% 8 7.1% 6.1% 6 5.0% 4 3.1% 3.1% 2.9% 2.8% 2.5% 2 1.4% 0 Yes No Yes No Yes No Yes No Yes No Yes No Diabetes Hypertension Kidney Disease Current Smoker Obesity Depression Data source: Texas Behavioral Risk Factor Surveillance System (BRFSS), 2017, Center for Health Statistics, Texas Department of State Health Services.

Stroke Prevalence among Adults by Select Comorbidities, Texas, 2017 Title (hide) 14 13.2% 12 10.6% 10 PERCENT % 7.7% 8 7.1% 6.1% 6 5.0% 4 3.1% 3.1% 2.9% 2.8% 2.5% 2 1.4% 0 Yes No Yes No Yes No Yes No Yes No Yes No Diabetes Hypertension Kidney Disease Current Smoker Obesity Depression Data source: Texas Behavioral Risk Factor Surveillance System (BRFSS), 2017, Center for Health Statistics, Texas Department of State Health Services.

Stroke Prevalence among Adults by Select Comorbidities, Texas, 2017 Title (hide) 14 13.2% 12 10.6% 10 PERCENT % 7.7% 8 7.1% 6.1% 6 5.0% 4 3.1% 3.1% 2.9% 2.8% 2.5% 2 1.4% 0 Yes No Yes No Yes No Yes No Yes No Yes No Diabetes Hypertension Kidney Disease Current Smoker Obesity Depression Data source: Texas Behavioral Risk Factor Surveillance System (BRFSS), 2017, Center for Health Statistics, Texas Department of State Health Services.

Stroke Prevalence among Adults by Select Comorbidities, Texas, 2017 Title (hide) 14 13.2% 12 10.6% 10 PERCENT % 7.7% 8 7.1% 6.1% 6 5.0% 4 3.1% 3.1% 2.9% 2.8% 2.5% 2 1.4% 0 Yes No Yes No Yes No Yes No Yes No Yes No Diabetes Hypertension Kidney Disease Current Smoker Obesity Depression Data source: Texas Behavioral Risk Factor Surveillance System (BRFSS), 2017, Center for Health Statistics, Texas Department of State Health Services.

Stroke Prevalence among Adults by Select Comorbidities, Texas, 2017 Title (hide) 14 13.2% 12 10.6% 10 PERCENT % 7.7% 8 7.1% 6.1% 6 5.0% 4 3.1% 3.1% 2.9% 2.8% 2.5% 2 1.4% 0 Yes No Yes No Yes No Yes No Yes No Yes No Diabetes Hypertension Kidney Disease Current Smoker Obesity Depression Data source: Texas Behavioral Risk Factor Surveillance System (BRFSS), 2017, Center for Health Statistics, Texas Department of State Health Services.

Evaluating Hospital Care of Stroke in Texas Data from the 50 participating hospitals were evaluated for the period of January 2008-December 2018. Time to initial brain imaging • Time to IV thrombolytic therapy • IV tPA- patient arrives by 2 hours, treatment received by 3 • hours Drip and Ship • Endovascular therapy • Thrombolytic complication (bleeding) • Rehabilitation considered • Discharge disposition •

Stroke Cases, 2008-2017 Total Reported Participating Final Stroke Cases Hospitals Diagnosis Reported Cases Year N=115,903 (%) N N=115,903 % Ischemic Stroke 76,674 66.4 2008 4,845 (4.2) 21 TIA (<24hrs) 15,756 13.6 2009 6,318 (5.5) 27 Intracerebral 2010 8,329 (7.2) 33 Hemorrhage 12,491 10.8 2011 9,359 (8.1) 36 Subarachnoid Hemorrhage 4,273 3.7 2012 10,429 (9.0) 40 Stroke NOS 1,669 1.4 2013 12,500 (10.8) 44 Elective Carotid 2014 14,046 (12.1) 49 Intervention only 3,191 2.8 2015 16,672 (14.4) 49 No stroke 2016 16,779 (14.5) 50 related diagnosis 1,490 1.3 2017 16,626 (14.3) 49 Missing 359 0.3

Time to Brain Imaging CT performed <= 25 minutes of hospital arrival 29.3% CT performed >25 minutes of hospital arrival 70.7% 100 80.0% 76.7% 74.6% 80 70.1% 67.6% PERCENT (%) 66.0% 65.0% 63.0% 59.1% 60 53.3% 40 20 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year

Time to IV tPA IV tPA ≤45 Minutes IV tPA ≤60 Minutes Yes No 32.1% 36.5% Yes No 63.5% 67.9% 100 82.7 78.5 IV t- PA ≤ 45 Minutes 75.5 80 PERCENT (%) IV t- PA ≤ 60 Minutes 65.0 61.2 60 51.5 48.5 46.7 46.8 42.9 40.0 40 29.6 28.5 26.8 22.2 20.7 19.0 21.9 15.1 20 13.6 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year

IV tPA – Arrive by 2, Treat by 3 5.4% IV tPA < 3 Hours of LKW IV tPA > 3 Hours of LKW 94.6% 96.1% 96.0% 95.3% 94.6% 94.5% 93.9% 94.2% 93.9% 100 91.6% 89.6% 80 PERCENT (%) 60 40 20 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year

Drip and Ship Adult Ischemic Drip-Ship Stroke Cases, N = 789 (2.7%) 2008-2017 18 16 14 12.3% PERCENT (%) 12 9.9% 10 8.8% 8 6 4 2.9% 1.8% 1.8% 1.7% 1.6% 2 0.6% 0.2% 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year

Endovascular Therapy Adult Ischemic Stroke Cases, IA catheter-based reperfusion 2008-2017 N n % 76,657 1,217 1.6 4 3 2.8% 2.6% PERCENT (%) 2.0% 2 1.6% 1.1% 0.9% 0.9% 0.9% 1 0.7% 0.4% 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year

Thrombolytic Complication (bleeding) 4.9% No bleeding complicatons after thrombolytic therapy Bleeding complications after thrombolytic 95.1% therapy 10 8 PERCENT (%) 6.4% 6.3% 6 5.2% 5.1% 4.9% 4.8% 4.8% 4.6% 4.1% 4.0% 4 2 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year