NHLBI Efforts to Enhance Heart Disease and Stroke Surveillance

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NHLBI Efforts to Enhance Heart Disease and Stroke
Surveillance

• Jean Olson, M.D., M.P.H.
• Deputy Chief, Epidemiology Branch
• Division of Prevention and Population Sciences,
  NHLBI

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Calls from Workshops for Nationwide Surveillance
(Circulation. 20051113158-3166)
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NHLBI Strategic Plan Goals

• 1. Improve understanding of the molecular and
  physiologic basis of health and disease. Use that
  understanding to develop improved approaches to
  disease prevention, diagnosis and treatment.
• Form ? Function
• 2. To develop personalized preventive and
  therapeutic regimens for cardiovascular, lung,
  and blood diseases.
• Function ? Cause
• 3. Generate an improved understanding of the
  processes involved in translating research into
  practice and use that understanding to enable
  improvements in public health and to stimulate
  further scientific discovery.
• Cause ? Cures

http//apps.nhlbi.nih.gov/strategicplan/Default.as
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Strategic Plan Challenge of Particular Relevance
to HDS Surveillance

• Challenge 3.2.a.
• Evaluate the risks, benefits, and costs of
• diagnostic tests and treatments in representative
• populations and settings.
• Surveillance systems that allow for the rapid
  analysis and communication of health status can
  provide data on the effectiveness of
  community-based and population-based
  interventions.
• Based on Recommendation 3 from Level 1 CV
  Working Group 9 Translation, Implementation, and
  Community Research

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Activities Supporting National Level Surveillance
Efforts

• Support for NHANES data collection
• Standardized BP, lipid, pulmonary function
  measurements
• Questions about weight loss, sleep patterns and
  disorders
• Compilations of NCHS survey data
• NHANES, NHDS
• Trends in RF awareness, treatment and control
  disease-specific mortality and case-fatality
  trends

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Activities Supporting National Level Surveillance

• National Hospital Discharge
• Survey Redesign
• Advice and funding for ACS surveillance module
  pilot and pre-test
• Data abstraction from medical records
• Goal enable better estimates of ACS annual rates
  and trends
• Pre-test now in the field

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Community Surveillance Studies

• Ongoing Investigator-Initiated Studies
• Olmsted County, MN
• Worcester, MA
• Minneapolis-St. Paul, MN
• ARIC Study Surveillance Component
• Incident MI and CHD death since 1985
• Ages expanded from 35-74 years to 35-84 years in
  2005
• Incident heart failure initiated in 2005
• Ages 55 years and older

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Community Surveillance - Example
Ni et al. Am Heart J. 200915746-52.
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Longitudinal Cohort Studies

• Multiple ethnic groups
• ARIC Study cohort component, CHS, CARDIA, MESA
• Single populations
• Framingham, Jackson Heart Study, Strong Heart
  Study, GOCADAN, Hispanic Community Health
  Study/Study of Latinos

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Longitudinal Cohort Studies Example
Bibbins-Domingo et al. NEJM 20093601179-90.
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Other NHLBI-Supported Projects

• Cardiovascular Research Network
• Collaboration among the 15 health plans of the
  HMO Research Network (HMORN)
• Electronic medical records and administrative
  data resources to support research
• Current efforts include
• Hypertension recognition, treatment and control
• Warfarin therapy in AF and VTE
• ICDs for primary prevention in clinical practice

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Other NHLBI-Supported Projects - Example
Data from Kaiser Permanente Northern California
Yeh R et al. Abstract, 49th Cardiovascular
Diseases Epidemiology and Prevention Annual
Conference 2009.
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Other NHLBI-Supported Projects

• REGARDS-MI grant
• Ancillary study to REGARDS (Reasons for
  Geographical and Racial Differences in Stroke)
• Longitudinal study (n30,000)
• Aims
• Quantify geographic and ethnic variations in CHD
  mortality, attack rates, and case fatality
• Study relationships to risk, socioeconomic and
  medical care factors
• Inventory of Population-Based State Surveys
• Co-fund NCI contract to UCLA
• Opportunities for data collection on specific
  localities, small populations, ?linkage to
  clinical data

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Potential Opportunities for New HDS Surveillance

• Registries
• New initiatives in other arenas that might be
  exploited for new HDS surveillance efforts?
• NHLBI Challenge Grant Addressing Disparities
  (Topic 09-HL-101)
• Develop new measures of early determinants of
  disparities
• Develop and test interventions to reduce health
  and healthcare disparities
• Goal to mitigate differences in health outcomes
  at the population level.

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Disparities in Life Expectancies Across U.S.
Counties
Murray C et al. PLoS Med. 20063(9)e260.
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Questions...

• Is there a need for a new surveillance and
  research infrastructure for HDS?
• Could existing data collection efforts be
  expanded and/or integrated?
• How should surveillance data be collected and
  used to enhance research to address health
  disparities?
• How might relevant stakeholders collaborate in
  surveillance of HDS data collection,
  determination of research priorities, and
  development of public policy?