1. Cardiovascular Disease (CVD) in Texas
Philip Huang, MD, MPH
Texas Department of State Health Services

2. Overview Burden of CVD Risk Factors Quality/Performance
Mortality
Morbidity
Economic Cost
Risk Factors
Quality/Performance
HEDIS
EMS
Strategies to Address

3. Burden of CVD Leading cause of death in Texas and in the United States
34% of all deaths in Texas
1,422,000 Texas adults reported that they have had heart disease or stroke in 2005

4. MORTALITY DATA

5. Mortality Data
Death certificate data were compiled and tabulated by the Statistical Services Division of the Texas Vital Statistical Unit (VSU)
All death rates are age-adjusted using the 2000 US standard population

6. Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 2004

7. Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 2004

8. Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 2004

9. Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 2004

10. Trends of Heart Disease
Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services,

11. Trends of Stroke
Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services,

12. Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services,

13. Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services,

14. Mortality Data-Ischemic Heart Disease
6 Year Average Age-Adjusted Mortality Rates,
Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services,

15. Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services,

16. Mortality Data-Stroke
6-Year Average Age-Adjusted Mortality Rates,
Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services,

17. Hospital Discharge Data

18. Hospital Discharge Data
Data Source: Texas Health Care Information Collection (THCIC), Department of State Health Services, 2005

19. Data Source: Texas Health Care Information Collection (THCIC), Department of State Health Services,

20. Estimated Hospital Charges

21. Data Source: Texas Health Care Information Collection (THCIC), Department of State Health Services,

22. Data Source: Texas Health Care Information Collection (THCIC), Department of State Health Services,

23. Medicaid Claims Data for Cardiovascular Disease Texas, 2005
The data is based on paid Medicaid claims for Fee-For-Service (FFS) and Patient Care Case Management (PCCM) clients. It does not include information on individuals served by Medicaid HMOs or those served by STAR+PLUS.
This information is derived from paid or partially paid Medicaid claims and does not include data on denied or pending claims.

24. Primary CVD Diagnoses, Inpatient Cost, Texas, 2005
Hypertension
$2,132,630
Hypertensive heart disease
$1,655,524
Ischemic Heart Disease
$47,697,130
Stroke
$20,071,425
Congestive Heart Failure
$30,885,743
Source: Fee for Service (FFS) and Patient Care Case Management (PCCM) clients

25. Primary CVD Diagnoses, Outpatient Cost, Texas, 2005
Hypertension
$1,640,395
Hypertensive heart disease
$1,061,310
Ischemic Heart Disease
$18,415,949
Stroke
$9,944,830
Congestive Heart Failure
$11,801,680
Source: Fee for Service (FFS) and Patient Care Case Management (PCCM) clients

26. Primary CVD Diagnoses, Emergency Department Cost Texas, 2005
Hypertension
$6,561,670
Ischemic Heart Disease
$7,348,006
Stroke
$3,248,339
Congestive Heart Failure
$3,762,690
Source: Fee for Service (FFS) and Patient Care Case Management (PCCM) clients

27. Total Medicaid Paid Claims Due to CVD, Texas, 2005
Inpatient
Emergency Department
Outpatient
Medicaid Paid Amount for CVD
$182,524,852.67
$42,641,919.19
$103,351,622.91
Source: Fee for Service (FFS) and Patient Care Case Management (PCCM) clients

28. Risk Factor Surveillance

29. BRFSS
Ongoing telephone survey sponsored by DSHS in partnership with CDC
Conducted on a monthly basis of 500 randomly selected Texans 18 years or older are asked questions about their health habits

30. BRFSS Behavioral Risk Factors Medical Risk Factors
Preventive Health Practices

32. Adult Cigarette Smoking Prevalence – 2006
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006

33. Adult Cigarette Smoking Health Service Region – 2006
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006

34. Cigarette Smoking Among Youth – 2001 & 2005
Data Source: Texas Youth Risk Behavior Surveys (YRBS), Texas Department of State Health Services, 2001, 2005
(Excluding Houston ISD) High School Survey

35. Overweight/Obesity

36. Overweight or Obesity Texas and US Adults, 1995-2006
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services,

37. Overweight or Obesity Texas, BRFSS,- 2006
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006

38. Overweight or Obesity Health Service Region-2006
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006

39. Overweight among Youth Prevalence – 2001 & 2005
Data Source: Texas Youth Risk Behavior Surveys (YRBS), Texas Department of State Health Services, 2001, 2005
(Excluding Houston ISD) High School Survey

40. Lack of Physical Activity

41. Lack of Physical Activity* Texas & US Adults, 1995-2006
* During the past 30 days, did you participate in any physical activities or exercise?
% of adults who did not participate in any physical activities during the past 30 days
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services,

42. Lack of Physical Activity* Adults, Prevalence – 2006
* During the past 30 days, did you participate in any physical activities or exercise?
% of adults who did not participate in any physical activities during the past 30 days
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006

43. Lack of Physical Activity* Adults, Prevalence – 2006
* During the past 30 days, did you participate in any physical activities or exercise?
% of adults who did not participate in any physical activities during the past 30 days
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006

44. Poor Nutrition

45. Poor Nutrition* Adults, Prevalence – 2005
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005
*% of adults who reported eating fewer than 5 servings of fruits
and vegetables per day

46. Poor Nutrition* Health Service Region – 2005
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005
*% of adults who reported eating fewer than 5 servings of fruits
and vegetables per day

47. Nutrition* Public High School Students – 2001,2005
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005
*% of students who reported eating 5 or more servings of fruits
and vegetables per day

48. Diabetes High Cholesterol High Blood Pressure
Medical Risk Factors
Diabetes
High Cholesterol
High Blood Pressure

49. Diabetes Texas and U.S Adult - 1995-2006
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services,

50. Diabetes Prevalence
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006

51. Diabetes Prevalence Health Service Region– 2006
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006

52. High Cholesterol Texas and U.S Adult-1995-2005
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services,

53. High Cholesterol Prevalence - 2005
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005

54. High Cholesterol Health Service Region– 2005
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005

55. High Blood Pressure Texas and U.S Adult -1995-2005
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services,

56. High Blood Pressure Prevalence - 2005
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005

57. High Blood Pressure Health Service Region--- 2005
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005

58. HEDIS Health Plan Employer Data and Information Set

59. HEDIS
Standardized performance measures designed for comparing the quality of care of managed care organizations

60. Result from HEDIS. Texas, 2001-2006
Measures
2001
2002
2003
2004
2005
2006
Controlling High BP 1
47.8
50.9
57.9
59.2
64.5
Beta Blocker Treatment After a Heart Attack2 NA
90.3
86.9
85.2
83.3
84.3
LDL-C Screening after acute CV event3
72.4
76.2
77.1
77.9
79.4
75.6
LDL-C Level < 130 mg/dL4
42.6
57.7
56.3
55.8
46.8
Data Source:

61. STRATEGIES Surveillance, Data and Outcome Management
Health Education and Outreach
Clinical Prevention and Treatment Services
Community Policy and Environmental Changes