1. Kimberly A. Rogers, RNJune 2013 HEART DISEASE Risk Factors & Prevention Heart Disease Risk Factors & Prevention

2. Section I: U.S. Disease Statistics Heart Disease Risk Factors & Prevention

3. U.S. Disease Statistics 25% of all deaths in the U.S. for all ethnic groups are caused by heart disease 600,000 people in the U.S. die each year of heart disease Over ½ of all heart disease deaths in the U.S. annually (385,000) are caused by coronary heart disease (Pasco County Population is 468,000) There are 935,000 heart attacks each year in the U.S. Coronary heart disease costs the U.S. economy $1.89 billion each year (Centers for Disease Control, 2013) Heart Disease Risk Factors & Prevention

4. 1.Demographic Summary 2.Epidemiological & Statistical Data 3.Health Status Section II: Pasco County Statistics Heart Disease Risk Factors & Prevention

5. Pasco County Demographics Summary Pasco County is predominantly white, and non-Hispanic, as whites make up 90% of the population and people who identify themselves as Hispanic are 12% of the Pasco population, versus 22% statewide Pasco County high school diploma attainment is similar to the statewide rate Pasco County has a lower percentage of college degreed individuals than the state of Florida as a whole Heart Disease Risk Factors & Prevention (U.S. Census Bureau, 2010)

6. Epidemiological & Statistical Data: Pasco County vs. State of Florida Coronary Disease Death Rates (Florida Charts.com, 2013) Heart Disease Risk Factors & Prevention Deaths per 100,000 Population Three-year Rolling Average

7. Epidemiological & Statistical Data Summary Hospitalizations and deaths from Coronary Heart Disease have dropped in Pasco County and statewide since the early 1990’s The rate of deaths from Coronary Heart Disease is still higher in Pasco County than the state as a whole for both males and females The rate of deaths from Coronary Heart Disease is higher for men than women, in Pasco County and statewide Heart Disease Risk Factors & Prevention

8. Health Status: Percentage of People with Cardiovascular Disease (Florida Department of Health, 2013) Heart Disease Risk Factors & Prevention

9. Health Status: Percentage of Adults Who Smoke, Pasco County vs. Florida Statewide (Floridacharts.com, 2013) Heart Disease Risk Factors & Prevention

10. Health Status: Percentage of Adults Who Are Overweight or Obese in Pasco County vs. Florida Statewide (Floridacharts.com, 2013) Heart Disease Risk Factors & Prevention

11. Health Status: Percentage of Adults with High Cholesterol in Pasco County vs. Florida Statewide (Floridacharts.com, 2013) Heart Disease Risk Factors & Prevention

12. Health Status: Percentage of Adults with Hypertension in Pasco County in vs. Florida Statewide (Floridacharts.com, 2013) Heart Disease Risk Factors & Prevention

13. Health Status Summary Adults in Pasco County are more likely to smoke than their peers statewide Adults in Pasco County are more likely to be overweight or obese than their peers statewide Adults in Pasco County have similar incidence of high cholesterol as compared to their statewide peers Adults in Pasco County are more likely to have high blood pressure than their statewide counterparts The health status data summarized above all represent known risk factors for coronary artery disease (American Heart Association, 2013) Heart Disease Risk Factors & Prevention

14. Heart Disease Risk Factors & Prevention Section III: Heart Disease Risk Factors

15. Non-Modifiable Heart Disease Risk Factors Age (Increased Risk Above 65 Years of Age) Gender (Increased Risk for Males) Heredity (Increased Risk for African Americans, Mexican Americans, Native Americans, Native Hawaiians, and Some Asian Americans) Heart Disease Risk Factors & Prevention (American Heart Association, 2013)

16. Modifiable Heart Disease Risk Factors Tobacco Smoke (Increases 2X – 4X above non-smokers) Second-hand Smoke Also Increases Risk High Blood Cholesterol Total Cholesterol Should be <200 mg/dL LDL Should be 100 mg/dL – 160 mg/dL depending on other risk factors High Blood Pressure Heart Disease Risk Factors & Prevention (American Heart Association, 2013)

17. Modifiable Heart Disease Risk Factors (cont’) Physical Inactivity Overweight & Obesity Diabetes Stress Alcohol Consumption Diet/Nutrition Heart Disease Risk Factors & Prevention (American Heart Association, 2013)

18. Heart Disease Risk Factors & Prevention Section IV: Heart Disease Characteristics & Symptoms

19. Coronary Artery Disease & Anatomy (Drchandler.com, 2005) Heart Disease Risk Factors & Prevention

20. Coronary Artery Disease Progression (Bean et al, 2006) Heart Disease Risk Factors & Prevention

21. Signs & Symptoms of Coronary Heart Disease Chest Pain (squeezing, pressure, or heaviness) Pain in Shoulders, Arms, Neck, Jaw, or Back Persistent Indigestion or Nausea Fatigue and Weakness Shortness of Breath Sweating Lightheadedness (American Heart Association, 2013) Heart Disease Risk Factors & Prevention

22. Signs & Symptoms of Coronary Heart Disease in Diabetics Diabetic Nerve Damage Can Interfere with Pain Signals in the Body Diabetics Can Have Some or All of the Typical Symptoms Some Diabetics May Have a Heart Attack without Symptoms When in Doubt, Always Call 9-1-1 (National Institutes of Health, 2011) Heart Disease Risk Factors & Prevention

23. Differences in Signs & Symptoms of Coronary Heart Disease in Women Women May Not Have Typical Symptoms Signs Can Be Subtle May Perceive as Flu-like Symptoms May Have Shortness of Breath without Chest Pain May Have Back Pain or Pressure May Have Dizziness, Light-headedness, or Fainting (American Heart Association, 2013) Heart Disease Risk Factors & Prevention

24. Related Conditions Resulting from Coronary Heart Disease Congestive Heart Failure Loss of Blood Pumping Ability Chronic, Progressive Condition Cardiomyopathy (Weakened Heart Muscle) Heart Rhythm Conditions Bradycardia Heart Blocks Tachycardias Atrial Fibrillation (American Heart Association, 2013) Heart Disease Risk Factors & Prevention

25. Signs & Symptoms of Congestive Heart Failure Persistent Shortness of Breath, Coughing, Wheezing (without lung disease) Excess Fluid Build-up in Tissues Fatigue Lack of Appetite Impaired Thinking Increased Heart Rate (American Heart Association, 2013) Heart Disease Risk Factors & Prevention

26. Signs & Symptoms of Heart Rhythm Disorders Fatigue Dizziness Fainting Rapid Heart Beat Heart Pounding or Skipped Beats Shortness of Breath Chest Pain (American Heart Association, 2013) Heart Disease Risk Factors & Prevention

27. Heart Disease Risk Factors & Prevention Section V: Heart Disease Prevention

28. Prevention: Controlling Modifiable Risk Factors Hypertension Comply with medications Reduce salt intake Maintain a healthy weight Limit alcohol Manage stress (American Heart Association, 2013) Heart Disease Risk Factors & Prevention

29. Prevention: Controlling Modifiable Risk Factors Elevated Cholesterol & Triglycerides Adopt a heart healthy diet Increase physical activity Take any cholesterol medications as directed by your doctor Obesity & Sedentary Lifestyle Exercise at least 30 minutes a day – can be broken into three 10-minute sessions Adopt a heart healthy diet (American Heart & Dash Diet) (American Heart Association, 2013) Heart Disease Risk Factors & Prevention

30. Prevention: Controlling Modifiable Risk Factors Poorly Controlled Blood Sugar Perform blood sugar checks as recommended by doctor A1C Checks Medications: insulin or oral medications taken as directed Diet & Exercise Smoking There are many options & resources available for smoking cessation (American Heart Association, 2013) Heart Disease Risk Factors & Prevention

31. Resources for Success American Heart Association – www.heart.orgwww.heart.org American Diabetes Association – www.diabetes.orgwww.diabetes.org Tobacco-Free Florida – www.tobaccofreeflorida.comwww.tobaccofreeflorida.com Florida Quit Line – www.doh.state.fl.us/Tobacco/quitline.html www.doh.state.fl.us/Tobacco/quitline.html Heart Disease Risk Factors & Prevention

32. Heart Disease Risk Factors & Prevention Section VI: Heart Disease Diagnosis & Treatment

33. Diagnosis of Coronary Artery Disease History & Physical Exam Lab Work EKG Stress Test Echocardiogram Cardiac Cath Heart Disease Risk Factors & Prevention

34. Treatment of Coronary Artery Disease Medication Risk Factor Modification Cardiac Stent Coronary Artery Bypass Graft Surgery (CABG) Heart Disease Risk Factors & Prevention

35. Heart Attack Persistent Symptoms = Acute Event This is a Cardiac Emergency Early Activation of EMS is Important Call 9-1-1 Rapid Intervention is Associated with Better Outcomes (Less than 120 Minutes from Onset of Symptoms) Treatment Cardiac Stent Coronary Artery Bypass Graft Surgery Heart Disease Risk Factors & Prevention

36. Diagnosis of Congestive Heart Failure History & Physical Exam Lab Work Echocardiogram Identify Causative Factors Heart Disease Risk Factors & Prevention

37. Treatment of Congestive Heart Failure Medications Risk Factor Modification Pacemakers or Implantable Defibrillators Heart Disease Risk Factors & Prevention

38. Diagnosis of Heart Rhythm Problems History & Physical Exam EKG Portable EKG Monitoring Devices Stress Test Electrophysiology Study Tilt Table Test Heart Disease Risk Factors & Prevention

39. Treatment of Heart Rhythm Problems Medication Pacemakers Implantable Defibrillators Cardiac Ablation Heart Disease Risk Factors & Prevention

40. Heart Disease Risk Factors & Prevention Section VII: Florida Hospital Zephyrhills Heart Institute

41. Florida Hospital Zephyrhills Heart Institute Established in 2006 Award-winning Program Accredited Chest Pain Center Offers Comprehensive Cardiac Care Has Performed Thousands of Procedures Highly Skilled Staff – Board Certified Cardiologists, Cardiac Surgeons, and Specialized Cardiac Care Nurses & Technical Support Staff Heart Disease Risk Factors & Prevention

42. Florida Hospital Zephyrhills Heart Institute Services Offered Open-heart Surgery Coronary Bypass Grafting Cardiac Valve Repair/Replacement Minimally Invasive Valve Surgery Thoracic Aneurysm Repair Cardiac Catheterization Diagnostic Heart Caths Coronary Angioplasty & Stenting Radial Catheterization Heart Disease Risk Factors & Prevention

43. Florida Hospital Zephyrhills Heart Institute Services Offered (Cont’) Other Catheterization Procedures Valvuloplasty Renal Artery Stenting Peripheral Artery Stenting Electrophysiology Procedures Electrophysiology Studies 3D Mapping Cardiac Ablations, Including Atrial Fibrillation Pacemakers/Defibrillators Heart Disease Risk Factors & Prevention

44. Florida Hospital Zephyrhills Heart Institute Services Offered (Cont’) Other Cardiac Testing Procedures & Services Stress Tests Echocardiograms Tilt Table Tests Cardiac Rehabilitation Program Congestive Heart Failure Support Group Device Support Group Heart Disease Risk Factors & Prevention

45. Florida Hospital Zephyrhills Heart Institute Services Offered (Cont’) Other Services State of the Art Cardiovascular Operating Room (CVOR) Cardiac Intensive Care Unit (CVICU) Cardiac Step-down Unit (CSDU) Cardiac Procedure Recovery Unit (CRU) Heart Disease Risk Factors & Prevention

46. Questions & Answers Heart Disease Risk Factors & Prevention

47. References The American Heart Association (2013). Retrieved from www.heart.org.www.heart.org Bean, C.A., et al (2006). Image. ACC Atlas of Pathophysiology, 2 nd Edition. Philadelphia: Lippincott & Wilkins. Centers for Disease Control and Prevention (2013). Heart Disease Facts. Retrieved from http://www.cdc.gov/heartdisease/facts.htm.http://www.cdc.gov/heartdisease/facts.htm Florida Department of Health. (2013) Retrieved from www.Floridacharts.com.www.Floridacharts.com Heart Disease Risk Factors & Prevention

48. References Drchandler.com (2005). Image. Retrieved from http://drchander.com/diagnoseCAD.html. http://drchander.com/diagnoseCAD.html National Institutes of Health (2011). What Are the Signs and Symptoms of Diabetic Heart Disease? Retrieved from http://www.nhlbi.nih.gov/health/health- topics/topics/dhd/signs.html.http://www.nhlbi.nih.gov/health/health- topics/topics/dhd/signs.html U.S. Census Bureau (2010). American Fact Finder. Retrieved from http://factfinder2.census.gov/faces/nav/jsf/pages/searchresults.xhtml http://factfinder2.census.gov/faces/nav/jsf/pages/searchresults.xhtml Heart Disease Risk Factors & Prevention