GRAAHI

CHAAP Program

CHAAPCardiovascular Health in the African American Population

The “CHAAP” is a program for African American’s with the emphasis on reducing cardiovascular risk through optimal prevention and raising awareness around treatment goals and high quality health care.

Participation is free of charge and for each participant, information on the cardiovascular risk factors, personal and family health history is collected. After screening a risk assessment with all individualized data is given to the participant to help identify areas in need of improvement including suggestions (e.g. doctor visit needed to adjust blood pressure medication) for necessary action.

Follow up meetings are scheduled on average once per quarter to update any health events, changes in medications, lifestyle, doctor visits or hospitalizations.

Program personnel will also answer questions or help find information in regards to treatment options, meaning of diagnostic tests and other health related issues. In general the program’s intent is to accompany its participants over the long term. We are able to improve the quality of your care by arming you with meaningful information and reminders to stay on track. We do not serve as health care providers in the traditional sense and therefore do not issue prescriptions or referrals.

Background

Health statistics

Cardiovascular disease (CVD) is impacting the African American population on an epidemic scale. African Americans suffer from CVD and its complications more often, starting at a younger age and die from it in higher numbers than any other ethnic group. They frequently also have not just one positive risk factor, but multiple, which increases risk. Nationwide statistics and organizational reports reveal disparities in treatment and outcomes between African Americans and the total population.1,2,3 The American Heart Association annually reports on statistics around CVD4 and year after year the differences remain; please click here for detailed statistics.

Achieving treatment goals – Improving Quality of Health Care

An important issue in health care we try to address is quality of care and achieving “treatment to goal”. Through research and guidelines many benchmarks for optimal prevention and treatment are published. However, achieving those treatment goals in chronic diseases presents a huge challenge in daily practice. In CVD many risk factors are life style influenced (achieving goal blood lipids, blood pressure, body weight, regular exercise etc.) and physicians and physician’s offices lack personnel and tools for follow up and initiating changes on that level. Left to their own devices individuals easily get confused and don’t know where to start. Questions arise such as “Where do I start?”, “What do I focus on?” and “What are my goals?” Eventually we get overwhelmed with the task and abandon our good intentions. For example, of all people with high blood pressure 67.8% of African American males are aware of it; 56.4% take medication for it and 29.9% are at goal blood pressure level. For African American females the numbers are slightly different; 81.1% are aware of the high blood pressure; 71.7% take medication for it and 36% are at goal.5 Yet, reaching treatment goals is the only way of really making a difference in outcomes.

Prevention

The true intent of this initiative is ideally to prevent the disease from doing any harm to the body, also called "target organ damage"; tissue in the organ is permanently damaged and function impaired.

To stop this from occurring we need to check risk factors for CVD and try as best as possible to keep them in the normal range. This is called preventing illness from developing or primary prevention.

Many risk factors are influenced by aging, which we cannot control. One influence we can control is our life style. How we live and eat strongly impacts our body weight, blood lipids and blood pressure. We decide, if we are physically active or not, if we smoke or not. Making those choices early on can make a difference of 5 - 10 years in your life span. J. Stamler et al looked at the difference in mortality of low risk cohorts compared to others or normal risk cohorts. The criteria for qualifying as “low risk” were to have at baseline a blood pressure measurement of < 120/80 mmHg, a blood cholesterol <200 mg/dl, be a non-smoker and have no history of heart attack or diabetes. In summary, there were three different cohorts: young men aged 18-39, middle aged men from 40 to 59 years and middle aged women from 40 to 59 years. In all three of those groups the “low risk” individuals had a total mortality of less than half of the others (50-58%). Mortality from CVD alone was lower by 72-85% and for Heart Disease alone lower by 77-79%. The estimated greater life expectancy for low-risk subgroups compared to others ranged from 5.8 years to 9.5 years.6 Not going into further details and not saying this is all there is to it, but roughly applied this report gives you a good reason why taking care for yourself, eating healthy and exercising is worth the effort: It will add about 5-10 years to your life. Your quality of life will also be a lot better, for which there is data in other articles.

Aims

The aims of the CHAAP program can be described as follows:

  1. To establish a registry tracking the prevalence, incidence, and progression of hypertension and the overall cardiovascular risk in the African American population in Kent County/West Michigan.
  2. To assess cardiovascular risk for each participant in the registry.
  3. To use the data gathered to examine the effectiveness of current care and to help raise awareness about evidence-based guidelines in order to attain treatment goals.

Methods

We try to get organizations with a significant number of African Americans like businesses, churches or clubs to introduce the program to their members. We make the effort to meet with the participants at places that they regularly visit. The program’s uniqueness is “We come to you!”

Program staff provides comprehensive information on the program’s goals and intent and accommodates size, time and format of an informational event that fit the location’s needs.

Consent Form

Participation requires a signed consent form. This form is required when performing “research on human subjects”. The whole design of the program and what we do has been reviewed by the GVSU Human Research Review Committee. This committee oversees and protects the rights and welfare of human subjects.

Overall the project is considered “low risk” since no experimental research is performed. The most crucial aspect is confidentiality and keeping your personal health information private. For this reason any public reporting that might be generated from the data collected will be in aggregate form. No personal information will be released.

Follow Up

As a participant you should plan on meeting with program staff once every three months or about 4 times per year. In the beginning visits will be more frequent (every two weeks ideally) until all data is collected for the risk assessment.

Risk Assessment

The risk assessment contains all information we collect and most importantly your individual treatment goals for the different risk factors. Areas in need of your attention are pointed out in a personal commentary and next steps for optimal risk reduction highlighted.

In cases whereof immediate action is necessary (e.g. uncontrolled elevated blood pressure or untreated diabetic metabolism) follow up will occur more frequently until issue is resolved.

We also try to answer your questions around health care, for example drug side effects, what tests and questions to ask the physician and where to seek care. This can be done on an individual basis and any misconceptions can be clarified. We can also help find other programs, events or initiatives that might offer the service searched for (help in weight loss, exercise etc.). However, ultimately every person themselves need to step up and try to make those necessary changes happen. The CHAAP program will provide reminders and encouragement to reach those goals.

What to expect – and what not - when becoming a CHAAP participant:

As a participant in this program we will not come and turn your life up side down. We will provide information about your health and counsel what areas need work to reduce risk. You decide where to take it from there. Adopting a healthy lifestyle can happen in different ways: gradually or all-at-once. You can introduce one change at a time (start with avoiding sugared drinks/sodas) and add on over time or decide to become a “new you” in every way. This depends on your personality, prior experience and current situation. The CHAAP program helps you to know where to start and challenges you in accountability as in “Are you doing what you said you wanted to do?” This is sometimes perceived as “nagging”, we call it “compassionate strictness”. In any case, it all starts and ends with your determination and that is why we would like everyone to remember the "CHAAP Vow" and take it to heart.

References

  1. National Health Care Disparities Report, AHRQ Publication No. 05-0014, December 2004
  2. Racial/Ethnic Differences in Cardiac Care, Kaiser Family Foundation, Oct. 2002
  3. Yancy CW, Benjamin EJ, Fabunmi RP, Bonow RO. Discovering the full spectrum of cardiovascular disease. Minority Health Summit 2003, Executive Summary. Circulation. 2005; 111:1339-1349
  4. AHA, Heart Disease and Stroke Statistics2009 Update. Circulation 2009;119;e21-e181
  5. NHANES data from 1999-2004
  6. Stamler J, Stamler R, Neaton J, et al. Low Risk-Factor Profile and Long-term Cardiovascular and Noncardiovascular Mortality and Life Expectancy: Findings for 5 Large Cohorts of Young Adult and Middle-Aged Men and Women. JAMA 1999:282(21):2012-2018