1. Lafayette County
Stephanie Thompson, BSN
Heart to Heart
A Heart Disease Screening Program for Women

2. • In 2013, Lafayette County had a higher mortality rate for
diseases of the heart than the state of Arkansas and the
nation. (Centers for Disease Control and Prevention,
National Center for Health Statistics, 2015).
• According to the CDC Wonder database (2015), 11
women (ages 35-85+) died in Lafayette County related to
heart disease in 2013.
• The CDC reports “Heart disease is the leading cause of
death for women in the United States” (2015).
Why Heart to Heart ?

3. Lafayette County Demographics
 Population (2013)
◦ 7,252 (6.98% decrease from 2010)
• Southernmost part of Arkansas bordering Louisiana
• Four towns: Bradley, Buckner, Lewisville, and Stamps
 Characteristics (2103)
◦ High school graduate or higher (77.5%)
◦ Caucasian (61.1%)
◦ African American (37.1%)
◦ Persons 65 year and over (21.5%)
◦ Median age 65
◦ Women (51.7%)
◦ Median household income:$29,732 (State, $40,768)
◦ Persons below poverty level (24%)

4. Lafayette County Demographics
• Occupations/Industry
• Administrative (12.2%)
• Sales (9.19 %)
• Production (9.11%)
• Repair (7.14%)
• Management (6.22%)

5. Lafayette County Resources
• Schools
• County School District;
• Elementary School in Lewisville, and High School in Stamps
• Churches
• First Methodist Church in Lewisville
• First Presbyterian Church in Stamps
• Parks/Recreational Facilities
• Conway Cemetery State Park
• Maya Angelou City Park
• Community Resources/Centers
• Cooperative Extension Service 4-H

6. Lafayette County Medical Resources
• Health Resources
• CABUN Rural Health Services (8 counties in rural southern
Arkansas)
• Southwest Arkansas Counseling and Mental Health Center
• AR State Dept. of Health
• Health Resources lacking in Lafayette County but nearby
• Magnolia Regional Medical Center (Columbia County)
• Dentists available in Hope (Hempstead Co), Magnolia
(Columbia Co), and Texarkana (Miller Co)

7. Lafayette County Health Disparities
• Health Disparities (2013)
higher mortality rate for diseases of the heart than
Arkansas and the US
lower mortality rate from malignant neoplasms than
Arkansas and the US
lower mortality rate from ischemic heart disease than
Arkansas and the US

8. US Arkansas Lafayette County
Total population 316,128,839 2,959,373 7,252
MORTALITY RATES PER 100,000 POPULATIONS, 2013
US Arkansas Lafayette County
TYPES OF DEATHS RATE (NUMBER) RATE (NUMBER) RATE (NUMBER)
Diseases of the Heart 193.31 (611,105) 249.28 (7377) 330.94 (24)
Malignant Neoplasms 185.01 (584,881) 225.99 (6688) 179.26 (13)
Ischemic Heart Disease 117.11 (370,213) 147.19 (4356) 17.19 (15)
SELECTED POPULATION DATA FOR
U.S., ARKANSAS, and LAFAYETTE COUNTY, 2013

9. Community Assessment
of Lafayette County
• Community Diagnosis
• Increased risk of heart disease among adult women in
Lafayette County related to uncontrolled hypertension,
hyperlipidemia, and current smokers as evidenced by a
high mortality rate from diseases of the heart.

10. Healthy People 2020 Goal
Heart Disease
• Goal: Improve cardiovascular health and quality of life
through prevention, detection, and treatment of risk
factors for heart attack and stroke; early identification and
treatment of heart attacks and strokes; and prevention of
repeat cardiovascular events (USDHHS, 2015).

11. Healthy People 2020 Objectives
SHORT TERM Objectives – Heart Disease
1. “HDS-4 Increase the proportion of adults who have had their blood pressure
measured within the preceding 2 years and can state whether their blood
pressure was normal or high” (USDHHS, 2015).
2. “HDS-8 Reduce the mean total blood cholesterol levels among adults”
(USDHHS, 2015).
3. “HDS-17 Increase the proportion of adults aged 20 years and older who are
aware of the symptoms of and how to respond to a stroke” (USDHHS, 2015).

12. Targeted Health Issue
Heart Disease
• In 2013, Lafayette County had a higher mortality rate for
diseases of the heart (330.94) than Arkansas (249.28) and
the US (193.31) (Centers for Disease Control and
Prevention, National Center for Health Statistics, 2015).
• The U. S. Preventive Services Task Force (USPSTF)
recommends that all adults aged 18 and older be screened
for hypertension. (Blood Pressure in Adults, 2015).

13. Target Population
• The target population will be women ages 35-65 living
in Lafayette County who agree to participate in the
program.
• According to the CDC Wonder database (2015), 11
women (ages 35-85+) died in Lafayette County related to
heart disease in 2013.
• To prevent premature adult deaths, heart disease
preventative measures need to be taught to young adults.

14. Behavioral Objective # 1
• “HDS-4 Increase the proportion of adults who have had their
blood pressure measured within the preceding 2 years and can
state whether their blood pressure was normal or high”
(USDHHS, 2015).
• Objective 1: Within 6 months of implementing Lafayette
County’s “Heart to Heart” Heart Disease Screening Program
for Women, 90% of participants will be able to state what
their last blood pressure readings were and if the blood
pressure was normal or high.

15. Behavioral Objective # 2
• “HDS-12 Increase the proportion of adults with hypertension
whose blood pressure is under control” (USDHHS, 2015).
• Objective 2: Within 12 months of implementing Lafayette
County’s “Heart to Heart” Heart Disease Screening Program
for Women, 80% of participants ages 35-65 with hypertension
will have normalized blood pressure readings in provider
medical records.

16. Behavioral Objective # 3
• “HDS-8 Reduce the mean total blood cholesterol levels
among adults” (USDHHS, 2015).
Objective 3: After the completion of the program, Lafayette County’s
“Heart to Heart” Heart Disease Screening Program for Women
participants ages 35-65 will see a 25% decrease in their total
cholesterol level."

17. Behavioral Objective # 4
• “TU-1 Reduce tobacco use by adults” (USDHHS, 2015).
Objective 4: After the completion of the program, Lafayette
County’s “Heart to Heart” Heart Disease Screening Program for
Women, participants ages 35-65 will see a 35% reduction in tobacco
use.

18. Program Interventions
• Baseline Blood Pressure Screen - refer to PCP if indicated
• Baseline Cholesterol Level - refer to PCP if indicated
• Smoking Assessment – refer to Quit line if indicated
• Provide Educational Materials to the target population about ways to
decrease the risk of heart disease, such as exercise, dietary modifications,
and smoking cessation
• Sign up target population for email groups to be provide periodical heart
healthy educational materials from the American Heart Association
• Recheck Blood Pressure and Cholesterol at 6 and 12 months

19. Resources
• Finances:
• Community Sponsors
• Business Owners to invest
• Write Grants
• Facilities:
• The Cooperative Extension Service
• CABUN Rural Health Clinic
• AR Health Department in Lewisville
• Team members:
• APRN
• RN’s and LPN’s
• Administrative Personnel
• Community members

20. Recruitment
• The target population will be women ages 35-65 living in
Lafayette County who agree to participate in the program
to reach them advertisement is key!
• Ads in local newspaper, on TV, and radio
• Social media (Facebook, Twitter, Instagram)
• Fliers at all medical clinics and health department
• Post information on Lafayette County website
• Fliers at local banks, post office and library
• Word of mouth via nurses and providers

21. Evaluation Plan — 6 Steps
• Step 1 Engage the Stakeholders: stakeholders include the
target population, program facilitators/board members, and
myself.
• Step 2 Describe the program: to improve cardiovascular
health and quality of life through prevention, detection, and
treatment of risk factors for heart attack and stroke;
• Step 3 Evaluation design: quantitative study design to
measure the number of participants who will be able to state
blood pressure readings, have normalized BPs, reduced
cholesterol levels and reduction in tobacco use.

22. Evaluation Plan cont.
• Step 4 Gathering Evidence: Nurses complete screenings
with strict documentation LPN’s: BPs, lab draws, smoking
assessment. RN’s: education to participants APRN’s:
interpret data, make recommendations, full health history.
Administrative: email databases to send educational
materials.
• Step 5 Justifying Conclusion: analysis and interpretation of
data discussed before data collection begins.
• Step 6 Ensuring Use and Lessons Learned: Formal report
along with meeting of stakeholders.

23. Summary
• Lafayette County has a higher mortality rate for diseases of the
heart than the state of Arkansas and the nation.
• With this low-cost program, we can see a reduction in heart
disease risk factors in just 12 months!
• By reducing risk factors, we will see a decrease in mortality rates
for those living in Lafayette County.
• Teamwork is key for a successful Heart to Heart Program!

24. References
• Blood Pressure in Adults: Screening. U.S. Preventive Services Task Force. July 2015. http://www.uspreventiveservicestaskforce.org/Page
/Document/UpdateSummaryFinal/blood-pressure-in-adults-hypertension-screening
• CABUN Rural Health Services - Providing Healthcare for All in Arkansas. (2015). Retrieved September 2, 2015, from http://www.cabun.org
• Center for Disease Control and Prevention. (2015). Women and Heart Disease Fact Sheet. Retrieved September 16, 2015, from
http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_women_heart.htm
• Centers for Disease Control and Prevention. (2011). Program Performance and Evaluation Office. Retrieved from Centers for Disease Control
and Prevention: http://www.cdc.gov/eval/steps/index.htm
• Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 2013 on CDC WONDER Online
Database, released 2015. Data are from the Multiple Cause of Death Files, 2013, as compiled from data provided by the 57 vital statistics
jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Sep 7, 2015 10:57:09 PM
• Conway Cemetery State Park. (2015). Retrieved September 2, 2015, from https://en.wikipedia.org/wiki/Conway_Cemetery_State_Park
• Health Unit Details. (2015). Retrieved September 2, 2015, from
http://www.healthy.arkansas.gov/programsServices/localPublicHealthOffices/Pages/huDetails.aspx?show=Lafayette County Health Unit -
Lewisville
• James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., ... & Ortiz, E. (2014). 2014 evidence-based
guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee
(JNC 8). Jama, 311(5), 507-520.
• Lafayette County, Arkansas. (2015). Retrieved August 30, 2015, from https://en.wikipedia.org/wiki/Lafayette_County,_Arkansas#Demographics

25. References cont.
• Lafayette County, Arkansas Extension Office. (2015). Retrieved September 3, 2015, from http://www.uaex.edu/counties/lafayette/
• Lafayette County School District. (2015). Retrieved September 1, 2015, from http://www.lcscougars.org
• Magnolia Regional Medical Center. (2015). Retrieved September 2, 2015, from http://magnoliarmc.org
• Maya Angelou City Park. (2015). Retrieved September 3, 2015, from http://www.arkansas.com/attractions/detail/maya-angelou-city-
park/96650/
• McKenzie, J., Neiger, B., & Thackeray, R. (2013). Planning, implementing, evaluating health promotion programs: A Primer (6th ed.). San
Francisco, CA: Pearson Benjamin Cummings.
• Occupations in Lafayette County, Arkansas. (2015). Retrieved September 17, 2015, from
http://statisticalatlas.com/county/Arkansas/Lafayette-County/Occupations
• Southwest Arkansas Counseling and Mental Health Center. (2015). Retrieved September 2, 2015, from http://www.swacmhc.com
• U.S. Department of Health and Human Services. (2012). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics
objectives/topic/heart-disease-and-stroke
• U.S. Department of Health and Human Services. (2015). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics-
objectives/topic/heart-disease-and-stroke
• United States Census Bureau. (2015). Retrieved September 2, 2015, from http://quickfacts.census.gov/qfd/states/05/05073.html