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Colorado State Profile and Policy Report

Colorado Heart Disease and Stroke: State Profile and Policy Report

Table of Contents

Heart Disease and Stroke Burden

Colorado - State Deaths for Heart Disease and Stroke

  • Nearly 1 out of 4 deaths in Colorado are due to heart disease.

  • 6,124 Coloradans died from heart disease in 2006 (20.7 percent of total deaths in Colorado).

  • 1,532 Coloradans died from stroke in 2006 (5.2 percent of total deaths in Colorado).
    Source: National Vital Statistics Report, 2009.

      

Colorado - 2007 State Risk Factors for Heart Disease and Stroke

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Colorado - 2003 State Costs for Cardiovascular Disease

In October 2007, the Milken Institute, an independent research group, released a study, An Unhealthy America: The Economic Impact of Chronic Disease. The study details the economic effects of treatment costs resulting from chronic disease in the United States. Below is a breakdown of Colorado’s estimated medical costs to treat heart disease, hypertension and stroke based on 2003 Medical Expenditure Panel Survey data.

Colorado Annual Cost of Hypertension, Heart Disease and Stroke 

Treatment Expenditures (Direct Costs) - Total annual medical cost.

Hypertension 

$.34 billion
Heart Disease           $.59 billion
Stroke                     
$.14 billion
Source: Milken Institute, An Unhealthy America: The Economic Impact of Chronic Disease, October 2007. 

 

Colorado - Estimated 2007 Medicaid Treatment Costs for Cardiovascular Diseases

Based on Colorado's Medicaid population, economic estimates for 2007 were projected using Medical Expenditure Panel Survey data.  Medicaid spending has grown rapidly in recent years, placing a significant burden on state budgets.  To help states estimate the financial impact of cardiovascular diseases among their Medicaid beneficiaries, the Centers for Disease Control and Prevention (CDC) and RTI International developed the Chronic Disease Cost Calculator, which was used to estimate the Medicaid costs below. 

 

Heart Disease

$41 million

Hypertension          

$132 million

Stroke

$87 million

Congestive Heart Failure     

$17.8 million 

 

Funded CDC Heart Disease and Stroke Prevention Grantees in Colorado

The Centers for Disease Control and Prevention funds Colorado's Heart Disease and Stroke Prevention program to increase control of high blood pressure and cholesterol; increase awareness of the signs and symptoms of heart attack and stroke and the importance of promptly calling 911; improve emergency response; improve quality of care; and eliminate related health disparities.  These efforts are informed by monitoring heart disease, stroke and related risk factors statewide.

Colorado State Highlights - Heart Disease and Stroke Prevention Program

  • The Colorado Department of Public Health and Environment, with primary support from the Cardiovascular Disease and Stroke Prevention Program, is the lead agency for the Stroke Advisory Board that was legislatively established in 2002. The Stroke Advisory Board has completed its mandate and made recommendations on key strategies to reduce the burden of stroke in the state. The program will look for ways to integrate these recommendations into the state plan. In addition, some members of the Stroke Advisory Board are willing to form a Stroke Task Force (under the coalition) to work to implement the recommendations of the Advisory Board.

  • During the 2005 legislative session, the Colorado General Assembly enacted legislation (House Bill 05-1262) that allocated 16 percent of the revenue generated from the passage of a constitutional amendment to increase the excise tax on tobacco products for a competitive grants program for prevention, early detection and treatment of cancer, cardiovascular disease and pulmonary disease. The Cancer, Cardiovascular and Pulmonary Disease (CCPD) competitive grants program is intended to help implement the state’s strategic plans for cancer, cardiovascular disease and pulmonary disease. The funding available through this program has greatly extended the reach and breadth of heart disease and stroke efforts in Colorado. For example, in 2006, CCPD funding was allocated for the development of a pilot stroke registry using the American Heart Association’s Get with the Guidelines–Stroke (GWTG) module as the tool. Colorado’s Quality Improvement Organization received funding to implement the GWTG – Coronary Artery Disease and Heart Failure modules in hospitals throughout Colorado.

State Laws and Policies

Public Awareness of Heart Disease and Stroke

CO SJR 10 (2011, adopted) - Recognizes Friday, February 4, 2011, as “National Wear Red Day” and encourages all citizens to show support for women and the fight against heart disease by wearing red.

CO SJR 10 (2009, adopted) - The members of the General Assembly, in recognition of the importance of the ongoing fight against heart disease and stroke, proclaim February 2009 to be "American Heart Month", and declare Friday, February 6, 2009, to be "National Wear Red Day." We urge all citizens to show their support for women and the fight against heart disease by commemorating this day by wearing the color red.

HJR 07-1011 (2007) - The Colorado General Assembly, in recognition of the importance of the ongoing fight against heart disease and stroke, hereby proclaims Friday, February 2, 2007, to be "Go Red For Women Day" in the state of Colorado. We urge all citizens to show their support for women and the fight against heart disease by commemorating this day and by wearing the color red. By increasing awareness and empowering women to reduce their risk for cardiovascular disease, we can save thousands of lives each year.

SJR 07-025 (2007) - March 2007 has been designated as "Brain Injury Awareness Month" by the Brain Injury Association of America and the Brain Injury Association of Colorado.

HJR 05-1012 (2005) - The members of the Colorado General Assembly, in recognition of the importance of the ongoing fight against heart disease, hereby declare February 2005 American Heart Month in Colorado. In recognition of the importance of the ongoing fight against heart disease and stroke, [the Colorado General Assembly] hereby declares February 4, 2005, to be "Go Red for Women Day" in the State of Colorado, and urges all citizens to recognize the critical importance of knowing the risk factors and the warning signs of heart attack and stroke by wearing the color red to commemorate this day.

Prevention of Risk Factors (Nutrition, Physical Activity and Tobacco)

Tobacco Control

Colorado's state employee tobacco cessation program does not meet the three CDC guidelines that include:

1) Coverage for at least four counseling sessions of at least 30 minutes; NO
2) Access to smoking cessation agents, including prescriptions and nicotine replacement; NO
3) Counseling and medication coverage for at least two quit attempts annually; NO 

  • Colorado also has a statewide tobacco-free policy, cigarette excise tax and quit line.  The $.84 Colorado cigarette excise tax is used to fund tobacco control programs.

  • Colorado's state Medicaid tobacco cessation program covers over-the-counter and prescription products, therapy, counseling and social support. A statewide public program is also available; coverage may vary from other programs. 

  • Colorado state law requires basic health plans in the state to cover cessation services, among other preventive health services.  Benefit must be under physician supervision, and not exceed $150 per lifetime.  The law does not specify the treatments that are covered.

Increase Detection and Treatment of Risk Factors

Colorado Revised Statute 22-1-125/SB08-118 (2008) - There is hereby created in the state treasury the tobacco tax cash fund, which fund is referred to in this section as the "cash fund". The cash fund shall consist of moneys collected from the cigarette and tobacco taxes imposed pursuant to section 21 of article X of the state constitution. All interest derived from the deposit and investment of moneys in the cash fund shall be credited to the cash fund. Any unexpended and unencumbered moneys remaining in the cash fund at the end of a fiscal year shall remain in the cash fund and shall not be credited or transferred to the general fund or any other fund, except as otherwise provided in this section. For fiscal year 2008-09, and each fiscal year thereafter until and including fiscal year 2012-13, after the allocation and transfer required by subparagraphs (II) and (III) of this paragraph (d), of the moneys in the prevention, early detection, and treatment fund, two million dollars shall be transferred to the department of health care policy and financing for medicaid disease management and treatment programs, authorized by section 25.5-5-316, C.R.S., that address cancer, heart disease, and lung disease or the risk factors associated with such diseases. For fiscal year 2008-09 and each fiscal year thereafter, after the allocation of moneys in the prevention, early detection, and treatment fund shall be annually appropriated by the general assembly to the prevention services division of the department of public health and environment for the cancer, cardiovascular disease, and chronic pulmonary disease prevention, early detection, and treatment program established in part 3 of article 20.5 of title 25, C.R.S.

 

State Employee Health and Wellness

 No policy listed at this time

Improve Quality and Access to Care

Colorado Revised Statute 25-1-108.5 (2007) - Each tobacco settlement program shall pay a proportionate share of the costs incurred by the department in implementing the requirements of this section. The amount paid by each tobacco settlement program shall be proportionate to the amounts annually appropriated to each tobacco settlement program; except that the total amount of the program evaluation costs shall not exceed four-tenths of one percent of the total amount of moneys received by the state pursuant to the master settlement agreement in any fiscal year. For the fiscal year 2001-2002, seventy-five thousand nine hundred seventy-eight dollars from the moneys paid to the department from the tobacco settlement programs pursuant to this section shall be appropriated to the stroke prevention and treatment cash fund created in section 25-34-105 for allocation to the stroke advisory board created in section 25-34-104 to cover the costs of such board's duties pursuant to such section.

SB 06-219 (2006) - The General Assembly declares that state and local policymakers and health and human services administrators recognize that the management of and the delivery system for health and human services have become complex, fragmented, and costly and that the health and human services delivery system in this state should be restructured to adequately address the needs of Colorado citizens. For fiscal years 2005-06 and 2006-07, after the allocation and transfer required by subparagraphs (II) and (III) of this paragraph (d), two million dollars shall be transferred to the Department of Health Care Policy and Financing for Medicaid disease management programs, authorized by section 26-4-408.5 25.5-5-316, C.R.S., that address cancer, heart disease, and lung disease.

Colorado Revised Statute 25.5-5-702/SB 06-165 (2006) - On or before August 1, 2006, the state department will issue requests for proposals to conduct pilot programs to investigate the feasibility of managing and treating recipients with specified chronic medical conditions using telemedicine whenever appropriate. (b) Other than the use of telemedicine and the documentation of such use for purposes of a pilot program under this section, the course of treatment for recipients selected for a pilot program shall not differ from those recipients' probable course of treatment had they not been selected. (c) Recipients shall be selected based on factors that include, but are not necessarily limited to, the fact that they have required or will require medical services of unusually high frequency, urgency, or duration; cognitive ability; living situation and family or caregiver support network; and the availability of touch-tone telephone service. Any necessary telemedicine equipment or devices shall be supplied by the entity conducting the pilot program, and charges for recipients shall be billed on a monthly basis. (2) The chronic medical conditions included in the pilot programs shall be: (a) Congestive heart failure; (b) Diabetes, its indicative conditions, or both; and (c) Chronic obstructive pulmonary disease.

Colorado Revised Statute 25-20.5-301-304 (2005) - There is hereby created, in the Prevention Services Division of the department, the cancer, cardiovascular disease, and chronic pulmonary disease prevention, early detection, and treatment program for the purpose of assisting in the implementation of the state's strategic plans regarding cancer and cardiovascular disease. The program shall fund competitive grants to provide a cohesive approach to cancer, cardiovascular disease, and chronic pulmonary disease prevention, early detection, and treatment in Colorado. The division shall administer the program with the goal of developing a comprehensive approach that will bring together stakeholders at the community and state level who are interested in impacting cancer, cardiovascular disease, or chronic pulmonary disease.

 

Address and Eliminate Disparities

Colorado Revised Statute 25-4-2201-2207/SB 07-242 (2007) - There is hereby created in the Department of Public Health and Environment the health disparities grant program, referred to in this section as the "grant program", to provide financial support for statewide initiatives that address prevention, early detection, and treatment of cancer and cardiovascular and pulmonary diseases in underrepresented populations. The office shall administer the grant program. The state board shall award grants to selected entities from moneys transferred to the health disparities grant program fund created in section 24-22-117. There is hereby created in the Department of Public Health and Environment the Office of Health Disparities. The purpose of the office is to serve in a coordinating, educating, and capacity-building role for state and local public health programs and community-based organizations. The office shall be dedicated to eliminating racial, ethnic, and rural health disparities in Colorado by fostering systems change and capacity-building through collaboration with multiple sectors impacting minority health and with input from a variety of multicultural professionals. There is hereby created in the office [of health disparities] the Minority Health Advisory Commission. The purpose of the commission is to: Provide a formal mechanism for community members to raise awareness of minority health needs, issues, and resources and to give input on health programming at the level of the executive director of the department; help the department determine culturally innovative data collection strategies; and strengthen collaboration between the department and minority communities to ensure that programs and services meet minority health needs.

SJR 05-035 (2005) - The Center for Women's Health Research, of the University of Colorado at Denver and the Health Sciences Center, was created on June 28, 2004, in an effort to improve women's health through research into women's health issues [including heart disease and stroke]; training of new scientists in the study of women's health; and educating women, healthcare providers, policymakers, and the public about research findings to benefit women and their families in Colorado and the nation. The members of the Colorado General Assembly, hereby recognize and applaud the creation and efforts of the Center for Women's Health Research, of the University of Colorado at Denver and the Health Sciences Center, to change the future of women's health.

 

Emergency Medical Services (EMS) and Automated External Defibrillators (AED)

Colorado Revised Statute 22-1-125/SB 08-181 (2008) - The General Assembly hereby declares that it is the intent of the General Assembly to encourage school districts to acquire and maintain automated external defibrillators on public school grounds. The General Assembly finds that it is in the best interest of students, staff, and visitors to a public school to ensure that automated external defibrillators are available in public schools for use in emergency situations.

Colorado Revised Statute 13-21-108.1 (2005) - (1) In order to ensure public health and safety, a person or entity who acquires an AED shall ensure that: (I) Expected AED users receive training in cardiopulmonary resuscitation (CPR) and AED use through a course that meets nationally recognized standards and is approved by the Department of Public Health and Environment; (II) The defibrillator is maintained and tested according to the manufacturer's operational guidelines and that written records are maintained of this maintenance and testing; (III) There is involvement of a licensed physician in the program at the site of the AED to ensure compliance with requirements for training, notification, and maintenance; (IV) There are written plans in place concerning the placement of AEDs, training of personnel, preplanned coordination with the emergency medical services system, medical oversight, AED maintenance, identification of personnel authorized to use AEDs, and reporting of AED utilization, which written plans have been reviewed and approved by a licensed physician; (V) Any person who renders emergency care or treatment to a person in cardiac arrest by using an AED activates the emergency medical services system as soon as possible and reports any clinical use of the AED to the licensed physician affiliated with the program. (2) Any person or entity whose primary duties do not include the provision of health care and who, in good faith and without compensation, renders emergency care or treatment by the use of an AED shall not be liable for any civil damages for acts or omissions made in good faith as a result of such care or treatment or as a result of any act or failure to act in providing or arranging further medical treatment, unless the acts or omissions were grossly negligent or willful and wanton.

HJR 1090 (2004) - The members of the Colorado General Assembly, recognize and commend the partnership formed by the American Heart Association and Kaiser Permanente, which resulted in the donation of: 8 AEDs to Denver International Airport; 45 AEDs to the Metro Denver fire departments; 3 AEDs to the Denver Center for the Performing Arts; 2 AEDs to the Colorado State Capitol; 1 AED to the Colorado History Museum; 1 AED to the North Central Fire Protection District; and future donations to the Colorado Department of Transportation's Training Center as well as the Colorado Convention Center.

 

Stroke Systems of Care

CO HJR 1034 (2010, adopted) - Recognizes the importance of stroke awareness and urges all Coloradans to become familiar with the risk factors, and warning signs and symptoms associated with stroke; urges hospitals in to adopt the national standards for heart disease and stroke treatment and seek accreditation as stroke centers from the Joint Commission's accreditation of hospitals program; recognizes the Department of Public Health and Environment for developing a comprehensive strategic stroke plan; encourages the Department to educate EMS responders to: communicate effectively with patients and callers who do not speak English as their primary language, partner with the Colorado Department of Education to introduce stroke awareness and prevention education in public schools, stress the importance of providing training and education to EMS providers to ensure that they know how to identify and treat stroke victims immediately, and continue to support the use of telemedicine in rural areas.


Sources: CDC Division for Heart Disease and Stroke Prevention | CDC WISEWOMAN Program | Milken Institute

NCSL Resources: Heart Disease and Stroke Overview | State Employee Health Benefits | Tobacco Cessation, 2009

NOTE:  NCSL provides links to other Web sites from time to time for information purposes only. Providing these links does not necessarily indicate NCSL's support or endorsement of the site.

For questions or information please contact the Health Program Health-info@ncsl.org

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