Decreasing Heart Disease and
Sudden Cardiac Death for Kent
County
Vanessa Bennett RN
Nicole Conway RN
Mary Jacobs RN
Sarah Raden RN
Ferris State University
Abstract
 Heart disease is the number one cause of death not only in Kent
County but in the United States as a whole. Preventive
education is the key element to decreasing the risk of developing
heart disease with advancing age. By targeting the younger
population we are giving them the necessary tools needed to
make healthier lifestyle choices and arming them with the
knowledge of how and when to activate emergency response so
we can also decrease Sudden Cardiac Death (SCD)
 There are two types of risk factors for heart disease and these are
modifiable and non-modifiable.
 By assessing youth early, during a pre-participation exam, and
well child visits these risk factors can be identified and
monitored for the development of heart disease and prevention
of SCD.
Introduction
 Prevention of heart disease begins with the understanding of what
causes the disease as well as how to identify both the modifiable and
non-modifiable risk factors. By targeting the younger population ages
10-18 and providing them with the tools/information necessary to make
healthier lifestyle changes it is possible to greatly reduce the prevalence
of heart disease within Kent County.
 By assessing young athletes early, during a pre-participation exam,
family history evaluation, and well child visits these risk factors can be
identified and monitored for the development of heart disease and
there by lead towards prevention of sudden cardiac death.
 In addition to understanding the causes of and prevention of heart
disease among the younger population, it is also imperative to educate
our youth in the identification of signs and symptoms of myocardial
infarction, activation of emergency response systems, and the use of
CPR and AED to improve the outcomes of those who may suffer a
sudden cardiac arrest
Fennville Teen hits winning shot Then Dies
 FENNVILLE, Mich. (WOOD) - The Fennville varsity basketball
player who hit the game-winning layup in overtime on Thursday
night -- lifting his team to a perfect 20-0 season -- collapsed on the
court after the game, and later died at Holland Hospital.
 Wes Leonard, 16, was a junior at the high school.
 An autopsy revealed Wes Leonard died from "cardiac arrest due to
dilated cardiomyopathy (enlarged heart)," Ottawa County's chief
medical examiner Dr. David A. Start's office told 24 Hour News 8.
Etiology and Health Problem
 Heart disease continues to be the leading cause of mortality in Michigan and Kent
County (Michigan Department of Community Health, 2010). Heart disease is a
generalized term to identify the different diseases the may affect the heart function.
 One the illnesses’ that is categorized with in the term heart disease is Sudden Cardiac
Death of the Youth (SCDY). SCDY can occur without any warning signs, and affects the
younger population ages 1 to 39. The Michigan Department of Community Health (2010)
defines SCDY as a cardiac or ill-defined cause of death occurring in the emergency room
(ER), en route to the hospital, out of the hospital, or dead on arrival to the ER in a
individual between the ages of 1 and 39 (p.2).
 Kent Counties leading cause of death for 2008 was heart disease with its number of
deaths being 1,022 with a rate of 168.9 (Michigan Department of Community Health,
2011). Kent County age adjusted mortality rate for sudden cardiac death from 1999-2006
was 3.0-5.5 per 100,000 (Michigan Department of Community Health, 2009).
 National benchmarks vary and are difficult to find, at this time, Kent County is on the
moderately high scale in comparison to other Michigan Counties. According to the
Michigan Department of Community health SCDY affects blacks more
disproportionately (2009) with in the State of Michigan.
Modifiable and Non-Modifiable Risk Factors
 The modifiable risk factors include smoking, alcohol and caffeine
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consumption, diet, inactivity, stress and weight management
(American Heart Association, 2010).
By identifying these risk factors and making healthier choices will
decrease of risk of developing heart disease or having a SCDY.
Epidemiology and etiology of heart disease and SCDY has multiple
factors most of which are preventable.
The non-modifiable risk factors include genetics, advanced age,
race/ethnicity, sex and post-menopausal women.
According to the Michigan Department of Community Health (2010)
as many as 40% of families with a victim of SCDY under age 40 have
been identified as having a heritable disease (p.11).
By identifying a family history of heart disease can help identify,
screen, and manage patients that could be at risks for SCD (Michigan
Department of Community Health, 2010).
Bioecological Systems Theory
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Bronfenbrenners’s Ecological Systems Theory helps
define the differences related to cardiac disease and
possibly SCDY, this theory examines which personal
characteristics and contextual variables such as
peers, family, and community play a role in health
behaviors (Gilmore, Harrell, Miles, & Hepworth,
2003).
This theory also alludes to the positive impact
nursing can play by proper application of
community interventions.
This theory is now know as the Bioecological
systems theory, in which: culture, society, global,
school, religion, community, and family are all
inputs which contribute to the child's output or
behavior (Paquette, & Ryan, 2011).
Community and Nursing
Involvement
 The simple fact that knowledge is power leads this project into the community. There is a
definite need for information to hit the public in regard to our younger populations;
there is a lot of information out there about cardiac disease however the populations that
are targeted appear to be those of the aging.
 According to Wheeler et al. (2010) “In athletes with underlying but undiscovered heart
disease, the risk for sudden cardiac death may be more than 100-fold higher than that of
unaffected peers. Identification and appropriate treatment for these high-risk persons
may substantially reduce their likelihood of dying suddenly” (p.276).
 Other disciplines that may be asked to assist in the goal/outcome attainment would be
from physicians to assist in cardiac screening that may require follow up.
 Nurses for screening; pretest and posttest, body weight, fat, blood pressures, etc.
 Teachers and educators, along with coaches and athletic directors, to set up a venue for
education relating to SCD.
 Social workers to assist with emotional needs for those at risk as well as to provide
information to obtain the tools needed to improve health and wellness.
 The American Red Cross, or other such entity; which would be willing to provide civilian
training in CPR and AED use.
Prevention needed as a Resource
 Prevention is the key to decreasing the number of deaths related
to heart disease and SCD.
 An example of primary prevention would be pre-participation
sports screening for all athletes within the state of Michigan.
Male athletes are more prone to die suddenly then female
athletes (male: female ratio for SCD is 10:1) (Michigan
Department of Community Health, 2010).
 The purpose of pre-participation screens is to identify those
athletes that may be high risk for having heart disease. There are
currently no evidenced-based practice guidelines for screening
the younger population for heart disease, more studies are
needed to determine which screening tools are the most
successful in determining which patients are more at risk for
heart disease.
Present Community Groups
 Kent County Health Department (2011) presently offers some classes geared
towards education and health promotion: Walking into wellness, Cholesterol &
Blood Pressure screening services, and Educational Services (nutrition, dining
out, cholesterol, stress management, and child nutrition), these services can
further expand on the education age group and focus. Metro health also holds
free screening for BP on Fridays.
 Local Cedar Springs man gets to the heart of the matter. Gary Gust now 66 died
for over two minutes before his heart was restarted by an AED, national
statistics show fewer than 10 percent of people having an arrest outside the
hospital make a recovery (Reens, 2011). “Grand Rapids Fire Department
Battalion Chief Bart Perry hopes to jump-start that number as part of his
recently pitched program that would train more people in CPR and place
defibrillators in factories, office buildings, churches and other places where
people congregate (Reens, 2011).” The second part of the plan is to use a texting
system to call trained community members to the scene quickly. “There's
obviously a big cost, but its well worth it,” Chalfoun said. “Its something that I’d
hope this benevolent community will get on board with.” Gust marks his five
year survival anniversary by buying his wife roses and Lori roses, Lori is the
trainer whom used the AED and saved his life.
Planning
 According to Freedman et al. (2009) “Overweight children
(CDC 85th–94th percentile) are more likely than thinner
children to have adverse levels of cardiovascular disease
risk factors and to become obese adults” (p.755).
 A result to this is that as children chance of a SCD event is
increased, and by not addressing these issues early the risk
will only increase over time. Inactivity and obesity in our
children is quickly becoming an epidemic.
 The First Community goal for Kent County is that the
population of 10-18 year olds will have increased knowledge
of cardiac disease and the link to obesity as a factor.
Healthy People 2020
 Developing Healthy People 2020s objective is to increase the
proportion of adults aged 20 years older who are aware of the
early warning symptoms and signs of a heart attack and the
importance of accessing rapid emergency care by calling 9-1-1
(U.S. Department of Health & Human Services, 2011).
 Due to the overwhelming number of children/athletes who have
suffered SCD, it is important to also include a goal of knowledge
of symptoms related to cardiovascular events/myocardial
infarction and the use of activating the emergency response team
and the use of CPR and AEDs. Across the age span.
 The third goal to address in regard to knowledge of preventable
risk factors affecting the younger populations early adolescent to
age 30 that may lead to SCD; hypertension, hyperlipidemia,
obesity, smoking/alcohol, stress management.
Objectives
 By September 1, 2011 all Kent County Middle/High Schools will
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incorporate cardiac risk factors and disease prevention,
including SCD, into the health education curriculum.
All middle/high schools in Kent County will have obtained an
AED and trained faculty to use by December 1, 2012.
Beginning May 1, 2012 a county-wide Cardiovascular Health
Summit will be held with information on surveillance, risk factor
modification, and best practices.
Information regarding cardiovascular disease will be distributed
quarterly to local health departments beginning January 2, 2012.
A comprehensive surveillance system for cardiovascular disease
including a youth risk behavior surveillance system, weight
monitoring of Kent County children and physical activity will be
established by January 2012.
By January 2 of 2013, Kent County will have a 5% decrease in SCD
in individuals age 10-18.
Interventions
 To accomplish this, we will speak with the middle and high schools within Kent
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County to propose an addition to the health course to incorporate a unit dedicated
to cardiac disease prevention and emergency response listed above and will be
mandatory for all student athletes.
Prior to the course a pre- test will be given to students in the course to assess the
initial knowledge and design a program to reach the target population.
Students will be educated in the importance of obtaining a family history to screen
for possible links/risks of cardiovascular disease to decrease the SCD among
children and adolescents.
“It is estimated that 40% of pediatric patients who suffer an SCD event may have
unrecognized or underappreciated warning symptoms. Specifically, patients should
be questioned about the history of syncope or seizure during exercise, emotion, or
startle; extreme fatigue associated with exercise (different from other children);
and/or unusual or extreme shortness of breath during exercise, often mimicking
exercise-induced bronchospasm.”
“Nearly all Americans believe that family health knowledge is important, but only
one third of families have written a family medical history to share with their
relatives. In November 2004, the US Surgeon General launched a family-history
initiative. A computerized checklist (available at:
www.hhs.gov/familyhistory/download.html) can help families organize their
history, especially during family gatherings”
SCDY may have critical implications for the victims family, especially if the death was related to an inherited condition (Too
Young to die). While there is still a need to better understand the problem of SCDY in Michigan, there are steps that
can be taken now to improve:
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-DETECTION of individuals at increased risk
-TREATMENT of those with predisposing conditions and
-INTERVENTION for victims experiencing sudden cardiac death
It should be noted that evidence-based guidelines for pre-participation screening of non-professional athletes
currently do not exist, there for in the U.S. there are presently no universally accepted or mandated standards for
screening athletes of this age, nor are there approve certification guidelines for the healthcare provider whom perform
such exams.
National research on the best method of conducting pre-participation screening for athletes has led to inconsistent
conclusions.
The American Heart Association and American College of Sports Medicine recommend that an athlete preparticipation evaluation include detailed family history and physical exam.
Heart screening test studied for student athletes www.boston.com/news/health/blog/2010/03/by_kay_lazar_gl.html.
This article discussed two studies that were completed about medical screenings for young athletes for the prevention
of SCDY. The first study was completed by the Massachusetts General Hospital and Harvard University. They added
an EKG screen to their physical exam and twice as many athletes with a unknown cardiac condition. They also
determined that there were several false positives. Harvard added the EKG screen to their pre-participation screen for
all athletes.
The second study was completed by Stanford University of Medicine discussed the cost of adding this the EKG exam to
the pre-participation exam would be about 89.00 per athlete tested. There are estimates of approximately $ 2 billion
per year to test all middle and high school athletes across the country.
Pre-participation Screening of Young Competitive Athletes for Prevention of Sudden Cardiac Death.
http://www.medscape.com/veiwarticle/585032_print
.
This study was published in 2009 and discusses the need for EKG testing in young athletes provides the detection of
different cardiac conditions that may have otherwise been missed by just a physical examination. This study was
completed in Italy among middle and high school athletes. This study suggests that SCDY during sports is often the
first and definitive manifestation of an underlying cardiovascular disease, which usually has a silent clinical course
(Basso, Corrado, Schiavon, Pelliccia and Thiene, 2009). Knowing that many of the cardiac condition are silent by
using a EKG is able to detect one of these conditions and get the individual the treatment necessary before something
occurs. A screening test is not meant to get diagnostic; it separates apparently well persons who probably have a
disease from those who do not (Basso, et. al, 2009).
In conclusion this study suggest that pre-participation cardiovascular evaluation of competitive athletes essentially based
on EKG seems, according to long term Italian experience, to be a lifesaving strategy that adequately meets the criteria
for a good screening program :
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1. the risk of SCDY during sports represent a serious health problem
2. EKG screening allows identification of still-asymptomatic athletes with at-risk cardiovascular diseases
3. an effective management strategy exists on the basis of restriction of life threatening training/competition and
subsequent clinical treatment and most importantly
4. early detection and management of athletes favorably modifies the outcome of the underlying disease and leads to
the reduction of SCDY. (Basso, et. al, 2009).
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Pre-participation sports screening and physical along with a follow up-this is important in primary prevention,
however there are not currently standards among how the test is given.
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Provider education and public awareness of SCDY risk factors
Public awareness of cardiac symptoms and CPR/AED training
Emergency response protocols
Medical examiner protocols
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 All Kent County School educators and staff, and 9th and 10th graders will be trained in
CPR and Automated External Defibrillators (AED), This will be achieved through
training programs presented at the schools offered twice a year. This allows early
intervention and defibrillation by personnel most likely to be at the site of arrest. Project
ADAM will be the model used to implement teaching. Which was researched by Berger
et al. (2004), and “Implementation of Project ADAM in high schools in the United States
is potentially associated with an incremental cost-effectiveness ratio that is favorable”
 Every School in Kent County will have an accessible AED with in one year, which will
allow fast defibrillation of any student or adult suffering from a sudden cardiac event.
Each School will be responsible for obtaining their AED. Information will be given to
each school regarding grant applications and government money matching programs.
Information like AEDgrant.com, Catalog of Federal Domestic Assitanc, Cintas Scholastic
AED programWho, Philips HeartStart Giving Program, and local resources like Kiwanis
Clubs, Lions Clubs, and Rotary International (Sudden Cardiac Arrest Foundation, 2011)
will be provided to each school.
 “The suggested preventive measures were categorized into five major areas: preparticipation sports screening and follow up; provider education and public awareness of
SCDY risk factors; public awareness of cardiac symptoms and CPR/AED training;
emergency response protocols; and, medical examiner protocols”
.
 With parental permission, all Kent County high school students
will be given a Youth Risk Behavior Surveillance questionnaire as
part of their health/physical education curriculum. This is a
voluntary and anonymous survey that includes high-risk health
behaviors including diet, physical activity, drug use, alcohol
consumption, and obesity.
 High-risk health behaviors which contribute to leading causes of
morbidity and mortality such as heart disease often originate
during childhood and carry into adulthood.
 According to The Youth Risk Behavior Surveillance conducted by
the CDC among high school students nationwide in 2007,
“20.0% had smoked cigarettes during the 30 days before the
survey, 35.4% had watched television 3 or more hours per day on
an average school day, and 13.0% were obese.” Additionally, it was
found that in the 7 days prior to the survey, that 65.3% of
students failed to exercise as recommended, 78.6% did not
consume the recommended servings of fruits and vegetables
each day, and 33.8% reported consumption of at least one soda
pop per day (Eaton et. al, 2008).
Evaluations
 The Community Public health Nurse will measure how many employees and
students are presently certified in CPR and AED use. The expected goal is to
have a twenty five percent increase in certification with in one year. This will be
measured by a secondary count of certified staff and students. (should we use a
survey?)
 AEDs will be at every school as counted by Community Health Nurse.
 To determine the change in deaths related to SCD will be obtained by
reviewing the death certificates for those whom passed away between the ages
10-18.
 Completed YRBS questionnaires will be compiled at one local health
department where results will remain on file for tracking of student behaviors.
 These results will be factored into the development of health/physical
education curriculum at all Kent County high schools.
 These percentages will be calculated to determine the relationship from 2011 to
2013 to obtain either a decrease or increase in incidence of SCD.
AED Saved Huntley Boys Life
Thirteen year old Brooks Beler was saved by CPR and an
AED. He had known cardiomyopathy inherited from
his father. These are the results from education and
awareness, it is worth the cost.
He is now scheduled
to have a defibrillator
inserted.
“I want to thank my
Teachers for helping me”
References
 Berger, B.N., Whitstone, S.J., Frisbee, J.T., Miner, A., Dhala, R.g., Pirrallo, L.M., Utech., &
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