STRONG HEART STUDY Cardiovascular Disease in American Indians NEWSLETTER April 1990 Volume 2, Number 2 FLEXIBILITY AND RESOURCEFULNESS REQUIRED OF STRONG HEART STUDY STAFF Conditions for the Strong Heart Study vary The Dakotas have also suffered with personnel from center to center but are always a changes when Arliss Keckler resigned from the challenge. While the Dakota center suffers Eagle Butte clinic to pursue other interests. from the cold weather that makes recruitment We appreciate the contribution of Arliss during difficult, the Arizona center appears to have the early stages of this study. Dr. Welty has picked up the momentum as the weather is hired Mary Clown to replace Arliss. We most accommodating. The Dakota center welcome Mary to the Strong Heart Study staff. waits for the summer when conditions are good enough to reopen the Fort Totten clinic Along with the personnel adjustments and (scheduled for late-May) and boost recruitment weather conditions, two other hurdles confront and response rates while the Arizona center the Strong Heart Study: where is my check? recognizes the heat of summer will slow and where are my result? In response to these progress. In Oklahoma, the weather is not as concerns, all centers have tried to develop ways extreme as in the Dakotas or in Arizona, so of providing payments immediately after the more uniform examination rates are expected. exam, and a review of the process for returning However, weather is not the only challenge. results of the exam to participants in a timely manner will be undertaken. We are pleased to In Arizona, merging the exam with the NIDDK announce that starting this month every center study at Gila River continues to provide an will be handing out cash after the exam. With avenue for resourcefulness. When Strong Heart respect to results, staff should stress that Study staff found that the ·existing flow was central laboratories around the United States exceeding their ability to respond, two IHS are providing the highest quality measurements master's degree students volunteered to help. available at the most reasonable costs and this Daryl Allis and Gregory Wood have joined the effort requires time. effort and provided the helping hands that have greatly smoothed the exam process and Even with these obstacles, the exam process allowed the stepped up recruitment to continued and 1322 exams had been completed continue. Welcome aboard to Daryl and by mid-March. This included 451 in Arizona, Gregory. 399 in the Dakotas and 472 in Oklahoma. By the time you read this newsletter the Strong In Oklahoma, each center has one nurse to do Heart Study will be over the 30 percent mark the clinical exam. This worked well until the of projected total exams. The flexibility and nurse at Anadarko, Gail Tackett, resigned to resourcefulness of the Strong Heart Study staff pursue an opportunity in Alaska. We thank will be tested and found up to the test as the her for her contribution to the study and wish study continues. Keep up the good work! her the best. QUALITY CONTROL OF RECORD ABSTRACTING BEGINS As part of the procedures used to ensure the and morbidity events began in November, best possible data for the Strong Heart Study, 1989. Quality control abstracts for each type assessment of the reliability of abstracting of form used in the mortality and morbidity information from medical records of mortality surveys will be done on a quarterly basis each 1 year. The Dakotas Center was the first to number of discrepancies, and the specific items provide copies of a death certificate, medical on each form for which there was disagreement. records from a fatal event, a non-fatal MI and This file will be used to ident,ify specific a stroke for abstraction by every member of the abstract items that are consistently completed Strong Heart Study staff involved in data incorrectly so that we can improve the forms or collection from medical records (Thanks to provide additional clarification in the Beverly Blake!). The second set (for the procedures for abstracting. The file also serves January-March quarter), from the Oklahoma as a record of improvement for each abstracter. Center, should have been recently received by Abstracting information from medieal records all of you. is a difficult and time-consuming process, although it becomes easier with practice and Once a set of Quality Control (QC) records is experience. The efforts of all staff members to assembled, copies are sent to each of the accurately and completely abstract medical centers and to Linda Cowan at the Oklahoma records is greatly appreciated. Center. As QC abstracts are completed and forwarded to Dr. Cowan, she checks them with The first QC set provided useful experience for the abstracts she has done. Discrepancies are all of us, and a number of changes in noted on the QC abstracts, and after the set procedures were made to make the abstracting has been completely checked, it is returned to more uniform and sensible. These changes the abstracter for review. A file is kept of the were described in a memo recently sent to all of results of each QC abstract. The file contains the centers. Hopefully, the abstracting will the abstracter's code number, the date the QC now proceed more smoothly, but suggestions abstract was completed, form type, total for improving the process are always welcome. THE ELECTROCARDIOGRAPHY CENTER-ELECTRIFYING Fitzsimons Army Medical Center is the site of Each cardiogram is then copied and read ', the ECG Center for the Strong Heart Study. blindly by 3 Staff Cardiologists. The panel of Direct computer connection is made by modem readers is composed of Maj. William Highfill, with all field MAC-PC units directly to a large M.D., Maj. Steven Atchley, D.O., and Maj. "mainframe" central processing unit located on John Van Deren III, M.D. Col. Richard Davis, ' the hospital grounds. From the "mainframe" M.D., Ph.D. is chief of the Cardiology Service there is a direct connection with the Cardiology and serves as the adjudicator of any Service in the hospital. Although represented disagreements among the panel of readers on the Steering Committee by Dr. Oopik, there concerning the possibility of myocardial is extensive involvement by most members of infarction. Arvo Oopik, MD. adjudicates other the cardiology staff at Fitzsimons to ensure the differences in readings among the panel. success of the ECG analysis. Both active-duty and civilian technical personnel assist with data Following this process, a single reading is processing and with technical advice when calls entered as the "confirmed" reading, is returned come in from the field centers. by modem to the field site and is entered in the database. The mainframe· transmits all Before an electrocardiogram arrives in the confirmed copies in the middle of the night to cardiology clinic, it has already been minimize phoneline costs. "digitized" prior to reaching the MAC-PC, it has been stored in the electronic memory of the All cardiograms read as "abnormal" by the MAC-PC, interpreted locally and transmitted MAC-PC will be transmitted to the University digitally without any loss of resolution several of Minnesota, where they will be "!Vlinnesota­ hundred miles to the Marquette CAPOC unit coded". at Fitzsimons. Electronic storage to hard disk takes place with remote processing carried out The technical staff at Fitzsimons, who actually from the cardiology clinic. At Fitzsimons, each enter data into the computer, sort arriving ECG is further archived in a personal computer ECGs, as well as respond to phone inquiries, is database for continual tracking as well as made up of a tireless crew of people who have secondary data analysis. multiple other duties in addition to the Strong 2 ECG Center and Strong Heart Study Staff: Left to Right - Dr. Van Deren Dr. S. Atchley Dr. R. Davis Dr. W. Highfill Dr. A. Oopik Heart Study. SPC John McCulley and SPC from day-to-day operations because of DonnaWalker are the military personnel who multiplesclerosis and will be missed have assisted tremendously to date. tremendously. Future assistance will be provided by Mr. Al Johnson. The civilian component of the ECG center crew has been composed of Ms. Esther "Heidy" In addition to the Strong Heart ECGs, Heidenreich, Ms. Vicki Duran, Ms. Anne electrocardiograms from all military facilities in Elliott, and Ms. Rachel Motakhaveri. Jack a 15-state region are processed at Fitzsimons. Weber has provided the technical assistance in The Fitzsimons staff is also well-known for its modifying computer partitions and other work in invasive and interventional cardiology operational matters necessary to successfully and for the strength of its fellowship training accomplish this study. Jack has recently retired program. STRONG HEART STUDY CONTINUES TRADITION AT LAWTON INDIAN HOSPITAL The Lawton Indian Hospital is the location of days a week, include a first-floor conference one of the two Oklahoma exam sites of the room for the informed consent and excellent Strong Heart Study. Located about 85 miles laboratory facilities. On the third floor, the southwest of Oklahoma City, Lawton 1s Study occupies three rooms for the personal Oklahoma's third largest city, with a interview, physical examination and chart population of 88,000. The hospital has a review. history dating back to 1914, when the first section was constructed to take over medical The Strong Heart Study has an excellent staff: care of the many Indians who were relocated to Martha Stoddart, in Oklahoma City, and Jary Oklahoma in the early 1900's. It is a 42-bed Mayes, Carol Mote and Juanita Cortez in hospital with 14 physicians and 1 dentist. The Lawton. hospital has hosted research projects since the early 1970's.