Cardiovascular Disease in Rural America
In the United States, someone suffers a heart attack every 40 seconds, and events related to cardiovascular disease kill more than one person per minute. Often, heart attack survivors suffer debilitating damage that impairs their ability to live a normal life. In addition, heart arrhythmias, leaky valves, and cholesterol-clogged arteries put patients at risk of further problems, including stroke.
Quick medical help reduces a person’s chances of dying from a heart attack. In rural communities, however, resources are limited. First responders often provide basic stabilization before transporting the patient to the nearest medical facility. There, the patient is further stabilized before being sent on, either by ambulance or by helicopter, to a larger facility where there is at least one cardiologist on call.
Let’s talk about Rural Heartaches
For the past 3 years I have held the position of Networking Chair on the Arizona Healthcare Executives’ (AHE) Programming Committee. The most profound aspect of being in this position was witnessing how small the healthcare world is and experiencing how intertwined we all are. These, usually unknown, connections span diversity, unite healthcare sectors, link healthcare settings, and transcend job responsibilities. I’ve learned how networking can open up unknown job markets, foster support, inspire encouragement, cultivate relationships, and is seen as a marketable asset.
- Less education
- Lower incomes, reduced ability to pay for medical help
- Increased tobacco use
- Poor diet
- Lack of physical activity
- Traumatic backgrounds
- Fewer opportunities for social supports
Assessing cardiovascular risk factors can be tricky. First, not everyone agrees on what the risk factors are. Ones that often are assessed include diabetes, leisure-time physical inactivity, obesity, high LDL cholesterol, high blood pressure and tobacco use. Three that also might be considered are low serum levels of Vitamin D, thyroid dysfunction and untreated sleep apnea.
Classical & Novel Assessments of CVD Risk
Sometimes, patients are reluctant to provide accurate information or to undergo testing. Also, test results may not provide a complete picture, one that will give the physician the knowledge needed to take appropriate action. For example, an angiogram may show the formation of blood clots rather than an artery clogged by plaque. However, it does not reveal why the blood clots exist. Resolving the problem and reducing risk may involve prescribing medication as well as determining whether vitamin supplementation or reduction is needed. Making both classical and novel assessments of CVD risk increases the likelihood of assessment accuracy.
Medical practice management teams that take an active part to address the problems in our communities that contribute to a higher incidence of cardiovascular disease make a huge difference in the lives of community members and their families. Every heart attack prevented or life saved affects the lives of several others.
Management teams and the staff we supervise may unite with local schools, senior citizen centers and restaurants to educate the public as to the existence of locally grown foods that are healthy, ways to prepare well-balanced meals that please the taste buds, and small dietary changes that make a big difference over time. Other areas in which members of practice management have the opportunity to affect positive change include the following:
- Sponsoring events or competitions that require physical activitys
- Using social media as well as local media outlets to help increase knowledge of the risk factors for heart disease
- Presenting ways people can lessen their risks
- Publicizing the signs of a heart attack and the importance of getting help without delay
- Holding health fairs and free clinics on heart health
- Providing additional access to healthcare for those who are isolated or poverty-stricken
Providing additional access to healthcare may mean making home visits or furnishing transportation. It might involve applying for grants and researching other avenues for increased funding so that rural facilities can stay open. It also may require finding some way to keep the facility fully staffed even though qualified workers are scarce.
Healthier Rural Hearts
- Centers for Disease Control and Prevention: Interactive Atlas of Cardiovascular Disease and Stroke Tables https://nccd.cdc.gov/DHDSPAtlas/Reports.aspx
- Centers for Disease Control and Prevention: Cardiovascular Disease Death Rates, 2014-2016; Adults, Age 35+, by County https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_disease.htm
- Centers for Disease Control and Prevention: Cardiovascular Disease and Stroke Prevention – State and Local Public Health Action Programs https://www.cdc.gov/dhdsp/programs/spha/index.htm
- Intechopen.com: Strategies for Cardiovascular Disease Prevention in Rural Southern African American Communities; Ralphenia D. Pace, Norma L. Dawkins and Melissa Johnson; 2012 http://cdn.intechopen.com/pdfs/36934.pdf
- National Institute of Health: Clinical Utility of a Novel Coronary Heart Disease Risk-Assessment Test to Further Classify Intermediate-Risk Patients https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231217/
- Rural Health Information Hub: Chronic Disease in Rural America https://www.ruralhealthinfo.org/topics/chronic-disease
- U.S. Department of Health and Human Services: Million Hearts https://millionhearts.hhs.gov/
By: Aikaterini Papadopoulou, B.Arch