​​What makes a community-based health center for cardio treatment successful?

Despite decades-long improvements in cardiovascular disease (CVD) mortality, recent trends indicate that the rates of myocardial infarction, stroke, and other CVD events have plateaued and are even increasing among certain populations. This trend is most prominent among adults aged 35 to 64 years—a group that has also seen increased rates of all-cause mortality.

Although the prevalence of CVD-related events is high, these events are largely preventable with proper risk management. However, evidence suggests that fewer than 50% of individuals at risk of developing CVD are treated according to clinical care guidelines, with rates of proper care being critically low among racial/ethnic minorities, the uninsured, and low-income patient populations. 

Reaching low-income patients

Access to a cardiovascular disease specialist is not only costly, but it can be completely unavailable in certain communities. To fill this gap, federally qualified health centers (FQHCs) provide primary care services, including cardiovascular care, to approximately 30 million low-income patients across the US, regardless of a patient’s ability to pay. FQHCs provide services to 1 in 5 rural residents and 1 in 3 individuals with an income lower than the federal poverty level in the United States. 

By embedding in the communities they serve, FQHCs are in an ideal position to tackle cardiovascular health disparities.

The role of community-based health centers 

Community-based programs can include initiatives to increase physical activity, improve nutrition, and prevent smoking and tobacco use among at-risk populations. 

A study by the Trust for America’s Health (TFAH) found that investing $10 per person, per year in community-based programs can save the country a staggering $16 billion annually within 5 years. 

“Health care costs are crippling the US economy. Keeping Americans healthier is one of the most important, but overlooked ways we could reduce these costs,” wrote Jeff Levi, PhD, executive director of TFAH in the report. “This study shows that with a strategic investment in effective, evidence-based disease prevention programs, we could see tremendous returns in less than 5 years—sparing millions of people from serious diseases and saving billions of dollars.”

Success story: Lessons from Appalachian Kentucky 

Researchers from the University of Kentucky recently enrolled 355 people in a 12-week self-care course. The University worked with a well-established clinic in Appalachian Kentucky—an area of the state that is in the top 1% for cardiovascular disease but near the bottom in economic measures.

Outcomes of the study were CVD risk factor goals chosen by study participants, which included blood pressure, lipid profile, HgA1c, body weight, and physical activity levels. 

Compared with individuals not enrolled in the course, those enrolled in the community-based initiative were more likely to meet their goals when it came to critical measurements, such as blood pressure (83% met their goal vs 18% in the control group), cholesterol levels (83% vs 10%), and body weight (36% vs 9%). 

The key to this program’s success was an understanding of the area’s culture—not only educating people about the importance of self-care, but taking the time to teach them how to apply self-care principles in their lives. 

As an example, bean soup is a popular dish in the area. While it is not inherently unhealthy, common methods of preparation in this region include adding excessive salt and pork fat. As part of the community-based health initiative, study participants were given healthy alternatives to favorite recipes that still managed to take local tastes into account. 

How you can promote community-based initiatives 

To ensure the success of community-based health initiatives, clinicians can partner with community health workers, who often bridge the gap between communities and healthcare systems. Community health workers can provide patients with information ranging from how to reduce their daily sodium intake to less expensive ways to increase fruit and vegetable consumption. 

For clinicians looking for other ways to support community-based efforts, adopting health initiatives in your own practice is a good way to start. As an example, the AMA has partnered with investigators at Johns Hopkins to provide clinicians with a team-based framework to help patients achieve hypertension control. 

This approach is called MAP, and includes the following tenets: 

1. Measure blood pressure accurately, every time it’s measured. 

2. Act rapidly to address high blood pressure readings.

3. Partner with patients, families, and communities to promote self-management of high blood pressure.

Sources 

1. Cole MB, Kim JH, Levengood TW, Trivedi AN. Association of medicaid expansion with 5-year changes in hypertension and diabetes outcomes at federally qualified health centers. JAMA Health Forum. 2021;2(9):e212375.

2. How community health workers can improve your patients’ health. American Medical Association. 2015. 

3. Moser DK, Feltner F, Biddle MJ, Chung ML, Lennie TA. Reduction of health disparities in Appalachians with multiple cardiovascular disease risk factors: A randomized controlled trial. Circulation. Published online June 9, 2018. 

4. Prevention for a healthier america. Trust for America’s Health. 2008. 

5. Vaughan AS, Ritchey MD, Hannan J, Kramer MR, Casper M. Widespread recent increases in county-level heart disease mortality across age groups. Annals of Epidemiology. 2017;27(12):796-800.