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How Intense Efforts Boosted Heart Health for One Maine Community
Better screening, control of high cholesterol and blood pressure cut deaths and hospitalizations, study finds
By Steven Reinberg
TUESDAY, Jan. 13, 2015 (HealthDay News) -- With heart health, sometimes it takes a village.
That may be the take-home message from a new study. It found that one Maine community's long-term focus on screening for heart risk factors, as well as helping people quit smoking, saved both money and lives.
Over four decades (1970 to 2010), a community-wide program in rural Franklin County dramatically cut hospitalizations and deaths from heart disease and stroke, researchers report Jan. 13 in the Journal of the American Medical Association.
Between 1970 and 1989 the death rate in the county was 60.4 per 100,000 people -- already the lowest in Maine. But between 1990 and 2010, that rate dropped even lower, to 41.6 per 100,000 people.
According to the research team, the health benefits were largely due to getting citizens to control their blood pressure, lower their cholesterol and quit smoking.
"Improving access to health care, providing insurance and concentrating on risk factors for heart disease and stroke made a substantial difference in the health of the overall population," said co-author Dr. Roderick Prior, from Franklin Memorial Hospital in Farmington, Maine.
Prior believes that the Franklin County experience can be a model for other communities in the country.
"If communities begin to take hold of their health problems, they can increase longevity and decrease the cost of health care," he said.
Begun in 1974, the Franklin Cardiovascular Health Program aimed at reducing heart disease and stroke among the roughly 22,000 people living in the county at the time. During the first four years of the program, about 50 percent of the adults in the county were screened for heart health.
Outreach was key. According to the study authors, organizers sent "nurses and trained community volunteers into town halls, church basements, schools and work sites," to help get residents motivated for screening.
Screening helped alert people to potential health issues, and after screening, the proportion of residents whose blood pressure was controlled jumped from about 18 percent to 43 percent, Prior's team said.
Regular cholesterol screening was added in 1986, and over five years reached 40 percent of the county's adults, 50 percent of whom had high cholesterol, the researchers said. Between 1986 and 2010, the proportion of people whose saw improvements in their cholesterol numbers rose from 0.4 percent to about 29 percent, respectively.
Likewise, after a quit-smoking program began, the rate of nonsmokers in Franklin County jumped from 48.5 percent to 69.5 percent. This increase was significantly higher than changes in nonsmoking rates elsewhere in Maine, the team said.
Lives were saved or extended, as well. In the 1960s, the death rate in Franklin County was at or above the overall death rate in the state, but from 1970 to 2010 the county's death rate fell to below the state's average, including deaths from heart disease and stroke.
Not only did the program reduce the death rate, but it saved the county money. From 1994 to 2006, hospitalizations were less than expected, which saved nearly $5.5 million in total in- and out-of-area hospital costs for county residents each year, the researchers said.
"This important study demonstrates that community-based interventions are feasible and can be sustained over a prolonged period," said Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, and a spokesman for the American Heart Association. He believes the Maine example also "highlights the potential impact of targeted, multidimensional community-based interventions for improving heart health and outcomes."
Dr. Darwin Labarthe is a professor of preventive medicine and epidemiology at the Feinberg School of Medicine at Northwestern University in Chicago, and co-author of an accompanying journal editorial. He believes that "the communities in which we live have the capability to do what was done in Franklin [County], Maine."
Find out more about heart disease in your community at the U.S. Centers for Disease Control and Prevention.
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