NHLBI creates community partnership to eliminate disparities in cardiovascular health

To ensure that science-based information about cardiovascular disease (CVD) reaches people in low-income and minority communities, the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health today announced a partnership with six community-based organizations. These organizations, which have been dubbed Enhanced Dissemination and Utilization Centers (EDUCs), are the first to be selected to participate in what will eventually be a nationwide NHLBI network of community-based organizations implementing targeted, culturally sensitive heart health education strategies aimed at changing local physician practices and patient behaviors.

The EDUCs are located in communities with heart disease and stroke death rates far in excess of the national average.

Said NHLBI Director Dr. Claude Lenfant, "Despite the scientific and technological advances in cardiovascular medicine during the past 50 years, many Americans are not enjoying the improvements in health that application of existing information has the potential to offer. The NHLBI is taking aggressive steps to enhance dissemination and outreach activities to address this disturbing problem."

Heart disease and stroke are the first and third leading causes of death in the U.S., and recent data suggest that this is not likely to change soon. The decline in coronary heart disease mortality that began in the 1960s appears to be slowing, and the recent decline in stroke mortality is leveling off. Control of high blood pressure, especially among older Americans, is less than optimal; teenage smoking is on the increase; and overweight/obesity, coupled with high levels of physical inactivity, is on the increase. There are tremendous geographic variations in heart disease and stroke death rates, and certain racial/ethnic minority groups are disproportionately affected.

The EDUCs initiative is an important part of NHLBI's response to meeting the Federal government's Healthy People 2010 objectives for the Nation which aim to eliminate racial and ethnic disparities in the burden of disease and improve health care for everyone.

The NHLBI strategy is to focus on communities at highest risk of cardiovascular disease, collaborate with local health care providers and other community leaders who understand local issues and concerns, and encourage broad partnerships to ensure that an infrastructure exists to sustain the project over time.

The six new NHLBI EDUCs and their strategies are:

* The Dan River Region Cardiovascular Health Initiative Program (DR CHIP) in Southside, VA, a partnership between the Danville Medical Center and the Danville/Pittsylvania Public Health Department, was designated a Cardiovascular Center of Excellence by the Consortium of Southeastern Hypertension Centers in 1999. Since then, the program has been providing community cardiovascular screening, referral, and treatment services, as well as professional and public education, to the Dan River region. This area ranks in the top 15 percent of health service areas nationally for coronary heart disease mortality and has twice the national rate for stroke deaths.

As an NHLBI EDUC, DR CHIP will expand its current programs to provide a comprehensive community-wide approach to health professional and public education and risk factor identification and treatment. This intervention will involve community cardiovascular risk factor screenings and referrals; collaboration with community-based hypertension and lipid specialty clinics; and education activities with schools, churches, and other community organizations like the YMCA. DR CHIP will also promote additional continuing education programs for health care professionals in this Federal Medically Underserved area.

* Delta Health Education Center (DHEC), in the Arkansas delta, is a seven-county health education outreach program of the University of Arkansas for Medical Sciences in Little Rock. It will implement professional education and church-based health education programs to improve cardiovascular health in St. Francis and Lee Counties in the delta. Both counties are largely rural and suffer from extreme poverty and low educational attainment rates. Both also are in the top 15 percent in the Nation for coronary heart disease and stroke mortality.

Based on input from a Community Advisory Board in each county, the DHEC will recruit approximately 8 churches in each county. Half of the churches in each county will then be selected to participate either in a Lay Health Minister program or a Witness Role Models program. In the Lay Health Minister programs, health professionals from participating congregations will be recruited and trained to conduct health assessments of community members and to followup with information, advice, and referral services for those found to have CVD risk factors. In the Witness Role Models program, survivors of stroke or heart disease will be recruited from each congregation to work with a health educator to present information to the congregation about CVD risk factors and their own personal experiences with CVD.

The project will kick off with a health fair in each church at which participants will undergo a health assessment and be screened for blood pressure and cholesterol levels. Those found to have CVD risk factors will be referred either to their personal physicians or to the Lee County Community Clinic where they will receive care regardless of their ability to pay.

All participating churches will be offered the opportunity to provide educational activities for congregation members in a wide range of health areas, including smoking cessation, nutritional counseling, and exercise classes. Cooking demonstrations and youth group presentations aimed at discouraging tobacco use and encouraging heart healthy eating and physical activity will also be available.

The DHEC, in conjunction with the University of Arkansas for Medical Sciences regional programs, will also provide onsite training programs and Continuing Medical Education courses for physicians and nursing/office staff in the two counties to ensure that participants in the program receive appropriate care.

* St. Mary's Hospital in Huntington, WV, in collaboration with the State Education and Health Departments and American Heart Association chapter, is developing a school-based intervention for 8,000 third, fourth, and fifth graders, their families, and school staff in 45 public schools in a three-county area in Appalachia. This is a medically underserved community with high rates of unemployment, poverty, poor health, geographic isolation, and low adult education levels.

The intervention, called Helping Educators Attack Cardiovascular Disease Risk Factors Together (HEART), will enhance the local public school curriculum to provide information about healthy lifestyles and expand physical education programs to promote personal fitness and aerobic conditioning. It also will improve school meals and provide in-service training programs for teachers to increase their effectiveness in teaching health-related school subjects. Outreach to parents will also be conducted to promote the same attitudes, knowledge, and behavior. Children and families with CVD risk factors will be identified, and referrals will be made for treatment.

This approach is based on science-based interventions from NHLBI's SPARK and CATCH programs, two large health promotion studies that showed that multicomponent health promotion efforts targeting both children's behavior and the school environment will reduce CVD risk factors later in life.

* University of North Texas Health Science Center at Fort Worth, in partnership with a community-based clinic, a private hospital, and two coalitions of community-based organizations in the Dallas/Forth Worth area, is developing a comprehensive health promotion, health education and outreach initiative to increase awareness and knowledge about CVD prevention and promote heart-healthy lifestyles among Hispanics. The Hispanic population in this area is characterized by high rates of poverty, un/underemployment, poor educational attainment, and significant lack of access to health care, health education, and preventive services.

The project will use the materials and tools produced by NHLBI's "Salud para su Coraz�n" program, a community-based CVD prevention and outreach initiative. A major focus will be the use of lay health educators, called Promotores de Salud, to help identify individuals with CVD risk factors and to guide them through treatment and followup, providing individualized risk factor reduction education and promoting adherence to prescribed regimens. The intervention will also create a variety of neighborhood and community-wide awareness and education activities, such as guided group discussions, or charlas, community health fairs, cooking demonstrations, and mass media activities to reach community residents with heart health and family wellness messages.

* Wake Forest University School of Medicine in Winston-Salem, NC is developing the HEARTQUEST intervention to improve health care services in primarily rural Robeson and Columbus Counties in the southeastern part of the state. This is one of the most ethnically diverse parts of the U.S., with large numbers of Native Americans and African Americans. It also has one of the highest rates of CVD mortality in the country, attributable to such socioeconomic factors as high poverty rates, low levels of educational attainment, unemployment, and limited availability of quality health care services.

Working with local community-based organizations, HEARTQUEST will implement a variety of educational and health care activities to complement existing health promotion activities in this area. For example, they will provide training for primary care physicians and health clinics on the use of low-cost strategies and therapies for treating people with high blood pressure and high blood cholesterol levels. They also will work with local community-based organizations to help them improve their advocacy efforts for environmental policy changes to promote heart health�for example, walking trails and smoke-free restaurants and shopping centers. A model for training lay health educators to provide CVD prevention education to local community members will also be developed, and health fairs will be scheduled to conduct screenings and education activities to make community members more aware of their risk for CVD. Individuals with CVD risk factors will be referred to care. A special component will focus on improving emergency services and educating the community about responding quickly to heart attack symptoms.

HEARTQUEST is an acronym for Heart Attack and Stroke Education, Awareness, Rapid Response, Treatment Adherence, Quality Enhancement through Science Translation.

* West Virginia's Health Right Inc.'s Healthy Heart Project, located in Charleston, Kanawha County, WV will track and compare two groups of patients with heart disease risk factors who are seen at this free primary care clinic which serves the uninsured and underinsured poor in south-central West Virginia.

The project will provide one group with intensive behavioral interventions in exercise, nutrition, weight loss, and smoking cessation, as well as best medical practices, including pharmacological, diagnostic, and therapeutic interventions. The second group will receive only the same level of medical care.

The behavioral interventions will be tailored for each patient to achieve blood pressure and cholesterol control, to reduce hospital admissions and emergency department visits for CVD events, and to increase the number of people who know how to respond to signs of a heart attack. Special efforts will be made to address the problem of CVD in women.

Said Dr. Gregory Morosco, Director of NHLBI's Office of Prevention, Education, and Control, "We believe that mobilizing partners in high-risk communities and helping them implement today's best prevention strategies will save more lives and give more Americans a better quality of life. That is the goal of our Enhanced Dissemination and Utilization Centers."

For more information, contact the NHLBI Communications Office, at 301-496-4236.

For additional information on the NHLBI CVD EDUCs and cardiovascular health, visit the NHLBI Web Site at www.nhlbi.nih.gov.