Defining Community Strategies to Reduce the Impact of Cardiovascular Disease

Strategies are needed to translate research outcomes to community CV benefits. The Dan River Cardiovascular (CV) Health Initiative Program (DRchip), a COSEHC Cardiovascular Center of Excellence, is an NHLBI Education & Dissemination Center, in a high CV mortality community. Four interventions were tested. Interventions: 1) faith-based, business, and community CV risk screening and education; 2) middle school student CV health education, risk factor screening, and physical activity promotion; 3) enhanced physician CV continuing medical education (ECCME) with clinical educational outcomes; 4) community case management (CM) of congestive heart failure (CHF). Study Population: 1) Over 6000 adults over 3 years were CV screened and educated, 2) 431 middle school children were screened annually for 3 years and received 22 hours per year of CV education, 3) 10 of 49 physicians chose to participate in CV ECCME, and 4) 39 hospital CHF patients entered CHF CM. Outcomes: 1) CV adult screening, 45% BP >140/90 mm Hg, 11% blood cholesterol >200 mg, and/or 20% elevated BMI. All referred to medical management. 2) In 2002 among 6th, 7th, and 8th grade middle school children (MSC) the prevalence of overweight (OW) (>85th percentile for age/gender) was 19%, 25%, 60% & the prevalence of HBP (>90th percentile for age) was 9%, 10%, 15%, respectively. In 2003 the prevalence among 6th, 7th, and 8th grade MSC of OW had increased to 61%, 46%, and 48% with the prevalence of HBP being 6%, 11%, and 11%, respectively. In response to this MSC data, fried foods and high sugar content juices were removed from school foods and heart healthy alternatives were provided. After-school DRchip physical activity program was begun. MSCs reported improved CV lifestyles. 3) Systolic HBP control was better over 6 months by 10 ECCME physicians compared to 29 non ECCCME physicians.(ECCME: 156.6 vs. 134.7 mm Hg; P < 0.004) (Non-ECCME physicians 157.7 vs. 139.7; (NS). 4) None of the 39 CHF CM patients returned to the emergency room (ER); 3 readmitted to hospital for terminal care. Conclusions: The community interventions were shown to 1) identify adults with CV risk factors, 2a) identify a high prevalence of OW MSC of whom 10.3% (mean of 3 grades/2 yrs) had HBP, 2b) improved MSC CV lifestyles opportunities, 3) improved systolic HBP control by ECCME physicians, and 4) eliminate hospital ER of CM CHF patients.