AHA awards $20 million to address health challenges in rural communities

People who live in rural areas of the U.S. are 40% more likely to develop heart disease and have a 30% higher risk of stroke than people who live in urban areas, according to data reported in the 2020 Call to Action: Rural Health: A Presidential Advisory From the American Heart Association and American Stroke Association. At least 20% of the U.S. population live in rural areas and these people face unique health challenges related to individual risk factors, social determinants of health and lack of access to health care. To address this issue, the American Heart Association, the world's leading nonprofit organization focused on heart and brain health for all, is funding a new $20 million scientific research initiative comprised of a network of special projects focused on advancing the understanding of the factors that impact health in rural America.

The Health Equity Research Network on Improving Access to Care and other Health Inequities in Rural America is part of the multi-pronged approach of the American Heart Association's ongoing work to improve health in rural America. Teams of scientists from Children's Hospital Medical Center in Cincinnati, Ohio; Duke University School of Medicine in Durham, North Carolina; Oregon Health & Science University in Portland; VA Palo Alto Health Care System in Palo Alto, Calif.; and the University of Washington School of Medicine in Seattle will lead the community engaged research projects. The University of Washington will also serve as the coordinating center for the network, leveraging expertise across network sites and nationally, to help train the next generation of rural health equity researchers, providing consultation and guidance, compiling data reports and coordinating the administration of the initiative.

"Along with higher rates of heart disease and stroke, people living in rural areas of the U.S. have a 20% higher death rate than people in metropolitan and urban areas and rural Americans live an average of three years fewer than their urban counterparts," said American Heart Association 2022-23 volunteer president Michelle A. Albert, M.D., M.P.H., FAHA, who is the Walter A Haas-Lucie Stern Endowed Chair and professor of medicine, director of the CeNter for the StUdy of AdveRsiTy and CardiovascUlaR DiseasE (NURTURE Center) and associate dean of admissions at the University of California, San Francisco. "Rural populations have higher levels of obesity, diabetes and hypertension and higher rates of tobacco use – all factors that negatively impact heart and brain health. They have also been plagued by increasing prevalence of substance use disorders associated with opioids and methamphetamines. All of these risk factors contribute to poor health. In addition, higher rates of poverty, lower levels of education, lack of public transportation and shortages of health care facilities and providers contribute to the unique obstacles rural communities face in achieving good health. This new research initiative will explore innovative ways to address these challenges, as well as determine how tried-and-true methods can be used to make meaningful change."

Reciprocal Innovations to Improve Cardiovascular Care in Rural America (Rural PRO-CARE) is the name of the overarching research network. The coordinating center will be managed by a team from the University of Washington School of Medicine, led by Chris Longenecker, M.D., FAHA, an associate professor of medicine and director of the university's Global Cardiovascular Health Program. Key activities of the coordinating center will include communication and reporting, scientific and regulatory oversight with the assistance of an expert advisory board, organizing annual meetings and providing a coordinated training curriculum for fellows across the network. The center team will also support collaborative efforts among the five project sites in developing and testing technology-based implementation strategies to promote uptake of evidence-based interventions within local rural practice in the U.S. Drawing on expertise in health policy and workforce development, the center team will help bring research findings to more widespread practice by disseminating policy briefs to policymakers and by conducting workforce training events for allied health professionals.

The five targeted research projects, which begin on July 1 and run for four years, include:

• Implementation and Scale-up of the American Indian Structural Heart Disease Partnership (IN-STEP) at Children's Hospital Medical Center in Cincinnati, Ohio – led by Andrea Beaton, M.D., M.S., FAHA, an associate professor at Children's Hospital Medical Center, this team developed an approach to bring heart disease diagnosis closer to where people live. This includes teaching health workers to use portable ultrasound machines to check people for heart disease. These ultrasound machines have tools that help non-experts take the pictures and know if something is wrong. Their goal is to figure out how to bring this approach to more people. In the American Indian community this will be done by patterning with community health representatives (CHRs). CHRs are Tribal members who provide health screening, education, and support. As community members, they understand what people need and how it is best delivered. This study will determine how effective the program is in finding people living with heart disease. It will also look at how communities react to the program and if it is well designed to meet their needs.

• Developing and Testing Drone-Delivered AEDs for Cardiac Arrests In Rural America at Duke University School of Medicine in Durham, North Carolina – led by Monique Starks, M.D., M.H.S., an associate professor of medicine and cardiologist at Duke University, this team test the use of drones to bring automatic external defibrillators (AEDs) to out-of-hospital cardiac arrest patients faster. Every year, more than 350,000 people have a medical emergency called sudden cardiac arrest. It is hard to survive a cardiac arrest, but fast medical treatment, including CPR and the use of an AED can help. According to the American Heart Association, 9 in 10 cardiac arrest victims who receive a shock from an AED in the first minute live. Right now, it takes at least 8-10 minutes for emergency responders to reach most out-of-hospital cardiac arrest patients. This study aims to help more people survive, especially in rural areas where it takes longer for health care professional help to arrive.

• Rural Community Peer Partnerships for Improving Methamphetamine-Associated Heart Failure Screening and Engagement at Oregon Health & Science University in Portland, Oregon – led by Todd Korthuis, M.D., M.P.H., professor of medicine and head of the addiction medicine section at Oregon Health & Science University, this team aims to improve the identification of risks and the treatment of heart failure among people who use methamphetamine. Oregon currently has rural peer recovery support specialists who work with people who use drugs and facilitate screening and linkage to telemedicine for hepatitis C treatment. Similar peer-based telemedicine approaches may also improve heart failure care in rural Oregon communities where 97% of people who use drugs report recent methamphetamine use. The team will train rural heath peer specialists to incorporate into their routine outreach work ways to assess the risk of heart failure among people who use methamphetamine. People at increased risk of heart failure will be assigned to remote heart expert team visits using the internet arranged by peers or referred for local cardiology care. This study will improve rural health by increasing the number of people working on this issue, and by finding new ways to improve life for people in rural areas who experience substance use disorders.

• Implementation and Evaluation of Pharmacist-Based Management of Chronic Heart Failure for Rural Veterans (PHARM-HF) at the VA Palo Alto Health Care System in Palo Alto, California – led by Paul Heidenreich, M.D., M.S., FAHA, a professor, and vice chair for quality in the department of medicine in the Stanford University School of Medicine, this team will test ways to increase care by pharmacists for rural veterans with heart failure. The team will train pharmacists on heart failure care and determine if this approach will expand heart failure care delivery in rural areas. Patient engagement is also critical for the best care and patients can advocate for their best care if they have the proper knowledge. Therefore, the team will modify an existing smart phone education app to help rural veteran patients learn about their heart failure and test if using the app improves care.

• GROW-RURAL: A Global to Rural Innovation Network to Adapt Evidence-Based Cardiovascular Interventions to Context at the University of Washington School of Medicine in Seattle, Washington – also led by Dr. Longenecker, this team will study people with health challenges living in rural areas of the United States including special rural ethnic groups of people like American Indians and Latinos. The team will look into how geography plays a role when long distances to the nearest doctor which can limit access to care. They'll also explore whether new ways of delivering health care in other countries may be adapted in the rural U.S. Their goal is to discover barriers as well as opportunities to improve heart health care and then let local health workers and patients design programs to test new innovations in their communities.

The Health Equity Research Network on Rural Health is the third health equity research network funded by the Association. The Health Equity Research Network on Disparities in Maternal-Infant Health Outcomes launched in July 2022 to focus on advancing the understanding of the factors underlying the disproportionate impact of pregnancy complications and deaths women of color, The Health Equity Research Network on the Prevention of Hypertension launched in July 2021 with research projects focusing on hypertension prevention in underserved populations.

The American Heart Association has funded more than $5 billion in cardiovascular, cerebrovascular and brain health research since 1949, making it the single largest non-government supporter of heart and brain health research in the U.S. New knowledge resulting from this funding benefits millions of lives in every corner of the U.S. and around the world.