Cardiovascular Risk Reduction in Rural Appalachian Kentucky

Cardiovascular disease (CVD) is the number one killer of Americans. The same is true in Kentucky, with heart disease accounting for 35% of all deaths. Only six states have higher rates of CVD mortality. Southeastern rural Kentucky is in the "heart and stroke belt" because of its extremely high rate of heart disease, stroke, and related risk factors. CVD mortality in Breathitt and Perry counties is many times that of other Kentucky counties and the nation.

The Kentucky River Area Development District (KRADD) in rural southeastern Kentucky had the highest number of heart disease-related deaths in Kentucky, with an age adjusted rate almost double that of the state overall. Breathitt, Clay, Knott and Perry counties are among Kentucky's least healthy, with Breathitt ranking 108 out of 120, Clay 119, Knott 114, and Perry 117. High rates of obesity, diabetes, and smoking, poor diets, and infrequent physical exercise add to the problem.

This Collaborative will bring the HeartHealth initiative to rural Appalachian Kentucky. HeartHealth is a one-on-one cardiovascular disease (CVD) risk factor management education and support program that is culturally appropriate for rural Appalachia. It is currently being delivered to Perry and Breathitt County residents with one or more CVD risk factors. The HeartHealth team, led by Debra K. Moser and including M. John Novak, Baretta Casey, Alison Bailey, Terry Lennie, and Gia Mudd, is multidisciplinary, involving nursing, dentistry, medicine, and nutrition sciences. Its education and support program addresses individual and cultural barriers to reducing risk of cardiovascular disease and teaching self-management of risk factors using state-of-the-art educational strategies for promoting behavior change. This initiative will use a group version of the HeartHealth intervention in Perry, Breathitt, Knott, Clay, and surrounding counties to maximize impact and reduce cost.

Community partners include the Center for Excellence in Rural Health-Hazard and its satellite clinics; the elementary school system in Clay County; the Perry, Breathitt, and Knott County senior centers and public health departments; and multiple churches. All of these entities are working to facilitate participation and retention in the program. All partners have provided time and space to put on the program and collect participant data. Equally important, staff at these community sites are learning the program in order to continue it after the UK team is no longer on site.

UK will continue to work with all of these sites and others to identify and test programs for improving rural Kentucky's poor cardiovascular health. Over time, the intent is to extend the program to all Kentucky Centers for Excellence in Rural Health.

Expected Actions and Outcomes

Several short and long-term outcomes will be tracked over time so changes can be detected. Measures include specific medical tests as well as other factors impacting cardiovascular health: health literacy, family health history, and past and current health history.

The team will track and report on the initiative over a three-year period.