Heart Failure in Rural Areas
- Heart failure disproportionately affects people living in rural areas, especially Black men, according to a new study published in JAMA Cardiology.
- Heart failure is a condition in which the heart does not pump blood as well as it should.
- The underlying reasons for this trend need to be recognized, such as lack of access to healthy foods and lack of access to physicians.
- To lower your risk of developing heart failure, you can eat nutritious meals and snacks, avoid cigarettes, get regular exercise, and work with your doctor to manage your other conditions, like high blood pressure.
Rural Black men especially face a much higher risk of the disease. A lack of healthy grocery stores, a shortage of physicians in rural areas, and longstanding healthcare disparities may all be to blame for this trend.
Read MoreHeart Failure: What Does It Mean?
The Centers for Disease Control and Prevention (CDC) defines heart failure as the inability of the heart to pump enough blood to keep up with the demands of the body. The underlying cause is usually repeated damage to the heart muscles, be it through years of uncontrolled high blood pressure or heart attack(s).Heart failure does not mean that your heart has actually "failed" or stopped beating just that it is having some issues pumping blood.
This condition does not develop overnight. Rather, it happens slowly, and its early signs and symptoms often go undiagnosed. A very slow onset of shortness of breath with normal activities is commonly noted in heart failure patients.
It is a very common disease in the United States, with an estimated 6.5 million people affected by it, according to the Heart Failure Society of America (HFSA). Around 1 million new cases of heart failure are diagnosed annually with most people developing it after 65 years of age.
The disease can also be deadly, with a study noting heart failure as the cause of death on 379,800 death certificates in 2018.
RELATED: My Doctor Says I Have Heart Failure. What Does That Mean?
Heart failure, thus, is one of the major healthcare problems facing our nation today.
Risk Factors for Heart Failure
The mechanism of heart failure is relatively straightforward. The heart muscle is repeatedly injured over time, becoming progressively weaker until it is unable to perform its function adequately.
Numerous health conditions can cause these injuries, including but not limited to:
- High blood pressure, usually when it is uncontrolled and unmanaged
- Older age. The risk of heart failure is highest in individuals older than 65 years
- Heart attacks, which can sometimes cause the death of a significant amount of heart muscle
- Heart valve abnormalities or damage. These usually make it harder for the heart to pump blood. Over time, they tax the heart muscle to the point that it cannot keep up.
- Plaque or fat buildup within the arteries. As fat progressively builds up, it makes it harder and harder for the heart to squeeze the blood through.
- Diet
- Smoking
- Obesity
- Diabetes
Managing Heart Failure
Time is of the essence in the management of heart failure. The earlier it is diagnosed, the sooner measures can be taken to alleviate the stress on the heart and prevent future injuries to the heart muscle.
RELATED: Treating Heart Failure: How Diuretics Can Help
Management is usually customized to each patient but usually involves a multipronged approach. This can commonly include lifestyle changes, such as improving diet and exercise, paired with medications, such as those that control blood pressure.
If a mechanical defect, such as a faulty valve, is the underlying cause of the failure, surgery may be recommended to correct the defect. In severe cases, where the heart has been significantly compromised, a heart transplant may be considered.
All in all, it is extremely important to diagnose and treat this condition early as that gives patients their best shot at living a normal, active life.
Care can, however, be significantly impacted by access to healthcare services. Therefore, areas with limited access, like the rural U.S., oftentimes suffer the most at the hands of this disease.
The Link Between Rural Areas, Race, And Heart Failure
Researchers at the National Institutes of Health (NIH) and Vanderbilt University put their heads together to investigate the effect of rural locations on heart failure outcomes. Their findings were published recently in a revealing study.
They recruited 27,115 low-income, underserved adults without any heart failure from rural and urban areas of 12 states between 2002 and 2009. The states included in the study were Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia.
Of the participants, 5,556 (20%) lived in rural areas while the rest lived in urban areas. And 18,647 (68.8%) participants were Black.
The investigators followed these people over 13 years on average and recorded which individuals developed heart failure. Rural inhabitants were 19% more likely to develop heart failure than urban dwellers.
Broken down by race and sex, Black men, Black women, and White women living in rural areas were significantly more at risk for heart failure than their urban counterparts. Black men in rural areas especially faced the most concerning odds (35%).
There was no difference in heart failure risk for White men in rural or urban areas.
Why Does The Rural Population, Especially Black Men And Women, Have A Higher Risk?
This exact answer to this question is an area of active research. However, it is reasonable to say that it is due to a combination of reasons.
Access to Health Food
The rural population often has limited access to affordable and healthy grocery stores. Since diet plays an important role in heart failure development, this limited access can contribute to an increased risk.
Access to Physicians
There is also a severe shortage of doctors serving rural areas. This means that patients often have to travel long distances to see a physician, which can both be inconvenient and costly. Many may end up waiting until their symptoms get significantly worse to make such a trip.
Predisposition to Other Health Conditions
Predisposition to certain diseases may also play a role. Several studies have shown that Black patients are at a higher risk for developing high blood pressure and obesity, both of which can lead to heart failure over time.
Disparities in Healthcare
The Black population faces extreme inequities and biases within our healthcare system. Time and again, studies show that such healthcare disparities translate into poor health outcomes for the Black population.
There is a general mistrust of physicians and the healthcare system among Black patients. Studies show that they are less likely to trust and seek help from physicians.
Healthcare Systems & Physicians Can Change This Trend
To address the rural physician shortage, many medical schools and hospital systems now recruit and train physicians to practice specifically in rural areas. Many states incentivize this practice as well through medical student loan forgiveness programs.
Further expanding and incentivizing rural medical practice can help change the physician shortage epidemic.
Improving telemedicine services is another way to expand healthcare access in rural areas. The COVID-19 pandemic saw a boom in telemedicine, allowing physicians to care for their patients remotely during lockdowns.
For the patients, the ability to converse with their physicians from the comfort of their homes without the need to travel long distances opened up an era of unparalleled convenience and access. This telemedicine model can easily be adapted to provide accessible healthcare in rural communities.
How Can I Take Charge Of My Heart Health?
RELATED: How Lifestyle Changes Can Help with Managing Heart Failure
Many of the risk factors for heart failure, fortunately, are modifiable with diet, exercise, and medications. To lower your risk of developing heart failure or worsening the condition, you can:
Eat healthy meals and snacks.
- Food that is high in fiber, low in saturated and trans fats, and low in cholesterol can help keep your heart healthy.
- If you have diabetes, monitoring your sugar consumption can help control your blood sugar levels.
- If you have high blood pressure, lowering your salt intake may help you manage your blood pressure better.
Avoid excessive alcohol consumption.
Avoid cigarette smoking.
- Smoking has a strong link to heart disease. Never smoking or quitting the habit can significantly reduce your risk of developing heart failure.
Get regular exercise.
- Studies show indisputable benefits of exercise for controlling blood cholesterol and sugar levels, blood pressure, and maintaining a healthy weight.
Maintain a healthy weight.
- Being overweight or obese can put a significant amount of stress on your heart. Reducing this stress by maintaining a healthy weight will promote heart health.
Manage Your Other Health Conditions
- If you have high blood pressure, high cholesterol, or diabetes, work closely with your physician to manage these conditions. This can include regularly checking your blood pressure at home, getting blood work done at regular intervals, checking your blood sugar levels throughout the day, and taking your medications as directed.
If you are not established with a physician or a healthcare team, take steps to do so. Telehealth services have expanded by leaps and bounds recently, and you may be able to have regular checkups with your doctor via telephone/computer.
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