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• Posted January 27, 2023

Risks for Heart Failure Rise in Rural America

Adults who live in rural areas, and Black men in particular, are at much higher risk for developing heart failure.

Heart failure is a chronic, progressive condition that develops when the heart fails to pump enough blood for the body's needs.

Researchers from the U.S. National Heart, Lung and Blood Institute (NHLBI) and Vanderbilt University Medical Center in Nashville, Tenn., analyzed data from a long-term health study of adults in the southeastern United States.

They found that, overall, adults who live in rural areas of the United States had a 19% higher risk of developing heart failure compared to those living in urban areas. For Black men in rural areas, that risk was 34% higher.

"We did not expect to find a difference of this magnitude in heart failure among rural communities compared to urban communities, especially among rural-dwelling Black men," said study co-author Dr. Véronique Roger, a senior investigator with the Epidemiology and Community Health Branch in the NHLBI's Division of Intramural Research.

"This study makes it clear that we need tools or interventions specifically designed to prevent heart failure in rural populations, particularly among Black men living in these areas," Roger said in a news release from the U.S. National Institutes of Health (NIH), which supported the research.

White women living in rural areas had a 22% increased risk of heart failure compared to those living in urban areas. Meanwhile, Black rural women's risk was 18% higher than their urban counterparts.

The research team did not find an association between rural living and heart failure risk among white men.

"It is much easier to prevent heart failure than to reduce its mortality once you have it," said co-author Sarah Turecamo, a fourth-year medical student at New York University's Grossman School of Medicine and part of the NIH Medical Research Scholars Program.

For the study, researchers compared the rates of new onset heart failure among rural and urban residents in 12 states, which included a total of more than 27,000 people. About 20% lived in rural areas and 80% lived in urban locations. About 69% of study participants were Black adults recruited from community health centers that care for medically underserved populations.

The states studied were Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia and West Virginia.

It's not clear why this disparity in heart failure rates exists. Potential reasons could include structural racism, inequities in access to health care and limited grocery stores providing affordable, healthy foods.

"Finding an association between living in rural areas and an increased incidence of heart failure is an important advance, especially given its implications for helping to address geographic-, gender- and race-based disparities," said Dr. David Goff, director of NHLBI's Division of Cardiovascular Sciences.

"We look forward to future studies testing interventions to prevent heart failure in rural populations as we continue to fight heart disease, the leading cause of death in the U.S.," he said in the release.

Heart failure affects about 6.2 million American adults. It can be prevented with a lifestyle of healthy foods, exercise, no smoking and preventing or treating high blood pressure.

The findings were published Jan. 25 in the journal JAMA Cardiology.

More information

The American Heart Association has more on heart failure.

SOURCE: U.S. National Institutes of Health, news release, Jan. 25, 2023