Heart disease is personal battle for AHA officer
By Paul Bowers
When Carolyn Bivona reports for work at the American Heart Association's Gervais Street headquarters, it's more than just a paycheck. She's been without her father for 12 years, and she's been working here for five.
"It certainly makes what I do very important to me personally, that I can do something that will help someone else have family maybe not have to go through that," she said. Like many Americans, she has lost a parent to a heart attack. In other words, this job is personal.
As the American Heart Association's (AHA) director of state health alliances in South Carolina, she promotes what she calls "systems change" -- big-picture shifts in prevention, treatment and awareness of heart disease, especially when it comes to racial and gender disparities.
Cardiovascular disease, a family of conditions that includes hypertension, heart disease and stroke, is the leading cause of death in South Carolina. The state was ranked 36th lowest in a 2005 AHA study on state-level cardiovascular disease death rates, and the Department of Health and Environmental Control places South Carolina just five positions from the worst in stroke mortality rates.
At the South Carolina Department of Health and Environmental Control (SCDHEC), chronic disease epidemiologist Khosrow Heidari compiles and interprets survey data on heart disease from around the state. Heidari said he would venture to call the racial gap in heart disease prevalence rates significant. In 2006, black males over age 20 in South Carolina had a cardiovascular disease prevalence rate of 46 percent, compared to 38 percent for white males.
However, Heidari warns, "At the cross-sectional level, it's very difficult to say what causes what."
SCDHEC gets most of its funding from the federal government, which primarily provides tax money for sample-based studies that monitor statewide health. Longitudinal studies, which are better for showing causal relationships, are left to national-level researchers.
"We believe that, based on what is published, it is not the racial disparity," Heidari said. "It's not the outcome itself that can be explained by what we see in race, but it is more like determinants of health that can contribute."
Heidari tracks and analyzes trends in these determinants, including smoking, diet, exercise and access to medical care.
"A lot of studies focus issues on race where race doesn't mean anything," Heidari said. Factors such as income and education level are better predictors of heart disease risk than race, he said.
In some areas, mortality rates can be linked to lack of quickly available treatment. When it comes to heart attacks, minutes lost can mean heart muscle lost, and when it comes to stroke, they can mean brain function lost.
"The I-95 corridor is an area that we recognize as the buckle of the stroke belt in South Carolina," Heidari said. The problem, he said, is that many hospitals in the area lack specialists to deal with issues like stroke. The solution? Telemedicine.
At the Medical University of South Carolina (MUSC) in Charleston, Dr. Robert Adams has helped establish virtual connections with six hospitals, including McLeod Regional Medical Center in Florence and the Georgetown Hospital System.
Through videoconferencing, neurologists at MUSC speak to patients across the state and instruct doctors to administer treatment. For instance, after making a diagnosis, an MUSC neurologist could tell a doctor in Florence to give the patient a blood clot-busting medicine.
"We'll support them as far as they can go," Heidari said. SCDHEC does not have the funds to throw itself behind initiatives like Dr. Adams' financially.
According to SCDHEC, heart disease killed 174 of every 100,000 Richland County residents in 2006, compared to 12 killed by homicide. Heidari said the competition for funding among state agencies is a long-standing one.
"Chronic diseases aren't sexy," he said. "Somebody dying of a heart attack or a stroke is not as intriguing to the public as somebody getting shot."
Amidst funding deficiencies, state agencies sometimes partner with private organizations. SCDHEC and the American Heart Association work together to raise awareness and promote prevention statewide, with varying degrees of success. This is where Carolyn Bivona gets involved.
"I personally think it's wonderful to get out awareness and work with people on an individual basis," Bivona said. "But I think in order to really make significant changes that will reach a lot of people, what you have to do is change the system."
The AHA's efforts in South Carolina are broad-ranging, including billboards, public relations campaigns and corporate partnerships to encourage physical activity during break time.
Bivona said part of the state's mortality problem, whether in the black community or elsewhere, is a hesitancy to call 911 or make an emergency room visit in the event of a stroke or heart attack.
"A lot of times what they'll do is diminish their symptoms and think it's not that severe, so they'll either put off going to the emergency room or they'll have a family member drive them to the emergency room, which just wastes tremendous valuable time," she said.
Honing in on racial health disparities, the AHA's Power to End Stroke campaign is designed partly to encourage African-Americans to seek medical help sooner rather than later.
While African-Americans have had higher prevalence rates of stroke and heart disease mortality in recent years, they have also reported themselves less likely to be diagnosed with heart disease while living than their white counterparts. The Behavioral Risk Factor Surveillance System, a survey conducted by SCDHEC, shows a 2.4 percent Yes response rate among African-Americans to the question "Has a doctor ever told you that you have angina or coronary heart disease?" compared to 5.5 percent for whites.
The campaign, which pushes preventative health measures (including cutting back salt intake) and emphasizes the black community's statistically greater risk, includes partnerships with Columbia area churches to get the message across. Bivona said her office was working with Bethel A.M.E. Church in Melrose Heights and Brookland Baptist Church in West Columbia, among other churches.
"People tend to trust their churches sometimes more than they would trust someone from the outside giving them information," Bivona said. "Either having the minister or an elder or someone that's respected in the church get up and talk about healthcare issues can really reach people where maybe they wouldn't be reached another way."
At Brookland Baptist on Sunday morning, Senior Pastor Charles Jackson took a moment to commemorate congregants and loved ones who had died recently. Some, including a man named Freddie who was 45, died young. The church, which has a dedicated Health and Wellness Center, ministers to the body as well as the spirit.
However, among the senior leadership milling about behind the pews after the service, none could give information about the Power to End Stroke movement when approached.
"I wish I could say more, but I've never heard about it," said a nonplussed Donald Jackson, a director at the Health and Wellness Center.
At SCDHEC, Khosrow Heidari acknowledges the agency's efforts can be hit and miss.
"I think there are a couple of areas where we've done well," he said. "Others, not so much."
Overall, South Carolina has seen improvements. It has climbed from worst in the nation for stroke mortality to fifth-worst. Diabetes is on the decline.
However, following a nationwide trend, obesity is on the rise and physical activity continues to drop. And a cardiovascular health gap persists between black and white South Carolinians. It is a gap maintained by cultural, economic and political barriers.
"If you want to say what causes this health disparity: access to care, education, income," Heidari said, pausing to take a sober sip from a cup of just-brewed tea. "Those are the determinants of health that, if you factor in those elements, all of a sudden health disparity disappears." RCT