MATTERS OF THE HEART: Cardiac care is making great strides in North Carolina, as health care systems improve outreach to rural and urban populations.

AuthorBlake, Kathy
PositionFOCUS ON: CARDIAC CARE

More than half of Macon County rests in the Nantahala National Forest in a secluded western North Carolina pocket popular for hiking, whitewater rafting and waterfalls.

Highlands, one of the county's two incorporated cities, sits on an Appalachian Mountain plateau 4,100 feet up and has fewer than 1,000 residents. County seat Franklin is a stop on the Appalachian Trail.

Asheville-based Mission Health, the state's sixth-largest system with an eight-hospital network, owns Highlands-Cashiers Hospital and Angel Medical Center in Franklin.

Every three years, the two update their Community Health Needs Assessment and strategize ways to battle the same persistent beast: Heart disease is Macon County's No. 1 killer.

In 520 square miles, nearly half of it wilderness, Macon has fewer than 35,000 people. Like its counterparts across the state, Mission is tasked with reaching a rural population to communicate coronary dangers, causes, remedies and prevention.

"Every visit, at least in my own clinic, not only talk about their coronary disease or their bypass or the stent we put in, it's their weight control, their exercise," says William Kuehl, Mission Health's chief of cardiology.

The N.C. Department of Health and Human Services says Macon had from 141 to 165 annual heart disease deaths from 2013-17. Sixty-two of the state's 100 counties had a higher fatality rate. Overall, 18,840 fatalities in 2017--the equivalent of two per hour and 20% of all deaths--were attributed to heart disease, the state's second-leading cause behind cancer. Stroke is third. Richmond, Bladen and Columbus counties in the south and Pasquotank County in the northeast have the highest coronary numbers, at 229 to 302 in that four-year span.

North Carolina is in the 11-state Stroke Belt, where minimal exercise and unwholesome diets drive heart disease risk 34% higher than in other areas of the country. One factor is location: Eighty of 100 counties are considered rural, with fewer than 250 persons per square mile. About 40% of the population, or 4 million people--second only to Texas--live away from urban areas. Hospitals are fighting back with outreach, technology and surgical advances.

"One thing we did was to be more proactive in getting people to be active, knowing that heart disease is associated with people who are not moving or eating healthy," says Bonnie Peggs, manager of community relations and hospital chaplain in Franklin, who coauthored the needs assessment.

Angel initiated a free Passport to Wellness program, which includes seven annual community events such as tobacco education classes, health fairs, blood pressure and glucose checks, and stroke assessments. "Every week, we encourage business people to meet with us and walk the paved greenway walking trail during lunch," Peggs says.

Hospitals across the state are pushing into the outskirts of their coverage areas to fight obesity, tobacco use, high blood pressure and lack of physical activity.

Charlotte-based Atrium Health's The Perfect Care: Personalized Cardiac Care and Collaborative, an...

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