Primary Care: Support for Rural and Vulnerable Populations

Cardiovascular disease (CVD) continues to be the leading cause of morbidity and mortality across the globe, and rural and vulnerable populations are disproportionately affected by CVD. Primary care support for rural and vulnerable populations is the ideal setting for addressing the acute and chronic issues faced by these individuals, as well as providing a consistent location for addressing risk factors, providing access to prevention services, and referrals to specialty care when warranted. 

Primary Care

Primary care offers a wide range of health-related benefits, including:

• A usual or regular source of care, early disease detection, and chronic disease management^1,2
• Higher likelihood of receiving recommended preventive services (e.g., flu shots, blood pressure readings, cancer screenings)^1,3

Primary care settings are not immune to issues such as staffing and resource limitations, which can lead health care professionals to feel overwhelmed. Working in partnership with patients, families, colleagues, and communities helps to provide consistent, accurate messaging about healthcare issues, empowers individuals to take an active part in their health, and can provide a springboard for advocacy efforts to alert decision-makers about issues facing individuals and populations.

Cardiovascular Health Measures

Since 2010, the American Heart Association has provided a simple metric to help patients with a lifelong framework for improving or maintaining good cardiovascular health. Updated in 2022 to Life’s Essential 8™ (LE) these key measures can help patients reduce their risk for heart disease, stroke, and other major health issues. A scoring system helps to identify where patients are with regards to their overall cardiovascular health.

Applying strategies to address the LE categories and improve patient outcomes can be done in any setting. For those in primary care, they provide a touchstone at each visit and a longitudinal guide for helping patients best understand what they can do to improve their overall and cardiovascular health.

Discouragingly, however, the measures indicate that there continue to be gaps for many groups. Especially for young adults aged 18-44—and particularly for those in vulnerable populations—most measures of cardiovascular fitness and health are lower than for their non-Hispanic White counterparts and, additionally, fitness levels have remained stagnant or even declined since 2007.⁴

Sex disparities are also seen in cardiovascular health measures. While strides have been made in improved scores for smoking and lipids, declines continue in scores for body mass index, blood pressure, and other measures—particularly for males.

Rural Health

A particular patient population to consider for primary care interventions and follow-through is those that live in rural areas—which encompasses 20% of the US population. These residents have a 40% higher prevalence of cardiovascular disease (CVD) and worse LE8 factors.⁶

The disparities between rural and urban areas have continued to widen, with health outcomes now significantly worse for people in rural counties, with rates of overall mortality and cardiovascular mortality continuing to rise.⁶

There are a number of factors that complicate those in rural areas with acute or chronic conditions, including CVD:⁵

• Rural populations are significantly older than those in urban areas—although their lifespan averages 3 years less than urban dwellers
• Rural residents have less favorable mental and behavioral health—which has been tied to CVD incidence and mortality in both children and adultsvi
• In a recent study of 3,143 rural counties, less than 54% had at least 1 cardiologist
• Average round-trip distance to the nearest cardiologist ranged from 16 miles in those counties with a cardiologist, and over 87 miles for those living in counties without a cardiologist

Primary Care Support for At-Risk Individuals and Populations

What does this data mean for primary care? 

Primary care support for rural and vulnerable populations can provide coordinated care for those most at risk for CVD, meeting patients where they are and offering regular, consistent opportunities to engage with the health care system and participate in not just treatment, but prevention.  

As in other settings, it is important for those in primary care to recognize how social determinants of health impact patients. Factors such as limited access to care, financial instability, language barriers, and discrimination at the systemic and individual levels can negatively impact individual and population health. Being aware of barriers faced by individuals and communities, providing links to resources, and advocating for rural and vulnerable populations can collectively reduce barriers and lead to improved health. 

Key Takeaways

• Primary care settings that are easily accessible, have adequate staffing and other resources, and are welcoming to all audiences, can be a keystone in the solution set of addressing the health disparities for vulnerable populations and those in rural areas
• In primary care and other settings, identifying and addressing social determinants of health can positively impact patients and their outcomes
• Primary care teams, in tandem with local, regional, and national stakeholders, can advocate for the needs of rural and vulnerable populations.