CardioExchange Archive

A 40-year program in one poor rural county to combat cardiovascular disease appears to have been successful, resulting in reduced rates of hospitalization and death compared with other counties in the same state over the same period. The new findings are described in a paper published in the Journal of the American Medical Association.

Beginning in 1970, Franklin County, Maine began a nearly unprecedented, comprehensive, county-wide program to improve cardiovascular risk. The program sought to help residents lower elevated blood pressure and cholesterol levels, quit smoking, improve their diets, and increase their physical activity. During the program, county residents, who numbered 22,000 at the start of the study, had more than 150,000 individual interactions with the program. The program was created and run by local public officials, physicians, and the community hospital.

When compared with other counties in Maine, Franklin County had a higher-than expected, income-adjusted total mortality rate before the start of the program.  After the start of the program, mortality was significantly lower than expected. There was a similar reduction in hospitalization rates, resulting in a cut of $5.4million in county hospital charges each year.

Other risk factors also improved at different points over the study period as new initiatives were implemented. Blood pressure control increased from 18.3% in 1975 to 43.0% in 1978 . Control of elevated cholesterol increased from 0.4% in 1986 to 28.9% in 2010.

Because this is not a report from a randomized trial, it is impossible to state with full confidence that the findings are a genuine result of the program. But in an accompanying editorial, Darwin Labarthe and Jeremiah Stamler write that the findings appear plausible given that the individual interventions used have been found to be effective previously. The report, they say, should “reinforce the importance of cardiovascular health promotion and disease prevention policies and practices at the community level; stimulate efforts in communities to document and publish their past experience in this area to inform related ongoing work; and foster wider application of program evaluation and implementation research, exploiting new data sources and technologies to accelerate replication and scaling up of community-based prevention.”