The Solution to the Rural-Urban Heart Failure Risk Disparity Surly Benefits from a Cyber-Physical Human System (CPHS)

Rural communityPhoto byby author using Wonder Digital Art

Heart failure, also referred to as congestive heart failure, is a chronic progressive ailment of the Cardiac muscle. The affected patient's heart muscle fails to pump enough blood to their body and organs to sustain its vitality.

The failure to pump blood through the body causes the blood to back up in the lungs yielding shortness of breath or other parts of the body, ensuing swelling, organ failures, and disability.

Those with heart failure can suffer from various symptoms, including shortness of breath with activity or when lying down, fatigue and weakness, swelling in the legs, ankles, and feet, rapid or irregular heartbeat, and chest pain if a heart attack causes heart failure. They can also have other symptoms such as decreased exercise tolerance, intractable cough or wheezing, swelling of the abdomen, very rapid weight gain from fluid buildup, nausea and lack of appetite, and difficulty concentrating.

Any condition that damages the heart muscle can cause heart failure. However, the most common causes constitute heart attack and coronary artery disease, persistent untreated high blood pressure, heart valve diseases, dysfunction, damage to the heart muscle by toxins, infections, congenital heart structure issues, and unknown causes.

American Heart Association reports that up to 1.9% of the U.S. and Canadian population and about 2% of Europeans suffer from heart failure.

Another study conducted by the U.S. National Heart, Lung and Blood Institute (NHLBI) and Vanderbilt University Medical Center in Nashville, Tennessee, recently found that adults who live in United States Rural communities have a 19% higher risk of suffering from heart failure than their peers in the urban neighborhoods.

The study also finds black males living in rural areas have 34% higher risk than white citizens. Meanwhile, white women with a 22% increased risk and black rural women with an 18% higher lead their urban counterparts on heart failure risk.

A recent publication in JAMA Cardiol finds the relationship between rurality with risk of heart failure independent of cardiovascular risk factors and a person's socioeconomic status.

Despite the breakthrough finding, the reason behind rural and urban disparity in heart failure prevalence is still unclear.

Some researchers speculate that many elements may contribute to the higher risk of heart failure in rural communities. These include structural racism, healthcare access inequities, and a shortage of grocery stores that offer healthy and affordable nutrition.

Another observation negates the close association between rurality and heart failure risk among white men. This finding may serve as a reason as to how structural racism may, indeed, be partially responsible for risk disparity.

Regardless of the precise reason for heart failure risk disparity between rural and urban citizens, one thing most likely is the healthcare and health education accessibility for the former class. That, combined with increasing independent medical practice shutdowns in rural areas and physician shortage, translates into this risk contrast.

It should not come as a surprise; folks living in rural communities with underlying diseases that may lead to heart failure go untreated for a long time before they seek or get attention.

Heart FailurePhoto byby author using Wonder Digital Art

Furthermore, studies demonstrate that those who live in lower-income environments tend to have higher levels of stress-related activities that stimulate a part of the brain related to stress and emotion. (Called Amygdala)

The Amygdala's response yields higher inflammatory cell production in the bone marrow and more inflammation in arteries, including the heart. Therefore, the more assault on the heart, the higher the risk of heart failure.

Indeed, rural healthcare in the United States is under constant stress. People living in these communities feel the upshot of health inequity.

Funneling taxpayer money to rural communities has yet to help. Local independent clinics and hospitals are shutting down, and rural physicians are retiring. Economically, it is not feasible for larger organizations to serve rural communities.

“The survival of independent physician practice is vital to the sovereignty of our rural communities” — Adam Tabriz, MD

To revert this trend healthcare system requires a robust healthcare delivery infrastructure that can eliminate heart failure disparities between rural and urban neighborhoods. That system is the Cyber-Physical Human System. (CPHS)

The CPHS meets rural health expectations and aids health equity by closing the technology, information, and human support gap for rural patients. That is by providing a round-a-clock network of sensors, medical devices, and humans that can remotely connect, disconnect, and collaborate regardless of location and distance.

The Cyber-Physical Human System is the healthcare logistics of the 21st century that is patient-centered and interactive. It incentivizes physicians and stakeholders while empowering patients with more high-quality options.

Reference

1. Risks for Heart Failure Rise in Rural America [WWW Document], 2023. . U.S. News & World Report. URL //www.usnews.com/news/health-news/articles/2023-01-27/risks-for-heart-failure-rise-in-rural-america (accessed 1.29.23).
2. Turecamo, S.E., Xu, M., Dixon, D., Powell-Wiley, T.M., Mumma, M.T., Joo, J., Gupta, D.K., Lipworth, L., Roger, V.L., 2023. Association of Rurality With Risk of Heart Failure [WWW Document]. Association of Rurality With Risk of Heart Failure | Cardiology | JAMA Cardiology | JAMA Network. URL https://jamanetwork.com/journals/jamacardiology/fullarticle/2800877 (accessed 1.29.23).
3. The risk of developing heart failure is much higher in rural areas vs. urban [WWW Document], 2023. . National Institutes of Health (NIH). URL https://www.nih.gov/news-events/news-releases/risk-developing-heart-failure-much-higher-rural-areas-vs-urban (accessed 1.29.23).
4. Heart Failure Risk Higher in Rural Areas [WWW Document], n.d. . Heart Failure Risk Higher in Rural Areas — Nashville Medical News — Healthcare News & Marketplace. URL https://www.nashvillemedicalnews.com/article/5707/heart-failure-risk-higher-in-rural-areas (accessed 1.29.23).
5. Stress links poverty to inflammation and heart disease [WWW Document], 2019. . National Institutes of Health (NIH). URL https://www.nih.gov/news-events/nih-research-matters/stress-links-poverty-inflammation-heart-disease (accessed 1.29.23).
6. TABRIZ, Dr.A., 2022. Can We Ever Break The Curse of the Rural Healthcare Crisis? [WWW Document]. Medium. URL https://medium.com/illumination-curated/can-we-ever-break-the-curse-of-the-rural-healthcare-crisis-f9f496c2b93f (accessed 1.29.23).

Illumination Publication initially publicized this article on Medium!