David Heller, MD, right, demonstrates blood pressure screening on Raymond Aborigo, PhD, for nursing students in Navrongo, Ghana.
Every year, the month of February is American Heart Month, a campaign to raise awareness of cardiovascular disease as the leading cause of death in the United States during a Valentine’s Day season associated with hearts and all things red. But this risk does not end in March or April—nor does it heed national borders. Diseases of the heart and blood vessels—which include not just heart attacks but also strokes— are the single leading cause of death worldwide. And the single leading risk factor for early death is high blood pressure.
The good news is that most heart disease is preventable. And even better news: You don’t need a physician to prevent heart disease. A few changes in behavior can greatly decrease risk of disease: A diet rich in fruits and vegetables, regular physical exercise, avoidance of tobacco, reduction of alcohol, and management of stress and depression. Research from around the world shows that nurses, pharmacists, and even volunteers can provide peer coaching and support to help persons at risk of heart disease to make these changes.
David Heller, MD
Unfortunately, this type of peer support is not available everywhere, either in the United States or the world. Raymond Aborigo, PhD, and I are researching care models to change that. Dr. Aborigo is Deputy Chief Health Research Officer at the Navrongo Health Research Centre (NHRC) in Ghana—a country with a massive and rising burden of heart disease, especially in recent years as diets and lifestyles have changed. With our teams at NHRC and Mount Sinai, we are exploring how best to train and equip Ghana’s health workers to treat and prevent the root causes of heart diseases through behavior change.
Ghana has a secret weapon: A nationwide rural health program that sends nurses and health volunteers door-to-door to counsel on healthy behaviors, offer basic health interventions like childhood vaccines, and link communities to essential medical care such as safe labor and delivery. This program, the Community-Based Health Planning and Services (CHPS) initiative, cut in half the number of children in Ghana dying before age 5.
Our research partnership trained the nurses of CHPS to provide door-to-door screening for two of the largest treatable risk factors for heart disease: high blood pressure and depression. We trained these nurses to treat these two conditions with medication at clinics within walking distance, and taught CHPS volunteers to visit patients at their homes weekly—offering advice on how to remember to take these medications, how to improve low mood, and other healthy habits like quitting tobacco and cutting back on salt. The team is supervised remotely by physician assistants and an on-call doctor, but nurses provide all clinical care.
In our pilot work to date, 93 percent of persons diagnosed completed our 90-day program, and 97 percent of them achieved the goal of normal blood pressure or improved depression score. We now want to scale up this program from four clinics to 20—and to adjust our care model to be as effective and easy to use for both CHPS staff members and patients alike. And because these healthy habits—including taking your medicines daily—can treat and prevent many other common chronic diseases such as diabetes and asthma, we hope to expand the model to bring comprehensive basic primary care to the people of northern Ghana and beyond.
Keeping a healthy heart is not just a one-month affair, and chronic health conditions like heart attacks cause 74 percent of all deaths worldwide. We hope to build a care model to help all people worldwide to access medications and support to prevent and control conditions like heart disease.
David Heller, MD, is an Assistant Professor at the Arnhold Institute for Global Health and the Department for Global Health and Health System Design at the Icahn School of Medicine at Mount Sinai and a practicing general internist.