Engaging Community Health Workers Recommended to Prevent Cardiovascular Disease

Did you know that public health interventions that engage community health workers (CHWs) can help people manage risk factors and prevent cardiovascular disease, as well as reduce health disparities? The Community Preventive Services Task Force (Task Force) recommends interventions that engage CHWs to prevent cardiovascular disease (CVD).

Researchers examined evidence from 31 studies from the United States and other high income countries and found that engaging CHWs in a team-based care model where CHWs work with patients, physicians, nurses, and other healthcare providers, led to large improvements in blood pressure and cholesterol outcomes. There were modest improvements in health behavior outcomes (e.g., physical activity, healthful eating habits, and smoking cessation) when CHWs were engaged as health education providers or as outreach, enrollment, and information agents. Additionally, a small number of studies suggest that engaging CHWs improves appropriate use of healthcare services and reduces morbidity and mortality related to CVD. Most included studies engaged CHWs to work with minority and medically underserved groups, suggesting these interventions can be effective in improving minority health and reducing health disparities.

The Task Force based its recommendation on a systematic review of all available studies that was conducted with oversight from the Task Force by scientists and subject matter experts from the Centers for Disease Control and Prevention (CDC) in collaboration with a wide range of government, academic, policy, and practice-based partners.

Peer-reviewed articles of the systematic review are not yet published; however, a summary of the findings and supporting materials are available on The Community Guide website. You can also subscribe to be notified when materials are posted.

What are Community Health Workers?

CHWs are frontline public health workers who serve as a bridge between communities and healthcare systems. They are from or have an unusually close understanding of the community served. CHWs are trained to provide culturally appropriate health education and information, offer social support and informal counseling, connect people with the services they need, and in some cases deliver health services such as blood pressure screening. Because CHWs are considered informed and trusted community members, they are uniquely positioned to advocate on behalf of people and communities. CHWs often receive on-the-job training.

What can community health workers do to prevent cardiovascular disease?

For cardiovascular disease prevention, CHWs may implement one or more of the following models of care:

• Screening and health education for CVD risk factors and health behavior change
• Outreach, enrollment, and information by helping people and their families apply for needed medical services
• Team-based care by working with patients and licensed providers such as nurses and pharmacists
• Patient navigation by helping people navigate complex medical services systems
• Community organization by helping with community development and by serving as a link between the community and healthcare systems

Why are these Task Force recommendations important?

• Heart disease is the leading cause of death for both men and women in the United States (CDC, NCHS, 2015).
• About one in four people (approximately 610,000) die of heart disease in the United States every year (CDC, NCHS, 2015).
• Stroke is the 5^th leading cause of death in the United States killing nearly 130,000 U.S. adults each year (Kochanek, 2014).
• High blood pressure, high cholesterol, and smoking are key heart disease and stroke risk factors. About half of U.S. adults (49%) have at least one of these three risk factors (Valderrama, 2011).
• Annual direct and indirect costs resulting from CVD and stroke in the U.S. are estimated at $320.1 billion (Mozaffarian, 2015).

What are the Task Force and Community Guide?

• The Community Preventive Services Task Force (Task Force) is an independent, nonfederal, uncompensated panel of public health and prevention experts. The Task Force works to improve the health of all Americans by providing evidence-based recommendations about community preventive programs, services, and policies to improve health. Its members represent a broad range of research, practice, and policy expertise in community prevention services, public health, health promotion, and disease prevention.
• The Guide to Community Preventive Services (The Community Guide) is a collection of all the evidence-based findings and recommendations of the Community Preventive Services Task Force and is available online at www.thecommunityguide.org.

For More Information

• The Community Guide: Cardiovascular Disease Prevention and Control: Interventions Engaging Community Health Workers
• CDC: Division for Heart Disease and Stroke Prevention CHW Toolkit
• Million Hearts

References

CDC, NCHS. Underlying Cause of Death 1999-2013 on CDC WONDER Online Database, released 2015. Data are from Multiple Causes of Death Files, 1999-2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program.

Kochanek KD, Murphy SL, Xu JQ, Arias E. Mortality in the United States, 2013. NCHS data brief, no 178. Hyattsville MD: National Center for Health Statistics. 2014.

Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2015 Update: A Report from the American Heart Association. Circulation. 2015; 131.

Valderrama AL, Loustalt F, Gillespie C, et al. Million Hearts: Strategies to Reduce Prevalence of Leading Cardiovascular Disease Risk Factors — United States, 2011. MMWR. 2011; 60(36): 1248-1251.