The Impact of a Population-based Prevention Program on Cardiovascular Events: Findings from the Heart of New Ulm Project.

Abstract Background Cardiovascular disease (CVD) and its associated risk factors are the principal drivers of mortality and healthcare costs in the United States with rural residents experiencing higher CVD death rates than their urban counterparts. Methods The purpose of this study was to examine incidence of major CVD events over 9 years of implementation of the Heart of New Ulm (HONU) Project, a rural population-based CVD prevention initiative. HONU interventions were delivered at individual, organizational, and community levels addressing clinical risk factors, lifestyle behaviors and environmental changes. The sample included 4,056 residents of New Ulm matched with 4,056 residents from a different community served by the same health system. The primary outcome was a composite of major CVD events (myocardial infarction, ischemic stroke, percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and CVD-related death). Secondary outcomes were the individual CVD events and procedures. Results The proportion of residents in New Ulm with a major CVD event (7.79%) was not significantly different than the comparison community (8.43%, p =0.290). However, the total number of events did differ by community with fewer events in New Ulm than the comparison community (447 vs 530, p = 0.005), with 48 fewer strokes (84 vs 132, p = 0.001) and 42 fewer PCI procedures (147 vs 189, p=0.019) in New Ulm. Incidence of ischemic stroke was lower in the New Ulm community (1.85 vs 2.61, p=0.020) than in the comparison community. Other specific CVD events did not have significantly different incidence or frequencies between the two communities. Conclusions In HONU, the proportion of residents experiencing a CVD event was not significantly lower than a match comparison community. However, there was a significant reduction in the total number of CVD events in New Ulm, driven primarily by lower stroke, PCI, and CABG events in the intervention community.