Over nearly two decades, the rate of Floridians in all age groups dying from heart disease has plummeted about 38% — from 238 deaths per 100,000 people in 1999 to about 148 per 100,000 annually in 2018.

The decline reflects a worldwide trend due in part to decreases in smoking and the widespread use of cholesterol-lowering statin drugs and blood pressure medications. At the same time, more effective treatments are available for coronary artery disease, the most common type of heart disease, and other heart ailments.

“We cardiologists have become better with angioplasty and stenting,” says Dr. Wade Fischer, a cardiothoracic surgeon at Osceola Regional Medical Center in Kissimmee. He says stents that are coated with a medication that prevents arteries from reclogging are particularly effective in keeping vessels open, and doctors have also gotten better at performing coronary bypass surgery and valve replacement surgery.

But after bottoming out around 2011, the heart disease death rate for Floridians between ages 45 and 64 has been inching upward — by about 7.5%, from 119 deaths per 100,000 people in 2011 to 128 deaths per 100,000 in 2018, according to data from the Florida Department of Health.

The geographic distribution of heart disease is unequal — and the risk of dying from heart disease in Florida varies significantly depending on where you live.

The counties with the highest heart disease death rates are clustered mostly in the northern part of the state — and that holds true for all age groups.

Among the 45-to-64 age group, six northern counties have heart disease death rates that are more than double the state average for that age range. They include Madison County, with a heart disease death rate of 354.9 per 100,000; Union County at 320.3; Liberty County at 293.5; Citrus County at 283.9; Gulf County at 274.5; and Baker County at 266.6.

Washington County — a rural county just below the Alabama border in the Panhandle — ranks worst in the state for overall age-adjusted heart disease deaths. Age-adjusted rates are statistically modified to eliminate the effects of age differences in a population and are especially useful when examining rates of illnesses such as heart disease, which are influenced by age.

In Washington County, the heart disease death rate of 287 per 100,000 is nearly twice the state rate and more than three times higher than that of Collier County, which has the lowest rate in the state. The problem appears to be getting worse. Washington County’s overall heart disease mortality rate has increased nearly 44% since 2014. There’s also a gender gap: Approximately two-thirds of the Washington County residents who died from heart disease in 2018 were men.

It’s a similar tale in Union, Liberty, Madison, Citrus, Baker, Calhoun, Taylor, Holmes and Lafayette counties — where income is low and risk factors are high.

Fischer and other heart doctors believe increasing obesity rates are a major contributor to the trend. “With obesity, you get Type 2 diabetes, and all these things are facilitators of atherosclerotic disease — which is the blockages, plaque and junk that accumulates and gets laid down in the coronary arteries or in the carotids and can cause stroke or in the kidneys can cause kidney failure,” he explains. “Whatever end organ develops these blockages is at risk.”

The data reveal higher-than-average rates of diabetes and obesity in nearly all of the Florida counties where heart disease death rates are the highest. Residents in those counties also report higher rates of inactivity or sedentary lifestyles and a greater percentage of smokers among their populations.

“There’s still a reasonably high rate of smoking among patients in the more rural areas, and so when they do present for care, it’s often advanced disease, and we wished they’d have come in a year earlier, five years earlier,” says Dr. William Dixon, an interventional cardiologist at Tallahassee Memorial HealthCare. “Sometimes they will come two or three days after experiencing heart attack pain, and it’s kind of hard to help somebody three days later as opposed to coming in right as soon as they start feeling symptoms.”

Dr. Don Davis, a cardiologist with Gulf Coast Regional Medical Center in Panama City, sees another culprit underlying the rising heart disease deaths: An epidemic of depression, or “listlessness.” He says middle-aged people — men in particular — “are starting to run into a significant amount of depression and loss of meaning in their lives.” Some are turning to alcohol and drugs to cope, which leads to worse outcomes in coronary artery disease, he says.

Others just don’t have the motivation to get healthy. Davis points out that about 95% of heart disease is preventable and can be conquered by getting people to exercise, eat right and stop smoking — but he says apathy can stifle a person’s desire to change.

“If you don’t have a meaning or a reason in your life or things that drive you to get up and do stuff, you’re not going to be willing to do a whole lot. You’re not going to care that much about your diet,” he says. “I know it’s a strange hypothesis, but I see listlessness as more (of a factor) leading to our overabundance of cardiovascular disease than anything else.”

Diffuse Disease

Dr. Don Davis, a cardiologist at Gulf Coast Regional Medical Center in Panama City, performs 15 to 25 heart catheterizations each month and can always tell when he’s looking at the arteries of someone who smokes or suffers from diabetes. “Their blood vessels are diffusely diseased. We kind of have a proverbial term — ratty, meaning they’re just eaten up all the way, top to bottom,” Davis says. The poor condition of the vessels also limits patients’ options. “If somebody comes in with a major blockage of 95% and it’s one discrete area, we can stent that open. They do really well with that,” Davis says. “These patients that have diffuse, moderate-to-severe disease that’s just ratty and small vessels — you can’t do anything. There’s nothing that stenting is going to do there because you’ve got another area all around there that you just stented that’s as bad as before.”

Cardiac Outreach

Since 2016, the Florida Department of Health has been funding a Heart Health Plus Program in 17 counties with high rates of heart disease. The focus so far has been on implementing blood pressure self-monitoring programs within communities to help those with uncontrolled high blood pressure, a major risk factor for heart disease. County health departments are also referring individuals to smoking cessation programs and diabetes prevention and self-management programs. Last July, seven participating counties — Dixie, Gadsden, Gulf, Madison, Liberty, Jefferson and Union — each hired a Heart Health Plus Outreach manager to work with community partners such as churches, health systems and employers in their efforts. Dr. William Dixon, an interventional cardiologist at Tallahassee Memorial HealthCare, says access to cardiovascular services can be more challenging for those living in rural areas, so TMH also does what it can to make care more accessible through outreach clinics. That way, patients can get advanced evaluations “where they live, instead of having to travel an hour or more to get in to see somebody,” Dixon says.

 

Read more in Florida Trend's February issue.

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