When asked how Arkansas adults are doing relative to the trendline data for the indicator, the stakeholders stated the following:

• There has been a very slight increase in the percentage of adults in Arkansas dying from AMI from 2014 to 2020.

Stakeholders identified the following negative factors promoting AMI death in Arkansas adults.

• Chronic Disease

• COVID-19 is not on this year's data  

• Cultural factors for diet as well

• Data source (from death certificate) 

• Diet  

• Lack of education to identify the signs and symptoms (s/s) 

• Lack of access to primary or acute care; not available or can’t pay or is not a priority or working hours or organization they work for 

• Fewer people want to go to the hospital 

• Less time to engage  

• Not calling 911: lack of trust in the system

• Obesity  

• Particulate matter in the air

• Physical activity  

• Rural/access to care: long time for the ambulance to get there, terrain, coverage, transportation, road conditions Shortages of EMS/slow EMS response time 

• Smoking  

• Substance abuse 

Stakeholders identified the following positive factors that are preventing AMI death in Arkansas adults.

• Awareness of the signs and symptoms of heart attack/education efforts 

• Change in insurance aspects and its relation to income tax that has increased the coverage 

• Clean Air Act  

• Efforts to quit smoking; smoking be well program  

• EMS education and distance from PCI hospitals  

• Infrastructure similar to stroke  

• Make access to care easy in clinical settings 

• Mobile health units

• Prevention education and education to understand the s/s 

• Screenings  

• Smoking rates going down 

• STEMI program at ADH; focused on the outcomes/clinical care 

• Urban areas with multiple hospitals/ more hospitals in metropolitan areas per capita but the distribution may be a problem 

Are there any factors creating disparities?

•  Yes  

• Rurality: doesn’t have access to screenings  

• Education  

• Preventive services  

• Minority population  

• Culture of the cases

• Cultural competency of providers 

• Lack of diverse workforce 

• Broadband reception/technology 

• Digital literacy 

• Equipment and places to get BP checked

Stakeholders identified the following potential partners to strengthen the positive factors or address the negative factors influencing the rate of AMI mortality for Arkansas adults.

• American Heart Association (AHA) 

• Hospital Association  

• ADE: to educate on the s/s as kids, gate keeper idea; Preventive education as kids 

• Non-medical organizations: faith-based organizations, access points for telemedicine, ambulance associations, EMS associations, school nurses association  

• Insurance companies  

• Employers: well being programs that could be focused on prevention  

• Voluntary fire departments: so that they know the signs  

• Firefighters Association  

• Community partners 

• Nail salons, hair salons, barbershops 

• Other providers such as dentists, behavior providers, psychologists,  

• Local stores: Walgreens, Kroger  

• Community leaders  

• Pharmacies  

• UAMS IDHI

• Municipal league

• County government

Stakeholders proposed the following potential solutions to strengthen the positive factors or address the negative factors, impacting how adult Arkansas access dental care.

• Community fairs  

• Local level education 

• Good relationship with the community and the leaders  

• Get involved with the Municipal leagues 

• County health officers education and training  

• Staffing issues: help with staff shortage  

• A policy that every county has access to broadband for telehealth  

• AMI prevention and intervention  

• Federal level cap on the medicines  

• Reimbursements on BP monitoring  

• Policy to help hospitals survive: 900 hospitals are on the verge of closure in rural AR; PPS hospital are the ones that are struggling the most  

• OFF THE WALL: Rely less on technology and electronics to schedule appointments. Just make care walk-in. Going to clinics, doctor office visits without having to wait on the phone calls from the doctor’s office, welcome door: trying to meet people where they are. Make times flexible, adjustment of time, expand on the services you have to offer.  

• Home-based care   

• Telehealth resource centers  

• Train community health workers 

• Remote patient monitoring: BP, glucose  

• Better shared data 

• Criteria to meet the doctor: reduce them 

• OFF THE WALL: stress, increase self awareness, recognizing stress level and take rest. Not only for individuals but also employers. Being able to open up to the employers, collective stress source: finances, education, health literacy; communication across the board: help individuals connect to the doctors/psychologists if they are stressed  

• Involve social workers and other professions  

The following strategies were prioritized on 9.13.22 because they ranked highest across four criteria: Impact, Feasibility, Specificity, and Value.

• Engage state policy makers to protect the solvency of Arkansas hospitals, particularly those in rural parts of the state and/or that are primarily funded by Prospective Payment Systems (PPS)
• Expand telehealth medicine with the specialization capacity for AMI mitigation, especially in under-resourced part of the state
• Promote education at a local level, especially with the support of trained Community Health Workers, through outreach and messaging at community events (health fairs, etc.) 

While the following strategies were not prioritized by the group at 9.13.22 work session, they are included here for future collaboration.

• Advocate for change at the federal level that would set a cap on the cost of medicines that reduce the risk of AMI
• Increase the possibility for patients to access care by encouraging hospital systems to adapt their scheduling systems so that walk-in appointments are possible
• Launch a statewide program that promotes walking and/or active living
• Provide reimbursements for blood pressure (BP) monitoring

Strategy: Engage state policy makers to protect the solvency of Arkansas hospitals, particularly those in rural parts of the state and/or that are primarily funded by Prospective Payment Systems (PPS).

Work plan for the strategy

Strategy: Expand telehealth medicine with the specialization capacity for AMI mitigation, especially in under-resourced part of the state.

Work plan for the strategy

Strategy: Promote understanding at a local level through education and outreach at community events (health fairs, etc.), including through the engagement of Community Health Workers trained about the risks of AMI and how to access prevention and intervention supports.

Work plan for the strategy