Tailoring Cardiac Care for Women

Joe Cantlupe, for HealthLeaders Media , December 13, 2013
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Using the ProvenCare program, "we have a link between the OB-GYN navigator and the cardiology navigator, and we have ready access—in real time—to these pregnancy-related complications that are known to increase cardiovascular problems," Skelding adds. "This continually identifies these women and brings them to our attention."

The idea is to develop educational materials targeting women who might not have picked up a packet in the OB-GYN clinic or hadn't read about it on the Internet, she says. "We can focus our educational efforts toward them … offering them screening programs, as well as further educational material, to help keep them healthy for years to come."

Coordination is important with specialties and evaluation by primary care providers, Skelding says. There are OB-GYN partners "who are also very interested and motivated to identify these women and get them to us for screening, prevention, and treatment if needed," she adds.

Success key No. 3: Facing care discrepancies

While healthcare leaders are working to improve treatment equity for cardiovascular disease that impacts women, they are also looking at the demographics of subgroups of women, especially among African-American and Hispanic populations.

A 2012 study by the American Heart Association noted that education campaigns helped white women become more aware of heart disease risks, but those efforts did not have an apparent impact in minority communities.

The study of trends among racial and ethnic groups showed that from 1997 to 2010, the rate of awareness among whites of cardiovascular disease as a leading cause of death increased from 30% to 56%. Yet awareness in 2012 was only 36% among black women and 34% among Hispanics—at levels similar to those of white women in 1997.

The AHA report noted, "Awareness of cardiovascular disease among women has improved in the past 15 years, but a significant racial/ethnic minority gap persists." It added, "Continued effort is needed to reach at-risk populations."

Findings like that have prompted officials of Baltimore's 372-licensed-bed St. Agnes Hospital's women's heart center to initiate a community outreach program to improve awareness.

African-Americans and Hispanics have "some of the highest rates of cardiovascular disease in the city, and the gap is even greater among women," says Shannon Winakur, MD, medical director of the St. Agnes Hospital women's heart center.

Heart disease and stroke are the leading cause of death in Baltimore. African-American men die 6.7 years earlier than white men, and African-American women die 4.2 years earlier than white women there, according to a 2011 report from the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities.

To overcome the challenges, St. Agnes Hospital has initiated a Heart to Heart initiative that includes partnerships with churches in the region to screen African-American women for cardiovascular disease.

If patients are found to have risk factors such as diabetes, hypertension, high blood pressure, or other symptoms of heart disease, they can receive follow-up screenings. As of October 29, 222 women have been screened, with 160 of them qualifying for the intervention, which included participating in St. Agnes' well4life program with four months of exercise and educational classes, plus access to a lifestyle coach and support groups, she says.

St. Agnes has conducted screenings at four churches so far. "For the first three screenings, we are in the process of conducting the follow-up visits for postintervention after four months," she says.

The follow-up visits repeat first-round biometrics, such as weight, blood pressure, and waist circumference, as well as blood work for cholesterol and blood glucose, to follow the women's progress after the intervention.

The hospital also conducts a heart health assessment in an hour-long program that costs patients $60 each. Patients complete a comprehensive risk assessment and can receive a personalized education program based on the results.

St. Agnes wants to keep up the drumbeat for women's cardiac care. The hospital sponsors seminars, meetings, and educational events. While there is often great interest among women in the topic around Valentine's Day—with American Heart month and AHA Go Red for Women activities—sometimes interest drops off afterward. That shouldn't happen, Winakur says. It's a year-round, day-to-day effort, and women "need to be aware of the risk factors."

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This article appears in the December issue of HealthLeaders magazine.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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