Circulate the facts: RNs step up efforts to raise women’s awareness of heart disease risk and prevention

Once or twice a year, Lynne Braun, RN, PhD, CNP, FAHA, FPCNA, is welcomed to the pulpit of a church with a predominantly African-American congregation in Chicago. Her mission: To preach the tenets of heart disease prevention to the women sitting in the pews. Her message is straightforward but hopeful: Heart disease and stroke are the number one and three killers, respectively, of women — particularly African-American women — in the U.S. But they can be prevented through lifestyle changes.

“Notably, the highest coronary heart death rates and the highest overall CVD (cardiovascular disease) morbidity and mortality occur in black women,” according to the Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women-2011 Update, published online in the Journal of the American College of Cardiology’s March 7, 2011, issue. “These disparities in the occurrence of CVD and established risk factors underscore the need for heightened preventive efforts in subpopulations of women.”

Braun, a nurse practitioner at Rush University Medical Center’s (Chicago) Preventive Cardiology Center and Heart Center for Women and a professor at Rush University College of Nursing, is doing just that. Through the “Have Faith in Heart” initiative, Braun brings her expertise to churches in the city’s African-American community.

“The healthcare community hasn’t been reaching the most at-risk groups,” Braun said. “And this is what we have to do. Through ‘Have Faith in Heart’ we have educated many groups of African-American women about what they can do to improve their heart health.”

Who is getting the message?

Similar efforts are needed among women of other ethnic groups. According to the “Twelve-Year Follow-Up of American Women’s Awareness of Cardiovascular Disease Risk and Barriers to Heart Health” conducted in 2009 by the American Heart Association, “awareness of CVD as the leading cause of death among women has nearly doubled since 1997 but is stabilizing and continues to lag in racial/ethnic minorities.”

According to the report, between the first survey in 1997 and the 2009 survey, twice as many white and Hispanic women and three times as many African-American women became aware that heart disease is the leading cause of death for women.

Non-Hispanic white women are most aware of this fact (60%), followed by Hispanic women (44%), African Americans (43%) and Asians (34%), according to the report.
The study also found that only about 53% of women would call 911 if they thought they were experiencing symptoms of a heart attack. Many women also believe unproven preventive therapies will reduce their risk of heart disease. For example, the study found 79% of women thought taking aspirin regularly could prevent heart attacks, and 70% thought antioxidants were a preventive method. Also, 69% thought multivitamins were preventive, while 58% thought vitamins A, C and E could help deter heart disease.

According to the report, women favor approaches such as increased access to healthy foods, use of recreational facilities and enhanced nutrition labeling to lower their risk for heart problems.

The good news is the commitment by the healthcare community during the past decade to raise awareness about heart disease in women has been successful. But, as with any effort to change human behavior, initiatives such as the “Red Dress” campaign launched by the National Heart Lung and Blood Institute a decade ago, need to be sustained and expanded. That is the goal of the Preventive Cardiovascular Nursing Association, which had its 18th annual Symposium in April.

“More than half of all women know heart disease is the leading cause of death in women, but the majority of them don’t think it is one of their personal concerns,” said Suzanne Hughes, RN, MSN, FAHA, FPCNA, the clinical education project director for PCNA. “They don’t think they themselves are at risk. And if they don’t think they are at risk, they won’t take appropriate actions if they are having symptoms of a heart attack.”
The findings that only half of all women would dial 911 if they thought they were having symptoms of a heart attack is a concern for healthcare providers. “This distressing lack of appreciation by many women for the need for emergency care for acute cardiovascular events is a barrier to optimal survival among women and underscores the need for educational campaigns targeted for women,” according to the writers of the AHA’s 2011 updated prevention guidelines.

“Women need to pay attention to their symptoms,” Hughes said.

Those symptoms could include:
• Uncomfortable pressure, squeezing, fullness or pain in the center of your chest that lasts more than a few minutes or goes away and comes back.
• Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
• Shortness of breath with or without chest discomfort.
• Breaking out in a cold sweat, nausea or lightheadedness.

“Those are 911 calls,” she said. “We want everyone to know that time is heart muscle. Getting to a hospital in an ambulance is crucial.”

Pregnancy as a cardiac stress test

The AHA’s effectiveness-based 2011 Heart Disease Prevention Guidelines for Women encourages all women “to know their numbers,” Hughes said. The numbers all women need to know, as spelled out in the AHA’s guidelines, are:

• Blood pressure: Optimal level less than 120/80 mm Hg
• Total cholesterol: Less than 200 mg/dL
• LDL: Less than 100 mg/dL
• HDL: Greater than 50 mg/dL
• Triglycerides: Less than 150 mg/dL
• Glucose (HbA1c) Less than 7%
• Body mass index (BMI): 18.5-24.9 kg/m2
• Waist circumference: Less than 35 inches

“There is no way you can lower your risk without knowing where you stand now,” Hughes said. She encourages women to know all elements of their cholesterol, including total cholesterol, LDL, HDL and triglycerides.

For the first time, the AHA’s guidelines for women include pregnancy complications as a risk for heart disease.

“The expert writing panel noted that pregnancy complications may predict heart disease,” Hughes said. “Pregnancy is a metabolic stress test. If a woman had gestational diabetes, pregnancy-associated hypertension or preeclampsia, it may predict cardiovascular disease in her future.”

The pregnancy complications specifically cited in the guidelines are the development of high blood pressure or diabetes and delivering a preterm infant. Braun added women who have had preeclampsia have approximately double the risk for subsequent ischemic heart disease, stroke and venous thromboembolic events during the five to 15 years after pregnancy.

10 minutes to better health

The PCNA believes who better to spread the latest word about the prevention of heart disease in women than nurses? “Lifestyle Counseling in Ten Minutes or Less” was a breakout session at PCNA’s 18th Annual Symposium in April. It was led by Braun and Jane Nelson Worel, RN, MSN, APRN-BC, a nurse practitioner at Meriter Heart & Vascular Hospital in Madison, Wis.

They used as their case study a 57-year-old woman who had some atypical chest pain. She had a stress test that was negative for ischemia and then returned to the clinic to discuss the results. Her lipid profile revealed elevated triglycerides, low HDL, a mildly elevated LDL and moderately elevated glucose.

“Everything was a little bit off,” Worel said. “It may not grab anyone’s attention, so patients like this sometimes slip by.”

The case study patient was on lisinopril for blood pressure, which was well controlled. And she met most of the criteria for metabolic syndrome because of a slightly elevated BMI and a waist size greater than 35 inches.

Other than lisinopril, the treatment Worel and Braun recommended were lifestyle changes including starting a regular exercise program and eating a diet of fruits and vegetables, whole grains and high-fiber foods; limiting saturated fat, alcohol, sodium and sugar; and avoiding transfatty acids.

Although losing weight can be a struggle for middle-age women, taking off just 10 pounds can make a difference, Worel said. “Many times women start eating healthier and don’t see a big impact on the scale, but just changing behaviors can have an impact on reducing risk factors. We encourage people to focus on healthy behaviors.”

Worel and Brown’s 10-minute counseling includes:
• Assessing patients’ diet and physical activity patterns.
• Comparing the patients’ activity levels and diets to the national goal.
• Giving patients simple steps to reach increased activity and healthy eating goals and explaining how this lowers their risk of heart disease.
• Partnering with patients to decide on specific, measurable goals and strategies to achieve them.
• Addressing patients’ barriers to making lifestyle changes.
• Referring patients to specialists when appropriate.
• Following up with calls or in-person appointments.

Through the website, many free educational resources for nurses and patients are offered on a various of subjects, including the 2011 Heart Disease Prevention Guidelines for Nurses, atrial fibrillation, antiplatelet therapy and more.

“We want nurses to know about the PCNA resources,” said Braun, who is a PCNA board member. “They can download the resources free and then deliver this important information to groups of women.”

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