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Primary Care Partnerships to Prevent Heart Disease in Women
Primary Care Partnerships to Prevent Heart Disease in Women

National Heart Failure Training Program (N-HeFT™), Case Western Reserve University
Nurses Prevent Heart Disease in Women

Challenges:
Heart disease, stroke, and other cardiovascular diseases are the #1 killer of women and account for 33.2% of all female deaths in Ohio.[1] On average, about 51 females die from heart disease and stroke in Ohio each day. African-American and Hispanic women face the highest risk of death from heart disease and stroke, but conversely have the lowest risk factor awareness of any racial or ethnic group. As minority communities often do not have adequate access to health care, coronary heart disease is often not identified early in patients of color.[4] [2] Preventable risk factors such as obesity and smoking are highly prevalent in all the major cities of Ohio.[1] Over 63% of Ohioans were overweight in 2008 according to the Center for Disease Control.[3] Approximately 18,500 adults die each year in Ohio from smoking.[5]

Strategies:
Many minority health experts believe educational outreach is a key strategy to prevent cardiovascular disease and reduce heart disease risk.[2] Heart Truth-Ohio cast a wide net and incorporated a multi-modal approach to outreach for nurses:

  • On-site educational activities such as grand rounds and half-day workshops at hospitals, nursing homes, home care agencies and nursing schools

  • Train-the-Trainer programs incorporating information about heart disease in women and brief behavior interventions using simulation to teach these methods

  • Continuing education programs offered at a variety of venues that incorporated information about managing risk factors such as diabetes and included brief behavioral interventions

  • A robust website connecting nurses to free online courses, resources for patients and patient education tools

  • Site visits to health centers to offer patient education materials

  • Outreach at professional meetings and conferences attended by nurses using exhibits to market materials and programs

  • Building collaboration with faculty from nursing and nurse practitioner programs to disseminate information

  • Developing partnerships with professional nursing associations such as the Cleveland Council of Black Nurses and providing them with education and resources to use in their outreach efforts to women in the community

  • Collaborating with organizations such as the Ohio Department of Health and First Call for Help to provide services which address prevention of risk factors

Activities/Tactics:
Our goal of disseminating education and tools to as many providers as possible led us to a wide variety of activities and tactics utilizing multiple venues all over Ohio:

  • Nurses attended a variety of N-HeFT™ educational activities focused on teaching evidenced-based guidelines to prevent cardiovascular disease in women

  • Workshops, conferences, grand rounds, and "train-the-trainer" programs conducted by N-HeFT™ also taught brief behavioral interventions using case studies, videos demonstrations and simulation and offered samples of The Heart Truth® and NHLBI patient education materials, in addition to other simple tools such as pocket cards and readiness rulers

  • 5,000 brochures for the Ohio Tobacco Quit line and 3000 Resource Guides have been distributed to date

  • Heart Truth-Ohio staff exhibited at a variety of professional meetings and conferences attended by nurses, offering samples of educational tools, resource guides for patient referrals and an open invitation for education at their own site. Raffles and sign-up sheets were used to market these activities

  • Heart Truth-Ohio staff visited nurses at healthcare centers to determine educational needs and provide resources for patients. Feedback from healthcare center nurses was elicited to assess which resources were found to be the most helpful with their client populations

In partnership with Heart Truth-Ohio, professional nursing organizations such as the Cleveland Council of Black Nurses have initiated their own activities in a variety of venues, including churches and community fairs. These activities have been well attended by minority women. At each activity, the Cleveland Council of Black Nurses has provided a wide range of interventions:

  • Patient education, utilizing NHLBI and The Heart Truth materials, with health screenings for hypertension, diabetes, and high cholesterol.

  • The incorporation of scales and tape measures to determine waist circumference and BMI in screening

Distribution of cookbooks for healthy eating, and a variety of other simple educational tools to help assist program participants improve their cardiovascular health by addressing know risk factors.

Results:
N-HeFT™ has reached more than 594 nurses through professional workshops, conferences and grand rounds to date. In turn, these nurses have reached out to more than 2,700 women in underserved communities through twelve consumer events. In all, more than 3,200 The Heart Truth and the NHLBI patient education materials have been distributed. Based on numbers distributed, women have been most receptive to the following materials:

  • Heart Healthy Recipes African American Style (366)

  • On the Move to Better Heart Health for African Americans (531)

  • The Heart Truth Wallet Card (574)

  • The Heart Truth for Women: When Delicious Meets Nutritious (335)

  • The Heart Truth for African American Women: An Action Plan (415)

References:
[1] Centers for Disease Control and Prevention. Mortality data based on WISQARS Leading Cause of Death Reports, 2005

[2] Huggins S. Heart Disease in African-American Women: Heart Disease in African-American Women. Topics in Advanced Practice Nursing. 2006; 6(2).

[3] Pan L, Daluska DA, Sherry P, et al. Differences in Prevalence of Obesity Among Black, White, and Hispanic Adults -- United States, 2006-2008. Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention. 2009; 58(27);740-744.

[4] Doty MM and Holmgren AL. Health Care Disconnect: Gaps in Coverage and Care for Minority Adults Findings from the Commonwealth Fund Biennial Health Insurance Survey (2005). Commonwealth Fund pub. 941; 2006; 21.

[5] Website: The Toll of Tobacco in Your State. www.tobaccofreekids.org

Last Updated: February 29, 2012

The Heart Truth, its logo, The Red Dress, and Heart Disease Doesn't Care What You Wear—It's the #1 Killer of Women are registered trademarks of HHS.
Red Dress and Red Dress Collection are service marks of HHS.
National Wear Red Day is a registered trademark of HHS and AHA.

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