Listen to Your Heart
To tackle the leading cause of death among women, nurses encourage female patients to evaluate their risk for cardiac disease

By Heather Stringer
January 14, 2004

Ernestine Lipford had more important things to worry about than her heart health. After all, she was caring for her 89-year-old mother, who was declining from the effects of dementia and a hip fracture. But then Lipford attended a presentation where a nurse spoke about how today's children are suffering from the effects of apathy about heart health, and she started listening.

"We're seeing Type 2 diabetes in children, and heart disease in younger and younger people," said Diane Todd Pace, Ph.D., APRN, a family nurse practitioner at Regional Medical Center at Memphis/Health Loop in Tennessee. "If we don't make a change in todaykids, we will see these problems worsen."

Pace was speaking to members of an African-American church in Memphis. She is among a cadre of nurses that is determined to improve heart health among female patients, and one of their goals is to tackle cardiac problems earlier in their patients' lives.

One of the groups on the frontlines is the Association of Women's Health, Obstetric and Neonatal Nurses, which has launched a training program that equips nurses to talk to their patients about heart health.

"We religiously do Pap smears and breast checks annually, yet women are dying in much greater numbers of heart disease," said Claudia Reid Ravin, MSN, CNM, project manager for the Cardiovascular Health for Women initiative at the association. "We all think someone else is doing it."

In 2000, more than 365,000 American women died of heart disease-the leading cause of death, according to the CDC. By comparison, 42,300 women in the United States died of breast cancer that year.

In the association's training, family nurse practitioners, women's health practitioners and other nurses learn to ask female patients about their heart health during routine visits. They are encouraged to question patients about cigarette smoking, family history, racial and ethnic factors, stress and also to get a waist measurement and lipid profile. The nurses are encouraged to strategize with patients about ways to change lifestyle habits that increase their risk of heart disease.

Pace participated in the association's training, and started using the Framingham Heart Study risk survey as a way to get through to patients. The survey uses six factors to assess a patient's risk: LDL levels, HDL levels, age, blood pressure, diabetes condition and smoking. Pace said she tells her patients their percentage chance of heart disease in the next 10 years, and puts this in their medical record.

Seeing Pace write something in their medical records caught her patients' attention, she said. "It seemed to help people understand it was important," she said. "Just verbally saying it was not enough."

Change is good

Once she pointed out patients' highest risk factors, she would investigate their interest in making a change. She was careful not to overwhelm them or harp on patients about changing. If someone expressed interest in improving an area, then they'd talk about strategies to implement changes. Pace called about a month later to check on the patient's progress.

Before long Pace, 51, couldn't ignore that she, too, needed to improve her heart health in certain ways. "I thought I was kind of immune to it because I had no history of heart disease in my family, but because I was overweight and sedentary, I knew I had a risk of diabetes and heart disease."

She knew it wasn't realistic to change her eating and exercising patterns all at once, so she targeted a diet change first. She researched different diets and settled on the Atkins approach. She lost 16 pounds in 10 weeks, and dropped two dress sizes.

Rosemary Theroux, Ph.D., RN, also is taking suggestions from the association and talking to her female patients in Massachusetts about heart health. Like Pace, she noticed that one of the key factors to success is taking time to help patients strategize about how to make changes in their lifestyle.

This takes time, though, and she usually needs 35 to 40 minutes with a patient, rather than 30, when she walks through a plan for making changes.

She also acknowledged that it's time-consuming to call patients and check in after a month or two, but this reinforcement seems to be vital in keeping patients motivated.

Theroux reaps the benefit of this extra time in the end, though. "It's very rewarding to see people change," she said. "Almost every person in the study, if their goal was to lose weight, they lost weight. If they wanted to exercise, they increased exercise."

Spreading the word

Although nurses like Theroux are taking the time to start improving cardiac health among women, one nurse said heart health advocates may encounter some resistance because of the age group that is most affected.

"The thing that troubles me is that there has been a big push on breast cancer, but it's not the leading cause of death in women," said Judy LaRosa, Ph.D., RN, FAAN, a professor of preventive medicine at SUNY Downstate Medical Center in New York. "Despite the best efforts of the [American] Heart Association, heart disease in women is not sexy, and I suspect it's because heart disease tends to happen in older women. We don't value our older people. Breast cancer can happen in younger women, but heart disease begins when women are pushing 60, 70 and 80."

LaRosa said this lack of interest in heart health means that many women suffer from heart attacks without even knowing it.

She said a woman may feel discomfort in her upper abdomen and think she is having indigestion, when, in fact, she is having a heart attack. A doctor may tell her to come in a week later, when she should be going to the emergency room. Fatigue or shortness of breath also can be signs of a silent heart attack in a woman.

LaRosa is eager to see nurses learn to look for signs of heart attack in women. She's also adamant that nurses make every effort to help women reduce their risk factors to delay or altogether avoid silent heart attacks. She suggested that one way to help increase awareness is for nurses to be role models of healthy lifestyles that promote strong hearts.

Like LaRosa, Pace believes nurses have a critical role in influencing patients to care about heart health, and each success story can have far-reaching implications.

"I enjoy knowing I have helped people who are going to then affect the whole community," she said. "That's going to have a positive economic influence on health care, plus an overall effect on lifespan."

Contact Heather Stringer at heather_stringer@yahoo.com