Every year, the month of February is an exciting time for cardiac programs across the country – it is National Heart Month, and also the traditional time for “Go Red for Women” recognition. These efforts across the country are aimed at promoting awareness of heart disease in a way that speaks to the masses. For many, especially women, information regarding heart attacks (What does one feel like? Am I at risk?) can be elusive, even despite efforts to increase widespread public knowledge of the signs, symptoms, and risk factors for heart disease — a disease that remains on the rise as the population continues to age. 

Even with additional program and media focus on the need for early detection efforts, with ever-present risk factors such as high blood pressure, obesity, and smoking, the prevalence of heart disease shows no signs of leveling, particularly in men 45 and older and women 55 and older. Among women, only 55% even recognize that heart disease is their number-one killer. Even more staggering is that less than half understand the risks. 

To remedy this situation, Corazon strongly believes that hospitals must focus on early intervention; however, this solution can be effective only after a well thought out and dedicated marketing campaign designed to increase public awareness through community education. Indeed, heart disease must remain a key strategic priority for programs across the country. The result of focused efforts should equate to a healthier population by lessening risks for those who otherwise may not understand their own likelihood of having a heart attack. 

Providing basic education through various forums will increase awareness, and hopefully offer the chance to engage people in conversation about their understanding of the complexity of heart disease, along with a look at controllable risk factors for individuals in the community. 

Heart disease and women

Beginning in 2003, a stronger focus on women and heart disease was marked by the introduction of the “red dress” symbol. For many years prior, and even during this early evolution of the awareness campaign, heart disease was considered to be an “old man’s disease.” Today, that is no longer the case. In fact, in 2004, when the American Heart Association (AHA) faced the fact that cardiovascular disease was responsible for claiming the lives of approximately 500,000 women in the U.S. each year, the organization decided to launch its “Go Red for Women” campaign. 

This effort has become increasingly recognized over the past decade, providing a forum in which women can come together to recognize and discuss their risks, and band together to support and educate one another with numerous tools, education materials, and inspirational stories of survival. 

Consider the typical symptoms of heart attack: shortness of breath, a heaviness across the chest, left arm weakness, and other more atypical symptoms, such as fatigue, abdominal discomfort, or even dizziness and/or light-headedness. But also consider that these symptoms are true IF you are male and present with “typical” symptomology (Figure 1).

As Corazon works with cardiovascular programs across the country, assisting with the development of advanced services, most hospitals recognize the differences between men and women, and their emergency and cardiac teams work well to treat those patients, while others across the care continuum admittedly don’t quite meet the mark in recognizing the difference in symptoms…and unfortunately, it is the patient that suffers. 

The typical emergency room is prepared and provides appropriate, high quality care of the patient with traditional chest pain. However, best practice cardiac care goes well beyond this “typical” presentation, meaning, many care algorithms in place at hospitals across the country are ill-equipped to care for non-traditional acute myocardial infarction (AMI) patients expeditiously, even if that involves transfer to another hospital that can provide care. 

Clearly, programs need to ensure that ALL clinicians or staff who may come in contact with a known or suspected heart attack patient know the signs/symptoms, understand the care protocols, and can adequately and confidently make decisions for these time-sensitive patients, where minutes can mean the difference between life and death.

Outreach for community benefit

Risk factor and symptom awareness is often the best first step in terms of shifting the paradigm of heart disease. This effort must begin in the primary care physician (PCP) office. Corazon believes collaboration between the hospital and PCP office is essential for effecting change. How? A savvy cardiovascular administrator can pave the way by taking time to meet with PCPs or practice administrators in order to arm them with education tools for their patients. Furthermore, the cardiovascular professional has much more detailed information to offer and can provide advice on ways to initiate an up-front discussion with patients about the risk factors associated with heart disease. 

As a strategy, this involves minimal investment — more time and human resources than financial or otherwise — so we believe it is a smart start in raising awareness. There are several turnkey programs that assist with public education through the PCP office. As mentioned earlier, campaigns such as “Go Red for Women” are a place to start. This campaign seeks to not only educate the community, but also raise awareness at the hospital or program level about just how impactful it is to provide education through their packaged web-based initiatives, research studies, and other educational campaigns. 

Basic community-friendly ways to present information, like the F.A.S.T. acronym that is widely used and accepted as the standard for stroke symptom awareness, are also worthwhile. With such materials and resources, PCPs and cardiac programs have a great starting point that is easily available. 

Is it enough, however? We believe it is not. 

While efforts targeted to women are worthwhile, nearly half of the population is left out of this campaign. Risk factors for men are similar to women, but have always been pulled to the forefront, and again, perhaps this is largely in part due to the fact that men present with the “typical” symptomology discussed earlier, and are much more likely to be immediately recognized with and treated for AMI. So, particularly for women, increased awareness remains key to shifting the paradigm. 

Many cardiac programs partner with their in-house practicing cardiovascular physicians, or even primary care doctors in their network, as described above; however, we advise our clients to do much more. Successful hospitals establish collaborative efforts through opportunities to “outreach” with a local rotary, senior center, or church to provide education. These partnerships work well for scheduled, brief education sessions that reveal the basics about heart disease to the general public. Education can also be provided as a “lunch ‘n learn”, with assistance from the hospital marketing department. Typically, the session should last 30-60 minutes and can cover information such as “who is at risk?” “how do I know if I am at risk?” and “what can I do to lessen my risk?” Depending on population dynamics, the topics can be more specific, targeted at particular segments of the population with more in-depth information and/or programs to alleviate risk or recover from surgery, for example. 

In this era of healthcare reform, the cath lab is becoming increasingly challenged to consider the full continuum of patient care beyond the lab walls. In fact, no acute care providers can focus on just the injury and illness within a particular clinical specialty. Today’s practitioners must consider approaches to keep the patient well — both before and after a hospitalization — and this often begins with symptom recognition including but not limited to, weight gain, change in diet, or poor eating habits, a diagnosis of “borderline” or “pre-diabetes, and more. It is important for patients to report any changes in how they are feeling to their doctors, especially if those changes have impacted their quality of life in terms of everyday activity.

Corazon began as a company with roots in the cardiovascular specialty, and while many of our team members have been personally impacted by this devastating disease, this is often the case for the general public as well. In 2015, our company’s mission has evolved. We seek to elevate and challenge not only the programs we work with, but focus on the communities as well. We have recognized a significant need to promote public awareness, and then develop and implement a successful campaign that will not only educate communities, but clinicians and physicians alike, in clear and measureable ways (Figures 2-3).

A program’s ability to measure outreach success is critical, and hospital marketing departments can assist. Whether developing web-based content or using social media, these avenues can be tracked in order to understand and measure effectiveness for the demographic responding to your efforts. This information is quite powerful when strategic (hospital-wide or program-    specific) decisions need to be made as to where to focus outreach efforts. 

Strategies to employ

As a cath lab leader, consider tools that can be provided to patients as part of an education plan — the basics of how to read and understand a nutrition label, or simple “get up and move” tactics and the rationale behind maintaining adequate activity levels. Such things can be considered fundamental building blocks in raising awareness and educating patients and the public regarding heart disease. 

Let’s take it one step further and deploy efforts beyond the continuum of care, within the walls of the hospital. Cath lab professionals should serve as ambassadors of awareness who can provide education to the PCPs (beyond the traditional “I have a pamphlet from a vendor that I would like you to place in your office”) AND the patient. We advise scheduling time to meet with providers and their office managers. The focus of this meeting should be to ask what would assist in providing their patients the best possible information to raise awareness of the many risk factors associated with heart disease. We believe a brief in-person visit is impactful and goes a long way in developing a solid referral relationship as well. 

The task of raising awareness through education and outreach can no doubt be daunting, especially if current efforts are minimal. Depending on the starting point, an overhaul or even just an update of education materials, outreach strategies, partnerships, or Heart Month-focused efforts can involve significant resources across hospital departments, financial and otherwise. How to make this happen should remain a goal throughout the year, well beyond “Heart Month.” 

Corazon challenges many hospitals across the county to consider enlisting bedside clinicians to assist in this effort. Perhaps the cardiac catheterization team or the post-care unit clinicians can become involved in outreach efforts within the community. Enlisting their assistance may be easier than expected, as in Corazon’s experience, many caregivers are more than willing to dedicate their time and extra effort for this important initiative. 

Specific to February as Heart Disease Month, many resources are available. We suggest looking at each week as a chance to focus on an education topic relevant for the patient community. The first Friday in February is dedicated to “Go Red for Women,” so simply wearing RED in order to raise awareness and support could lead to more meaningful discussion. 

Also, consider collaborating with the hospital marketing team to make a larger impact this month. In many cases, a budget specific to particular service lines exists, such as Hearts in February, so additional funds could possibly be directed to promotions about heart disease. 

Corazon always advocates the importance of recognizing, engaging, and educating not only patients, but also the community at large, along with primary care physicians who may need to send their patients with known or suspected cardiac disease to the cath lab. The entire cardiac cath lab team must have the ability to treat these patients with the highest quality care while in the hospital and then beyond the episode of care. Program leaders should challenge themselves and their organizations to raise the bar… raise awareness and help communities become more heart healthy, one patient at a time. 

References

1. American Heart Association: Facts About Heart Disease in Women. Available online at https://www.goredforwomen.org/home/about-heart-disease-in-women/facts-about-heart-disease/. Accessed January 26, 2015.
2. Centers for Disease Control and Prevention. Division for Heart Disease and Stroke Prevention. Women and Heart Disease Fact Sheet. Available online at: https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_women_heart.htm. Accessed January 26, 2015.
3. The Heart Foundation. Heart Disease Facts. Heart Disease: Scope and Impact. Available online at: https://www.theheartfoundation.org/heart-disease-facts/heart-disease-statistics/. Accessed January 26, 2015.
4. Centers for Disease Control and Prevention. Heart Disease. Heart Disease Facts. Available online at: https://www.cdc.gov/heartdisease/facts.htm. Accessed January 26, 2015.

Amy Newell is a Vice President at Corazon, Inc., offering strategic program development for the heart, vascular, neuro, and orthopedic specialties. Corazon provides a full continuum of consulting, software solution, recruitment, and interim management services for hospitals, health systems and practices of all sizes across the country and in Canada. To learn more, visit www.corazoninc.com or call (412) 364-8200. To reach the author, email anewell@corazoninc.com.