Creating Powerful Alliances for Reducing Disparities in

Cardiovascular Outcomes in Harlem

Mrs. Patricia R. Butts Abyssinian Baptist Church

Elizabeth Cohn, RN, DNSc Columbia University

Make a Call-Don’t Miss a Beat

• This work is funded under a grant by the NYS Office of Women’s Health Region II

• Department of Health and Human Services, Office of Women’s Health.

Project Aims1. To develop a set of culturally tailored strategies to

educate women and their families about the signs and symptoms of heart attacks.

2. To raise awareness of medical providers to the alternative presentations of heart attacks in women.

3. To use social marketing for widespread dissemination of these health messages.

4. To demonstrate the power of a partnership between faith-based organizations, Schools of Nursing and DHHS.

Four Factor Intervention

• Individual: Trained church women in low-tech, high-touch methods. Pocketbook training.

• Medical Providers: Huddles; next generation of provides.

• Faith-Based/Congregants: Sermons based on CVD information. Original Gospel music and short plays.

• Social Marketing: Times Square Jumbotron, Amsterdam news. Jingles.

Review of the morningWhat do you think is the number one cause of

death in women in the United States?

A. Breast CancerB. Heart DiseaseC. AccidentsD. Lung Cancer

Disparities in CVD• African American women are 40% more likely to have

three or more risk factors1 and are significantly more likely to die from heart disease2 when compared to their white counterparts.

• Although at increased risk, 60% of African American women lack awareness of the signs and symptoms and the need for a definitive action plan2.

• Early recognition and treatment saves lives and improves outcomes. But this depends on identification of the signs and symptoms both by the individual and hospital providers.

1. Giardina, et al. (2011). Journal of Women's Health. 20(6): 893-900 2. Canto, et al. (2012). JAMA. Feb 22;307(8):813-22.

The Facts A woman suffers a heart attack every minute

Even though awareness has increased over the years, women still don’t see personal risk for themselves

Women tend to dismiss symptoms leading to poorer outcomes and increased deaths

Only about half of women would call 911 if they thought they were having a heart attack

Sources: American Heart Association 2008, Sheng et al. 2001 American Heart Association Statistical Update: Heart Disease and Stroke, 2009.Lloyd-Jones D et al. 2009.

Edna’s Story

What signs and symptoms can you identify in this

story?

Chest PainDescribed as “discomfort, ache, pressure, tightness, or fullness”

Can last for several minutes or go away and come back

This is the “hallmark” sign for heart attacks in men, but one study found that only 30% of women experienced chest pain or discomfort prior to their heart attack

Upper Body PainCommon sites for pain

•Chest•Upper back, between the shoulders•Left arm•Shoulder•Neck jaw •Upper stomach

Often vague or generalized to a region, if you can point to the pain with one finger, it is less likely that it is a heart attack

Shortness of Breath Difficulty breathing, you may be

panting or find yourself trying to take deep breaths

Occurs with normal daily activities

Can occur with or without chest pain

This was reported by half of women experiencing a heart attack

Dizziness Feeling lightheaded or

like you may pass out

Usually sudden in onset

Can be accompanied with severe weakness

Cold Sweats You may suddenly

break out into a sweat with cold, clammy skin

Can be confused with “hot flashes” of menopause

Nausea May or may not be

associated with vomiting

May or may not be associated with abdominal pain

Often described as “feeling sick to the stomach”

Can be mistaken for “a stomach flu”

Fatigue Tiredness that is long-lasting

or recurrent

Unusual, unexplained, extreme, and sudden in onset

May also feel very weak

More than half of women experienced marked fatigue prior to the onset of their heart attack

If you experience even one of these symptoms that is unusual for you, don’t wait. Call 911!

What to do…call 911!

For themselves, 53% of women said that they would call 911 if experiencing the symptoms of a heart attack

Only 46% of women would do something other than call 911 – such as take an aspirin, call the doctor or try to drive themselves

About 80% said they would call 911 if someone else were having a heart attack

911 Usage

Source: Circ Cardiovasc Qual Outcomes Mosca et al. 2010.

Results

• We wanted to change those statistics

• Both community members and medical personnel who attended the workshops had significantly improved knowledge (p=<0.05) and likelihood of having an action plan and (p=<0.05).

• An estimated 10 million women and their families were exposed to the information as measured by Plowshare, an independent social marketing agency.

Does increased knowledge translate into increased action?

– Measuring the number and types of calls to 911.– Tracking outcomes in women who have presented

to Emergency Departments with the signs and symptoms of heart attacks.

– Exploring ways of reducing risk factors and preventing heart attacks through greater collaboration of our faith-based organizations and school of nursing.

Collaborative work

We have benefited greatly from our collaborative work and invite you to join

us in improving health across the nation.

Thank you.

ec2341@columbia.edu

Let’s DANCE!

ResultsCommunity Professional