February is a month for celebrating matters of the heart. Most famously, Valentine’s Day is an occasion for exchanging cards, gifts, and declarations of affection. But February is also American Heart Month, an opportunity to promote heart health awareness.
To honor the women we love, ECG promotes the synergy of women’s health and cardiac health service lines as a way to enhance quality outcomes in these two important areas. A quick online search reveals disconcerting statistics aboutwomen and heart disease. From the American Heart Association’s Go Red for Women website, here are just four “Facts about Women and Heart Disease.”
The prevalence of women’s heart disease is exacerbated by race-based factors and social determinants of health (SDOH) that contribute significantly toward women’s risk during pregnancy and throughout their lifetimes.
There is more sobering news in the conclusion from the AHA Journal article “Social Determinants of Suboptimal Cardiovascular Health Among Pregnant Women in the United States.”
Patient/Provider Relationships
Within health systems, an opportunity to improve women’s heart care begins in the outpatient arena. Many women develop strong, trusted relationships with their OB/GYN providers during their pregnancies. ECG’s data shows that more than 30% opt to stay with those providers postdelivery for their ongoing wellness care. OB/GYN providers already manage a wide variety of clinical conditions related to pregnancy and gynecology.
Because their patients trust them for their healthcare needs, these providers must also stay current with primary care guidelines. This includes wellness screening for optimal heart care, an important topic addressed in this 2018 AHA Journal article, “Promoting Risk Identification and Reduction of Cardiovascular Disease in Women through Collaboration with Obstetricians and Gynecologists,” from the American Heart Association and American College of Obstetricians and Gynecologists.
In addition, OB/GYN providers should consider population-based risks, including those based on SDOH, along with each patient’s unique medical history and screen for heart disease accordingly.
Infrastructure
As hospitals and health systems strive to change the narrative around health disparities broadly and women’s heart care specifically, it is worthwhile for an organization to pursue a thorough assessment of its infrastructure. Ideas for improvement are to identify connection points between women’s health and cardiac services that can encourage and enhance system-wide thinking, and incorporate a variety of perspectives with the goal of enhancing women’s heart care. The AHA Journal article regarding SDOH, pregnancy, and cardiovascular health concludes that SDOH correlates to cardiovascular health for pregnant women, and a knowledge of SDOH factors contributes to improved clinical decision-making.
Evaluation of an organization’s infrastructure starts with studying the system’s process and outcomes data, looking for disparate and variable clinical outcomes across a broad range of metrics.
1. Establish Benchmarks
First, use health system data to benchmark against high performers with similar characteristics. Some suggested reviews include evaluating outcomes by gender for cardiac registry data (ACC/NCDR, AHA GWTG) and determining the number of unplanned readmissions or ED visits within 30 days of discharge. Also, examine pregnancy outcomes and rates of cardiac conditions like preeclampsia and readmissions for hypertension and related conditions.
When analyzing the data, look not only at the data in aggregate, but also compare different populations: women versus men, and white populations compared to the predominant race or ethnic groups in the health system’s specific market—these two categories might provide insight into the experience of diverse patient populations.
2. Evaluate Service Line Structure
Next, evaluate the overall service line structure using a framework like ECG’s Women’s Health and Cardiology Service Line wheels, shown below. Does the organization have a strong service line structure for cardiology and women’s services? If the answer is no, the best opportunity may be to start by organizing those two areas carefully, then bridging the two as the service areas mature.
3. Strengthen Connections among Service Lines
If the system already has well-developed service lines, determine the strength of the connection between cardiology and women’s health service lines, including primary care, OB/GYN, and MFM. The two areas may be anywhere on a continuum from well connected to virtual strangers. Connections may be found in the number of shared patients or the screening and referral processes, shared clinical meeting opportunities, or integrated locations.
Listed below are paths that can ultimately lead to a formalized service line relationship.
- Multidisciplinary committees
- Combined, multidisciplinary clinics for women at risk
- Routine CV health CME offerings for women’s health providers
- Shared trainings to identify and eradicate implicit bias
- Easy and seamless referrals between specialists, with a focus on shared care (because women need primary care, their trusted OB/GYN, and cardiology)
- Standardized provider tools for review of systems and routine assessment of aggregate data
- Formal CV screening and community education programs
- Women’s cardiovascular health program co-led by cardiologists and OB/GYNs
With the collective expertise of providers in cardiology and women’s health and administrative leaders, hospitals and health systems can work to improve women’s heart health. A multidisciplinary team model is the best practice approach for tackling gaps in care and improving the long-standing disparities in care for women.
Published February 24, 2022