1、How to Develop a Womens CVD Health Project in Western Countries: Prospects and Actuality,C. Noel Bairey Merz MD Womens Guild Endowed Chair in Womens Health Womens Heart Center Preventive and Rehabilitative Cardiac Center Heart Institute Cedars-Sinai Medical Center merzcshs.org,The Problem: Incidence
2、,Two Diseases and Their Toll,0 1.25 2.5 3.75 5,0 5 10 15,0 40 80 120,0 600 1200 1800,15-24,25-44,45-64,65 and over,AGE (years),RATE PER 100,000,HEART DISEASE,BREAST CANCER,Mortality rates per 100,000 women in the United States,More women die of CHD than breast cancer at all ages,Murphy SL. Death: fi
3、nal data for 1998. Natl Vital Stat Rep 2000;48:1-105,What Can We Do?USA Organizations: NHLBI AHA ACC Sister to Sister VHA Womens Heart Advantage Program WomenHeart,Womens CVD Health Project,Awareness Detection Healthcare Provider Education Diagnosis and Treatment Research,Womens CVD Health Project,A
4、wareness Detection Healthcare Provider Education Diagnosis and Treatment Research,The Problem: Awareness,78% believe breast cancer is greatest threat10% believe heart disease is a threat,18% incidence; 4% mortality50% incidence; 37% mortality,Perception Reality,National Heart, Lung and Blood Institu
5、te (NHLBI): The Heart Truth Red Dress Collection (2001, 2004, 2007),Women and CVD: Making an Impact,Amercian Heart Association (AHA) National Awareness Survey 1997 30% aware heart disease is #1 killer 2000 34% 2003 46% Knowledge gap remains especially in women younger than 45, Hispanic, and African
6、American women “Disconnect” remains only 13% say heart disease is their own greatest health risk,Womens CVD Health Project,Awareness Detection Healthcare Provider Education Diagnosis Treatment Research,Heart Risk Assessment,80% of women surveyed had cardiac risk factors (age, smoking, physical inact
7、ivity, obesity, hypertension, diabetes, family history, dyslipidemia) Few women had discussed cardiac risk with healthcare provide Most were interested in more information and screening for risk,CSMC unpublished VHA Womens HeartAdvantage survey data,CVD Risk Assessment,Women and CVD Wellness Program
8、 Pen and pencil risk factor assessment BMI, waist circumference and blood pressure Fingerstick blood cholesterol and sugar Cardiac risk and heart healthy lifestyle counseling Referral for physician evaluation, if appropriate,National Day of CVD screening for women started bya woman whose daughter di
9、ed of heart diseaseConcurrently held on a weekday across most major US citiesLeadership Executive Womens Breakfast to engageinvolvement, sponsorship and employer supportLocal medical and corporate sponsorsOn-site screening and referral donated by healthcare systemHealthfare and ExpoScreening data ar
10、e published in the Journal of Womens Health,On February 27 & 28, 2008, in Century City, the Sister to Sister Foundation, the Los Angeles Lakers, the Century City Chamber of Commerce and Century Park will undertake the extraordinary task of providing 1,000 free cardiac screenings to women in Los Ange
11、les in memory of the 1,000 women who will be taken by heart disease this month.,How Can I Know My Heart Disease Risk?,Visit the Womens Health Wellness booth and sign up for a screening,Womens CVD Health Project,Awareness Detection Healthcare Provider Education Diagnosis and Treatment Research,Nation
12、wide program, locally deliveredLead by “better practice” clinicians and hospitalsPatient and community centered Customizable for the health care organization or communityMeasurableSystems orientedScientifically valid,Top Five Elements,Paramedics/Emergency Response Emergency Department Protocols Cont
13、inuing Medical Education (CME/CEU) for Healthcare Providers Clinical Quality Indicators for Acute Myocardial Infarction (AMI) Discharge/Physician Care,Mortality for Women and Men Post-AMI* and After Adjustment by Risk Score Women have higher CHD mortality,*p0.001; p0.002.,Women Men,After adjustment
14、by risk score,(%),Post-AMI,(%),ACC/AHA Pocket Guidelines,“Guidelines for the Management of Patients with Acute Myocardial Infarction” “Guidelines for the Management of Patients with Acute Coronary Syndromes” Available for Palm/Visor handhelds, as small laminated pocket size booklets, or as posters t
15、hat can be posted in ED rooms or in triage area. Available downloaded from the web at www.acc.org or www.americanheart.org or by calling the American College of Cardiology resource center 1-800-253-4636, ext 694,Gender Differences in ED Care for CV Symptoms: Women receive less assessment for CV symp
16、toms,McKinlay JFl, J Health and Social Behavior 1996;37:1,Proportional Effects of Treatment Strategies on Mortality,Antiplatelet Beta Blocker Calcium Blocker FibrinolyticsStreptokinasetPA vs. SKThrombolytic ACE Inhibitors,0,0.5,1,1.5,2,OR (95% CI),0,0.5,1,1.5,2,OR (95% CI),Women,Men,Favors,Treatment
17、,Favors,Control,Favors,Treatment,Favors,Control,MI Treatment: Women and Men have similar risk benefit,Demographics Lipid Rx at Discharge Overall 31.7% Male 34.8%Female 26.8%Non-Black 31.9%Black 28.9%,Percent of patients discharged on lipid lowering therapy,Fonarow, Watson, French. Presented ACC 2001
18、; Orlando, FL,Example of Myocardial Infarction Automated Orders,Guideline care is delivered unless physician cancels it,Optimizing Physician CVD Management,Identify a cardiologist champion or group to work with hospital to establish guidelines and educate (CME) to other physicians and healthcare pro
19、viders Provide guideline materials and automated protocols regarding women and heart disease to physicians and allied healthcare professionals,Old Boys Club - 12% of US cardiologists are women Champions can be men who are interested in quality,Womens CVD Health Project,Awareness Detection Healthcare
20、 Provider Education Diagnosis and Treatment Research,NY Times,Obstructive CADMore prevalent In menMicrovascular Coronary DiseaseMore prevalent in women,JACHO AMI Core Measures Community Awareness & Risk Factor Measures,ASA at arrival ASA at discharge ACE for LV dysfunction Smoking cessation counseli
21、ng Beta blocker at arrival Beta blocker at discharge Time to thrombolysis/PCI Inpatient mortality,Do you have: Hypertension? High Cholesterol? Diabetes? A Family Member with Heart Disease? Do you smoke? What is the leading health threat for women? What is your leading health threat?,Prospects for Im
22、portant Sex-stratified Research Data Collection,Join the CSMC Womens Health Research Registry: Improve Womens Health for Yourself and Our Daughters,CVD disease mortality trends (US: 1979-2004). Source: NCHS and NHLBI (2008).,Updated CVD Mortality Trends in Women & Men,Summary: How to Develop a Women
23、s CVD Health Project in Western Countries,Media campaigns have raised heart disease awareness among women in the US. “Red Dress” campaigns are starting throughout Australia, Europe, South America and Asia. Screening/detection programs have been started aimed at women; data are being collected, analyzed and published. Use of guideline management is reducing CVD mortality in women. More research in women is needed, particularly international. Collaboration is welcome.,
