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Tailoring Cardiac Care for Women

Joe Cantlupe, for HealthLeaders Media, December 13, 2013
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"Among our priorities is to provide comprehensive cardiovascular care and early identification of cardiac disease," says Indu Poornima, MD, director of the women's heart center at the 661-licensed-bed Allegheny General Hospital in Pittsburgh, part of the 1,200-bed West Penn Allegheny Health System, which includes five western Pennsylvania–based acute care hospitals. "Comprehensive care for women is offered at the center before an event occurs because the heart conditions of women present differently, and specialty care in cases such as hypertension can manage symptoms."

Over time, physicians and academics have continually found differences in what men and women need in cardiac care. Some reports are contradictory, puzzling, and still being sorted out. For instance, women's risk of heart disease appears to increase as their estrogen levels decrease during menopause, but the link is not clear.

In addition, postmenopausal women undergoing hormonal modulation may have greater risks of heart disease, and pregnant women with certain conditions may be susceptible to more cardiology ailments. Most baffling of all, nearly two-thirds of the deaths from heart attacks in women occur among those who have no history of chest pain. Other studies also have raised growing concerns about atrial fibrillation among women.

Developing a heart center that specializes in women's cardiology care is of growing importance for institutions, not only for improving care for women but also for hospital ROI, says David X. Zhao, MD, FSCAI, FACC, chief of cardiology and director of the heart and vascular center for excellence at Wake Forest Baptist Medical Center.

Within months of his arrival in July, Zhao restructured the hospital's cardiology team to also ensure a focus on women's cardiac issues and appointed Wells to head the women's heart program. Previously, "we didn't have a lot of interaction" with women cardiac patients, says Zhao. The new program is part of an evolving "cohesive service line," including a physician champion for women's health and prevention programs to address patient weight management, risk stratification, and hypertension.

Developing such a women's heart program was "critical from an institutional standpoint and for patients," Zhao adds. The program "creates a specific health structure using a platform to educate the public" and a streamlined approach for primary care physicians who refer cardiac patients to the hospital, he says.

Having a specific heart center that focuses on women's cardiac issues also opens the door for improved economic returns for the hospital, says Zhao.

"You capture those referral volumes from physicians by having a heart center for women," says Zhao. "From a business standpoint, you are increasing patient visits from women. It's the woman who makes a lot of the healthcare decisions in a family. If you provide good service, they tell their husband or father, and we triple, quadruple the service from the hospital's standpoint if the entire family comes in."

The Center for Women's Heart Care at the 957-licensed-bed Duke University Medical Center is not located in a separate facility, but within the cardiac division on the main Durham, N.C., campus. It's what L. Kristin Newby, MD, MHS, a cardiologist at DUMC calls a "virtual" program.

It works this way, she says: "We have our physicians declare their interest or special interest in heart disease in women, and our communications center aligns patients when they call in—asking for specific services—with those physicians."

That, Newby says, helps patients feel more comfortable: knowing they have a women's cardiac program to address their needs.

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