The Women’s Heart Initiative brought together a diverse group of experts and stakeholders to discuss the current state of knowledge on women and heart disease with a specific focus on the primary and secondary prevention of cardiovascular disease in the primary care setting. The centerpiece of the Women’s Heart Initiative was an expert conference in December 2002. This conference entitled Women and Heart Disease – Putting Prevention into Primary Care, brought together healthcare professionals, researchers, advocates, and policymakers. The conference examined the state of the evidence on women and heart disease and drafted recommendations to improve primary and secondary prevention of heart disease for women in the primary care setting. During the conference, experts developed recommendations to address clinical practice, research, quality improvement and public policy. The conference findings and recommendations, along with three papers commissioned by JIWH, were published in a special edition of the Jacobs Institute’s peer-reviewed journal Women’s Health Issues.
Women’s Heart Initiative
JIWH created the Women’s Heart Initiative to increase awareness of the risk of coronary heart disease in women and to improve the health services that women receive for the primary and secondary prevention of heart disease in the primary care setting. Attention to preventive strategies in the primary care setting is warranted based on the large number of women at risk, the existence of proven strategies for risk reduction, and the conclusion from the expert panel that these strategies are being under-utilized.
The first day of the conference provided updates on the epidemiology of heart disease in women and on the diagnosis and management of coronary heart disease in women from an evidence report commissioned by the Agency for Healthcare Research and Quality and conducted by Deborah Grady and colleagues. Results were also presented by authors of three papers commissioned by the Jacobs Institute to address the state of evidence for key topics related to prevention of heart disease in women through health behavior change, physician adherence to preventive cardiology guidelines for women, and quality of care performance measures and quality improvement strategies related to heart disease in women. Speakers and their presentations were as follows:
- Veronique Roger, MD, MPH, Professor of Medicine, Mayo Medical School: Update on women and heart disease
- Deborah Grady, MD, MPH, Vice Chair, Department of Epidemiology, University of California, San Francisco and a lead investigator of the AHRQ evidence-based report on the management of coronary artery disease in women presented results of this report: Diagnosis and management of coronary heart disease in women
- Evelyn Whitlock, MD, MPH, Senior Investigator, Kaiser Permanente Center for Health Research and a member of the US Preventive Services Task Force presented the evidence and results of the Task Force’s work on counseling and heart disease: The primary prevention of heart disease in women through health behavior change promotion in primary care
- Michael Cabana, MD, MPH, Assistant Professor of Pediatrics, University of Michigan Medical Center: Physician adherence to preventive cardiology guidelines for women
- Allen Fremont, MD, PhD, Associate Natural Scientist, RAND Corporation: Managed care plans’ use of objective performance measures of quality of care for cardiovascular disease and diabetes and their impact on quality of care for women
Each presentation was followed by a question and answer discussion session.
These presentations were followed by a panel discussion on “Future practice, research, and policy initiatives.” Panelists included Carolyn Clancy, MD, Director, Agency for Healthcare Research and Quality, Wanda Jones, DrPH, Deputy Assistant Secretary for Health, Office on Women’s Health, Department of Health and Human Services, Augustus Grant, MD, PhD, President, American Heart Association, and Nancy Loving, Executive Director, WomenHeart. The day closed with a briefing over dinner by Carolyn Clancy and Vivian Pinn, MD, Director, Office for Research on Women’s Health, National Institutes of Health.
The second day of the conference utilized insights from day one to prompt discussion on recommendations. The day was divided into sessions around four topics: clinical practice recommendations, research recommendations, quality improvement recommendations, and public policy recommendations.
The conference resulted in key findings as well as clinical practice recommendations, research recommendations, quality improvement recommendations, and public policy recommendations that were published in JIWH’s journal, Women’s Health Issues.
Key findings were based on presentations, commissioned papers and discussion. There were four central findings:
- Counseling women for tobacco cessation is recommended for use in the primary care setting, but there is a lack of research on the effectiveness of physical activity and nutritional counseling in these settings.
- Multiple barriers prevent healthcare professionals’ adherence to clinical practice guidelines related to heart disease, including lack of time, lack of familiarity or agreement with guidelines, low self-efficacy or belief in their capacity to successfully follow the guidelines, absence of system supports for preventive counseling, inadequate insurance coverage for behavioral services, and fragmentation of women’s primary care.
- Despite research that confirms gender disparities in prevention and treatment of heart disease, efforts to improve quality of care for women are hampered because performance measures are not available by gender.
- Strategies for increasing the provision of recommended preventive services for women are hindered by the lack of a comprehensive public policy agenda addressing gender-specific research and data collection, health promotion strategies, and improvements in public health programs.
Four key recommendations also emerged from the conference. These recommendations addressed clinical practice, research, quality improvement, and public policy. They are as follows:
- Reduce barriers to provision of recommended preventive interventions, especially tobacco cessation, for women in the primary care setting by providing necessary educational resources to healthcare professionals, creating system supports for innovative approaches to patient education and counseling, and advocating for adequate health insurance coverage of behavioral services aimed at reducing risks.
- Partner with health plans, insurers, healthcare professionals, and accreditation organizations, such as the National Committee for Quality Assurance, to demonstrate the feasibility of gender-stratifying the Health Plan Employer Data and Information Set performance measures related to heart disease for monitoring and improving quality of care.
- Require that federally funded epidemiological, clinical, and health services research be analyzed by gender and that gender-stratified data be made available to the research community.
- Develop a comprehensive public policy agenda that addresses prevention of CHD in women by increasing federal funding for epidemiological, clinical, and health services research on heart disease health promotion and prevention, implementation of proven preventive strategies for women in public health programs at the state and local levels, measuring and improving the quality of care at the primary care level, and ensuring access to appropriate CHD services for women.
The final report discussing the conference’s findings and recommendations was published in the July/August 2003 issue of Women’s Health Issues. This report was unveiled at a September 2003 briefing on Capitol Hill to an audience of 150 policymakers, healthcare professionals, women’s organizations, the public health community, and government officials. Representative Louise Slaughter (D-NY) gave remarks at the briefing.
JIWH and the National Committee on Quality Assurance (NCQA) will commence Phase II of the Heart Project in 2007. This phase will focus on the dissemination of information related the HEDIS measures, heart disease, and gender.