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ACC Practice News Heart disease may be the leading cause of death
in American women; however, the number of
cardiovascular (CV) programs geared to women
does not attest to that fact. Yet, persistent voices-
ranging from consumer lobby groups to clinicians Indeed, hard work and challenges are what these
agents of change face when it comes to creating a
women's CV center. First, not enough genderspecific Second, preventive care-not high on payors'
reimbursement lists-is key to women's CV Finally, no databank exists to verify just how successful these programs can be. "The outcomes measurements are not in place yet, but it's an important issue because as these centers pop up, we must come up with strategies to evaluate them objectively," said Alexandra Lansky, MD, director of the angiographic core laboratory and women's health cardiovascular health initiative at the Cardiovascular Research Foundation, Manhattan. WomenHeart, one of the only organizations tracking these centers, puts the number of women's comprehensive CV programs at 33. A solid CV program generally provides screening, diagnostic testing, and preventive services- such as nutrition and exercise counseling. "What separates a women's health program is that it is specifically tailored to women, and the practice guidelines are designed with women in mind," said Dr. Bennett. Programs range from on-site to off-site, each with its advantages and disadvantages. The advantages to an onsite program include convenient access to services such as lab, x-ray, nuclear scanning and so forth. "From a budget standpoint, if it's onsite, you can use some existing services and space, so the startup costs are typically lower," said Stephanie Supple, RN. Supple and her business partner, Caroline Norman, MD, are recognized leaders in the field of women's CV centers. "However, lack of parking is often a disadvantage, and the program itself could lose visibility within the larger complex," adds Supple. Offsite facilities tend to have a higher visibility
and can be less intimidating; however, there are the
higher costs of hiring a full time staff and the lack
of all the necessary testing equipment.
In the near future, the number of comprehensive
women's CV centers could more than triple if
health care participants in Guidant Corporation's "Making a Difference - Heart to Heart"
preceptorship implement CV programs. Taught by
Supple and Dr. Norman, the program provides the
closest thing to a blueprint for women's CV centers
in the industry. Dr. Norman and Supple joined
Guidant in October 2002 with a vision to expand
on the organization's Guidant Reaches Out to
Women (GROW) program and to hold
preceptorships to help 70 institutions implement
comprehensive women's CV programs. "In 2003,
we preceptored 52, and 29 of the 52 have opened Dr. Norman first established the Heart to Heart program at North Mississippi Medical Center in Tupelo, Miss., and then implemented it at Our Lady of Lourdes Regional Medical Center in Lafayette, La., in 2000. The program includes teaching potential organizers and clinicians a model called "The Closed Loop to Care," which involves five phases: 1) increasing education and awareness levels; 2) diagnosis and intervention; 3) more extensive exams to determine if heart disease or major risk factors exists with appropriate follow-up steps; 4) strategies for education and lifestyle modification; and 5) set up for data tracking, outcomes, benchmarking. In a new move, Guidant has agreed to fund the first 10 sites of a pilot project Norman and Supple are currently setting up. "It's a step toward fulfilling a dream that Caroline and I have had for many years: To develop a national benchmark registry of women's cardiovascular programs from the preceptored sites, and other programs, across the country," said Supple. Such solid data will help fuel the growth of future women's heart centers.
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