“Heart disease is the number one killer in women,” said Dr. Gina Lundberg, clinical director of Emory Women’s Heart Center and a preventive cardiologist with Emory Clinic in East Cobb. “For some reason, awareness of women having heart disease is still very low.”
Since March 2014, the Emory Women’s Heart Center has been echoing the beat of progress in the field of female-focused cardiology and heart health awareness.
Like the multiple valves of the organ it honors, the Emory Women’s Heart Center operates through a combination of screenings, research and community awareness. Patients visit one of its six locations for cardiac screenings, while others tap into the pulse of heart disease knowledge at one of its community or corporate events. Alongside, its research branch explores the latest in heart disease research pertaining to women.
Building awareness around women’s heart health is nothing new for Dr. Lundberg. Prior to the 2012 merger of Emory Healthcare and St. Joseph’s Hospital, she directed a women’s heart screening program at St. Joseph’s. Once the hospitals joined forces, the decision was made to not only continue this program, but to increase the surge of its blood flow by pairing it with Emory’s research side.
“Emory Healthcare has had a long interest in women’s heart disease,” Dr. Lundberg explained. “Some of the most outstanding researchers in the field have been at Emory for years. … So we got together with the powers-that-be to come up with a program that has the best of both worlds.”
CALL OUT BOX
“Heart disease is the number one killer in women,” said Dr. Gina Lundberg, clinical director of Emory Women’s Heart Center and a preventive cardiologist with Emory Clinic in East Cobb. “For some reason, awareness of women having heart disease is still very low.”
Emory Women’s Heart Center then came to life. Dr. Leslee Shaw, one of those top researchers, was enlisted to direct the research side, and Dr. Lundberg was asked to helm the clinical aspect.
“I think especially here in the Southeast, it’s a program unlike others in the area,” said Kristan Langdon, one of the program’s nurse practitioners. “It’s very collaborative. We do outreach to both the general community as well as the medical community. So it’s a good team. We work well together.”
The screening component takes place at one of six Emory Heart & Vascular Center locations (the main Emory campus, East Cobb, Decatur, Johns Creek, Lithonia and Midtown). Langdon and two other nurse practitioners, each with their own home base, divide their time with other locations to administer the screenings.
An out-of-pocket initial assessment screening, which costs $75 and doesn’t require a referral, can be scheduled on the center’s page at the Emory Healthcare website. According to Lundberg, the ideal patient for a screening is between ages 40-60 and generally has some sort of heart disease risk factor.
The NPs put on their sleuthing caps to detect risk factors, offering a more extensive experience than what patients typically receive when seeing a primary care doctor for a cardiac evaluation. The process takes a look at any cardiovascular disease in the patient’s family tree. The two-hour comprehensive global cardiac risk assessment includes an examination with the nurse practitioner checking the patient’s blood pressure, body mass index, cholesterol and more.
“Patients often come in thinking they don’t have any risk factors,” said Stacy Jaskwhich, an NP and the program’s clinical coordinator. “Most of the people we screen have at least one or two risk factors for heart disease that they’re not aware of.”
While many people link heart disease with obvious culprits, including high cholesterol, high blood pressure, smoking and being overweight, Jaskwhich says the NP screeners find themselves unveiling nontraditional risk factors. These include rheumatoid arthritis, any auto-immune disorder and early kidney disease. An unhealthy diet, even if a person isn’t overweight, can be a risk factor for heart disease, she says.
After the initial screening, the nurse practitioner may recommend one or both of two additional screening packages, which cost $100 each. The first, dubbed Plan B, is customized for women with intermediate risk, hypertension or diabetes mellitus. It includes a preliminary echocardiogram, EKG and other tests. Plan C, for women with intermediate risk or diabetes mellitus, focuses on a patient’s calcium score. It’s found via computed tomography of the coronary arteries, examining the potential risk of coronary disease or blockage.
Once the nurse practitioner has completed the screening, it may be determined that the individual needs to be evaluated by one of the center’s five cardiologists. This five-woman team, including Dr. Lundberg, each hold specific specialties. For example, Dr. Carolina Gongora has a concentration on disparities in ethnic women, particularly Hispanics and Latinos. Dr. Ijeoma Isiadinso’s special interests lie in rheumatologic disorders and disparities in African-American women. Dr. Susmita Parashar hones in on cardio oncology, the study of the effects of cancer medications that can be toxic to the heart. Dr. Alexis Cutchins specializes in heart disease risk reduction, and pregnancy and heart disease
When patients are found to need more diagnostic testing or are at higher risk, they are referred to the general cardiology clinic. Patients with minimal risks are simply provided with a comprehensive and customized game plan prepared by the nurse practitioners. This could include strategies to establish healthier eating habits such as adapting to the Mediterranean diet or recommending an appropriate exercise plan.
“Knowledge of and adherence to the guidelines established by the American Heart Association and the American College of Cardiology combined with the latest research help us to direct women in what is best for their cardiovascular health,” Jaskwhich said, “and gives them motivation to make the necessary changes as well”.
Whether a patient falls into the category of needing lifestyle interventions and behavioral changes or surgical and high-tech interventions has everything to do with timing, Dr. Lundberg says.
“Let’s say you have high blood pressure and cholesterol, but you haven’t developed heart disease yet,” said Dr. Lundberg, “then lifestyle is extremely important and the most beneficial. If you can eat a healthier diet, get more active and lose weight, it will have a tremendous impact on you.”
However, if a patient is older and has already had bypass surgery, cardiac stents or multiple admissions for congestive heart failure, she’s already down the path to end-stage heart disease. Although a change in lifestyle is still important, it’s not going to have the same effect it would’ve have had 10-20 years earlier. This is when more intense treatment would be an option.
The center also passes heart-healthy suggestions at community events held at civic organizations, churches and other venues. Corporations, including Georgia Power and Home Depot, have been known to invite center representatives to appear at corporate gatherings.
In the fall of last year, the Emory Women’s Heart Center launched the 10,000 Women Project. Its goal is to screen 10,000 African-American women for hypertension to reduce stroke and heart disease. Over the next few years, the center’s nurse practitioners, along with a team of volunteers, will continue to screen women at events held by local grassroots groups, churches and other organizations to reach its goal.
Upcoming 10,000 Women events take place Jan. 31 at Our Lady Lourdes Church and Feb. 5 in the atrium of Emory St. Joseph’s Hospital.
CALL OUT BOX
Upcoming 10,000 Women events take place Jan. 31 at Our Lady Lourdes Church and Feb. 5 in the atrium of Emory St. Joseph’s Hospital.
“We’re trying to have an impact on our community and improve the health of Atlanta’s women,” said Dr. Lundberg. “I think we’re just as much of a community service as we are a healthcare organization.”
Sidebar: From the Nurses’ Mouths
Pulse sat down with a pair of nurse practitioners who work for Emory Women’s Heart Center to learn more about what they do, their backgrounds and what drives them forward.
Kristan Langdon, APRN, ANP-C
On the most gratifying part of her job:
“I think the biggest thing is the new knowledge and insight that the women gain from these screenings. We have a very unique setup. We are able to spend two hours of dedicated time with each woman. We can give them a lot of education, speak directly to the concerns they have, and tailor education specifically to the patient and her unique situations. …With our larger community screening events, the biggest thing is meeting people where they’re at. They may not be out there seeking medical care or knowledge, but through the screening process we’re able to help impart some of that knowledge to them. We get to bring awareness about something they may not know of, because they don’t have routine medical follow-ups or maybe they’re avoiding the problem. We can really bring to light why they need to take action now as opposed to later. For example, a woman may have changes in her heart structure due to longstanding hypertension, but has no symptoms and therefore has not sought evaluation. Unrecognized or long-term unmanaged cardiovascular risk factors often lead to heart attacks, strokes and/or heart failure. And tragically, most of the risk factors that lead to cardiovascular disease are 100 percent modifiable or preventable.”
On the growing interest in heart disease in women from the professional nursing side:
“It’s happening, but a big knowledge deficit [of cardiovascular disease risk in women] is still there. …There’s a big amount of research that can be done to expand our knowledge of pathology and risk factors for cardiovascular disease in women, and there’s a lot more grant funding that can occur, because this is a new area for research. I think as more women are going into health professions, there’s a draw toward working with women, because it’s unique. It’s women taking care of women. It maybe helps validate some of the symptoms. And I also think women hearing it from women might hit closer to home when it comes to being proactive and taking care of themselves.”
On her advice to those interested in the field:
“I’m a big proponent for shadowing in healthcare settings, doing volunteer work for different health based organizations, so you can get a good feel for what that role is like. It also helps with good networking connections as you progress through your career and education. …In the Emory Women’s Heart Center 10,000 Women Project, we use volunteers who are clinical and non-clinical. We have a wide need base, and it’s a great place to get more experience and knowledge about women and heart disease.”
On enjoying both screening and working in general cardiology:
“A lot of the general cardiology patients are older and this means more chronic disease management. I do a lot of education and counseling on dietary and behavioral modifications to maintain health and prevent further decline in this population of patients. I have a passion for helping individuals have the best possible health and wellness. At the Emory Women’s Heart Center, I can hopefully prevent people from having long-term sequelae from co-morbid health conditions. And hopefully our education and interventions can improve their wellness habits overall and even the health of their children. When parents change their behaviors, they model healthier behaviors for their children. They’re more active as a family, they eat healthier and take on other behaviors that decrease risk factors for heart disease. By what we are doing with the Emory Women’s Heart Center, we have great opportunity to impact health and decrease cardiovascular disease risk and deaths for generations to come. And that is pretty awesome.”
Stacy Jaskwhich, NPC
On her interest in matters of the heart:
“I’ve always had an interest in cardiology. I started out as a nurse in the cardiovascular ICU recuperating patients from open heart surgery. Then I decided that so many people have heart disease, that there must be a way to decrease the incidence. So I started focusing more on the preventative aspect in my nurse practitioner career. I kind of went full circle with cardiac disease.”
On her passion for the field:
“I feel pretty passionate about health in general, and I think helping patients decrease their cardiovascular risk factors helps improve their overall outcome. Motivating women to make lifestyle changes is something that energizes me. A lot of people don’t know where to start. They know that they’re overweight or need to stop smoking, but they’re stuck in a rut and don’t know how to begin to change bad habits. I love devising a plan to include healthy alternatives and suggesting practical tools that they can use to help with things such as weight loss. I like to recommend apps that you can download on your phone to help count calories and analyze nutritional content.”
On success stories:
“A lot of times when patients have high risk, they’re referred into our general cardiology program. So not only do I get to see them from a screening standpoint, but I also see them through diagnostic testing. I can see first hand how treatments have either saved them from catastrophic events or merely assisted them in making several lifestyle changes that put them on a healthier track. We’ve had patients who have lost a significant amount of weight through lifestyle changes avoiding diabetes and other comorbidities. We’ve seen women who’ve had subclinical disease found through a cardiac CT who weren’t aware of it. On occasion, screening tests have uncovered underlying conditions and identified the need for further procedures or interventions that may have potentially saved their lives.”
On other avenues available at the Emory Women’s Heart Center:
“We work with other personnel, such as sonographers and medical assistants to accomplish the evaluations. The sonographers help complete our more advanced screening package that includes a preliminary echocardiogram. They also perform a test called an ABI which looks for circulation abnormalities in the legs. In some locations, we have medical assistants who help with checking vital signs and lab work. Most of the visit is accomplished by the nurse practitioner and reviewed by the cardiologist. We also have help from researchers, the school of nursing, marketing and many other entities that help support our cause. It’s definitely a team effort.
