BY: CATHERINE SHOUP, M.A., M.J.
A unique faith-based intervention for women's health began to take shape in Baltimore nine years ago, when an executive from a Baltimore hospital and several of the city's political leaders were discussing the epidemic of heart disease among African American women. Their challenge was how to reach and connect with this audience so that they could be empowered to change their lives.
"We were looking for ways to convince these women to pay attention to themselves, rather than just taking care of everyone else — to improve their health, especially their heart," said Helen Holton, a longtime Baltimore City Council member. She was involved in early discussions with Saint Agnes Hospital along with Maryland Delegate Shirley Nathan-Pulliam.
"We realized that churches in Baltimore City are filled with women, every Sunday, from all walks of life. It's a captive audience, so Saint Agnes decided to do something there," said Holton.
Since 2005, those conversations have led to a long-term community health partnership between Saint Agnes Hospital, city leadership and more than 130 churches across the Baltimore region and beyond. Through the years, the partnership has flourished, inspiring an annual public awareness event, a cardiovascular screening center specialized for women and an innovative, community-based cardiac care intervention program for women without ready access to these services.
Through such outreach efforts as Red Dress℠ Sunday, tens of thousands of African American women have received lifesaving information and, in some cases, immediate medical care. This success illustrates how a determined health care team, guided by a 150-year Catholic health care mission, can create a vital public health movement with the potential to make a profound impact on a community in need.
SAINT AGNES STEPS IN
In February 2013, Saint Agnes began an innovative church-based outreach, education and treatment program called Heart-to-Heart — the first of its kind in Maryland. Heart-to-Heart is an example of current trends in health care delivery with community-based solutions and outcomes as the primary indicators of success.
"Saint Agnes has taken the lead in creating awareness around the issue of women's heart health, and it's very gratifying to see the impact we are making," said Mary Kay Gardenier, vice president of cardiovascular and clinical support services at Saint Agnes Hospital. "There is a tremendous need for education about heart disease, which is the no. 1 killer of women everywhere, and we are taking that challenge on in our community and empowering our community members to help one another."
Nationwide statistics for this health crisis are sobering: One woman dies every minute from cardiovascular disease in the United States, and more than 50 percent of all women will develop cardiovascular disease in their lifetime. African American women are disproportionately affected by this disease, and in the areas of Southwest and Western Baltimore City served by Saint Agnes, the news is worse still.
Data from the Baltimore City Health Department, compiled as part of their neighborhood health profiles, shows that areas of Southwest Baltimore suffer from the highest rates of premature cardiovascular-related death in the city, more than half of which is attributable to preventable or treatable conditions. In its "Healthy Baltimore 2015" report, the Baltimore City Health Department identified heart disease as the leading cause of death for adults in the city and made fighting the disease and its associated risk factors a top health care priority in its strategic planning.
Supporting these findings, Saint Agnes Hospital also found that cardiovascular disease was a critical health concern in their recent community health needs assessment, which measures the most prevalent health issues in the areas served by the hospital. "Cardiovascular disease, along with diabetes and obesity, is a prevalent and growing crisis in our primary service area," said Carlos Ince, MD, chief of cardiology at Saint Agnes Hospital. "But we can make a difference, and we will. It takes dedication, clinical skill and innovation."
Saint Agnes Hospital long has been a leader in pioneering cardiovascular health. In 1981, the hospital opened the first chest pain emergency center in the world, and it has become a model for chest pain centers worldwide. In the 1990s, the hospital focused on reducing health disparities and partnered with other health care institutions in the city to improve access to cardiac care.
But it wasn't until recently that the issue of heart disease in women became a focal point for the hospital, and the need for women's health outreach became apparent not only to hospital leadership, but to cardiologists as well.
According to Saint Agnes cardiologist Shannon Winakur, MD, despite programs by the American Heart Association and local initiatives like Red Dress℠ Sunday, awareness of the prevalence of heart disease in women still lags far behind that of other diseases, such as breast cancer.
"In a recent survey only 56 percent of women knew that heart disease was the single biggest health threat that they face," Winakur said. "When you talk to African American women, only 36 percent, or roughly one-third, understand that it kills more women than anything else."
RED DRESS℠ SUNDAY
Saint Agnes Hospital began to address this informational gap in 2005 with Red Dress℠ Sunday, a church-based outreach program, which occurs on the second Sunday in February. Red Dress℠ Sunday combined the well-known National Heart, Lung, and Blood Institute program, The Heart Truth® and American Heart Month (February) — with the additional innovation of partnering with community churches. On Red Dress℠ Sunday, women (and men) in participating congregations are encouraged to wear red, the morning service includes speakers to discuss heart health, and screenings and educational resources are offered to all.
In 2005, Red Dress℠ Sunday was celebrated in 3 churches; just four years later, the number of participating churches had swelled to more than 130 throughout Maryland. Involvement remains high. Ince, who has been a long-time supporter of Red Dress℠ Sunday initiatives, said the impact on the congregations involved, amplified by extensive media coverage of the events and of the issue itself, has been enormous.
Holton said, "Bringing caregivers together with those who in the community are committed to serve is a powerful combination. Red Dress℠ Sunday has touched many thousands of women, and I believe has saved lives, as well, with knowledge and awareness."
One recent speaker at Red Dress℠ Sunday was Georgia Chapman, an associate at Saint Agnes Hospital who suffered a heart attack in 2012. Thanks to the information she received from Saint Agnes cardiologists and greater awareness of heart health, Chapman said, she has now lost 20 pounds, eats healthier and has a better understanding of how to stay healthy for years to come.
HEART-HEALTHY MESSAGE
Beginning in 2011, Saint Agnes Hospital added to the Red Dress℠ Sunday experience with a Women's Heart Health Symposium, an event held before February in order to prepare the participating churches with more detailed information about how to reach their congregations effectively and encourage positive, lasting improvements in heart health. Last year, the Women's Heart Health Symposium featured Debbie Phelps — mother of Olympic swimmer Michael Phelps — a Baltimore County educator, community activist and volunteer. In her presentation, Phelps challenged the audience — and women everywhere — to, for once, put themselves first and take better care of their health so that they can continue in the many critical roles women play in our society.
There are plans for the symposium to include more such high-profile guests in the future. "We are trying to move from an event which touches people once a year, to one which empowers women to make a change in their lives every day," said Gardenier."We have worked on raising awareness, and now we are moving into a more action-oriented, proactive approach to the issue."
The opening of Saint Agnes Women's Heart Center highlighted the hospital's strategic shift from education and outreach to action. The center offers a comprehensive "60-Minute Heart Check" customized for women, a service that includes a private consultation with a certified cardiovascular nurse, a detailed risk assessment, an electrocardiogram (EKG) and lab work to determine levels of cholesterol and average blood glucose levels.
"There is a great amount of information provided in the Heart Check," said Winakur, who is medical director of the Women's Heart Center. "We give women the information they need about their heart health, but we also give them a road map for how to prevent heart disease or treat the risk factors they already may have. So much of cardiovascular disease depends on empowering people, because most symptoms and risk factors can be controlled and treated."
Winakur reviews the EKG and lab results, and every woman who visits the center receives an action plan if she has cardiovascular issues or a follow-up recommendation if she has risk factors that could lead to disease.
HEART-TO-HEART
With the success of Red Dress℠ Sunday and the Women's Heart Center, Saint Agnes Hospital is taking the proactive fight for women's heart health back to the churches, using the network of partnerships and trust built through nearly a decade of collaboration with Red Dress℠ Sunday.
Made possible by a grant from AstraZeneca HealthCare Foundation's Connections for Cardiovascular HealthSM, this Heart-to-Heart initiative will identify and assess hundreds of predominantly African American women in nine Baltimore churches over the next three years. It will provide intervention and treatment as well as preventive measures for those at the highest risk. Screenings and a health program are free for those whose assessment qualifies them for care, and women who need immediate consultation with a cardiologist or surgeon will receive a referral.
In Baltimore, as is the case in many communities, churches are African American social and cultural centers. Heart-to-Heart therefore finds churches are ideal locations for outreach to those without ready access to preventive cardiac care.
"In many communities there is a lack of access to assessments, education and intervention programs, and our community needs these services," said Gardenier. "Heart-to-Heart will serve as a companion program to our current initiatives, expanding our reach and filling that critical gap between need and accessibility."
In its pilot stage, the Heart-to-Heart initiative will work at three churches each year, providing cardiovascular screenings that Winakur and her team will analyze. If they find risk factors such as diabetes, hypertension, high blood pressure, or symptoms of heart disease, the program participant will qualify for a 14-week modified version of the hospital's popular well4life® health program, with exercise and health education classes offered weekly right on church premises.
The program also incorporates the principle of positive, measurable outcomes by scheduling follow-up health evaluations for all participants four months after their screening and intervention and again at 10 months.
"The AstraZeneca HealthCare Foundation is proud to provide funding to an innovative, grassroots program like Saint Agnes Hospital's Heart-to-Heart program, which works to help prevent and control the effects of cardiovascular disease in its community," said James W. Blasetto, MD, M.P.H., FACC, chairman of the AstraZeneca HealthCare Foundation.
"As health care reform continues, there is a shift from providing treatment in hospitals once patients are sick to providing preventive measures within the communities so they may never need those treatments in the first place," explained Joseph Meyers, chief strategy officer at Saint Agnes Hospital. "And we are now more concerned with the real effect we are having with the programs on impacting the health of our community."
Results from the first three churches' Heart-to-Heart screening events were a powerful testament to the need for cardiovascular services in the Baltimore community. Program planners had originally estimated that approximately 25 percent of the women screened would qualify for well4life® participation and follow-up medical care. In fact, more than 85 percent of those who were screened had heart disease or significant risk factors that could result in a cardiac event.
While no emergency intervention has been necessary yet, Winakur has referred a number of the participants for consultation with a cardiologist, and Saint Agnes will work with these women to provide them access to that care regardless of their ability to pay.
Most of those screened who have high blood pressure, high body mass index or elevated cholesterol are being encouraged to learn how to take care of themselves with well4life® education seminars, online support and weekly exercise classes at the church.
"These women had significant health risks which were not being addressed in the traditional health care system, and we have been able to reach them with this program," said Meyers. "It's a very powerful statement of the importance of what we are doing, and it fits in with our Catholic mission of providing care which addresses not just the physical aspects of disease, but the spiritual and psychological components as well."
"The churches are the soul of the communities we serve," said Gardenier. "It is the center — socially as well as spiritually. We are bringing it all together now, in our attempt to treat those in need, body, heart, and soul."
CATHERINE SHOUP is a Baltimore-based freelance writer who specializes in health care.