Introduction to the program for a cardiac screening program for women
For a long time, heart-related diseases had been thought to affect only men. However, research shows that more women than men die of heart-related diseases every year. The main cause could be that the symptoms of a heart attack that present themselves in men are different from those in women. It is therefore important that women understand the symptoms of heart-related diseases that are unique to them to take the necessary steps in preventing death.
Pressure, pain, and discomfort in the chest are the most common symptoms of heart attacks in women. These symptoms are not always so severe as to warrant any alarm. Unlike men, women have heart attack symptoms that are not related to chest pain. Some symptoms are considered to be more indirect as compared to the obvious excruciating chest pains that are normally associated with heart attacks and they include neck, shoulder, upper back or abdominal discomfort, shortness of breath, nausea or vomiting, sweating, lightheadedness, or dizziness, and unusual fatigue. This can be attributed to the fact that women suffer from a condition known as small vessel heart disease or microvascular disease; blockage of the arteries and small vessels that transport blood to the heart (Maton, 1993).
It is not uncommon for women to show up in hospital after extensive heart damage has occurred. This is because their heart attack symptoms are not those typically associated with heart attacks. It is important for women who experience the above symptoms or think they are having a heart attack to seek medical attention immediately and if possible, avoid driving themselves to the hospital unless they have absolutely no other option.
Some heart-related disease factors are common to both men and women. These include high cholesterol, high blood pressure, and obesity. Nevertheless, other factors play a big role in putting women at a higher risk of heart disease. For instance, unlike men, women tend to have fat around their abdomen. When this is combined with high blood pressure, high blood sugar, and high triglycerides, it can lead to heart-related diseases (Siri-Tarino & Krauss, 2010). This is better known as a metabolic syndrome which is more common in women than men.
Depression and mental stress are known to affect women’s health more than men and make it difficult for them to maintain a healthy lifestyle or follow recommended treatment. Other factors that predispose women to heart attacks are smoking and low levels of estrogen especially after menopause. Low levels of estrogen cause cardiovascular disease in the smaller blood vessels.
Should heart-related diseases be a worry only for those aged over 65? The answer is no. Heart disease affects women of all ages especially those who have a family history of heart attacks and other heart-related diseases. Age however is a contributing factor to heart attacks. This is because as people age, the mechanical and structural properties of the blood vessels changes. They weaken and lose their elasticity and arterial compliance reduces.
The serum cholesterol levels increase with age and may lead to a coronary attack. Gender also plays an important role in coronary attacks. Women who are past their menopausal age tend to be at a higher risk than men. Estrogen levels tend to decrease after menopause and this decreases the level of lipid metabolism. One proposed difference that predisposes women to be at a higher risk of heart-related diseases is the difference in hormonal levels between men and women. Additionally, women who have undergone a hysterectomy or early menopause are also at a higher risk of developing heart-related diseases.
It is therefore important to come up with a cardiac screening program that is intended to bring up a Women’s Heart Initiative in a cost-effective way. The main goal of this program will be to:
- Identify and establish long-lasting relationships with women at risk for heart disease in targeted areas.
- Reinforce market awareness of and preference for comprehensive heart care and work in tandem with the upcoming branding campaign communicating Baptist as number-one in women’s cardiovascular services.
- Immediately create transactions to cover 150% of costs.
The program will target women between the ages of 35 to 64 years with commercial insurance. The current number of patients within this category is approximately 67, 993. The program aims to impact community health and the difference between program expenses and revenue could count as community benefit.
There will be web-based or paper-based assessments. A medical questionnaire and a consent form may be filled out online before the day of screening. The patients will be informed to wear loose-fitting clothes and take off their bras as the tests will be conducted on a bare chest. Female physiologists will be present if need be.
The program will involve a non-invasive examination known as an electrocardiogram (ECG). It illustrates the electrical activity of the heartbeat and is believed to take approximately seven minutes to complete. The ECG will be performed using electrodes that will be connected to a mobile recording device. The results can then be printed or sent through email. The ECG report will be delivered to the patient within 48 hours. The program will offer a proper follow-up to ensure a prompt, efficient, and accurate conclusion to the findings and further investigations for any abnormal conditions that may appear during the test.
Due to patient confidentiality, the results will only be accessible to the patient, and those who are directly involved in their care. In addition, a database will be designed to store information anonymously. The patient’s data will be used for research purposes only. The program is expected to commence slowly and expand with increasing demand.
The total package
A Wellsource Personal Wellness Profile (HRA) Comprehensive Cardiac Evaluation or any other product will be established. This will be based on the risk assessment score. If the patient seeks entry into the system for further screening, they will be offered a counseling session with an RN Coordinator.
There will be appointments via 202-CARE, scheduling line at each site depending on location preference of patient or web-based. The calls will be directed to the RN Coordinator.
The assessment will include: checking for vital signs of cardiovascular disease, the patients will have their blood pressure checked, their BMI will be evaluated including measurement of their waist and hip ratio, an ECG scan will be made available, a lipid profile will be done, glucose screening and finally a consultation with the RN Coordinator will be arranged. Solantic may be used for some of the components mentioned. The total patient cost is estimated to be $75. However, with an introductory discount, the cost is estimated to drop to $50.
Other services prescribed by MD/RN which will develop over time include FITT. This will be an Individual Exercise Prescription which will be conducted by the Wellness Center Staff. In addition, the patients will be advised on how to achieve successful lifestyle modifications. This can be done through supervised exercise, education, good nutrition, weight loss, etc. Other lifestyle habits that the patients can be helped to eliminate include smoking and how to manage stress. There will be quarterly coordinated education offerings at all sites that will be offered till evening to sensitize women on the risk factors associated with heart disease and how to identify heart disease symptoms.
The program will begin at all hospital sites simultaneously. Initial space could simply be a desk and a place for the patient to meet with the nurse coordinator. Testing will be scheduled and it will take place within each location (lab, EKG, etc.). The RN Coordinator will offer personal services by taking a patient from each location or potentially Solantic locations.
Background information on effective measures found in the literature to reduce the disease
Heart problems can be prevented by living a healthy lifestyle. Smoking or the use of tobacco has been known to increase the chances of suffering a heart attack more so in women. The chemical substances found in tobacco are responsible for heart and blood vessel damage and also lead to the narrowing of the arteries. No amount of smoking is considered to be safe. Similarly, no amount of exposure to secondhand smoke is also considered to be safe. Nicotine in cigarettes makes the heart work harder in pumping blood because of the narrowing of blood vessels. Therefore, quitting smoking reduces the risk of heart disease in a period of one year regardless of how long one has smoked.
Exercise is another sure way of reducing the risk of heart attacks. Exercises that get the heart rate up for 30 minutes daily can reduce the chances of developing conditions that strain the heart. Greater results can be achieved by combining physical activities and a recommended lifestyle. Simple day-to-day activities such as taking the stairs instead of the elevator can help one achieve notable benefits. This means that it is not necessary to do strenuous exercises that may end up hurting your body more than prevent heart diseases.
A healthy diet is also recommended if one hopes to avoid heart-related diseases. The DASH diet (Dietary Approaches to Stop Hypertension) is a good eating plan that can prevent one’s heart from failure. It involves eating foods low in fat, cholesterol, and salt. The diet should be rich in fruits, vegetables, whole grains, and low-fat dairy products. Sources of low-fat proteins such as beans must be included in this diet (Walker & Reamy, 2009).
Maintaining a healthy weight is also essential in avoiding heart diseases. Excessive weight gain can lead to high blood pressure, high cholesterol, and diabetes. It is a good idea to have one’s body mass index (BMI) checked. This is a good way of determining whether the percentage of fat in the body is healthy or unhealthy. If the BMI is over 25 then chances are that the level of blood fats is high and it puts one at risk of developing heart diseases and stroke. However, the BMI has been considered to be inaccurate because muscles have a greater weight than fat. The waist circumference can also be used to determine the amount of fat one has.
Regular health screenings are recommended to determine whether one has these conditions or not. Blood pressure screenings require being checked at least every two years in adults. Blood pressure screening can begin as early as childhood. Cholesterol levels also need to be checked at least once every five years for adults over the age of twenty. Frequent testing is required for individuals who have risk factors for heart disease. Screening for diabetes is a sure way of preventing heart diseases. This is because diabetes is considered to put one at risk of developing a heart-related problem. Doctors recommend screening to begin at the age of 30 to 45 depending on one’s risk factors and then retesting every three to five years.
This first table shows an estimate of the budget that could be shared among four sites. 150% return on the recurring costs would be $392, 136. 31.
|Charge per screening/ per counseling||56, 448|
|1.5 conversion rate to online screenings||1005|
|1-year revenue at $6, 680||419, 588||587, 423|
|Total downstream impact by end of 2years||642, 069||898, 897|
|Total number of patients converted to cv patients||63||88|
|Expenses paid for media||Amount in $|
|Newspaper ads||1, 000|
|advertising||5, 054. 59|
|radio||65, 022. 62|
|Software license||35, 000|
|total||236, 470. 21|
|Estimated expenses||Recurring in $||one time in $|
|Full time for the draft proposal||118, 300|
|Medical director fee||60, 000|
|Screening tool||4, 000|
|Space modifications and FFE||50, 000|
|Educational printing material||10, 000|
|total||261, 424||59, 000|
Maton, A. (1993). Human Biology and Health. Englewood Cliffs, New Jersey: Prentice-Hall.
Siri-Tarino P, W &Krauss R, M. (2010). Saturated fat, carbohydrates, and cardiovascular disease. American Journal of Clinical Nutrition, 91 (3): 502–509.
Walker, C & Reamy B. ( 2009). Diets for cardiovascular disease prevention: what is the evidence? Journal of Am Fam Physician, 79 (7): 571–8.