Elizabeth Cohn and Patricia Butts presented on how to create powerful alliances to reduce disparities in heart disease in Harlem.

1. Creating Powerful Alliances for
Reducing Disparities in
Cardiovascular Outcomes in Harlem
Mrs. Patricia R. Butts
Abyssinian Baptist Church
Elizabeth Cohn, RN, DNSc
Columbia University

2. Make a Call-Don’t Miss a Beat
• This work is funded under a grant by the NYS Office
of Women’s Health Region II
• Department of Health and Human Services, Office of
Women’s Health.

3. Project Aims
• To develop a set of culturally tailored strategies to
educate women and their families about the signs
and symptoms of heart attacks.
• To raise awareness of medical providers to the
alternative presentations of heart attacks in
women.
• To use social marketing for widespread
dissemination of these health messages.
• To demonstrate the power of a partnership
between faith-based organizations, Schools of
Nursing and DHHS.

4. Four Factor Intervention
• Individual: Trained church women in low-tech, high-touch
methods. Pocketbook training.
• Medical Providers: Huddles; next generation of provides.
• Faith-Based/Congregants: Sermons based on CVD
information. Original Gospel music and short plays.
• Social Marketing: Times Square Jumbotron, Amsterdam
news. Jingles.

5. Review of the morning
What do you think is the number one cause of
death in women in the United States?
A. Breast Cancer
B. Heart Disease
C. Accidents
D. Lung Cancer

6. Disparities in CVD
• African American women are 40% more likely to
have three or more risk factors1 and are significantly
more likely to die from heart disease2 when
compared to their white counterparts.
• Although at increased risk, 60% of African American
women lack awareness of the signs and symptoms
and the need for a definitive action plan2.
• Early recognition and treatment saves lives and
improves outcomes. But this depends on
identification of the signs and symptoms both by
the individual and hospital providers.
1. Giardina, et al. (2011). Journal of Women's Health. 20(6): 893-900
2. Canto, et al. (2012). JAMA. Feb 22;307(8):813-22.

7. The Facts
 A woman suffers a heart attack every minute
 Even though awareness has increased over the years, women
still don’t see personal risk for themselves
 Women tend to dismiss symptoms leading to poorer
outcomes and increased deaths
 Only about half of women would call 911 if they thought they
were having a heart attack
Sources: American Heart Association 2008, Sheng et al. 2001
American Heart Association Statistical Update: Heart Disease and Stroke, 2009.Lloyd-Jones D et al. 2009.

8. Edna’s Story
What signs and symptoms
can you identify in this
story?

9. Chest Pain
Described as “discomfort, ache, pressure,
tightness, or fullness”
Can last for several minutes or go away
and come back
This is the “hallmark” sign for heart
attacks in men, but one study found that
only 30% of women experienced chest pain
or discomfort prior to their heart attack

10. Upper Body Pain
Common sites for pain
•Chest
•Upper back, between the
shoulders
•Left arm
•Shoulder
•Neck jaw
•Upper stomach
Often vague or generalized to a
region, if you can point to the pain
with one finger, it is less likely that it is
a heart attack

11. Shortness of Breath
 Difficulty breathing, you may be
panting or find yourself trying to
take deep breaths
 Occurs with normal daily activities
 Can occur with or without chest
pain
 This was reported by half of
women experiencing a heart
attack

12. Dizziness
 Feeling lightheaded or
like you may pass out
 Usually sudden in onset
 Can be accompanied with
severe weakness

13. Cold Sweats
 You may suddenly
break out into a sweat
with cold, clammy skin
 Can be confused with
“hot flashes” of
menopause

14. Nausea
 May or may not be
associated with vomiting
 May or may not be
associated with
abdominal pain
 Often described as
“feeling sick to the
stomach”
 Can be mistaken for “a
stomach flu”

15. Fatigue
 Tiredness that is long-lasting
or recurrent
 Unusual, unexplained,
extreme, and sudden in onset
 May also feel very weak
 More than half of women
experienced marked fatigue
prior to the onset of their
heart attack

16. What to do…call 911!
If you experience even one of these
symptoms that is unusual for you, don’t wait.
Call 911!

17. 911 Usage
 For themselves, 53% of women said that they would
call 911 if experiencing the symptoms of a heart
attack
 Only 46% of women would do something other than
call 911 – such as take an aspirin, call the doctor or
try to drive themselves
 About 80% said they would call 911 if someone else
were having a heart attack
Source: Circ Cardiovasc Qual Outcomes Mosca et al. 2010.

18. Results
• We wanted to change those statistics
• Both community members and medical personnel
who attended the workshops had significantly
improved knowledge (p=<0.05) and likelihood of
having an action plan and (p=<0.05).
• An estimated 10 million women and their families
were exposed to the information as measured by
Plowshare, an independent social marketing agency.

19. Does increased knowledge
translate into increased action?
– Measuring the number and types of calls to 911.
– Tracking outcomes in women who have presented
to Emergency Departments with the signs and
symptoms of heart attacks.
– Exploring ways of reducing risk factors and
preventing heart attacks through greater
collaboration of our faith-based organizations and
school of nursing.

20. Collaborative work
We have benefited greatly from
our collaborative work and invite you to join
us in improving health across the nation.
Thank you.
ec2341@columbia.edu

21. Let’s DANCE!

22. Results
Community Professional