High Risk, Low Focus

Heart disease has a greater impact on AA women than other groups. AA women have worse outcomes following myocardial infarction (MI) than white women, for example. (And all women have worse outcomes following MI than men). The burden of heart disease and risk factors like high blood pressure and diabetes also is greater in AA women than in white women. Importantly, structural racism and a lifetime of sexual and racial discrimination lead to high stress levels over the lifetimes of AA women. The stress also increases risk for heart disease. 

Not only is the burden of disease higher in AA women, but their experience in the healthcare system is often unacceptable. African Americans experience delays in treatment and are less likely to be referred for procedures and given guideline-directed medical therapy. According to surveys, most AA women have had a negative interaction with healthcare providers and are more likely to be dismissed by providers. As a result of their experiences, AA women often have a lack of trust in the system. OUR system. The issue of trust is something that we can improve for our patients.

Writing this article gave us an opportunity to look at the numbers at our cardiac rehab program, which registered 3,265 people from 2019-2022. Among them, 1,201 (36.8%) were women, and 89 (2.6%) were African-American women. Considering that about 14% of the population is African American and that there is a higher burden of heart disease in AA women, we expected this demographic to represent at least 7% of the CR enrollment. (Although women are not attending CR at equal rates compared with men, according to our numbers).

Why aren’t AA women coming? Are they being referred? Are they interested in participating?

How Can We Help?

We don’t have the data for numbers of referred patients versus numbers of enrolled patients. But regardless of the cause for the low takeup, we have many ways to make an impact and improve fitness of AA women. It’s vital, for instance, that AA women engage in cardiac rehab programs if we’re going to make an impact on the #1 killer – heart disease.  It’s our responsibility as a CR community to bridge the gap, improve trust and increase participation of AA women in CR. We must find ways that make it easier and more comfortable for AA women to receive this important care. It’s critical to understand the experiences that many of these women have had within our system and make sure that they are heard.  

To get started:

• Run the numbers at your program.
• Educate the referring providers about any gaps in referrals or enrollment for AA women; seek their help in closing the gaps.
• Reach out to AA women more than once; persist in your efforts to enroll them.
• Consider offering flexibility in attendance times or days to fit the schedules of these very busy women.
• Adapt a welcoming environment for people of all cultures; ask for help in identifying areas in need of improvement.

This April is a perfect time to embrace the challenge. We can make a difference in the health of our mothers, sisters, friends and colleagues. So, let me ask again: What are YOU doing for National African American Women’s Fitness month?

Dr. Caitlin Giesler is a cardiologist and Director of the Women's Heart Center at Ascension Texas Cardiovascular. She also is Affiliate Faculty at the University of Texas Dell Medical School in Austin, Texas, and President of the American Heart Association in Austin.

Salim Street, M.Ed, CSCS, is South Market Director of CR and PR at Ascension Seton Hays, Ascension Seton Southwest and Ascension Seton Bastrop in Texas; a director for the Texas Association of Cardiovascular and Pulmonary Rehabilitation; and an AACVPR Board member.