Dr. Alanna A. Morris is the Associate Professor of Medicine and the Director of Heart Failure Research at Emory University School of Medicine, and focuses on the impacts race and gender may have on health disparities in cardiovascular disease. She is part of a new educational initiative called Hear Your Heart, which is designed to speak directly to Black and Latina women living with heart failure and empower them to prioritize their care. We asked Dr. Morris to provide insight into managing heart failure and ways women can advocate for their health.
Why is it important for Black women to think about their heart health?
Black communities have higher rates of diabetes, obesity and high blood pressure which can lead to heart disease, including heart failure.¹ Black women, specifically, face many unique challenges and barriers that prevent optimal care and a variety of social determinants of health, such as socioeconomic barriers and environmental influences, which can contribute to poor health outcomes.² Education and access to the right resources can help improve disparities in care to ensure Black women are thinking about and addressing their heart health.
In some cases, women may not feel heard by their physicians. What can women do to improve their experiences and have their concerns addressed by their doctors?
It’s important to share as much detail as possible with your doctor to make sure your concerns are being addressed. Go into appointments prepared with questions and any health updates including any side effects or changes. You may be taking multiple medications to help manage your heart failure, as well as any related conditions, such as chronic kidney disease or diabetes.³ It is important to keep track of these medications and monitor how they make you feel. Take notes or record a voice memo with your phone at your appointments to refer back to and share with other members of your care team — like family, friends, nutritionists, physical therapists, or other physicians — for reference.
If you feel like you are not getting the best care possible, don’t be afraid to seek a second opinion on a diagnosis or treatment plan, or request a referral to a specialist. Finding the right doctor can take time, but it’s important to continue to advocate for yourself and your needs so you are receiving the best possible care. Managing heart failure can be complicated and overwhelming⁴ but women need to feel empowered to put themselves first and get the support they need.
Speaking of concerns, when it comes to heart failure in particular, what are some symptoms women should be aware of? At which point should they seek a diagnosis for these symptoms?
Diabetes, smoking, high blood pressure, high blood cholesterol, physical inactivity, obesity and family history of heart disease can all be risk factors for heart disease, which includes heart failure.¹
Symptoms are different for everyone, but women with heart failure often present with shortness of breath, fatigue and weakness, swelling in the legs, ankles and feet, irregular heartbeat, rapid weight gain and swelling of the abdomen.⁵ It’s important to go to your doctor as soon as you recognize these symptoms or if something does not feel right.⁵
When it comes to diagnosing heart failure, what kind of information should patients have at the ready for their physicians?
Women need to know their health history, including their personal history as well as their family history. Personal history would include any previous diagnoses like high blood pressure, diabetes, overweight and obesity or kidney disease.¹ Also knowing family history is critically important. If your mother, your aunt, your grandmother on your mother’s side and your great-aunt all had heart disease, that increases the risk that you too may develop heart disease. Bringing this information to your appointments will allow your physician to understand the full picture of your health history to accurately make a diagnosis and work with you to develop a tailored treatment plan.
How does education, or a better understanding of one’s health condition, lead to better care? How can one become an engaged patient?
Staying informed and taking an active role in managing overall health is critical to treating heart failure. Once you receive your diagnosis, it’s important for you to do your own research on your condition and understand all the aspects that go into care and treatment. For example, your doctor will likely prescribe multiple medications to you, and it’s important for you to understand what those medications are and why they’re being prescribed.³
Women with heart failure can be engaged in their care by coming prepared with questions and updates from their care team to all appointments and taking notes to be their best advocate. If you are struggling, connecting with a local advocacy group either virtually or in-person could provide support and advice to further understand your condition. Start by searching online to see what your options are, or ask around your community to see if there are any local efforts. It’s never too late to change your heart failure journey.
Once a patient is diagnosed with heart failure, what lifestyle changes should they make to manage their condition?
Managing heart failure is complex and every journey is different.⁴ Lifestyle changes including healthy diet, exercise⁶ and managing mental health⁶ can help prevent and improve symptoms associated with the management of heart failure.
In terms of diet, it’s important to reduce the amount of salt, because when you eat a lot of salt, the body may retain that salt and fluid with it, and that can make the symptoms of shortness of breath and swelling worse.⁶,⁷ Physical activity is also an extremely important part of lifestyle modifications for people with heart failure. We want people to be active, to walk, to exercise, to use their heart because it is a muscle.⁶,⁸
What is the importance of a support system while living with heart failure? How can a support system — friends, family, care providers — impact one’s journey through the diagnosis?
Having a strong support system while living with heart failure is essential to make sure you are prioritizing your health and are able to make the lifestyle changes required for managing your condition.
You have to be able to ask for the help that you need so that you can feel your best despite your condition. Be honest with your care team on how they can best support you. This could mean helping with grocery shopping or cleaning your house, bringing you to or from doctor appointments and even working with you to manage your treatment and medications. Keeping everyone connected and aware of how you are feeling can help you actively manage your care and positively impact your heart failure outcomes.
A doctor speaking to her patient
Can you speak more about how race and gender may contribute to health disparities in cardiovascular disease? How do those factors affect quality of care or even whether they receive care at all?
Heart failure impacts more than six million people nationwide⁹, approximately half of which are women.¹⁰ Despite a similar prevalence of the chronic condition,¹¹ women diagnosed with heart failure have worse outcomes compared to men.¹² Although professional treatment guidelines show no difference in recommendations between men and women, diagnoses are often missed or delayed in women, and they are often not treated as aggressively by their healthcare providers as compared to men.¹¹
A deeper look reveals that among Black and Latina women with heart failure, negative health outcomes are magnified due to significant health disparities and inequities that exist in the management of the condition.¹³,¹⁴,¹⁵ These factors lead to undertreatment and mismanagement of heart failure. That’s why I joined Hear Your Heart — to help tackle the gaps in care that can lead to worse health outcomes for Black and Latina women living with this condition.
Disparities, especially among Black and Latina women, may lead to mistrust with the medical system. What are the ways women can overcome this distrust and advocate for themselves at the doctor’s office?
Medical mistrust is a much greater issue for Black and Latina people in this country, particularly Black and Latina women. This medical mistrust is likely justified in many circumstances because of the historic injustices that have occurred in our communities.² Despite that, avoiding healthcare altogether will not result in a good outcome.
There are doctors out there of all genders, races and ethnicities who will listen to you, who will engage in care and shared decision making with you, but you have to find that person. If you’re seeing a doctor who you feel is not listening or engaging in the process of care with you, it is okay to leave that doctor and find another one.
And finally, do you have any other tips or words of advice for women living with heart failure?
Every heart failure journey is different and there isn’t a “one-size fits all” approach to treatment. You’ll have ups and downs in your treatment journey, but it’s important that you remain consistent with your treatment plan and take the time to prioritize heart health by making lifestyle changes,⁶ ensuring associated medical and mental health conditions are managed and securing the right care team.¹⁶
It’s time to hear your heart. It’s time to prioritize your heart health. Talk to your doctor today. Visit HFHearYourHeart.com for more information.
- American Heart Association. Heart disease in African American women. Go Red for Women. Available at : https://www.goredforwomen.org/en/about-heart-disease-in-women/facts/heart-disease-in-african-american-women. Accessed May 2022.
- Benjamin IJ, Valentine CM, Oetgen WJ, et al. 2021. 2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: A Consensus Conference Report. Circulation, 143(25). https://doi.org/10.1161/cir.0000000000000963.
- Shah D, Simms K, Barksdale D, Wu JR. 2015. Improving medication adherence of patients with chronic heart failure: Challenges and solutions. Research Reports in Clinical Cardiology, 87. https://doi.org/10.2147/rrcc.s50658.
- Fry M, McLachlan S, Purdy S, Sanders T, Kadam UT, Chew-Graham CA. 2016. The implications of living with heart failure; the impact on everyday life, family support, co-morbidities and access to healthcare: A secondary qualitative analysis. BMC Family Practice, 17(1). https://doi.org/10.1186/s12875-016-0537-5.
- Mayo Foundation for Medical Education and Research. Heart failure. Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142. Accessed May 2022.
- Centers for Disease Control and Prevention. Heart failure. Available at: https://www.cdc.gov/heartdisease/heart_failure.htm. Accessed May 2022.
- Cleveland Clinic. Heart failure diet: Low sodium. Available at: https://my.clevelandclinic.org/health/diseases/17072-heart-failure-diet-low-sodium. Accessed May 2022.
- Aggarwal M, Bozkurt B, Panjrath G, Aggarwal B, et al. 2018. Lifestyle modifications for preventing and treating heart failure. J Am Coll Cardiol, 72(19), 2391–2405. https://doi.org/10.1016/j.jacc.2018.08.2160.
- American Heart Association. Causes and risks for heart failure. Available at: https://www.heart.org/en/health-topics/heart-failure/causes-and-risks-for-heart-failure. Accessed May 2022.
- Cleveland Clinic. Heart failure in women. Available at: https://my.clevelandclinic.org/health/diseases/17078-heart-failure-in-women. Accessed May 2022.
- Bozkurt B, Khalaf S. 2017. Heart Failure in Women. Methodist DeBakey Cardiovascular Journal, 13(4), 216–223. https://doi.org/10.14797/mdcj-13-4-216.
- The University of Bergen. Half of women with heart failure get the wrong treatment. ScienceDaily. Available at: www.sciencedaily.com/releases/2020/01/200106103444.htm. Accessed May 2022.
- Eberly LA, Richterman A, Beckett AG, et al. 2019. Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center. Circulation. Heart failure, 12(11), e006214. https://doi.org/10.1161/CIRCHEARTFAILURE.119.006214.
- American Heart Association. Heart disease in Hispanic women. Go Red for Women. Available at: https://www.goredforwomen.org/en/about-heart-disease-in-women/facts/heart-disease-in-hispanic-women. Accessed May 2022.
- Williams RA. 2009. Cardiovascular disease in African American women: a health care disparities issue. Journal of the National Medical Association, 101(6), 536–540. https://doi.org/10.1016/s0027-9684(15)30938-x.
- Cooper LB, Hernandez AF. 2015. Assessing the quality and comparative effectiveness of team-based care for heart failure. Heart Failure Clinics, 11(3), 499–506. https://doi.org/10.1016/j.hfc.2015.03.011.
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