Northwell Health’s Women’s Heart Health Program at Lenox Hill Hospital: Where We See Women’s Health Differently

Background

Northwell Health’s Lenox Hill Heart and Vascular Institute, part of Lenox Hill Hospital in New York City, has a rich history as one of the nation’s leaders in cardiac, respiratory, and vascular care. The Women’s Heart Health program, which began in 2013 as a branch of Northwell Health’s Katz Institute for Women’s Health (KIWH), combines the renowned cardiac services at Lenox Hill Hospital with a focus on the unique health care needs of women. Cardiovascular disease (CVD) is the leading cause of death among women, claiming more lives per year than all cancers combined. Despite great progress in reducing the overall burden of CVD, improvement among women has lagged behind that of men. In an effort to improve this, the Women’s Heart Health program was implemented.

The Women’s Heart Health program is a leader in the delivery of comprehensive, integrated health care and wellness services for women with or at risk for cardiovascular disease. We see roughly 2,300 patients annually, and the number is only increasing as the program continues to make a name for itself in the diagnosis and treatment of female patients. 

The goal of the program is to improve the health of women by focusing on four key pillars (Figure 1). These include exemplary clinical practice, advancement in research, education, and commitment to health care equality and community engagement. As the associate director of the Women’s Heart Health program, I oversee the function of the program and ensure that goals are achieved and the four guiding principles are executed. 

Clinical Services

Our integrated approach means that our patients benefit from the expertise of a diverse group of specialists, as well as the most advanced technology and personalized care for the prevention, early detection, and treatment of heart conditions in women. Women may be self-referred through word of mouth or because they want to know their overall risk; however, the vast majority are referred through their doctors. Once referred, the patient is enrolled in our Women’s Heart Health program and her journey to wellness begins. At the initial visit to the Women’s Heart Health program, an assessment is done of the patient’s individual risk factors based on guidelines that are unique for women. We ask about previous medical history, family history, pregnancy-related issues, symptoms they may be concerned about, and lifestyle patterns that could impact their health, including level of physical activity, nutrition, along with anxiety and depression screening.  

One of our skilled cardiologists performs a comprehensive cardiac evaluation, which includes state-of-the-art diagnostic testing to develop a customized plan with specialized services for the patient’s heart health, highlighting education, lifestyle modification, and evidence-based guidelines. 
The Women’s Heart Health Program’s services include: 

• Behavioral Cardiology. Through our close relationship with the psychiatry department, we screen for and help treat behavioral issues that can often increase one’s risk for heart disease, such as anxiety, depression, anger, cognitive impairment, and substance abuse. We also assist patients in adhering to treatments, adjusting to life following a cardiac event, as well as balancing work and personal issues to minimize stress through referral to our peer support groups and behavioral psychologists within the health system.
• Heart Disease and Pregnancy. Women with pre-existing heart conditions should seek expert care before and during pregnancy, as special precautions may need to be taken. Cardiac problems may also develop because of changes to the heart and blood vessels during pregnancy, including: pre-eclampsia, eclampsia, gestational hypertension, gestational diabetes, and premature delivery. Our experienced team evaluates the patient’s heart function, discusses the safety of the pregnancy, and creates a personalized care plan with our specialized obstetricians and primary physicians. Women are followed well after pregnancy to help reduce their long-term risk of cardiovascular disease, by targeting their traditional risk factors such as elevated sugar and/or cholesterol, weight, and/or sedentary lifestyle — all risk factors that are nearly 80% preventable.
• Integrative Medicine. Lenox Hill Hospital’s Women’s Heart Health program knows the importance of the relationship between the mind and heart. We offer a broad selection of integrative therapies that offer a holistic approach to care — body, mind and spirit — to address women’s heart health.  We provide weekly classes of cardiac yoga that focuses on breathing exercises, meditation, and stretching exercises run by a licensed yoga instructor with specialized education in patients who have or are at risk for heart disease. We also offer our patients access to KIWH’s Center for Integrative Wellness, which combines conventional treatments with complementary therapies such as yoga, tai chi, meditation, massage, reiki, functional nutrition, homeopathy, and guided imagery to enable individuals to live healthier and happier lives.  
• Cardio-oncology. Patients who are undergoing or have undergone cancer treatments such as radiation or chemotherapy may increase their risk for heart disease. Our program collaborates closely with our oncology department to bring together the expertise of our cardiologists and oncologists to assess individual risk for cardiac side effects related to cancer treatment. Our cardiologists use advanced imaging techniques, along with enhanced surveillance measures, to minimize risk and allow for early detection of abnormalities, even before symptoms may arise. 
• Medical Nutrition Therapy. Our patients are referred to a registered dietitian (RD), who reviews their eating habits and nutritional intake, discusses their goals, and develops a personalized nutrition plan. The RD will also provide nutrition education for disease prevention and counseling for heart disease, including cholesterol reduction and diabetes management. We also offer these educational sessions during our women’s heart health-focused peer support groups.

Community Partnership/Education and Health Literacy

The Women’s Heart Health Program is dedicated to heart disease education and support to our patients at Lenox Hill Hospital and the surrounding community. We partner with both the American Heart Association and WomenHeart to educate our patients about their risk factors, signs and symptoms of heart disease, as well as prevention strategies. 

The Northwell Health System is a proud sponsor and supporter of the American Heart Association and its successful Go Red For Women® movement, to improve women’s heart health by inspiring women to make lifestyle changes, mobilize communities, and shape policies to save lives. Through this relationship with the campaign, we have several community-targeted screenings and lectures that raise awareness of heart disease — the number one killer of women.

The KIWH is a founding member of the National Hospital Alliance of WomenHeart. Northwell Health and WomenHeart, the national coalition for women with heart disease and the nation’s only patient organization supporting women living with or at risk for heart disease, are partners in advancing women’s heart health through advocacy, community education, and patient support. Lenox Hill Hospital is one of the select hospitals that have a national hospital alliance with WomenHeart, and offers monthly peer-led support groups for women living with or are at risk for heart disease.  

Research

Our research program focuses on advancing medical knowledge through science and innovation. All of our research trials are gender-specific and collaborative with other specialists. By providing this collaboration amongst different specialties, we break the traditional silo approach and enhance care. By making the women the central focus, we are redefining health care delivery (Figure 3).  

The Future of the Program

In addition to the program’s ongoing commitment to education and research, the Women’s Heart Health program at Lenox Hill Hospital will increasingly educate our own medical staff, including our midlevel providers, nutritionists, clinical psychologist, and hospital staff, about women-specific risk factors.

Our medical students, internal medicine residents, and cardiovascular fellows-in-training are encouraged to rotate with our cardiologists to receive focused training in clinical research on cardiovascular disease in women, including gender differences in cardiovascular health and disease.  They are provided with training in the comprehensive care of women across their lifespan, with the goal to expose them to research, teaching, health administration, and policy in women’s health. By doing so, we serve as a powerful example to other major academic centers. 

Lenox Hill Hospital’s Women’s Heart Health Program is committed to raising awareness of heart disease. By empowering women to understand their risks and symptoms and their treatment options, we can greatly reduce their risk of heart disease and improve their outcomes. 

Disclosure: The author has no conflicts of interest to report regarding the content herein.