Heart disease is the No. 1 cause of death in the United States, and because of disparities in health care, African Americans, nonwhite Hispanics, and Native Americans are especially hard hit. The good news is that taking some simple steps can produce a significant improvement in your heart health, and an important part of that is managing your risk factors by finding the right health care provider who understands your needs.
In this Q&A, Icilma Fergus, MD, Associate Professor of Medicine at the Icahn School of Medicine at Mount Sinai, and Director of Cardiovascular Disparities for the Mount Sinai Health System, explains how to ensure patients receive equitable care and offers some suggestions on how you can find the heart health care you need and deserve.
“Many conditions can be delayed or averted or minimized by managing your risk factors and taking care of yourself,” she says. “We know that many people are very busy these days with work, caring for children and their parents. Sometimes they neglect to take care of themselves. You should listen to your body. If you don’t feel right, get yourself checked out. We can help.”
What can I do to reduce my risk of heart disease?
A lot depends on you. Managing your blood pressure, following the guidelines of the American Heart Association. Managing your blood sugar, your cholesterol, and diabetes. Eating right, taking your medications, and getting enough exercise. The American Heart Association recommends exercising or getting physical activity on most days of the week for about 30 minutes. It doesn’t necessarily mean an expensive gym membership. It could simply be walking, taking the stairs instead of taking the elevator, or parking further away from the door so that you’re walking more. If you’re sitting down on a lot of calls, as many have done during the pandemic, you could be moving your feet, moving your arms if you’re not on camera. Getting up and walking while on the call will also be helpful. Making sure you get enough sleep and drink enough water. Knowing your family history and coming prepared when you come in to see your health care provider.
How are disparities in care affecting heart health?
When you look at cardiovascular care and outcomes in the United States, you can see different outcomes for Blacks, Hispanics, and other immigrants, compared with the white population. For example, Blacks are nearly twice as likely to die from preventable heart disease and stroke. Because there are adequate resources for all and great treatment for all, this is termed a disparity. Also, there are risk factors such as hypertension, diabetes, obesity, and others that are uncontrolled in certain populations, such as the Black population. This means additional resources should be provided to ensure that everyone can access the care they need and deserve. We also must address certain issues such as health literacy, understanding of culture, and providing access, to ensure that our patients are receiving equitable care.
What can be done about this?
We need additional education geared toward certain populations. Health literacy means patients have a better understanding of their medical condition and what needs to be done. Sometimes medical jargon delivered to patients may make them not only scared but they may not even understand what to do. Providing education and screening will ensure that people are coming to get care. We know that premature heart disease is 80 percent preventable. That means getting to the patient before the condition becomes almost incurable or very complicated is important. Managing the risk factors earlier on can prevent the progression that invariably may end up in the patient’s death or a significant compromise in their heart health.
What is Mount Sinai doing?
Mount Sinai is doing many things to educate patients and their families in our communities. We provide patient literature geared towards the appropriate age, appropriate demographics, and appropriate language, such as translating into Spanish and French, as well as having it at a level that patients can understand. We have a number of programs. Mount Sinai Heart in particular has a Diversity, Equity and Inclusion program that ensures we have a diverse staff and communities are aware of what’s going on. Valentin Fuster, MD, PhD, the President of Mount Sinai Heart, has a program that focuses on young children who are impressionable and could be coached and receive education about preventative measures—things like eating healthy, exercising, drinking water instead of sugary drinks. If they get this information early, then they’ll continue to do that later on in life. This program also focuses on getting the information to parents, grandparents, or other family members.
Any other examples?
There are a number of other programs, such as the one that I started in 2012, the Harlem Healthy Hearts. We conduct monthly workshops within the community. We discuss managing your cardiovascular risk factors and understanding how to talk to your health care provider. For example, the importance of writing things down, having a family member or friend with you so that they can help you to remember things or ask a question you might be afraid to ask. We talk about medication adherence. Some patients don’t understand their medications and may be afraid of them. For that reason, they’re not taking them, and they may not say anything to the health care provider. We discuss how to ask questions about your medications and how to speak to your health care provider about alternative solutions. We also talk to supermarkets in underserved communities to ensure that healthy foods are up front and available, such as fruit, vegetables, and water rather than sugary drinks and processed foods.
How does this help patients and consumers?
Patients are consumers of health. When it comes to any other item you are consuming or buying, people ask questions to ensure that they are satisfied, that they are receiving the care that they should, and the same goes for your health. You should be a healthy and happy consumer or patient when it comes to your health. Therefore, you should have a good rapport with your health care provider, whether it’s a nurse practitioner or doctor or anyone within the health care field so that you get your questions answered and feel comfortable. Mount Sinai provides a vast array of health care providers who are fluent in different languages, who are familiar with various cultures. If you go to the website, you can find a doctor or a health care provider who will ensure that you are a healthy and happy consumer.