How one Mass General program is improving the heart health of low-income women in Chelsea and Revere.

Years of visits to cardiologists and hospital emergency rooms had done little to improve Natalie Cicci’s heart health. Heart disease ran in her family. Her father suffered from heart trouble for years, her brother had a heart attack at age 40 and she underwent a cardiac catheterization by the time she reached middle age. Although she was receiving top-notch care, Ms. Cicci, 51, was overweight with fluctuating blood pressure and a cholesterol level that was through the roof. She desperately needed a change but had exhausted her resources.

Around this time, Ms. Cicci received a letter from the MGH Revere Healthcare Center inviting her to participate in a research study called the Heart Awareness and Primary Prevention in Your Neighborhood (HAPPY) Heart Program. Developed and directed by Malissa Wood, MD, co-director of the Massachusetts General Hospital Corrigan Women’s Heart Health Program, HAPPY Heart offers personalized care to low-income, English- and Spanish-speaking women between the ages of 40 and 60 who have two or more risk factors for cardiovascular disease (CVD). E. Gerald Corrigan and Cathy E. Minehan, chair of the MGH Board of Trustees, established the program with a generous gift in 2006.

“When I entered the program, I had to fill out a long questionnaire and undergo a thorough work-up with blood tests, a cardiac echo and an EKG, so they could measure my progress,” Ms. Cicci recalls about the heart health program. “A physical therapist, Ellen Tighe-Ventola, showed me how to stretch and warm up to make exercising easier. And the program’s nutritionist, Melanie Pearsall, reviewed my diet with me and suggested small changes that would make a big difference.”

Tackling Obstacles to Improving Heart Health

Over a two-year period, HAPPY Heart introduces participants to interventional techniques such as exercise, smoking cessation and changes in diet to help them achieve healthier lifestyles.

More women die of CVD, which includes stroke, heart disease and vascular problems, than any other cause — a shocking near one-in-two statistic. Although CVD is largely preventable, Dr. Wood says, “The obstacles to improving heart health for low-income women can seem insurmountable. For example, these women are more likely to be obese or have diabetes because of poor nutrition. But their diet is limited to what’s affordable or, in the case of those who live in shelters or with a relative, what’s available.”

Through one-on-one consultations with a health coach and weekly group meetings, the women in Dr. Wood’s study are armed with the tools to make aggressive primary prevention possible. Health education is a program priority. On Tuesday evenings, participants gather at their local healthcare center in Revere or Chelsea to listen to guest speakers address topics such as the effect of menopause, cholesterol medications, nutrition and sleep on heart health. These group meetings offer the women an opportunity to share their progress as well as their frustrations and stumbling blocks. Following discussions, the group joins in an array of exercise classes, from tai chi and Latin dancing to yoga.

HAPPY Heart nurse and health coach, Donna Slicis, RN, ANP-BC, identifies the health risks in every participant’s life in order to develop an individualized plan for each. Poverty, homelessness, domestic violence and cultural mores can make lifestyle changes difficult to put into practice. So Ms. Slicis has had to get creative to ensure the program’s effectiveness. For women who can’t make the Tuesday night sessions, she voluntarily leads a Saturday morning walk along Revere beach. Members of the HAPPY Heart team provide rides to and from appointments for those who don’t have access to transportation, and regular phone call check-ins can be expected by any participant who misses meetings or appears to be struggling.

Revere as a Heart Health Blueprint for Other Communities

“For the vast majority of these women,” Ms. Slicis says, “it’s stress that exacerbates chronic health issues. It’s my job, and a joy for me, to make the program a bit easier for them, which means listening to each woman and meeting her where she’s at — physically, emotionally and financially.”

Dulce Maria Cruz, 49, joined the program only six months ago, but already the HAPPY Heart approach has changed her health and her attitude overall. “I’ve made friends from diverse backgrounds, I have more self-esteem and I’m happy about who I am,” Mrs. Cruz says. “Donna and Eliana Mejia-Suarez, the research assistant and translator, have taught me to put myself first — a way of thinking that’s new to me.”

Ms. Cicci echoes this sentiment. After years of seeking medical help for her heart problems, she is finally seeing real, sustainable changes in her health.

Dr. Wood and HAPPY Heart program director, Donna Peltier-Saxe, RN, agree that easy accessibility to the program for patients has been the key to the study’s success, which they think can serve as a blueprint for programs in other low-income Boston communities. “The people in these communities won’t cross the bridge to the hospital’s main campus unless they are experiencing a major health crisis,” Dr. Wood says. “So we’re making heart disease prevention available in their own neighborhood.”