With Wendy Wray, Nurse Director of the Women’s Healthy Heart Initiative

“Yes, we need to know about mammograms and breast care, as well as pap smears and cervical health,” says Wendy Wray. “But women also have livers and kidneys and lungs and hearts.”
“Yes, we need to know about mammograms and breast care, as well as pap smears and cervical health,” says Wendy Wray. “But women also have livers and kidneys and lungs and hearts.” / Photo: Owen Egan

Lifelong nurse speaks – and acts – from the heart

By Neale McDevitt

Wendy Wray doesn’t just talk the talk, she also walks the walk – especially if it means raising her heart rate. “Do you want to take the elevator or the stairs?” asks the Nurse Director of the Women’s Healthy Heart Initiative (WHHI) at the Royal Victoria Hospital. Without waiting for an answer, she bounds up the stairs – perfect for a woman who spends the bulk of her waking moments driving home the importance of good lifestyle choices.

A nurse since the mid-1970s, Wray has spent the majority of her career working in cardiology. On top of her work with the WHHI, Wray runs a pre-angiogram and pre-angioplasty clinic at the Vic, and works on a project on cardiovascular risk management using a collaborative care model.

The McGill Reporter managed to pin Wray down long enough to talk about the WHHI, the myths surrounding women and heart disease and the roll nurses can play in a overtaxed medicare system. 

What is the WHHI?

The WHHI is a project under the MUHC’s women’s health program that is designed to raise awareness of women’s risk of heart disease. The Women’s Healthy Heart Clinic is part of the WHHI.

But isn’t heart disease generally a man’s problem?

That erroneous perception is part of the problem. Heart disease is the No.1 cause of death among women in North America – but most women don’t know that. Most practitioners don’t know that, either. In fact, more North American women this year will die of heart disease than breast cancer, uterine cancer and cervical cancer combined.

Why are we so in the dark?

Historically, women haven’t been included in research studies on heart disease. So researchers took what they learned about men and applied it to women. But part of the problem is that women don’t have the same symptoms as men when they have heart disease or heart attacks.

So heart disease hits everyone regardless of gender?

An expert once told me, “If you’re over the age of 50 and you live in North America, you have coronary disease.” It’s a process. We don’t all of a sudden have a heart attack and then coronary disease appears. We earn it over a number of years.

When do women generally suffer their first cardiac event?

On average around age 58-59, or about eight years later than men.

Are there other differences along gender lines?

Not only do women present different symptoms, we are also at three times greater risk of stroke. Aspirins don’t seem to work the same way in women as men. We need to start understanding why.

We need to move away from what we call the “bikini approach” to women’s health care. Yes, we need to know about mammograms and breast care, as well as pap smears and cervical health, but women also have livers and kidneys and lungs and hearts.

Tell us about the Women’s Healthy Heart Clinic.

We opened in May 2009, and at this point we have 110 women enrolled in the WHHC. They are all within our target population of between 45-65 years old and are in primary prevention, meaning they haven’t had a previous cardiac event.

The goal of the Clinic is to provide preventative care by addressing the risk factors for coronary disease, including high blood pressure, elevated cholesterol, smoking, poor nutrition and lack of exercise. By focusing on lifestyle issues, we hope to delay that first cardiac event or prevent it altogether.

What are some of the positive changes people can make in their lifestyles?

We usually start with physical activity because research has shown that you get the greatest benefit from taking someone who is sedentary and getting them to take part in moderate physical activity. Our target is about 150 minutes a week.

Any specific activities?

Anything that gets you moving. We have women in our program participating in everything from dance classes to learning the hula hoop.

What about people who complain about a lack of time?

You have to incorporate physical activity into your daily routine. Take the stairs instead of the elevator. Walk the five blocks to work instead of taking the bus. And the benefits are across the board, from helping control diabetes and stress to strengthening the immune system.

Is motivation the biggest challenge with your group at the clinic?

No. This group is overwhelmingly non-referred. They’ve heard about us; they’ve picked up the phone; they’ve come in. They are a very dynamic and motivated group.

How do you measure participants’ progress?

Quantitative things like blood pressure, cholesterol levels – anything numerical are easy to record in our database

For the softer issues – do they eat more vegetables; are they eating less food – we gave a pre-test during their very first appointment. Are you exercising regularly? How many fruits and vegetables do you eat daily? We’ll give them that test at the end of their first year and compare the two.

And what kind of feedback do you get from participants?

They look at me and ask, “why isn’t everybody doing this?”

What makes this clinic so special?

It is a nurse-led clinic, which is very exciting because it isn’t very common in Canada. One of the tenets of our medicare system is accessibility, but we all know that this is a real issue. I think clinics like ours are paving the way for increased accessibility.

What are your long-term goals for the program?

My hope, my vision is that others will want to replicate this model. We can’t take on every woman but we’re trying to create a model for others to follow. I would love to see similar clinics opening up from B.C. to P.E.I.

The ideal site for this kind of clinic would be in the women’s community. You would go to your local CLSC and walk in to the nurse-led clinic. They would do a cardiovascular assessment and then follow you in your own neighborhood.

So what is your message for nurses?

There is so much potential for us here. You take an experienced nurse, add on some training and she gets to work in her profession more autonomously. We’re an existing resource and our system is buckling under the burden. We can be part of the answer, which is huge.

I’m hoping other nurses will be inspired and say, “Oh wow, look what they’re doing there. Let’s start a clinic in our community.”

Is there some resistance to this type of initiative?

To be honest, I think some people in the medical community find our model a little tough because it is nurse-run. This is a barrier that we’re trying to break because we think there is great potential for this type of initiative in our health system.

Have you experienced any pushback?

I’ve been lucky, I’ve had a lot of support here in the MUHC and I wouldn’t be able to do a lot of this without that support. But it is a leap. It is a leap for the public. It is a leap for the doctors – even for the nurses. I kind of make them nervous a little bit because the program is not for everybody.

Why are you so passionate about this?

I really believe in it because it is so vitally important. The wonderful thing is that passion is transferable. If you really believe in something, your enthusiasm can rub off.

On Friday, Feb. 12, the second annual Wear Red Day will take place at the Royal Victoria Hospital and in many schools and companies throughout Montreal. People are being asked to make a $5 donation and all proceeds will go to the Women’s Healthy Heart Initiative. Tables will be set up at the Royal Vic where people can get information on women and heart disease.