Leanne Lefler, PhD, APN, CCRN, Clinical Assistant Professor

Reducing the burden of heart disease among older, ethnically diverse women

My program of research is focusing on evidence to support the  development of an individually tailored biobehavioral intervention to provide education, counseling, treatment, and referrals for modifiable coronary heart disease (CHD) risk factors in older, African American and White women. Coronary heart disease has long been the leading cause of death among women aged 65 years and over. Older women carry a disproportionate burden for CHD, yet they are understudied, especially minority women. Previous research indicates treatment of bio-behavioral risk factors has excellent efficacy and cost-effectiveness as part of life-long therapy for CHD. Yet, only a small proportion of older women understand their risk factors, are aware that these can be treated, and even smaller proportions have CHD risk factors controlled.

My previous research examined the accuracy of older, racially diverse women’s perception of personal risk for heart disease and heart attack, their understanding and identification of risk factors, and knowledge of women’s most common MI symptoms. This evolving program of research indicates that older women do not perceive themselves at risk for heart attack, do not recognize women’s symptoms of heart attack and often do not reduce their risks for heart disease or heart attack. We have limited evidence in understanding the mechanisms by which risk beliefs are translated into positive health behaviors and if the quality of communication with health care providers are adequate to motivate elder women to reduce their CHD risks over time. Health behavior related to the primary and secondary prevention of coronary heart disease is a challenging area and more research is needed to improve health in older adults with heart disease.

I am also involved in interdisciplinary research examining barriers and facilitators of medication adherence in older women with CHD and how health care providers can prospectively tailor interventions to improve medication adherence that is so important in reducing not only re-hospitalizations, but the mortality and morbidity burden in this population.