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Special Considerations for Women and Communities of Color: Monologues to Dialogues—A 52-Year-Old Native American Woman With HFrEF

Special Considerations for Women and Communities of Color: Monologues to Dialogues—A 52-Year-Old Native American Woman With HFrEF



Time to Complete

1 hour


April 13, 2017


April 13, 2018
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American College of Cardiology Curriculum

This activity is part of the curriculum in the American College of Cardiology’s RIGHTSTEPS: Optimizing Medical Therapy for Chronic Heart Failure. The initiative seeks to ensure patients with chronic heart failure receive the right guideline-dictated medication. The program is committed to providing education that offers clinicians the right steps to treat the right patients with the right drugs at the right dose at the right time.

To see more information about RightSTEPS, including details about live meetings and after-education coaching, please click here.

All online activities for RightSTEPS are listed below, with links for those currently available.

Expert Perspectives
Guideline-Driven Game Changers: Integrating Sacubitril/Valsartan Into Practice
Guideline-Driven Game Changers: Integrating Ivabradine Into Practice
Understanding Heart Failure Core Measures: Got Data?
Chronic Heart Failure: Stretching Care Beyond Its Limits
Reduced vs Preserved: The Heart Classification That Matters
Guideline-Directed Pharmacologic Treatment of Chronic HF: The First Step to Improved Care
Chronic HF Hospitalization and Reducing Readmissions

Viewpoints in Heart Failure
Sacubitril/Valsartan: A Game Changer in HF Treatment
Ivabradine: A Novel Heart Failure Therapy
Heart Failure Nation: Taking a Hard Look at Implications
The Impact of HFrEF vs HFpEF: How Do We Measure Up?
Falling Short on Simple Guideline-Directed Care for Heart Failure
Interrupting the Revolving Door of HF Hospitalization and Readmission
Leveraging the Quality Payment Program to Optimize Heart Failure Care

Special Considerations for Women and Communities of Color: Monologues to Dialogues
Case: A 52-Year-Old Native American Woman With HFrEF (You are here!)
Case: A 63-Year-Old Female HF Patient Recently Diagnosed With HFpEF
Case: A 42-Year-Old African American Man With HF Recently Discharged From the Hospital
Case: A 59-Year-Old Hispanic Man With HF and Multiple Comorbidities: A Caregiver's Perspective

Online Reinforcing Activities
How to Reduce Performance Variation in Heart Failure Management—Conference Capture (Coming Soon)
Concerns and Controversies Over New Treatments in Heart Failure (Coming Soon)

Maximum Credits

1.00 / AMA PRA Category 1 CreditTM
1.00 / CNE Contact Hour

Accredited Provider

Provided by the American College of Cardiology Foundation in collaboration with Haymarket Medical Education

Commercial Supporter

Supported by an educational grant from Novartis Pharmaceuticals Corporation

Program Description

Cardiovascular disease (CVD) is the primary cause of death in the Native American and Alaska Native community, although as recently as 50 years ago, heart disease was considered rare in this population. Rates of CVD have now surpassed those of the general population, and CVD accounts for much of the discrepancy in life expectancy between indigenous communities, including Native Americans, and nonindigenous populations. When managing Native American patients with heart failure (HF), it is important for healthcare providers to offer counseling about diet, lifestyle interventions, and medical management in a culturally sensitive manner to provide comprehensive care. In this module, expert faculty will discuss evidence-based approaches for managing patients with HF within the Native American community and will talk to a patient to discuss how to individualize approaches for optimal HF management.

Intended Audience

This module is intended for cardiologists, internists, primary care physicians, nurses, nurse practitioners (NPs), physician assistants (PAs), and other clinicians who manage patients with chronic HF

Educational Objectives

At the conclusion of this activity, participants should be better able to:

  • Assess the prevalence of heart failure (HF) within the Native American population
  • Analyze the comorbidities and risk factors involved in the development of HF in Native American patients
  • Evaluate standard HF medical management when taking into account the cultural needs of Native American patients

Accredited Provider Disclosure of Conflicts of Interest Statement and Disclosure Policy

As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME) and the American Nurses Credentialing Center (ANCC), the American College of Cardiology Foundation (ACCF) must ensure balance, independence, objectivity, and scientific rigor in all of its directly provided or jointly provided/co-provided educational activities. Planners, presenters, and other contributors in a position to control the content are required to disclose to the audience all relevant financial relationships he/she and/or his/her spouse or domestic partner may have, occurring within the past 12 months, with any entity producing, marketing, reselling, or distributing healthcare goods or services consumed by, or used on, patients. When an unlabeled use of a commercial product or an investigational use not yet approved for any purpose is discussed during an educational activity, the contributor should disclose that the product is not labeled for the use under discussion or that the product is still investigational.

ACCF is committed to providing its learners with high-quality activities and materials that promote improvements and quality in healthcare and not a specific proprietary business or commercial interest. The intent of this disclosure is not to prevent participation in certified educational activities by persons with a financial or other relationship, but rather to provide learners with information on which they can make their own determination whether financial interests or relationships may influence the certified activity.

ACCF assesses conflict of interest (COI) with its faculty, planners, managers, staff, and other individuals who are in a position to control the content of certified CME/CNE activities. All relevant potential conflicts of interest that are identified are thoroughly vetted by course directors, ACCF education staff, and members of the Accreditation Compliance Workgroup through a process that includes appropriate peer review for fair balance, scientific objectivity and validity, and patient care and safety recommendations.



Margaret Bowers, DNP, RN, FNP-BC, CHFN, AACC, FAANP

Associate Professor
Faculty Coordinator, Adult Nurse Practitioner Programs
Lead Faculty, Cardiovascular Specialty
Duke University School of Nursing
Durham, NC

Margaret Bowers, DNP, RN, FNP-BC, CHFN, AACC, FAANP, has received speakers’ bureau fees from Amgen.

Akshay Desai, MD, MPH, FACC
Director, Heart Failure Disease Management
Cardiovascular Division
Brigham and Women’s Hospital
Associate Professor of Medicine
Harvard Medical School
Boston, MA

Akshay Desai, MD, MPH, FACC, reports receiving research grants from Novartis and consulting fees from AstraZeneca, Cheetah Medical, Janssen, Merck, Novartis, Relypsa, Sanofi, and St. Jude Medical.

Alan Wasserman, MD, MACP, FACC
Chairman, Department of Medicine
Eugene Meyer Professor of Medicine
George Washington School of Medicine & Health Sciences
George Washington University Medical Center
Washington, DC

Alan Wasserman, MD, MACP, FACC, has no relevant financial relationships to disclose.

Cathleen Biga, RN, MSN
President and CEO
Cardiovascular Management of Illinois
Woodridge, IL

Cathleen Biga, RN, MSN, has no relevant financial relationships to disclose.

Kimberly V. Cheramie, MSN, RN-BC
Nurse Planner
American College of Cardiology
Washington, DC

Kimberly V. Cheramie, MSN, RN-BC, has no relevant financial relationships to disclose.


Dena Wilson, MD, FACC

CDR, United States Public Health Service
Phoenix Indian Medical Center
Phoenix, AZ

Dena Wilson, MD, FACC, has nothing to disclose.

Carlos Jose Rodriguez, MD, MPH, FACC, FAHA
Associate Professor of Epidemiology and Medicine - Cardiology
PI NHLBI Echocardiographic Study of Latinos/Hispanics (ECHO-SOL)
Associate Director of Research
Maya Angelou Center for Health Equity
Wake Forest School of Medicine
Winston-Salem, NC

Carlos Jose Rodriguez, MD, MPH, FACC, FAHA, has received consultant fees from Amgen.

Accredited Provider Disclosures

ACCF staff involved in this activity have no relevant financial relationships to disclose.

Haymarket Medical Education staff involved in this activity have no relevant financial relationships to disclose.




AMA PRA Category 1 Credit(s)TM

Accreditation Statement

The American College of Cardiology Foundation (ACCF) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement

The ACCF designates this enduring material for a maximum of 1.00 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physician Assistants
The American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for AMA PRA Category 1 CreditTM   from organizations accredited by ACCME.




CNE Contact Hour(s)

Accreditation Statement

The American College of Cardiology Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Designation Statement

The ACCF designates this educational activity for a maximum of 1.00 continuing nursing education contact hour.

While offering credits noted above, the module is not intended to provide extensive training or certification in the field.

Disclosure of Unlabeled Use

This CME activity may or may not discuss investigational, unapproved, or off-label use of drugs. Participants are advised to consult prescribing information for any products discussed. The information provided in this CME activity is for continuing medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options for a specific patient's medical condition.


The American College of Cardiology Foundation (ACCF) is not responsible for statements made by any contributor. Statements or opinions expressed in this program reflect the views of the contributors and do not reflect the official policy of the ACCF.


This activity is offered at no cost to participants. Please proceed with the activity until you have successfully completed this program, answered all test questions, completed the post-test and evaluation, and have received a digital copy of your credit certificate. Your online certificate will be saved on myCME within your Profile/CME History, which you can access at any time.

If you have an American College of Cardiology (ACC) account, you can choose to have your credit information sent to your ACC Transcript upon completion of the course. You will be prompted to log in to your ACC account, which will automatically trigger your credit submission. If you do not have an ACC account, you will have the opportunity to create one.

ACCF Learner Bill of Rights

The ACCF recognizes that you are a lifelong learner who has chosen to engage in continuing medical education to identify or fill a gap in knowledge or skill and to attain or enhance a desired competency. As a participant in an ACCF activity, you have the right to expect that your continuing medical education experience with ACCF includes the following.

Content that:

  • Promotes improvements or quality in healthcare
  • Is current, valid, reliable, accurate, and evidence-based
  • Addresses the stated objectives or purpose
  • Is driven and based on an independent survey and analysis of learner needs, not commercial interests
  • Has been reviewed for bias and scientific rigor
  • Offers balanced presentations that are free of commercial bias
  • Is vetted through a process that resolves any conflicts of interest of planners and faculty
  • Is evaluated for its effectiveness in meeting the identified educational need

A learning environment that:

  • Is based on adult learning principles that support the use of various modalities
  • Supports learners’ abilities to meet their individual needs
  • Respects and attends to any special needs of the learners
  • Respects the diversity of groups of learners
  • Is free of promotional, commercial, and/or sales activities

Disclosure of:

  • Relevant financial relationships that planners, teachers, and authors have with commercial interests related to the content of the activity
  • Commercial support (funding or in-kind resources) of this activity


Hardware and Software Requirements
  • A computer with an internet connection
  • Internet Browser: Internet Explorer 7.x or higher, Firefox 4.x or higher, Safari 2.x or higher, or any other W3C standards compliant browser
  • Additional Software: Adobe Flash Player and/or an HTML 5 capable browser maybe required for video or audio playback. PowerPoint or Adobe Acrobat Reader may occasionally be required
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