Pregnancy is the body's first natural stress test, says Dr. Tracey Colella, nurse-scientist at UHN's KITE Research Institute and a clinician in UHN's Cardiovascular Prevention and Rehabilitation Program,* who is on a mission to target this population of women and raise awareness about future risk. (Photo: KITE Research Institute)

Did you know a diagnosis of pre-eclampsia, gestational diabetes, and other common hypertensive conditions in pregnancy can raise a woman's risk of a future heart event by three to four times?

According to Dr. Tracey Colella, nurse-scientist at UHN's Kite Research Institute and a clinician in UHN's Cardiovascular Prevention and Rehabilitation Program (Cardiac Rehab),* knowing this risk plays a key role in developing a targeted prevention plan for some women.

That's why Dr. Colella and her team are studying how to best engage this targeted group.

"The purpose of our research is to understand the best way to reach at-risk women; promote awareness and screening; and understand the optimal time to deliver education and prevention strategies – at a time where many women are putting their own health needs on hold, in order to care for others," says Dr. Colella.

To mark the start of Heart Month in February, UHN News sat down with Dr. Colella to learn more about her and the team championing postpartum women's heart health.

Q: What inspires your research?

A: Women make up 30 percent of UHN's Cardiac Rehab population – and that number is growing every day. Yet, even at UHN, where we pioneer care and make global impact, it's been in very recent years that we've started capturing conditions of pregnancy as part of a woman's health history, on our intake assessment forms. I believe we have a duty to ensure we're capturing their unique needs in our approach to cardiac rehab prevention and recovery.

The good news is that we're not alone in this at UHN. Broader campaigns, through organizations such as the Canadian Women's Heart Health Alliance, are focused on highlighting the importance of prevention throughout a woman's lifespan. By working together, I know we can correct inequities, facilitate a new and better understanding of women's heart health and increase women-related heart research.

Q: What have you discovered, through your research, so far?

A: Together with our patient partners, we are examining the current knowledge, as well as interventions that are in place to empower and educate women around their risk profile and how to best manage and monitor these risks.

Looking at this health care need through the lens of patient partners has highlighted how critical both timing and the format of education delivery are, when it comes to fitting in primary prevention strategies, alongside the demands of being a new mom.

Clinicians, researchers and staff across Toronto Rehab's Rumsey Cardiac Centre have been key in planning Heart Month events for patients and staff. (Photo: UHN)

Q: How are we translating this knowledge into care at UHN?

A: We are expanding our current women's program, to identify and further highlight education specific to postpartum risk and topics that address transitions in a woman's life that may increase her future risk of heart disease.

That's where we believe virtual care will continue to play a critical role. While UHN Cardiac Rehab is personalized to meet the needs of patients, barriers such as timing, work schedules, geography, transportation and caregiving responsibilities need to be addressed. Offering a virtual or hybrid program can help reduce barriers to participation women may encounter.

With that said, while we feel energized about the direction we're taking women's heart health within our program, it's not enough to say "this is what we're doing at UHN." We need to collaborate with the community, to reach more women.

Q: How are you accomplishing that?

I am passionate about my involvement with the Canadian Women's Heart Health Alliance, which brings together a national network of experts, women with lived experience and advocates, working together to share evidence-based strategies to transform how we deliver care and take action.

Each February, during Heart Month, we host Wear Red Canada – a movement dedicated to raising awareness about women's heart health, complete with a calendar of events held across the country.

At UHN, I'm also excited to be co-leading, alongside Dr. Rajni Nijhawan and Dr. Lisa Cotie, a two-week celebration of women's heart health, complete with our own series of events for both staff and patients​.

I'm especially excited about our kick-off event on Feb. 9 titled "Cardiovascular Risk Assessment in Women," which will be presented by Dr. Paul Oh, Medical Director of UHN's Cardiac Rehab Program. He'll be describing approaches to cardiovascular risk assessment and discussing how events, such as pregnancy-related complications and early menopause, impact heart health later in life.

Q: What excites you most, about the potential of your work?

I'm thrilled that awareness around women's heart health is continuing to gain momentum. The Wear Red Canada campaign has grown exponentially in the past four years. It now includes mayoral proclamations from over 45 cities across Canada, and over 85 key city structures will be lit up in red on Feb. 13, to foster this awareness. In fact, here in Toronto, the CN Tower and Four Seasons Hotel are among the many structures participating.

While it's true that postpartum women do not fit our typical cardiac rehab patient profile at UHN, recognizing that pregnancy is the body's first natural stress test presents us with an opportunity to really target this population and raise awareness. Understanding risk is the first step to empowering women to prevent future heart disease. And with 80 percent of risk factors being preventable, these conversations need to start happening now, so we can truly drive change for a future that does not include heart disease.

*We are proud of the cardiovascular care we provide at UHN. From prevention, to acute, to rehabilitation, we offer an integrated continuum of care through the Peter Munk Cardiac Centre and Toronto Rehab. The Cardiovascular Prevention and Rehabilitation Program at UHN is located at Toronto Western Hospital's GoodLife Fitness Cardiovascular Rehabilitation Unit and Toronto Rehab's Rumsey Centre.

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