New cardiac tool asks about women’s usual tasks
Questions target neglected patient population
At a recent meeting of the American Heart Association in Atlanta, one session seemed to draw more interest from the nonmedical population than others. Session monitors, who normally sit outside the room, crowded into doorways with other event staff. They were all listening to a speech given by Laura Kimble, RN, PhD, associate professor in the adult and elder health department at Atlanta’s Emory University on a better way to find out how female cardiac patients were progressing.
Kimble says the interest comes from a lot of things. First, there has been a lot of news in recent years about how prevalent heart disease is in women, and how often it goes unrecognized. Secondly, there has been an interest in how to provide better care to female patients who have been subjected to treatment regimens based on studies that included only men.
And her own interest in the subject was further spurred by an article Kimble read in the Journal of the American College of Cardiology that focused on the energy requirements of various household activities. (Wilke NE, Sheldahl L, Dougherty S, et al. Energy expenditure during household tasks in women with coronary artery disease. 1995; 75:670-674.)
"Making a bed required the most energy," says Kimble. "I found it intriguing to think of that. And my own work and other things I have read made me aware that doing housework is a worry to women with heart disease. While others don’t consider it work, if they can’t do it, these women felt guilty."
Most of the instruments used to measure functional ability of patients with heart disease are geared toward men. They ask questions about swimming and jogging that aren’t relevant to most of the older female patients, says Kimble. "There are several instruments that can be used to evaluate a cardiac patient’s functional status, but mine — to my knowledge — is the only one that focuses solely on housework. The problem with other tools is that they often include activities that aren’t salient for women, especially older women."
With that in mind, Kimble set to work to create a tool that could evaluate functional status over time using physical activities that women routinely do. The result is the Kimble Household Activities Scale (see list of chores included on the scale, above). It asks patients to state how easily they can do 14 tasks, whether they have had to modify how they do those tasks, or if they can do them at all any more.
Quick and appropriate
The tool can be administered quickly — it is only one page and requires the patient to check one of five boxes for each of the 14 chores. It can be used in both inpatient and outpatient settings, and Kimble thinks it holds up well against other standardized tools. "The idea is to find something sensitive to change that is relevant to [female patients]. We know these are relevant things for women. That paradigm hasn’t shifted, particularly in the retirement years. Men may have been physical in work, but when they retire, you have to measure different activities. With women, the work doesn’t change as much."
Using this tool should help physicians determine if there has been disease progression or if a patient is doing better, says Kimble. "Women may give up doing some tasks because of symptoms. That means there is some de-conditioning, which means they do less, and you have a vicious cycle. This helps you avoid that."
While the tool generated a lot of interest and subsequent inquiries at the November conference, Kimble says it has yet to be integrated into a large-scale organization for regular use. "We piloted it with 30 women, which is a small sample. But the physician who oversaw the cardiology database was very supportive of it. The next study is to do this over time to see whether my hypothesis that this is sensitive to change holds true."
• Laura Kimble, RN, PhD, Associate Professor, Adult & Elder Health Department, Emory University, Atlanta. Telephone: (404) 727-9678.
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