Kismet Rasmusson - She Leads Science

In this episode of She Leads Science, Dr. Liz Joy sits down with Kismet Rasmusson, DNP, NP—a nationally recognized leader in heart failure, women’s cardiovascular health, patient education, and clinical innovation. Drawing on more than 26 years at Intermountain Health, Kismet reflects on her journey from nurse practitioner student to system-wide heart failure program leader, helping shape patient education, prevention strategies, and multidisciplinary care pathways. Together, Liz and Kismet explore the evolution of heart failure care—from advanced therapies to prevention—and the critical role of patient education, including Kismet’s creation of MAWDS (Medications, Activity, Weight, Diet, and Symptoms), now a cornerstone of heart failure self-care. They also discuss women’s heart health, cardio-obstetrics, mentorship, and the power of collaboration. This conversation highlights how clinical excellence, innovation, and relationships can transform care and improve lives.

Transcript

SPEAKER_02 0:16

Welcome back to She Lead Science. I'm your host, Dr. Liz Joy. Today I am delighted to be joined by someone I have known for more than 20 years, Kismet Rasmussen. She and I first met in 2006 when she was a nurse practitioner student, and it has been one of the joys of my career to watch her evolve into a nationally recognized leader in heart failure, women's cardiovascular health, patient education, clinical research, and health system innovation. Kismet is a nurse practitioner with Intermountain Health, where she has spent more than 26 years helping shape heart failure care across the system. She is a clinician, educator, investigator, program developer, and leader whose work spans everything from direct patient care and advanced heart failure therapies to quality improvement, implementation science, patient education, telehealth innovation, and cardioobstetrics. She is perhaps best known for her deep commitment to helping patients understand and live successfully with heart failure. Early in her career, she developed what became known across Intermountain as MODS, which is an acronym, M-A-W-D-S for our listeners, and it stands for Medications, Activity, Weight, Diet and Symptoms, a patient education framework that remains part of heart failure care throughout the system today. Her work also extended far beyond Utah through leadership roles with the Heart Failure Society of America, the American Association of Heart Failure Nurses, and the American Heart Associate Association, where she is a fellow in all three organizations, and collaborations with colleagues around the world. She has helped to shape how clinicians think about heart failure education, prevention, pregnancy-associated heart disease, and multidisciplinary care. One of the themes that runs through Kismet's career is the power of relationships, mentors who opened doors, colleagues who became collaborators, and interdisciplinary teams working together to improve the care for patients and families. Today we'll talk about her journey in becoming a nationally recognized heart failure leader, what she has learned from nearly three decades in cardiovascular care, the evolution of women's heart health, the science of implementation and education, and why collaboration may be one of the most important leadership skills in healthcare. Kismet, welcome to She Leads Science. I am so happy to have you here.

SPEAKER_01 2:35

Such a great invitation. I love spending time with you. So thank you. Awesome.

SPEAKER_02 2:40

Well, before we get to your career, I'd love for listeners to meet the person behind the professional bio. What's something important about you that doesn't show up on your C V?

SPEAKER_01 2:53

Yeah, that's a really good question. You know, I um I think I really have drawn so much personally from my father role models. I had my father and my father-in-law, both of them were very passionate and very successful in their careers. Dad was an anesthesiologist, and he was trained in Turkey, did some other training in the US, and did a lot in the early days about smoking cessation, back when the Surgeon General first came out and said smoking is not good for us. And he did a lot of public education about that. So that I think was really important to me and seeing what he was able to do with the public. Then my father-in-law was a university professor, the University of Minnesota, that you know very well. And um, and he equally was very passionate about his career. So I think from both of them, you know, I learned about work, dedication, you know, and it's something that that my husband and I have then instilled on our kids, and they both are very successful adults with their own families. And I think that it's, you know, an important legacy that that hard work and passion uh is really important. But beyond that, like I love to eat really good food and I love to cook. So there's that other side of me too.

SPEAKER_02 4:22

That is great. You know, I I think we're better clinicians when we're when we're really whole people, right? And that we walk the talk. And you definitely do that. And I know we'll talk more about that. I'm curious what first drew you to nursing and then to becoming a nurse practitioner.

SPEAKER_01 4:39

Yeah. Well, it's quite a story. I'll make it short. Um, my dad, as a physician, was really hopeful that somebody of one of the three kids would go into medicine. So immediately after my first year in college, he wanted me to be productive. So he put me in an OR tech training course for the summer to give me something to do rather than just hang out by the pool and whittle away my time. Um, and so that was really very interesting. The first case that I saw was a um a brain surgery where the top of the cranium had been removed and the surgeons were there, and I was just looking through the window, but I could see the brain from the window, and I thought, I could do this. This is pretty amazing. As an OR tech passing instruments to help surgeons during surgery. Um, you know, and and from that I realized, all right, I need to go to college, I need to get a degree. I'm not sure if medicine is my thing, but I need a bachelor's degree. So I decided on nursing because right out of the shoot, with a bachelor's degree, I can have a job and then I can make decisions. And after that, I kind of realized, you know, I going to medical school was not really in my passion. And I worked as an ICU nurse and then I realized that I wanted something more, and realized back in the mid-90s that nurse practitioners were, as advanced practice nurses, able to diagnose and treat patients and have that advanced level of education, training, and autonomy and professional roles. So um, so that's what I did. I became a nurse practitioner and I've never looked back. I love it. Um, and my daughter also is a nurse practitioner as well, which I'm super proud about.

SPEAKER_02 6:30

That's awesome. And of course, we met when you were a nurse practitioner student, uh, working with some of my partners. And I'll tell a funny story about that because I think you were working with Chris Gay, and of course, I'm Liz Joy, and you're the one who said, Wow, I get to work in the happy hallway. And Chris and I referred to it as the happy hallway long after you left. I thought that was so funny.

SPEAKER_00 6:55

No, I I love that.

SPEAKER_02 6:58

So, you know, I know you ended up in cardiology, and and then, you know, obviously heart failure. So, you know, did heart failure find you or did you actively choose it?

SPEAKER_01 7:09

Well, that's an interesting question. I when I graduated from nursing school, I went right into the thoracic intensive care unit as an ICU nurse. And um, this was in the early 80s and excuse me, in the kind of in the mid-80s, and it was at the time when we were just starting the heart transplant program as a consortium with the University of Utah, Inner Mountain, and the VA, and the children's hospital came on later. And we were doing mechanical circulatory support, so mechanical devices to help support patients as they were waiting for a transplant or after complicated bypass surgery, et cetera. And those were some amazing days. The early transplant days, hanging OKT3 as this very potent IV medication to prevent rejection of that newly transplanted heart. It was exciting. And so I think from that, I just developed an intense love of cardiology, hemodynamics, what we can do to treat patients. So it, you know, I kind of happened into it because I was offered a residency during school in the thoracic intensive care unit, and I loved it. They offered me a job. And then from there, when I went through the family nurse practitioner program at the university, I um, you know, family practice is broad, and I decided to just specialize and stay in my wheelhouse and go back into cardiology. And again, I've loved it ever since.

SPEAKER_02 8:48

You know, one of my favorite parts of your story is um, you know, that when you were, I think, interviewed for one of the roles, one of probably the many roles you've had at Intermountain Health, um, that you would actually, you know, develop a program for heart failure patients. And I think that ultimately led to the development of the MODS approach. So can you tell us a little bit more about that story? Because that's that's at the whole other end of the spectrum, right? We've got transplant, you know, and anti-rejection drugs at one end, you know, and but really I know your, I think your passion is really about, you know, preventing people, you know, from either ending up with heart failure in the first place, and certainly from that heart failure progressing to that end stage.

SPEAKER_01 9:35

Yeah. I um, boy, it really takes me on a journey down memory, memory lane here. When I graduated and got my first job as a nurse practitioner, it was outside of Intermountain and I worked in general cardiology. And I remember vividly scribbling instructions on the exam table or scribbling, you know, on a piece of paper that they could take home and scribbling on the exam table what was going on with their heart function. Um, so in my two years that I worked there, I was repeatedly called by Dr. Don LePay, who was the um cardiovascular director for Intermountain Health in in Salt Lake City at that time, and you know, a friend and a mentor, but somebody who was hoping that I would come back to Intermountain. And he asked if I wanted a job as a nurse manager or, you know, other similar positions. And I said, Don, I'm a nurse practitioner, call me when you've got something clinical. So when they didn't made a determination that they really needed a formal heart failure program for Inner Mountain, he hired Dr. Dale Remlin, who was one of the transplant docs in the consortium to lead Inner Mountain as a physician, and he needed nurses, nurse practitioners to join him in program development. And so um, so I went to the interview, and the first question they asked is, What would you do? How would what would you do that would make a difference with patients? And I it came right off my tongue. It's like it, I I my handwriting is terrible. I'm always writing the same thing, but I have no standardized patient education material. I would help develop that so that we could consistently provide meaningful education to our patients living with heart failure so they can do as well as they can. So then I had the interview and I thought, all right, well, that I think that went pretty well. I was on a flight to go visit a friend who just had a baby. And on the flight, I'm rearranging the MODS acronym. You know, all of the meds, activity, weight, diet, symptoms, all of those words were from the joint commission that was mandating that we provide that kind of education to patients who are hospitalized with heart failure. So I kept rearranging them until MODS came out and they loved it. I was hired, and we built upon that as a team. That is yeah, incredible that it's throughout the system to this day. Very proud of that.

SPEAKER_02 12:17

I have to say, you know, I spent 13 years at Intermountain working closely with you for many of those years. Um, I've read about mods um in so many um publications, you know, care process models for providers, um, patient education. Um, and I never knew that that came from you.

SPEAKER_00 12:39

Very exciting. One interview question very in the year 2000.

SPEAKER_02 12:44

You never know, you never know when that spark is gonna happen, right? And you're gonna have such a such an impact, you know, um, on on the delivery of care and care outcomes. Because really that's that's that's the big picture here, right? Yeah. So um, you know, one of the remarkable things about your career is that you have, you know, witnessed and helped drive, I think, the evolution of heart failure care over the past, you know, quarter century. I'm curious, you know, what are some of the biggest changes you've seen over that time period?

SPEAKER_01 13:18

Boy, it's there have been a lot. Um, you know, I it it's funny when I first left the general cardiology practice to go work with Inner Mountain and help develop the heart failure program, one of the cardiologists said, Oh, you're going to be so bored. And I have been nothing but bored for 26 years. Heart failure has been in evolution since we now have a framework of stages of heart failure, which is the progression of the disease from those who are at risk that have some structural disease to those who have symptoms and structural disease and then end stage. And that has really allowed us to think about not only patients with heart failure, but how can we move upstream in terms of prevention? I think that's been an important framework. What we've learned over the last 26 years has just been really important and compelling in terms of the evidence base of medical therapy that reduces morbidity and mortality. And yet what we've seen nationally, and this is just kind of a continued problem, is under prescription of these really well-known medications in combination that can help reduce morbidity and mortality for heart failure patients. So we've got a lot of room to move. I think two other really important areas when I think about heart failure and its evolution include the types of heart failure. You know, if somebody hears heart failure, well, what is it? Their heart is somehow either not squeezing well, not relaxing well, they develop symptoms, fluid overload, poor quality of life. But now we know it's not only heart attack, it could be genetic, it could be infiltrative, where something like sarcoid or amyloid is causing these depositions, are causing the myocardium to end up being dysfunctional. But then the last thing is really what we've learned about genetics. And and now we know anybody that has a non-eschemic cardiomyopathy really should be screened for their genetics. Do they have a family history? Somebody that's died suddenly, had a pacemaker, um, had a transplant, had heart failure diagnosis. Even without that in the family history, there are other clues that would indicate that somebody needs genetic counseling and genetic testing. So we've really made a lot of progress in that space. And it's really important because if you can identify somebody that has um, you know, a genetic predisposition for cardiomyopathy, we move them upstream and start their screening and treatment early before they develop into the stages of heart failure. So it's it's really been remarkable.

SPEAKER_02 16:09

Really interesting. Um I'm curious about, you know, you talked about some risk factors, but what are some of the risk factors for heart failure that you think deserve more attention, that the listening audience should know about? You know, aside from having heart attack, for instance.

SPEAKER_01 16:27

Right. Well, there's now a really important framework. It's called CKM, cardiac kidney metabolic health. And, you know, if you go back for those of us that have been around a while, the syndrome X, right? Obesity, dyslipidemia, diabetes, prediabetes, those are the known risk factors. But now adding in renal disease, renal dysfunction is a real risk factor. So I think that the framework for prevention is really changing. So the usual risk factors, high blood pressure, obesity, smoking, diabetes, dyslipidemia, even now we know poor sleep can contribute and is a self-care um strategy that people with that want to prevent heart failure should use. But I think the other thing that's added in there, like I had mentioned, is really thinking about the family history. Um, and and whether there's a family history, talking about it at the Thanksgiving dinner table, you know, asking what have people died of? What conditions do people have in the family that that could be passed down is really important. And then the cardiotoxic agents. People that have had chest radiation, people that have had uh chemotherapies that can be cardiotoxic are really important. And of course, there's illicit drug use that we know can really affect the heart in bad ways. So, but it's really thinking about not only traditional cardiovascular risk factors, it's family history, and then it's cardiotoxic agents, whatever they may be. So, really important framework, too, of prevention that has evolved over time over time.

SPEAKER_02 18:16

Yeah, and then there's things like viruses, right? That, you know, cause you know, viral cardiomyopathies. And and I know we're going to talk more about cardioobstetrics, but you know, just being pregnant, you know, can be a risk factor for heart failure, I think, in probably um genetically susceptible people. Um and interestingly, you know, on the other side is, you know, here we have you know all these new um obesity management medications, um, the GLP ones and combination medications that, you know, we're seeing profound impacts on, you know, cardiometabolic, cardiometabolic, and renal disease. And I think it it from what I understand, the the we still don't have definitive evidence that it improves heart failure. But I would guess that in people with obesity, you know, and diabetes, that if they're losing weight and their blood sugar is controlled or their diabetes is reversed completely, that it certainly reduces their risk of developing heart failure and would likely decrease the load on the heart and prevent the progression or impact the progression of heart failure.

SPEAKER_01 19:28

Right. I think we're in such an amazing time right now in terms of these GLP1s and obesity treatment, um, in terms of not only prevention but treatment. The the signals are there for people that have heart failure with a preserved ejection fraction. So the amount that's squeezed out with every stroke is normal, but they still have heart failure with fluid overload and symptoms, etc. And there's mounting evidence that the GLP ones are helpful in that population. And other studies are underway for people that have a reduced ejection fraction, heart failure. So yeah, I think stay tuned in terms of where that comes in the guidelines. Clearly, they're helpful for people that have sleep apnea, sleep apnea, also, you know, risk factor and a comorbidity of heart failures. So it that's amazing the overlap of these risk factors and the treatments and how you know that one can either be prevention or treatment for the other.

SPEAKER_02 20:26

Yeah, that this is a good segue because I wanted to next ask you a little bit about your work in patient education, which has certainly been a defining thread throughout your career. Um, and you know, again, reflecting on your experience in the clinic, working with patients who have heart failure along that entire spectrum. What do patients most need to understand early on? You know, when they all of a sudden hear um you have heart failure? Because that's got to be a really scary thing to hear.

SPEAKER_01 20:58

Yeah. It really is. And there have been so many threads of conversation over the years about trying to change the name and say we we need to call it something else. So some people call their heart failure clinics heart function clinics, which you know is completely reasonable. But I I kind of pause and push back a little bit on that because you know, we haven't renamed cancer. Cancer is scary. Cancer can be deadly, cancer can be treated, we spend a lot of money on cancer, and it's the same with heart failure. Heart failure can be deadly, and we should call it what it is and and really have people understand the impact. This isn't just a little heart failure. You get better after you get out of the hospital. This is a lifelong diagnosis and needs to be treated seriously. So, um, you know, I I think that it's how we talk about it is important, under having patients understand the serious. Seriousness of the condition. But you know, when it gets down to brass tacks and the nitty-gritty, you know, they really need to understand how to take their medications, what they're for, don't miss them, don't run out. And if they get better, it's not a time to stop them, like an antibiotic for the, you know, for a vi uh, you know, uh uh infectious disease. It these are really usually lifelong medications. So it's not just about how to take medications, it's also about then how to monitor themselves. Are they getting better? Are they kind of struggling still or are they getting worse? So that we can intervene hopefully earlier. Um, you know, I've seen a lot of patients over the years that have gotten better, stopped their meds, and then they are back where they started. And we've seen that anecdotally, we know it from the literature that patients that stopped their medications that have had improvements and their ejection fraction, 40% or more are at risk of recurrence. So a lot that goes into what's important for patients to understand, uh, but certainly the power and the importance of medications and what it can do for their trajectory and their quality of life and hospitalizations and death, uh, and then monitoring themselves, I think, are really important.

SPEAKER_02 23:22

Yeah. You know, I've I I've obviously taken care of patients with heart failure as well. And, you know, predominantly my patient population was women. And one of the things they hated the most, you know, about medications was diuretics, right? Right. That, I mean, you know, these women had children, you know, they already have some pelvic floor problems, they may have some incontinence, you know, as a result of pregnancies and deliveries. And then along they come in their 70s and they have heart failure. And what do we do? We give them LASIKs, right? And it makes them pee all the time and they're having incontinence, you know, which really impairs their ability to exercise. You know, it uh it increases their risk of social isolation because they don't want to go out for fear of having uh an accident. Um, I'm curious, you know, you know, when you're working with patients at the point of care, and do you specifically ask that question? Because this is this is just one of those things as a family doctor that I have really kind of rallied around that we need to normalize conversations about, you know, uh urinary incontinence, you know, and and just make it a normal part of the of the conversation because it's so incredibly common in women. Um, but is even worse in women with heart failure. So I'll I'll get off my my podium here for a moment and and let you answer that.

SPEAKER_01 24:46

Maybe you'll have a solution. Yeah. Well, I'm not sure if I have a great solution, but I I think, you know, to your point, it's listening to the patients, it's figuring out what their barriers are to taking medications, and it's really working together to figure it out. I I I've seen, you know, those patients that you described many times, and they come in to the clinic and they're volume overloaded and they're feeling worse, and you ask them, and they just they don't want to take it. They don't want to take it that often. When they take it, it makes them urinate all the time. And you know, and the the flip side is then they come in, and whether it's giving them a big ivy bolus in the clinic so that they can quickly lose it, and excuse me, or putting them in the hospital. Like, who wants to do that? So, you know, it's it's tricky, it's a tricky balance and it's a trade-off. Um, but the reality is that if you are susceptible to fluid retention as a heart failure patient, then diuretics are your friend. And it's figuring out a time of the day that's gonna work. They don't have to be taken at the same time, whether, you know, if it's somebody that's working, kids, all of that, and they take it when they get home. I mean, that's you know, the trade-off is that it might um alter your sleep. And that's that's not good either. But it's, you know, what can we do to figure out a strategy that's going to work for them? And I think that that's what's most important.

SPEAKER_02 26:19

Yeah, you know, my conversations with people would be well, let's talk about what's contributing to your fluid overload, right? Um, your salt intake, um, you know, uh your activity, um, you know, not monitoring your weight. I mean, there's a lot of people who just really don't want to look at the scale. Um so, you know, I think your point is that there are trade-offs here, is a really important one. Um, and I often would go to, well, here's some ways that you can prevent fluid overload. So you don't have to take as many diuretics, and then we don't have to deal with this urination challenge. But easier said than done. I know that. Well, this is a good time to shift to all the work that you're doing in women's heart health. Um, as I was, as I was leaving Intermountain, I had the opportunity to work with you and you're just amazing leadership in bringing together people from all over the Intermountain West to develop, you know, a women's heart health program at Intermountain. And um, I mean, it's really been amazing. And I'm I I'm sure there are many reasons why you did this, but you know me, I'm I'm a I'm a person who likes stories, and I'm wondering if there was a patient story or a clinical experience that really shaped your personal interests in women's heart health.

SPEAKER_01 27:43

Well, yes. Um, I've had to, and I'll try not to blubber about them both, but they early on in my career working with heart failure and transplant, we had um a patient who was on one of these mechanical uh pumps to support her function. And um she was a doll and her husband and little baby, new baby, she had a peripartum cardiomyopathy that is heart failure in the last month, pregnancy into the five months postpartum. And you know, at that time we didn't know a lot about it, and that's part of the reason why I wanted to study it. But she ended up dying, and it was you know, a tragedy for everybody, her family, for all of us. And you know, when that happens, you pause and you want to learn more. Fast forward just a few years, and we had another female with the same condition, and um she had improvement in her heart function with medications, and we suggested back back in these early days before we really had evidence, we said another pregnancy is too high risk, you shouldn't become pregnant, and she became pregnant. And she in her latter months we followed her in the hospital, and unfortunately, she passed as well. And I'll never forget them. Like I said, hard, you know, it's hard. Um but what we learn from those hard examples is that we need to understand, we need to study, we need to gather in rare uh conditions like this, we need to reach out across the table to colleagues, and we need to um really dig in terms of our understanding of this condition. And that's what's happened over the last 20, 25 years is that we now understand it more. We don't have all of the answers, but that was a huge um impetus for me, those two patients, that led to my desire to study peripardum cardiomyopathy, to study them in transplant patients, and then to really think about you know women's cardiovascular health as the evidence has emerged about women with heart disease, they're under represented, understudied, under-treated, and there are incredible gaps in care that we can all work together to improve. And so, I mean, your your words are so kind, Liz, but it really takes a huge village. And when we had an OBGYN come to us in the cardiovascular world and said, we are seeing so much cardiovascular disease in women's health. We need to partner, we need to change the tide. And that was the beginning four years ago of this incredible group that we've gathered to be able to make a difference and really start creating this women's heart program. So it's really neat.

SPEAKER_02 31:07

Wow, gives gives me a little chest tightness hearing those stories as well. You know, I as a family doctor, I did obstetrics for 12 years. And, you know, I was fortunate to not have any maternal deaths or or infant deaths, you know, during that phase of my career, but it's just so devastating when that happens. And I think it's important for the listeners, you know, to just to reiterate that that peripartum cardiomyopathy is a rare complication of pregnancy. Um, I think somewhere between one in a thousand and one in four thousand live births. So it's it's not common, but to your point, um, you know, cardiovascular risk factors, you know, during pregnancy are increasing. And I think, you know, a lot of it is driven by obesity. Obesity is the most common chronic disease of pregnancy. Um, and obesity is an independent risk factor for pregnancy-induced hypertension as well as um gestational diabetes, both of which, you know, increase the risk of heart problems during and after pregnancy. Um, are there are there other, you know, are there other things, or I guess the question I should ask is, you know, what should others, what should clinicians understand about, you know, um both pregnancy uh risk factors and pregnancy as as as even a cardiovascular stress test?

SPEAKER_01 32:37

Yeah, I we again this is a a space that's been so dynamic. We've learned so much in the last 10 years. I think the the first point is that hypertension during pregnancy takes many forms. There people can go into pregnancy with hypertension, or they can develop it new during pregnancy, gestational hypertension, or they can have the more severe forms of eclampsia and pre-eclampsia. And it used to be you deliver the baby, you've treated the condition, all as well. But what we've learned over the last 10 years is that up to one in um 10 people may develop hypertension during pregnancy. And whatever form or degree of hypertension during pregnancy you have, it increases the risk of cardiovascular disease in the short term as well as long term. So pregnancy during or excuse me, hypertension during pregnancy really needs to be taken seriously so that they get treatment during pregnancy and then long-term follow-up, cardiovascular risk assessment, et cetera. So that's a really important thing. And I think the other thing to your point about pregnancy being a stress test is that it can uncover undiagnosed cardiovascular disease. And you know, because it is a stress test, because of the increases in cardiac output and all the hemodynamic changes that can occur during pregnancy, we see during pregnancy uh new forms of heart failure. It may be familial where they hadn't had this condition before. Um, it may be peripartum cardiomyopathy, it may be they may have sudden uh coronary artery dissection. Uh so there are different forms that can become unmasked because of the stress of pregnancy. Again, not common, but is certainly, as you mentioned, the increase in risk factors that we're seeing in pregnant individuals. We really need to be doing preconception counseling that includes optimizing those risks as much as possible, because if you don't, um, then it can affect mother and baby. There's an incredible publication that just came out this year that showed an increase in cardiometabolic risks leads to worsening outcomes for the baby. And I I think, you know, when women hear that, then that hopefully would be a motivator to really think about what they can do to protect not only themselves, but now they're most concerned about their baby. So a lot to learn in that space.

SPEAKER_02 35:19

Yeah, no kidding. You know, at least we've we've dropped um, you know, tobacco use during pregnancy, which of course is a huge cardiovascular risk, you know, considerably with the focus on that. And it's gonna take that same kind of intensive focus, you know, around other risk factors for cardiovascular disease, you know, which is still the number one killer in the United States and globally. Um, and you know, pregnancy is that perfect time to do it, to have those conversations, you know, especially whether it's a primary care physician or a obstetric care provider. I mean, we're seeing that woman every single month, you know, and then every single week until delivery. And then on a fairly regular basis thereafter, what an incredible opportunity to talk about both, you know, particularly the behavioral risk factors that contribute to heart disease, you know, over the course of time in terms of how it affects the health of the mom and of course um the developing fetus. So um I think there's lots of opportunity there. I mean, there's risk, but there's so much opportunity.

SPEAKER_01 36:20

So much. Yeah. I totally agree. And I think that you'd be surprised in talking with our women's health colleagues, how much care drops off after that six weeks uh postpartum visit and how hard it is for busy new moms to get into care. So newer models of care, using telehealth, texting, whatnot, you know, and having organized clinic to look at clinics to look at risk factors are really emerging in terms of this cardio OB space. So, you know, it's really trying to figure out how to get women the appropriate care after delivery.

SPEAKER_02 36:57

Yeah, good point. Um, well, obviously, this is an area locally, you know, where you have really been um a leader, as I mentioned previously, but you know, you've led, you know, academically, operationally, nationally. Um, you know, what has leadership looked like for you? Was it, you know, was it what you expected? I'm curious what skills you felt you needed to develop. Um, and and then I'll also, this is a complex question, you know, how has being a nurse practitioner shaped your leadership style?

SPEAKER_01 37:32

Yeah, all very good questions. Um I think leadership clearly takes many forms, right? There's the operational type of leader, um, and then there's the clinical leaders. And you know, I I had my cat in the operational leadership as the APP lead for our group for a while, and that's a tough job. It's um I'm much more comfortable and feel prepared and competent at being a clinical leader. And I I think you know, what that really takes is being a subject matter expert. Um, you know, for example, today, just in you know, the American Heart Association publication comes out a new taxonomy, an updated taxonomy, and how we talk about heart failure. And I look at the literature and I want to share that with my colleagues. So immediately, you know, I shared that so that everybody can be speaking from the same page, so to speak, about how we talk about and how we think about heart failure. So I really think having the time, the curiosity, the interest, the desire, having credible resources that we can go to are really important. And and I'm, you know, I kind of like the next person. I'm really intrigued by the use of AI. Um, I think that there are some that you have to be really cautious about and ask, is this really evidence-based? There are some that are better than others, like op open evidence um seems to be quite evidence-based. Um, but you know, none of them are without their their problems. So I think being a leader is is um is it evolves as you gain experience. You need to listen, you need to um gather team, you need to gather data and motivations. Um, I think understanding the problem, understanding the barriers, getting the stakeholders and and figuring out solutions that can be rapid cycle or longer-term solutions with clinical trials and research. But it's all really figuring out how to move the needle and talk to people and understand their perspective so that we can kind of all get on the same page and think about um about improvements or changes that might be needed. It's leadership is is uh is hard. You know, as a nurse practitioner, I I went and got my doctorate back in from 2012 to 2014. And it's a doctorate of nursing practice, and part of that is very important in terms of leadership and thinking about systems of care and the complexity of care and health delivery system, evidence-based, patient advocacy, etc. And I think that that really doing that kind of mid-career for me was really powerful in terms of thinking what next and what else and how to be a leader as a nurse practitioner. Um, you know, I've had other, I've had really nice mentors in the space as well, um, that are also nurse practitioner leaders. And I think having colleagues and friends and mentors is is really helpful in terms of shaping who you become as a leader. But I've had so many different mentors along the way, like you, for example, and you know, and and many others that, you know, the the beauty of so many collaborations and people that you work with is you can take the the best of a variety of strategies and see what works, what doesn't work, and then create your own.

SPEAKER_02 41:40

Well, this is a perfect segue. I wanted to ask you about collaboration, which I I really see as another theme, you know, in your work. You know, you have brought together physicians, APPs, nurses, pharmacists, researchers, operational leaders, administrators, even patients. You know, what have what have you learned about building trust across disciplines?

SPEAKER_01 42:03

Well, I, you know, that's such an important part of it. Um, you know, it's being honest, it's being reliable, being timely, uh, being that expert, uh being willing to say you're wrong. Yeah, I remember quite a few times where I had to do that. And you know, and having kind of humility to you know, you know, know that you're human and and we can all learn and and be better. So um I think those are a lot of important things for you know being being a a leader, a collaborator. I've you know been able to have incredible experiences through you know, national organizations of of people that I've met that have said, hey, I hear you're doing this. Can we maybe do something together? And I I love that. Yeah, my I mean my answer is yes, let's let's do it and let's understand and and and do a little bit more study in terms of whatever that question may be. So um I think it's you know a willingness and a kind of a insatiable desire to to keep learning. And that's that's what I feel like I'd do in heart failure.

SPEAKER_02 43:25

Yeah, well, well said, very well said. Well, we are coming to the end of our time, but I have a few rapid fire questions for you. So uh number one, what is the one thing every woman should know about her heart health?

SPEAKER_00 43:42

We have control of our risk factors for the most part.

SPEAKER_01 43:45

We don't have a family history. So I really think know your numbers, know your blood pressure, your A1C, your cholesterol, and and really figure out a good clinician you can partner with to reduce your risk. I think. really starting with prevention is so important because as you very apt, heart disease is the number one cause of death for men and women in the United States. And there's a lot that we can do in the prevention space.

SPEAKER_00 44:17

What leadership lesson did you learn the hard way? Making a decision without team buy-in.

SPEAKER_01 44:30

We've all made that one, myself included. Painful, but you you you try not to make that again. Exactly.

SPEAKER_02 44:42

What professional relationship or mentorship changed your career the most oh gosh.

SPEAKER_01 44:50

That was you know I I mentioned one physician who had hired me but my direct uh director of the heart failure uh prevention and treatment program when I started LDS hospital was Dr. Dale Burnland and he was an incredible thought leader and incredible collaborator and incredible human that wanted who wanted others to succeed who wanted to develop um a level of expertise we went to immediately after I was hired we went to a conference together Institute of Medicine really thinking about how to frame up a heart failure program and we became partners you know I was a relatively inexperienced nurse practitioner and as a mentor he was able to educate me I saw how he spoke to patients I saw how he looked at the literature and followed the data and um and then how he was able to speak eloquently in front of large audiences something that I was never comfortable doing. And you know he left an incredible mark on my career.

SPEAKER_02 46:07

Wow and now you are an incredibly articulate presenter having listened to many presentations from you over the years.

SPEAKER_01 46:14

All right last question who is a woman you'd like to have coffee with and why that is such a good question and I had to think about it for a second but maybe not too long. There's a a cardiologist who's kind of the the I don't know you don't want to call her the mother of women's heart health but she basically is um it's Dr. Nanette Wanger she is a cardiologist who really has been a thought leader and she has done so much in her career in cardiology and for women in heart disease that I just think the richness of somebody who is older who is accomplished who has this incredible national reputation publications experience in really changing how we think about women in heart disease I I think it would be fabulous to have coffee with her. I have a little snapshot of me with her at a conference um but I didn't get a chance to talk with her directly and and I think that that would be really lovely um just to kind of get to know her as a as a woman and what makes her tick kind of like what you're doing with me today.

SPEAKER_02 47:30

Awesome well she sounds like a very inspiring person. Kismet thank you so much for joining me today. You know what really strikes me as I look back over your career is that you've you've never stayed in one lane. You've been a clinician an educator an investigator innovator uh a mentor now program builder and national leader but perhaps most importantly you've shown how meaningful relationships and multidisciplinary collaboration can amplify impact far beyond what any one person can accomplish alone. It's been a privilege to know you from your student days in 2006 through your leadership today and I'm grateful that our listeners had the opportunity to hear your story.

SPEAKER_01 48:11

Thank you so much, Liz it's it's really been my pleasure and really appreciate it and love seeing all that you're doing in this in this incredible work. So thank you. Thanks.

SPEAKER_02 48:21

And to our listeners today thank you for joining us for this episode of Chi Lead Science. If you enjoyed this conversation please follow rate and share it with someone who cares about women's cardiovascular health heart failure prevention nursing leadership implementation science or building better healthcare teams. Until next time I'm Dr. Liz Joy and this is