Dr. Kimberly Souffront is Associate Director of the Center for Nursing Research and Innovation at the Mount  Sinai Health System and Associate Professor of Emergency Medicine and Core Faculty at the Institute for Health Equity Research at the Icahn School of Medicine at Mount Sinai (ISMMS).  She is pioneering research on asymptomatic hypertension. Her clinical experience has been as an emergency nurse practitioner for more than 20 years, focusing on health strategies to better manage patients with asymptomatic hypertension in the emergency department to achieve health equity. She joined ISMMS in 2014 after finishing her PhD and post-doctorate studies at New York University Rory Meyers College of Nursing. She recently had a conversation with Sunday Best Magazine’s Kemi Gbohunmi. The interview was slightly abbreviated for space considerations.

HER PATH TO NURSING

In my journey to nursing, the influence of my family’s legacy in healthcare—my mother, grandmother, and godmother, all nurses—instilled in me a deep understanding of the nuances of patient care. Despite having siblings and many cousins who are physicians, I made the deliberate choice to pursue nursing as my career path—and I’d say it’s probably one of the best decisions of my life, the other marrying my husband and having my four children of course.

During my undergraduate studies in a unique five-year program at Northeastern University in Boston, I had the privilege of gaining real-world clinical experience alongside my academic curriculum. Opting for the emergency department for these clinical experiences, where I had been working since the age of 17, allowed me to witness firsthand the disparities so apparent in health and healthcare.

After nursing school, I pursued a master’s in nursing science to become a family nurse practitioner, expanding my scope of practice and deepening my commitment to addressing healthcare disparities. My academic journey further led me to obtain a PhD and a postdoctoral degree, propelling me into a research career. Today, as I continue my practice in emergency care, my dedication extends beyond the clinical setting. Through ongoing research endeavors, I aim to contribute to a comprehensive understanding of healthcare disparities and work towards meaningful improvements in patient outcomes.

DR. SOUFFRONT ON THE DANGERS OF HYPERTENSION AND ASYMPTOMATIC HYPERTENSION

In addressing the dangers of hypertension and asymptomatic hypertension, my focus has been on demystifying common misconceptions, even among clinicians. In emergency departments, there’s often a belief that high blood pressure is related to pain, anxiety, or the chaotic environment of the visit. However, my recent study at Mount Sinai Hospital’s emergency department revealed a crucial finding: 100% of patients with asymptomatic hypertension had early signs of heart failure and did not know it.

Contrary to the misconception that high blood pressure in the emergency department is situational, my research emphasizes that it is a chronic issue. While the emergency department provides acute care, many patients seek care for non-urgent issues. This study allows us to consider the potential for brief targeted interventions to ensure our patients are connected to primary care. This is also something very important for minoritized patients, who may be frequent users of the emergency department, for a variety of reasons, and face the highest risks associated with hypertension, leading to increased morbidity and mortality.

For patients seeking to understand their blood pressure readings, I often explain that the top number reflects the heart working, while the bottom number indicates the heart resting. If the top number is too high, it means that the heart is working too hard. So I tell my patients that blood pressure control can address this so that your heart is not working so hard—and its important to be connected to care after this emergency visit.

But there are so many layers that involve the patient and their blood pressure—it involves the clinician too, and all the structural factors embedded in our healthcare system. A patient I see in the emergency department may not have blood pressure control for many reasons. This could be access to healthcare resources, socioeconomic determinants, or even the systemic biases that can significantly impact the quality of care received and health outcomes. So it’s more than just telling a patient that it’s important to be connected to care. It’s about telling them about their risks for not being connected and addressing the structural factors that may be preventing them from being connected. Patients are at the core of this effort. We need to create a more inclusive healthcare environment where everyone has the opportunity to achieve optimal health, even if it’s at the emergency department.

THE DANGERS OF HYPERTENSION

High blood pressure isn’t just a numbers game—it comes with serious risks. Imagine your heart as a balloon. If you blow it up too much, too often, it stretches out, causing potential problems. This is similar to what happens with hypertension—your heart works too hard, and it can lead to issues like having more severe heart trouble. It can also lead to stroke, kidney problems, and eye complications. And this is all preventable with blood pressure control.

But it’s not just about the numbers on the blood pressure cuff; social determinants of health play a huge role. Where you live, your income, your support system, and a number of other life factors play a big role. We know that your zip code is more predictive of your health outcomes than your genetic code, which means there is a much larger picture to blood pressure control that needs attention.

DR. SOUFFRONT ON WHAT PEOPLE WHO LACK ACCESS TO EQUITABLE HEALTHCARE CAN DO

Advocate for yourself! Don’t be afraid to communicate openly with healthcare providers about your financial situation and seek their guidance on achieving blood pressure control. They may be able to suggest alternative treatments such as adding or changing your medicine, or suggesting generic medications or other resources to help manage costs such as prescription assistance programs. You could also explore community health resources and even telehealth options if you are not able to get to an appointment. At the institution that I work at, we have a great conditions-management program for patients with chronic high blood pressure to ensure that they have all the resources that they need, whether it’s a social worker or a nutritionist or help with their insurance to ensure they achieve blood pressure control. This program also uses remote monitoring, but in a way that you don’t even need Wi-Fi to be included in the program. There’s some really fascinating stuff going on here at Mount Sinai. I think if patients are seeking care at Mount Sinai, they’re fortunate.

DR. SOUFFRONT ON WHY MORE CLINICIANS AREN’T USING THE AVAILABLE RESOURCES

I think it’s translational research. There is a bench-to-bedside delay, which stems from a lack of efficient sharing and application of new findings. While brilliant scientists may learn what works best for how to care for patients, there’s a tendency for these insights to stay within their isolated areas of expertise or to not be translated into actual practice fast enough. By no fault of their own, many scientists also work in silos and do not collaborate enough with other disciplines to share ideas. So for example, a nurse can work with a pharmacist on designing a better way to care for patients together.

DR. SOUFFRONT ON BIOMARKERS AND TELEHEALTH IN DEALING WITH ASYMPTOMATIC HYPERTENSION

Since we know that a large majority of emergency patients with asymptomatic hypertension have signs of early heart failure, we are exploring the use of a point-of-care blood biomarker to detect this in the fast-paced environment of the emergency department. We are also investigating whether communicating this risk at the point of emergency care by a nurse would improve blood pressure control and primary care engagement after leaving the emergency department. [Editor’s note: Examples of biomarkers are blood pressure, body temperature, and body mass index]. I’ve also done some work around telehealth. I conducted a pilot study to determine the feasibility of using telehealth for emergency department patients who had asymptomatic hypertension. Patients loved it. They were very accepting of it. They wanted to focus in the emergency department on the issue that brought them there, and address their hypertension in a less chaotic environment. So we were able to support their needs by getting them to their visit, providing whatever resources they needed, and coordinating their care. That small pilot study is really important for me because it really helps guide a future larger clinical trial that I’m designing.

DR. SOUFFRONT ON FOLLOWING UP WITH PATIENTS AFTER EMERGENCY DEPARTMENT VISITS

Imagine leaving the emergency department after getting treated for an ankle injury. It turns out, during your visit, that we notice your blood pressure was higher than it should be. Even though you weren’t there for blood pressure concerns, my work aims to make sure that patients like you don’t slip through the cracks.

So we send you home with a blood pressure cuff and a few days later, you receive a text or a video call from a registered nurse. They want to check in on you, see how you’re doing after the emergency department visit. The nurse then connects you with your primary care provider, making sure you have ongoing support and care. It’s not just about fixing the immediate issue; it’s about keeping tabs on your overall health, making sure everything is in check even if it wasn’t the main reason for your trip to the emergency department. That’s the kind of care I want to deliver in the emergency department—but in a way that doesn’t compromise the workflow of quick emergency care delivered by the nurse or provider.

DR. SOUFFRONT ON PATIENTS BEING UNAWARE OF THEIR ASYMPTOMATIC HYPERTENSION IN THE EMERGENCY DEPARTMENT

An emergency care visit may be the only place and time an individual interacts with a health system, so it can be a crucial moment, since many patients are unaware that they have hypertension. This critical time presents an opportunity to maximize the impact of healthcare interventions. The goal is for timely hypertension diagnosis and improved access to healthcare resources directly from the emergency department, regardless of the reason for the visit. Understanding the best way to do that, given the time constraints often experienced by clinicians, is what I am trying to figure out.

DR. SOUFFRONT ON THE DANGERS OF UNCONTROLLED HIGH BLOOD PRESSURE

With high blood pressure, most people are not aware of its presence until symptoms like chest pain or shortness of breath emerge or it is formally diagnosed. Because it is silent, it can go on for years if someone isn’t regularly seeing their primary care provider, so it can eventually affect your heart and kidneys or lead to other issues like stroke or heart failure, which is when your heart has trouble pumping effectively.

What I tell patients who I see in the emergency department is what their risk is now and what their risk over time is with blood pressure control. I tell them that connecting with your primary care provider after the emergency department visit is important—because their risks are essentially eliminated with blood pressure control. This may mean their medication needs titration or they may need confirmation of hypertension and treatment. This is sometimes hard because many patients are focused on the reason for their emergency department visit. However, I know that doing this at the point of emergency care heightens a patient’s perception of their risk and likelihood of follow up with a primary care provider, leading patients on the right trajectory to better health.

DR. SOUFFRONT ON WHY SHE CHOSE TO BE A NURSE PRACTITIONER AND SCIENTIST 

I think the approach for me was having diversity in my career, knowing that care delivery is patient-centered and holistic. That really just aligned well with a nursing career for me and I wouldn’t change anything. I don’t know one emergency nurse practitioner who’s doing research on asymptomatic hypertension at all. If you find that person send them my way because I would love to collaborate and work on a project! I don’t know anyone. That in itself is unique and I appreciate that. I can really just chart my own path and make an impact. Thankfully, I have had great mentors along the way. Some are nurses. Many are physicians. But they all encouraged me and have been instrumental in shaping my career and getting me to the place I am in now, and where I want to be in the future. I’m so grateful for the mentors I’ve had over my career, because without them I wouldn’t be here at all.

DR. SOUFFRONT ON HER ADDITIONAL RESEARCH INTERESTS

I am also committed to building research capacity among nurses and workforce diversity. My colleague and I were recently awarded a five-year grant from the National Institutes of Health to do just this, which we are really excited about. This grant will help support underrepresented minority nurses who are pursuing a clinical doctorate in nursing, called a Doctorate of Nursing Practice. Over 12 weeks, these students will learn the skills necessary to carry out translational research in their clinical practice, so that they are empowered to drive equity through practice improvement. My personal leadership and research vision is to achieve health and healthcare equity. For me, this is for patients who visit the emergency department who have uncontrolled hypertension—but my goal is to bring it all together, so that this work aligns with my efforts for building workforce diversity in the nursing community.

DR. SOUFFRONT ON HER FAITH AND SPIRITUALITY

I grew up Seventh Day Adventist. My faith taught me the value of holistic wellbeing; including the physical, mental, and spiritual aspects of health. This perspective has influenced how I care for my patients, encouraging me to really consider the person. I recognize the complexity of every individual circumstance, and so my approach reflects this commitment to understanding and addressing the diverse elements that surround each person. In the context of my area of research, I wouldn’t only say to a patient “follow up with your primary provider” or “take your medicine as you were prescribed.” I may consider also asking “Do you have transportation to get your medication? Do you have money to pay for your medication?” Some of those beliefs emphasize empathy and how I care for others. There are many different circumstances that impact a person’s wellbeing aside from their immediate health concerns.

www.mountsinai.org

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