Responsive cardiovascular screening: A grounded theory of nurse practitioner practices in primary care

BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of death among women in the United States. Despite well-documented sex- and gender-specific risk factors, women remain underrepresented in CVD research and continue to experience gaps in prevention and early detection. Nurse practitioners (NPs) deliver a substantial proportion of primary care (PC) in the United States, positioning them at the forefront of cardiovascular prevention and risk reduction. Despite this, gaps persist in understanding how NPs approach cardiovascular screening for women at risk. PURPOSE: The purpose of this study was to explore the critical factors that influence how NPs in PC screen women at risk for CVD and to construct a theoretical understanding of the processes underlying these NP-led screening practices. METHODOLOGY: A qualitative study using Charmaz's constructivist grounded theory approach was conducted with 17 PC NPs via semi-structured interviews. Constant comparative analysis guided data collection and interpretation, with credibility ensured through memoing, peer debriefing, and an audit trail to support methodological rigor. RESULTS: Four interrelated categories emerged: (1) complexities of sex and gender in women's cardiovascular health, (2) adaptive patient-centered cardiovascular care, (3) professional knowledge integration, and (4) organizational and social determinants influencing screening practices. Together, these categories informed the theory of responsive cardiovascular screening, describing how NPs dynamically balance evidence, patient context, and system factors in CVD risk assessment. CONCLUSIONS: Nurse practitioners employ responsive cardiovascular screening practices, reflecting a dynamic, context-sensitive process. IMPLICATIONS: This framework offers actionable guidance to strengthen sex-specific cardiovascular screening and promote equitable preventive care for women.