Survey: how women (and our doctors) respond to early cardiac symptoms

Only about 22 per cent of the primary care physicians surveyed told cardiac researchers that they felt extremely well-prepared to assess cardiovascular risk in their female patients, compared to 42 per cent of cardiologists.

But before we start high-fiving those cardiologists, let’s consider this singular  fact: these are CARDIOLOGISTS!  They have only one job. They’re the ones women see when we desperately need an extremely well-prepared expert to accurately assess our cardiac condition.

You might wonder what’s going on with the remaining 58 per cent of cardiologists who do NOT feel extremely well-prepared.  Given what we do know about women being at higher risk of cardiac misdiagnosis compared to men, this does, weirdly, make sense. Veteran U.K. cardiac researcher Dr. Sian Harding writes sternly about cardiology’s implicit bias in her new book The Exquisite Machine, published in February of this year:

“As well as being misdiagnosed, women are less likely to be treated quickly, less likely to get the best surgical treatment, and less likely to be discharged home with the optimum set of heart drugs. None of this is excusable.”

As if the findings of the Women’s Heart Alliance survey question are not concerning enough, here’s more: only 49 per cent of primary care physicians surveyed reported that their medical training prepared them to assess female patients’ cardiovascular risks. This is important because our family doctors are often the gatekeepers between us and appropriately swift treatment. How can half of family docs believe that their medical school training did NOT prepare them for the unique cardiac risk factors of their female patients?

And what about the statistics on medical training for cardiologists?  Their stats are, as you’d expect, higher than those of the family docs:  59 per cent of cardiologists reported that their training DID prepare them to assess female patients’ cardiovascular risks.

But again, what about the 41 per cent of trained cardiologists who answered that they were NOT adequately prepared during their training?

Finally – because I can stand only so much depressing bleakness at one time – just 49 per cent of primary physicians and 52 per cent of cardiologists who were surveyed agreed that women’s and men’s hearts are physiologically different.  What this essentially means is that half of doctors surveyed haven’t yet learned that women are not just small men.

See more on male-centric medicine in my review of the book Sex Matters:  How Male-Centric Medicine Endangers Women’s Health and What We Can Do About It , by Emergency physician Dr. Alyson McGregor (but remember to take your blood pressure meds before opening her book!)

Unlike the delayed treatment-seekers that cardiac researchers write about, in my own experience as a first-time heart attack patient, I was in the Emergency Department within half an hour of my first “Hollywood Heart Attack” symptoms (central chest pain, nausea, sweating and pain down my left arm) – yet I was still told by the confident Emerg doc: “You’re in the right demographic for acid reflux!” – before he sent me home. I was terribly  embarrassed about making a fuss “over nothing”. So there was no way I was going back to that Emergency Department – until my worsening symptoms day after day had become utterly unbearable.

But hey!  Even during my second trip to Emerg (same hospital, different Emerg doc this time) I still believed that a man with the letters M.D. after his name is  correct. The only reason I forced myself back to that Emergency Department was to get serious drugs for this “acid reflux” I was suffering.

Here’s how the Women’s Heart Alliance survey of physician participants summed up their results:

“Little progress has been made in the last decade in increasing physician awareness or use of evidence-based guidelines to care for their female patients.” 

I had to go have a wee lie-down after I read that.

In last Sunday’s Heart Sisters post, I wrote about the “decade of lost ground” reported by the American Heart Association (AHA) in describing the results of their last National Survey on women’s awareness of heart disease. Awareness turned out to be actually lower than the previous National Survey from 10 years earlier!

That’s truly shocking. But when we read reports of a decade of “little progress in increasing physician awareness of women’s heart disease or use of evidence-based guidelines” , it’s time to stop pretending that this is normal.

When the Women’s Heart Alliance survey asked current physicians if they thought a national “Get Heart Checked” reminder campaign for women might help to improve poor cardiac outcomes among their female patients, most agreed – but about 12 per cent did NOT support such an initiative. About half of the doctors who disagreed said they were“worried about creating fear.”

This is just one of the many reasons I’ve come to believe that we need to shift more focus to medical education, to our future physicians – quite possibly our only hope.

For example, cardiologists and cardiac researchers with the Canadian Women’s Heart Health Centre (CWHHC) at the University of Ottawa Heart Institute were also concerned about serious gaps in medical/nursing school education, as they explained:

“Historically, most cardiovascular research, awareness, education, diagnostic testing and interventions have focused on men.  Research also points to the fact that healthcare professionals do not have a clear understanding of women’s heart health or risk factors for heart disease. There are still disparities in care in almost all cardiovascular conditions, including ischemic heart disease, heart failure, heart valve conditions and aortic disease.

“Women with cardiovascular disease are under-enrolled in clinical trials – and under-investigated, under-diagnosed, and under-treated in clinical settings.”

But unlike some academic researchers who publish their data in medical journals and then move directly on to other studies they also hope to get accepted for publication, the CWHHC team wanted to do something to help reverse this disturbing trend in women’s health care. See also: Implementation science: should research actually DO SOMETHING?

To address this known gap in clinical training, their team created nine educational modules on women’s cardiovascular disease.

These free modules target all medical/nursing trainees in Canada or the U.S. – as well as current healthcare professionals in the specialties of Cardiology, General Internal Medicine, and Emergency Medicine. Basically, they’ve already done the hard work for any medical/nursing school professor interested in improving their students’ knowledge about women’s heart disease.

Learn more on how to access these nine free CWHHC educational modules.

A big THANK YOU to the Canadian Women’s Heart Health Centre, the University of Ottawa Heart Institute, and all healthcare professionals and cardiac researchers who champion the rights of female heart patients to be appropriately diagnosed and treated.

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(1) Anne G. Rosenfeld et al. “Understanding Treatment Seeking Delay in Women with Acute Myocardial Infarction: Descriptions of Decision-Making Patterns.” American Journal of Critical Care. 2005;14(4):285-293.

Maze image: Aberrant Realities, Pixabay

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Q:  How can female heart patients tell if their cardiologists are “extremely well prepared”  to diagnose and treat us?

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NOTE FROM CAROLYN:  I wrote much more about differences between men’s and women’s cardiac diagnostics, treatments and outcomes in my book, A Woman’s Guide to Living with Heart Disease. You can ask for it at your local bookshop (please support your independent neighbourhood booksellers) or from Amazon online (paperback, hardcover or e-book) – or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 30% off the list price).

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FYI, below are some interesting results from the female heart patients who completed the Women’s Heart Alliance survey.  If you’re experiencing unusual or disturbing cardiac symptoms, and recognize your own treatment-seeking delay behaviour from this list, stop reading and get medical help!