“Despite national campaigns to increase awareness and reduce cardiovascular disease (CVD) mortality in women, CVD remains our leading cause of death, annually killing more women than men.”
That statement from experts meeting at the Minnesota Women’s Heart Summit should send chills down your spine. For a number of years we have known that women are under-diagnosed for heart disease – and then under-treated even when appropriately diagnosed – yet here are a bunch of world-class cardiologists and public health experts still puzzling on how to address the deadly issue that is our #1 killer. Or, to paraphrase heart attack survivor Laura Heywood-Cory‘s take on the state of women’s heart health:
“Sucks to be female. Better luck next life!”
As the Summit report puts it:
“Although some progress has been made in our understanding and treatment of CVD in women, the causes, extent, and demographic trends of observed sex differences and disparities remain uncertain, and the growing burden of CVD and its risk factors among younger women is concerning.”
This multi-disciplinary summit was hosted by the Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, University of Minnesota, and Mayo Clinic.
Here are the four major recommendations identified by those who attended the Women’s Heart Summit: *
- 1. Community Awareness and Prevention. Women’s knowledge of risk of CV disease is improving but is still inadequate. Local events to raise awareness among the general public are an important part of reducing CV deaths in women. We must engage clinicians, health care consumers as well as government policy makers in order to make a difference.
- 2. Symptom recognition and delays in seeking treatment. Often women present atypically with CV disease and we must work to educate women. Public service informational campaigns are needed to promote symptom recognition in women as well as the importance of seeking timely treatment. A parallel campaign to educate primary care physicians and ER providers about the atypical nature of symptoms in women with a focus on avoiding therapy delays should be conducted.
- 3. Closing the Survival Gap. Women are less likely to receive evidence-based therapies such as beta blockers and ACE inhibitors, medications that have been proven to decrease mortality. Women are also less likely to have coronary artery bypass surgery, cardiac catheterizations and revascularization. The goal should be to address this gender imbalance through advocacy, better training of physicians and inclusion of more women in research and clinical trials.
4. Patient-Provider Connections. Physicians must strive to develop better relationships and have better communication with patients. Often depression, socioeconomic status and other issues become barriers to care. By seeing the whole patient and addressing these issues, a physician may be able to better partner with female patients and improve care.
From these identified issues, several specific targets emerged:
1. involve obstetric/gynecologic physicians in providing heart health education
2. involve mid-level providers (midwives and other advanced practice women’s health care providers) and other health professionals in women’s heart health education
3. maximize the use of social media and online newsfeeds to raise awareness of heart disease in women
Dr. Kevin Campbell practices cardiology and cardiac electrophysiology in North Carolina. He wrote recently:
“Disparities in cardiac care for women continue to exist. It is a significant public health problem today.
“More women than men die from cardiovascular disease each year. Although many have worked very hard to reduce these disparities, there is much work yet to be done. We must continue to communicate, advocate and educate in order to improve outcomes in the future.
“Many women today regularly see OB/GYN physicians as their only health care provider. OB/GYN physicians are not always well equipped to provide comprehensive primary care and may have little time to devote to screening for cardiovascular disease.
“Most women who see an OB/GYN are more concerned with dying of breast, uterine or ovarian cancer than with CVD or sudden cardiac death.”
To address this, Dr. Campbell has developed a quick and easy screening tool for the OB/GYN office that can be used to pre-screen women for CV disease. A simple waiting room questionnaire is filled out by the patient and handed to the nurse at intake. This questionnaire could then prompt a busy OB/GYN provider to more aggressively screen at-risk women.
Canadian researcher and OB/GYN Dr. Graeme Smith at Queen’s University takes OB/GYN screening one step further. He and his team have launched a women’s clinic he calls the MotHERS program in Kingston, Ontario. Women there are invited to attend the screening clinic for a 6-month postpartum assessment if they have had one of a number of pregnancy complications, like pre-eclampsia. Dr. Smith’s research suggests that women experiencing such complications are 2-3 times more likely to subsequently develop CVD.
Targeting our OB/GYN care providers is one step. What else can be done?
Q: Which of the four Women’s Heart Summit recommendations do you consider most important?
* Am Heart J. 2012 Jan;163(1):39-48.e1. Eliminating untimely deaths of women from heart disease: highlights from the Minnesota Women’s Heart Summit. Lindquist R, Boucher JL, Grey EZ, Cairns B, Bobra S, Windenburg D, Konety S, Graham K, Luepker R, Hayes SN.
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