Heart disease: women’s #1 cause of untimely death

7 Jan

by Carolyn Thomas     @HeartSisters

“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?

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* 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.

See also:

 

8 Responses to “Heart disease: women’s #1 cause of untimely death”

  1. Kathleen January 7, 2013 at 10:42 am #

    Hard time choosing between 3 and 4.
    Argument for 4: Bad attitude and disrespect is so prevalent. Having ruled out CV disease, for over 6 years 2 primary docs and the cardiologist smiled tolerantly as they dismissed my research and suggested diagnosis of Apical Hypertrophic Cardiomyopathy. Until this summer, when my new primary doc actually listened and made useful referrals that confirmed AHCM. On the other hand…

    Argument for 3: This young doctor has excellent communication skills and her (metaphorical) heart is in the right place, but she was shocked when I told her that CV disease kills more women than men. Not just a man’s problem, sure, she knew that, but that it actually kills MORE women?!? That was news, and this doc is rather fresh out of med school.

    Like

    • Carolyn Thomas January 7, 2013 at 12:21 pm #

      Thanks for this perspective, Kathleen. Yet another example of how important medical education is. Your story of your doc’s lack of awareness is discouraging and reminded me of a 2005 AHA survey of physicians to see how many knew that more women than men die of heart disease each year (a fact that’s been true, by the way, since 1984). The results: only 8% of family docs and (even worse!!) only 17% of cardiologists. CARDIOLOGISTS! This is their business. This is all they do. One hopes that these stats would have improved dramatically in the past eight years!

      Like

  2. Mary January 7, 2013 at 8:49 am #

    Um, Number 5! Training ER physicians & staff in not just the fact that MI symptoms can be different, but inform them about the “rarer” aspects of disease, and the inadequacy of current testing approaches to expose the disease.

    Train them on alternative ways to treat, i.e. nitro drip and how to not invalidate, humiliate and shame the patient in the ER.

    Like

    • Carolyn Thomas January 7, 2013 at 12:08 pm #

      Glad you voted for #5, Mary. Getting past the ER gatekeepers can be a challenge given that standard diagnostics can miss those “rare” forms – like Coronary Microvascular Disease or Prinzmetal’s angina. And even the standard treadmill stress test can completely miss a woman’s single vessel disease. And oh, yeah, there’s that ongoing issue of invalidating, humiliating and shaming. . .

      Like

  3. JetGirl January 7, 2013 at 6:54 am #

    Carolyn,

    I think one of the other areas of gender disparity is that when it is our spouse who is sick, we women make sure the appointments are made and kept, meds taken, prescrips filled, heart healthy meals prepared, exercise done . . . but who does that for US when we are too tired, too depressed, or too distracted?

    JG

    Like

    • Carolyn Thomas January 7, 2013 at 7:10 am #

      Hi JetGirl – good point. Not only do we wait longer before seeking emergency help in the first place, but women tend not to put ourselves FIRST even while recuperating. An interesting study (see: Women Heart Attack Survivors Know Their Place) also suggests that even while recovering at home following hospitalization, women resume their former household roles faster than male patients do. We insist on resuming them, and so do our families.

      Like

  4. cave76 January 7, 2013 at 6:41 am #

    Which of the four recommendations?
    Number Four!
    While realizing that may stand a snowball’s chance! I apologize to the few physicians who DO try their best.

    Like

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