Our two stories are freakishly the same in so many ways:
♥ In 58-year old Nancy Bradley’s story, she went to the Emergency Department at the Royal Inland Hospital near her home in Kamloops as soon as she felt alarming symptoms she knew might be heart-related: dizziness, sweating, shortness of breath and “an elephant sitting on my chest” feeling. (In my story, I was 58 as well, and I went to Emergency at the Royal Jubilee Hospital near my home in Victoria as soon as my own alarming heart attack symptoms started).
♥ All of Nancy’s cardiac diagnostic tests seemed to be “normal”. (All of my diagnostic tests seemed to be “normal”, too).
♥ Nancy’s Emergency physician suspected heartburn, and suggested she take antacid drugs. (My Emergency physician suspected heartburn, and suggested that I take antacids).
♥ Nancy was sent home, misdiagnosed with acid reflux within five hours of the onset of symptoms. (I was sent home, misdiagnosed with acid reflux within five hours of the onset of my symptoms).
♥ For the next two weeks, when her symptoms flared up, Nancy chewed antacids as directed by that Emergency physician. (For the next two weeks, when my symptoms flared up, I chewed antacids just like the doctor had told me, too).
♥ Two weeks after being misdiagnosed, Nancy finally returned to the same Emergency Department because her symptoms were so bad, she thought she was dying. (Two weeks after I was misdiagnosed, I returned to my Emergency Department because my symptoms were so bad, I thought I was dying).
♥ Each of us learned right away during this second trip to hospital that we were indeed having a heart attack just as we had first suspected, and each of us were immediately admitted for emergency treatment of a 95 per cent blocked coronary artery.
The striking difference: my heart attack happened in 2008, but Nancy’s happened 10 years later.
A number of physicians – in both Emergency Medicine and in Cardiology – have reassured me personally that what happened to me 10 years ago could not possibly happen today, because physicians are more aware of women’s heart disease differences now, and because cardiac diagnostic tests have improved since 2008.
But that’s what makes Nancy’s story so much more disturbing than mine – because it means that, a full decade later, we’re still seeing many female heart patients who are still not being diagnosed or treated in the same way our male counterparts are. As Mayo Clinic cardiologist Dr. Sharonne Hayes, founder of the Mayo Women’s Heart Clinic, told me on Twitter after she read Nancy ‘s story:*
This means that heart patients like Nancy are still suffering needlessly.
It means that despite study after study, report after report, expert after expert confirming this pervasive cardiology gender gap, the reality remains that when women seek help, they don’t always get it.
One such report launched earlier this week was Ms. Understood, Canada’s Heart and Stroke Foundation’s 2018 Heart Report. The 20-page document, which features Nancy Bradley’s dramatic misdiagnosis and survival story, pulls no punches by summarizing its findings:
“Women’s hearts are victims of a broken system that is ill-equipped to diagnose, treat and support them.”
This conclusion is no surprise to informed physicians, researchers, and patients like me who write about them. It is, apparently, a surprise to many of the journalists who covered the launch of this report on February 1st, as Heart and Stroke Foundation staff told me later that day: “In so many media interviews, journalists are saying what a ‘surprise’ the 2018 Heart Report is!”
Cardiologist Dr. Noel Bairey Merz, Director of the Barbra Streisand Women’s Heart Center at UCLA, bluntly describes this reality for them:
“We are 50 years behind in our knowledge about optimal screening, diagnosis, and treatment regimens for heart disease in women compared to what we know about heart disease in men – and every day, women pay the price.”
The Heart and Stroke report included these highlights (or, more accurately, lowlights):
• Heart disease is the leading cause of premature death for women in Canada.
“Today, when it comes to heart disease, women are under-researched, under-diagnosed and under–treated, under-supported and under-aware..“This complex mix of ‘unders’ began in health research where, for decades, specific therapies were tested in controlled studies on primarily middle-aged, white male subjects. The assumption was that one-size-fits-all.”
“Gender bias still exists..“Physicians may look for other causes of a woman’s symptoms, without first doing appropriate tests to rule out cardiac issues. It may not be intentional, yet when there are differences in medical care for men and women across large numbers of patients, it is an indication there is still systemic bias.”
The report also addresses how diagnostic tests are not created equal:
“While no test is 100% accurate, some perform worse for women. The exercise treadmill (or stress) test for cardiac output is far less sensitive for women compared to men, and even worse for younger women compared to older women..“A misleading diagnosis delays early treatment. For heart attack, the key to effectively treating and minimizing irreversible damage is time: open up the arteries quickly, restore blood flow quickly.”
“Most First Nations communities do not have a doctor and there are no specialists.“On-reserve, there are language problems – not only dialect, but also ‘doctor jargon’. Many people who have been through the residential school experience are hesitant to ask questions of people in authority, so may not understand their condition or medication..“The health care and treatment at the very beginning of these people’s medical journey is crucial. If that doesn’t work well, they are reluctant to return..“I believe that the healthcare system can learn from the experience of Indigenous people. We all need the biomedical model to determine a diagnosis, but it is up to us to figure out what will restore our health – within ourselves, our family and our community. We must understand that spiritual, cultural and traditional healing are all important.”
- know their own personal cardiac risk factors
- learn about women’s cardiac symptoms
- make themselves a priority when it comes to seeking immediate help for those cardiac symptoms
- demand the same quality of care that has been designed, researched and implemented for men
- support organizations that are working specifically to improve women’s heart care
… then 10 years from now, we’ll still be reading disturbing stories about many more Nancys and Carolyns – and wondering when somebody, somewhere is going to somehow start doing something to help them.
“Consider this story shared with me by a woman attending one of my Heart-Smart Women presentations. While lying on a gurney in the Emergency Department, she overheard this conversation between a physician and one of his (male) patients beyond the curtain separating her from the next bed. The doctor told the (male) patient:
“Your blood tests came back fine, your EKG tests are fine – but we’re going to admit you for observation just to rule out a heart attack”.
“So yet another male patient is thus kept in hospital for observation in spite of his ‘normal’ cardiac test results.”
But Nancy and I and countless other females in mid-heart attack are being sent home from Emergency mistakenly diagnosed with acid reflux or anxiety or menopause or a dog’s breakfast of other popular misdiagnosis options.
As Nancy told the Heart and Stroke Foundation recently:
“I would recommend that women be persistent. You know your own body; a person needs to follow their own gut feeling.
“Looking back, maybe I should have insisted more to the Emergency doctor the first time I went. I knew there was something wrong with my heart. I just knew it.”
NOTE FROM CAROLYN: If you’re an American reading this, and assuming that this new report’s findings are unique to Canada, think again. I’ve been documenting American and international reports for years, including these:
♥ January 2020: Professor Mark Woodward at the University of Oxford drops a bombshell in his report called Cardiovascular Disease and the Female Disadvantage
♥ February, 2018: Women are more likely than men to seek care for their cardiac symptoms during the week before hospitalization – but both women and their physicians are less likely to attribute these early cardiac symptoms to heart disease compared to men. Pioneer cardiologist Dr. Nanette Wenger weighs in on the VIRGO study, published in Cardiology.
♥ January 2016: The American Heart Association released its first ever scientific statement on women’s heart attacks (that’s ‘first’ – as in the first one in its entire 92-year history!) confirming that “compared to men, women tend to be under-treated”, and “While the most common heart attack symptom is chest pain or discomfort for both sexes, women are more likely to have atypical symptoms such as shortness of breath, nausea or vomiting, and back or jaw pain.”
♥ February 2016: Focused Cardiovascular Care for Women: The Need and Role in Clinical Practice, a report published in the journal, Mayo Clinic Proceedings on why we need Women’s Heart Clinics that can specifically address the many unique considerations of women’s heart disease, concluding: “The public health cost of misdiagnosed or undiagnosed cardiac disease in women is significant.”
* Troponins are a type of cardiac enzyme found in blood tests when the heart muscle is damaged during a heart attack.
Q: What changes do you think would make the biggest difference in closing this cardiology gender gap?
ANOTHER NOTE FROM CAROLYN: I wrote much more about the cardiology gender gap in Chapter 3 of my book, “A Woman’s Guide to Living with Heart Disease”. You can ask for it at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the JHUP code HTWN to save 20% off the list price).
Much more about the cardiology gender gap in my book A Woman’s Guide to Living With Heart Disease(Johns Hopkins University, 2017)
Read more about Nancy Bradley’s story in this Toronto Star interview.