by Carolyn Thomas ♥ @HeartSisters ♥ February 25, 2018
Two cardiology reports landed in my inbox on the same day this past week, inside the same issue of the same cardiology journal. The first was a Yale University study on how women, particularly women younger than age 55, fare worse after surviving a heart attack compared to male counterparts, partly because of a tendency to present with vague or atypical symptoms that can delay accurate diagnoses.(1) The second was about the future of the American Heart Association’s Go Red For Women® campaign.(2)* Both papers were published in the journal, Circulation.
The trouble was this: each report seemed to contradict the other.
In a nutshell, here’s the key section that caught my eye and raised an eyebrow from the second journal article, written by Israeli cardiologist Dr. Donna R. Zwas. She recommended six steps that the Go Red awareness-raising campaign for women’s heart disease should take. The #4 step on this 6-step list was this one:
“Simplify the message. The long list of potential signs and symptoms (of heart attack) is confusing and ultimately may decrease the likelihood of seeking help.
“If all of the atypical symptoms are given almost equal weight, and many may be experienced on a daily or weekly basis, a woman is unlikely to seek help even when she has chest pain. In our education programs, we find that women under-recognize the symptoms before the program, but frequently over-recognize unrelated symptoms afterward.
“If almost anything and everything can be a heart attack, there is no longer a clear trigger to action.
“Because women without cardiac disease commonly suffer from pain, including shoulder pain or back pain, the Go Red for Women® campaign should focus on chest pain, shortness of breath, and the intensity of the symptoms.“
I had to re-read that section of the recommendations a few times just to make sure I’d read it right. Then I had to go have a wee lie-down to recover. . .
I was so shocked by this goofy recommendation (essentially, to stop telling women about all cardiac symptoms) that I sent a letter to the editor of Circulation expressing my concern. Those vague, atypical heart attack signs are in fact confirmed by many women (and also by many, many studies like the Yale research published in the same issue of the journal).
Here‘s what I wrote to Circulation about the potential new direction of the Go Red campaign – a letter that
the journal has so far declined to publish) was published on February 27th!
“RE: Zwas, Donna R.. ‘Redressing the Red Dress.’ Circulation 137.8 (2018): 763-765. Feb. 2018.
From: Carolyn Thomas (submitted on 20 02 2018):
“Step #4: Let’s forget about all those pesky atypical symptoms”
“I was surprised to see the conclusions illustrated in Step #4: ‘Simplify the message’.
“Although the report happily suggests that the Go Red for Women® campaign has indeed succeeded in helping to raise awareness of women’s heart disease and to lower adverse events, this particular step paradoxically suggests that the campaign has been a little too successful in educating women about atypical cardiac symptoms.
“If Go Red messaging is too confusing to women, why not clean up the confusion rather than trashing the message?
“I’m not a physician. I’m simply a dull-witted heart attack survivor who, in the 10 years since my own cardiac event, has spoken (and listened) to thousands of women (and a few men!) – sharing what I learned during my training at the WomenHeart Science and Leadership advocacy program at Mayo Clinic. My blog ‘Heart Sisters‘ has had over 13 million views so far from 190 countries.
“In all that time, I have yet to encounter even one woman in my audiences or among my readers who is unaware that chest pain could mean a heart attack.
“And previous studies suggest that between 10-42% of women experience no chest symptoms at all during MI. The rates vary, unhelpfully, depending on the study, but they still describe women who present with only the vague or atypical cardiac symptoms now described as ‘too confusing’ for women to act upon.
“In my opinion, this puzzling and unfortunate step will push women’s awareness of cardiac symptoms backwards an entire decade.”
Meanwhile, over at Yale University, researchers led by study author
men aged 18 to 55 years, all hospitalized for acute heart attack. Here are some of their key findings reported in the same cardiology journal:
- chest pain (defined as pain, pressure, tightness, or discomfort) was the most frequently-reported heart attack symptom in both men and women
- women were more likely to present with three or more non-chest atypical symptoms than men, regardless of the presence of chest pain
- women with a type of serious heart attack known as STEMI (ST-Elevation Myocardial Infarction) were more likely than men to present with no chest pain
- women were more likely than men to seek medical care for cardiac symptoms before their hospitalization, but more of these women reported that their physicians did NOT believe their symptoms were heart-related (otherwise known as “misdiagnosis”)
For the time being, the AHA’s Go Red For Women® website does support the well-known premise that there are indeed important non-chest signs of heart attack in women. Cardiologist Dr. Susanne Steinbaum, for example, discusses on the site what she calls women’s silent heart attack symptoms including jaw pain, neck pain and nausea. Should that section be deleted from the site to avoid confusing women?
In my Heart-Smart Women presentations, I cover all possible heart attack symptoms – both typical and atypical, both the famous and the bizarre. But I also know that very few if any of my audience members are going to rush to the Emergency Department for every future twinge of neck pain or nausea just because I mention them in my talk.
For women, the problem is more often just the opposite: an acknowledged reluctance to seek appropriate help – even for textbook Hollywood Heart Attack symptoms (or what researchers call our treatment-seeking delay behaviour).
So I also remind women to respect the small voice inside that says “something is really wrong with me”. I like to ask them:
“What would you advise if these exact same distressing symptoms, or combination of symptoms, were happening to your mother, or your daughter, or your sister, or a friend?
“Take the same action to seek help that you’d demand for others, but do it for yourself!”
That’s the key message:
“YOU KNOW YOUR BODY! You KNOW when something is just not right. And if those vague symptoms feel unusual or alarming to you, then pay attention and seek help!”
Do you believe that fully informing women about vague or atypical symptoms would be too confusing for their tiny brains to comprehend? Me neither.
How is withholding information about women’s #1 killer more effective for the Go Red campaign than sharing it?
And how is doing so to somehow protect a target audience that’s easily confused not insufferably patronizing?
1.Sex Differences in the Presentation and Perception of Symptoms Among Young Patients With Myocardial Infarction.” ,
2. Donna R. Zwas, “Redressing the Red Dress.”,
Q: Is the Go Red for Women® campaign too “confusing” for you to understand?
- *Learn more about the American Heart Association’s Go Red for Women® campaign
- How does it really feel to have a heart attack? Female survivors answer that question
- Researchers openly mock the ‘myth’ of women’s unique heart attack symptoms
- Words matter when we describe our heart attack symptoms
- Why wouldn’t you call 911 for heart attack symptoms?
- How can we get female heart patients past the E.R. gatekeepers?
- Early warning signs: how women can tell if they’re headed for a heart attack
- Heart attack misdiagnosis in women
- Why we ignore serious symptoms
- Denial and its deadly role in surviving a heart attack
- Downplaying symptoms: just pretend it’s not a heart attack
- The sad reality of women’s heart disease hits home
- Slow-onset heart attack: the trickster that fools us