Will this $840,000 grant make a dent in women’s cardiac care?

♥ NOTE FROM CAROLYN:  $840,000 (or $210,000 per year) is a healthy chunk of change for cardiac research.  How does this grant compare with multi-million dollar women’s cardiac health research grants and, more importantly, with any practical results obtained from spending those funds?  See also: Implementation Science: Should Research Actually DO SOMETHING?

EP:  “In general, women present later than men with cardiovascular disease, but one-third of cardiovascular events in women occur before the age of 65 and these tend to be under-recognized, causing delays in diagnosis and poorer prognoses than in men.  We have heard far too many stories of delayed diagnoses and women feeling that they are being treated differently than men.”

♥ NOTE FROM CAROLYN:  My misdiagnosed heart attack also happened when I was in my 50s, which in the wonderful world of cardiology made me a “young” heart attack survivor.  Speaking of women feeling they’re being treated differently than men during their heart attacks, one of my readers shared an overheard Emergency Department comment from an Emerg doctor to his (male) patient that exemplifies the difference:  “All of your cardiac tests results came back normal, but we’re going to admit you for observation just to make sure it isn’t your heart.”  Thus yet another man in the Emergency Department with symptoms but “normal” cardiac tests is admitted to the hospital –  while I and countless other women with symptoms but “normal” cardiac tests are dismissed and sent home. That’s called treating women differently than men. How will this new grant affect the systemic bias that has allowed these differences to survive unchecked despite many previous cardiac studies that basically conclude: “Sucks to be female – better luck next life” ?

EP:  “One of the Alliance’s first initiatives will be to get an algorithm that has been developed to improve recognition of heart attacks in women into more Emergency Departments across Canada.”

♥ NOTE FROM CAROLYN:  I love the idea of improving the ability of all physicians to correctly diagnose women’s heart attacks, but whenever I hear healthcare professionals use words like “algorithms” to explain how something new will change healthcare as we know it, I get nervous. The medical profession, for example,  already has best-practice published treatment guidelines in place for diagnosis and treatment of all cardiac events. And as cardiologist Dr. Sharonne Hayes (founder of the Mayo Women’s Heart Clinic) once warned a staff audience at WomenHeart: The National Coalition for Women with Heart Disease:  “Right now, guidelines help women get the care that has been shown to improve survival and long term outcomes in large groups of patients.  But the problem is that the guidelines are less likely to be applied to women compared to men. We know that when hospitals have systems in place to ensure they provide care according to the guidelines, women’s outcomes improve, even more than men’s.”  But will the clinicians who are not applying existing guidelines be any more likely to embrace a shiny new algorithm instead?

EP:  “Chest pain is the most common heart attack symptom in both men and women, Mullen says. But, while men often describe a ‘crushing’ pain, women tend to describe it as a dull ache or nagging pain and describe other symptoms, such as jaw pain, back pain, fatigue or excessive sweating. That can be confusing for women and for healthcare providers.”

♥ NOTE FROM CAROLYN:   “Confused healthcare providers” are the reason I now advise the women in my ‘Heart-Smart Women’ presentation audiences to say loudly and firmly to their doctors:  “I have chest pain. I think I’m having a heart attack!” – and then shut up. Because apparently, if I’m having chest pain PLUS nausea PLUS sweating PLUS pain down my left arm, it’s too confusing for doctors.  And for more on how female heart patients tend to talk to doctors in the Emergency Department, read about the fascinating research of Harvard linguist Dr. Catherine Kreatsoulas. who reminds physicians that not all women use the words “chest pain” to describe their most common cardiac symptom.  She’s witnessed women, for example, who both minimize their symptoms and even argue with Emergency docs: “Well, it’s not really chest PAIN. It’s really more like pressure. . .” But removing the words “chest pain” from a woman’s medical chart essentially means she can kiss a cardiac diagnosis goodbye.

EP:  “The initiative comes at a time when there is an alarming trend in women’s heart health — an increase in deaths due to heart attacks in young women — which makes increased research, education and training more urgent than ever.  A key to the Alliance is the involvement of women with lived experience. Ottawa’s Risa Mallory is among them. Mallory was conscious of her own heart health throughout much of her adult life because her mother died at age 59 from cardiac complications. But, when she suffered a Spontaneous Coronary Artery Dissection (SCAD), she suspected it was angina and it took her a few days to get to a hospital. While being treated at a hospital in Phoenix, Arizona, Mallory had a massive heart attack and went into cardiac arrest. She spent eight days in the hospital there, and 12 more at the Heart Institute in Ottawa after returning home. She still deals with shortness of breath and fatigue, and is on a ‘cocktail’ of medications. Ninety per cent of spontaneous coronary artery dissections happen to women. Mallory says her own experience underscores the continuing need for education and research around heart health for women. She adds: ‘Typically, women do not respond quickly (to suspected cardiovascular problems). They often underestimate the risk, they don’t want to be a burden and don’t want to be seen as hysterical.’  She now advises: ‘If you think you are having a heart attack, just act!’ ”

♥ NOTE FROM CAROLYN: Great advice from Risa Mallory!  I like to ask my audiences to imagine what they’d do if their own cardiac symptoms were happening to their daughter or Mum or sister or friend – and then make exactly that decision to take action for themselves. Meanwhile, as Risa says, educating physicians and nurses about women’s unique cardiac risk factors, symptoms – and especially diagnostic challenges – is critically important. Yet a recent report on 16 Canadian medical schools still  “points to an ongoing scarcity of women’s health content in medical school curricula.”(1)  For some encouraging updates, read  about these nine innovative educational modules for med students from  the new Canadian Women’s Heart Health Education Course.

EP:  “But Mallory, who is part of the Women’s Heart Health Alliance, acknowledges that women tend to delay seeking urgent help during a heart attack. Early heart attack signs are missed in about 78 per cent of women, according to Heart & Stroke. She says it is an exciting opportunity to shift the trend in women’s heart health by increasing research, education and practice. Meanwhile, two-thirds of clinical research on heart disease continue to be done on white middle-aged men. 

“It is changing, but there is still a bias against women and a gender gap.”