by Carolyn Thomas ♥ @HeartSisters
I was invited recently to do my “Heart-Smart Women” virtual presentation to a medical school class in New York. For a heart patient like me, this was a dream invitation. I’ve spoken to thousands of people – including patients, the general public, doctors, nurses and academics- since graduating in 2008 from the WomenHeart Science & Leadership patient advocacy training at Mayo Clinic – but I’ve always known that what I really wanted to do was to reach our future doctors. Here’s why those trainees are so important to me. .
Cardiologists and cardiac researchers with the Canadian Women’s Heart Health Centre (CWHHC) at the University of Ottawa Heart Institute describe my own reason perfectly:
“Cardiovascular disease is one of the leading causes of hospitalization and premature death for women. Historically, most cardiovascular research, awareness, education, diagnostic testing and interventions have focused on men. Research also points to the fact that healthcare professionals do NOT have a clear understanding of women’s heart health or risk factors for heart disease. There are still disparities in care in almost all cardiovascular conditions, including ischemic heart disease, heart failure, heart valve conditions and aortic disease.
“Women with cardiovascular disease are under-enrolled in clinical trials and under-investigated, under-diagnosed, and under-treated in clinical settings.”
The CWHHC team also explained that access to appropriate heart health care can be impacted by several factors – including geography, resources, social acceptability and structural biases. One such bias has been the long-standing view of cardiovascular disease as a man’s problem, which shows up as “a lack of awareness of risk factors in women, and which continues to be reflected in research, health policies and programs and, importantly, at a clinical level.”
Now, remember that none of what CWHHC is describing is news to any of us.
I’ve been translating women’s cardiac research results here for the general public on this site since 2009. Every time I do, I feel like I’m simply reporting on the same study: different date, different authors, different university, different cardiology journal – but as my heart sister Laura Haywood-Cory (who survived a SCAD heart attack at age 40) once asked me:
“Do we really need yet another study that concludes: “SUCKS TO BE FEMALE – BETTER LUCK NEXT LIFE!”?
Well, Laura, apparently we do – because such studies continue to get funded and churned out by academics and their sleep-deprived grad students.
Yet we now know that the history of health care is essentially the history of men’s health care, as if what works for male patients probably works in women, too – even when that implication is quite wrong. See also: Modern Medicine is Male-Centric, and That’s a Problem for Women
And we also know from the shocking results of the American Heart Association’s latest national survey on women’s awareness of heart disease that awareness is actually significantly lower than survey results from TEN YEARS EARLIER! Over half of the women surveyed, for example, could not name chest pain as a cardiac symptom. The American Heart Association itself described their own disturbing survey results at the time as a “lost decade” in addressing women’s awareness of heart health.
And what current physicians know about women’s heart disease began back when they were in medical school.
But the CWHHC cites a 2011 survey of 44 North American medical schools which found that 70 per cent of those schools at that time had NO formal sex- and/or gender-based curriculum outside of reproductive or breast health (the so-called “bikini areas” of medical research). A more recent 2021 report on medical schools still “points to an ongoing scarcity of women’s health content in medical school curricula.” (1)
Despite the fact that 9 of every 10 women in mid-heart attack report documented chest pain, and even when women recognize and articulate their own symptoms as heart-related (as I did – loud and clear – to the Emergency physician who confidently misdiagnosed my heart attack as acid reflux before sending me home), we are significantly more likely than men to be dismissed by medical professionals, resulting in delayed diagnosis – which not surprisingly can play a role in the poorer outcomes experienced by women with acute coronary syndrome – particularly among younger women.
Now here’s the good news among those bleak stats and journal papers: somebody is actually putting all that academic knowledge into a practical, useful resource to teach medical students.
Recognizing that medical schools must incorporate current information throughout an integrated curriculum, the Training and Education Working Group of the CWHHA undertook the planning, development, and dissemination of nine educational modules called the Canadian Women’s Heart Health Education Course.
These teaching modules target both trainees and healthcare professionals within the specialties of cardiology, general internal medicine, and emergency medicine.
Users can also access each module on women’s heart health for individual learning or staff education. Academic faculty members can download the tools (including PowerPoint slides, speaking notes, and resource listings) to present at their institutions – all available at www.cwhha.ca.
See also: “Incorporating a Women’s Cardiovascular Health Curriculum Into Medical Education” published in the Canadian Journal of Cardiology.
Since my 2008 heart attack, I’ve spent much of my time thinking, speaking, writing and worrying about women’s cardiovascular disease. After coming home from my Mayo training, I started doing free presentations to small groups of women in living rooms – starting with my very first “Pinot & Prevention” Friday evening potluck (like this red-clad bunch of 19 who gathered at my friend Kit’s home to hear what I’d just learned about women’s heart health at the Mayo Women’s Heart Clinic). As the years went by, my audiences grew bigger, outgrowing living rooms for new venues like my annual sold-out Saturday morning “Cardiac Café” brunch talks at the University of Victoria, and then medical conference presentations, and then my COVID-triggered Zoom presentations.
But all along, what I really wanted was to reach medical students – because they’ll be the physicians of our own future. What they learn today about women’s unique cardiac risk factors and other heart issues will guide how they practice tomorrow. And those nine educational modules can help make every one of them a better doctor.
1. Anderson N.N., Gagliardi A.R. “Medical student exposure to women’s health concepts and practices: a content analysis of curriculum at Canadian medical schools.” BMC Medical Education. 2021; 21: 435
Light bulb image: Sakulich, Pixabay
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Q: Can medical students be the key to a brighter future for female heart patients?
♥
NOTE FROM CAROLYN: I wrote much more about raising awareness of women’s unique cardiac issues in my book, “A Woman’s Guide to Living with Heart Disease”. You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 30% off the list price).
Heart Sisters 
I have read your blog carefully. You have given good information about Heart Disease.
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Thanks Celeste!
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Loved your post. Thanks for sharing. The future of health care and particularly the future of women’s heart health care is in the hands of our current medical AND nursing students coming up. Burnout is real for those of us who have spent decades in the trenches, to battle the disrespect and threats of science-deniers for years, the ones who come to us for urgent help but attack us as if THEY are the trained experts. Insurance-based medical care, in hospitals bought out by wealthy hedge fund firms is not working for patients or staff in the US of A.
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Thank you RN in NYC for sharing your astute but distressing perspective. I wish the status quo you describe could be addressed starting with working conditions for the healthcare professionals we count on. Hang in there! Take care. . . ❤️
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Nice article! Very informative content. Thanks for sharing!
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Hi Carolyn,
I really enjoyed this article and I’m noticing some major changes to my medical records and the reasoning behind it.
I have been classified as a critical care cardiac patient since my heart attack in 2010. It left me with 8 cardiovascular problems. I suffered an AMI/ STEMI widowmaker with massive irreversible progressive damage. I was one and still am one of those people who suffered a true silent heart attack.
I’ve watched what my cardiologist calls a major cardiac issue and until I can be cleared that I’m having no cardiac issues, a visit to the ER causes a 48 to 72 hour stay in cardiac observation. I was looking at this as a statement about my heart and not a conditions.
It is one that if properly diagnosed appears in women and not men. The condition is called, “Coronary artery disease involving native coronary artery of native heart without angina pectoris.”
In short: no chest pains. It was at the bottom of my list of heart issues and it is now at the very top. They have found that it is a major problem that I am not aware of because I’ve never had chest pains.
Robin
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Hello Robin – It must be surreal to realize that you can indeed have a major cardiac problem – yet NO chest pain! The first study I read about re this type of silent ischemia (SI) was done by Norwegian researchers back in 1988, ironically concluding that “SI is frequently observed in apparently healthy middle-aged and old men, and increases the risk of future coronary heart disease considerably” – ironic because ALL of the over 2,000+ people studied in Norway were MEN!
Back then, recruiting no women in your cardiac research was unfortunately common! The results of newer studies differ, but the American Heart Association suggests that silent heart attacks may, as you say, actually be more common in women than in men. Some researchers have reported that both women and their physicians may also be more likely to chalk up symptoms of a silent heart attack to stress or anxiety – and to dismiss them.
Good luck . . . ❤️
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Glad you’re feeling better . . . missed your column last week.
— another heart sister and “fellow” champion
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Thank you for your kind words. I am SO much better this week, after a very brutal 3-4 weeks feeling so miserable!
Take care. . . ❤️
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BRAVA Carolyn!
You are an amazing woman and advocate for those of us without a voice in this critical “theatre”. Your audiences are standing together in a standing ovation for a job incredibly well done.
Again…BRAVA! 👏👏👏
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Thank you Jackie for that standing ovation – what a lovely comment! ❤️❤️❤️
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I’m so curious! How did that talk to the NY med students go? What did you say? How did they react? What questions did they ask? I’d love to read a blog about it.
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Hello Deborah – such good questions! I had an hour to speak to the med students. I covered most of the same content I cover in my ‘Heart-Smart Women’ talks (e.g. briefly went over my own misdiagnosed heart attack experience, then immediately the scary stats about women being 7 times more likely to be misdiagnosed compared to men presenting with the same symptoms, etc etc) and the gender bias throughout the history of women’s health care, etc etc, and of course some of my favourite studies (e.g. the U.S. ambulance study that reported ambulance drivers are significantly less likely to turn on flashing lights & sirens when a female with cardiac symptoms is being transported from home to hospital, etc etc. You just can’t make this stuff up!
There were so many shocking facts that they too found shocking! It was a very interactive class, LOTS of questions e.g. why are women so under-represented in cardiac clinical trials? Typical vs women’s ATYPICAL cardiac symptoms? I was told afterwards that some students were crying by the end of my talk.
These were young sharp adults who were already VERY aware of the gender gap in medicine, the field they were about to join. The interesting thing about this guest lecture was that it was entirely organized by one female med student who happens to be a regular reader of my blog. She had contacted me directly to ask if would agree to do a Zoom presentation to her classmates on women’s heart disease. We talked a few times via Zoom ahead of time about possible dates that might work for me and her class, and the content she thought would be most useful for her classmates, etc. Everything was finally scheduled – the only thing left to do was to clear the date and time with her professor – who then refused!
Apparently it was highly irregular for a student to take an initiative like this. So then she told me that the prof wanted to schedule a phone call with me first to check me out (because he’d never heard of me, and understandably this was after all HIS class!) We had quite a long chat, it was like applying for a job. I had to convince him that I was in fact capable of talking to all kinds of audiences (including at medical conferences filled with real live physicians) and that everything I say is backed up by credible academic research etc etc) and by the Mayo Clinic faculty who had taught us at the WomenHeart Science & Leadership training. I suspect it also helped that my book was published by Johns Hopkins University Press (the oldest academic publisher in North America!) I think he was reluctant about this talk right up until the Day Of when I started speaking. At the end, he was very gracious and thanked me for speaking to his students. Whew! ❤️
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