Women and Cardiovascular Disease: Disparities in Care

Women and Cardiovascular Disease: Disparities In Care

Sudden Cardiac Death and cardiovascular disease is the number one killer of women in the US second only to ALL cancers COMBINED.  The prevalence of coronary artery disease in women is similar to that in age-matched cohorts of men– yet women tend to be under-served and under-treated.  When we look at specific interventions such as Percutaneous Coronary Interventions (PCI or coronary stenting) and Implantation of Implantable Cardioverter-Defibrillators (ICDs), and advanced devices for Congestive Heart Failure, we find that men tend to have more access to advanced therapies and are undergoing procedures at two to three times the rate of women.

Why is this?  Let me offer my two cents:

Typically, married women and women with children in the US today strive to ensure that all other family members are cared for BEFORE considering their own needs.  Women often minimize their own symptoms and risks in order to better care for their families.  Often, women who work outside the home are very busy and try to perform well at work as well as at home as “Mom”.  Diet, exercise and other modifiable risk factors for cardiovascular disease go unidentified or are just plain ignored.  Time is at a premium and exercise, cooking healthy meals and preventative care doctor visits are often left off the “to-do” list.

Symptoms in Women with undiagnosed cardiovascular disease are often vague and easily dismissed.  Women with CV disease may present differently than men.  Rather than chest pain, shortness of breath and nausea, women may present with anxiety, feelings of dread and other vague, non-specific symptoms.  This can make diagnosis difficult.  Health care providers must be aware of an individual woman’s risk factors for CV disease and interpret the patient’s atypical symptoms within this context.  Often, women over the age of 55 see only OB/GYN physicians for their care and do not have a relationship with an Internist or Family Doctor who may be more equipped to deal with such issues.

So, this is a big issue but what can we do about it?

First, we must all work to empower women to take control of their own CV health.  Whether you are a health care provider, family member, spouse or co-worker, we must educate women about their risk for CV disease and how they can work to modify their own risk.  We must re-double our efforts to actively screen at-risk female patients and remain “tuned-in” to atypical presentations of CV disease.  As a cardiologist, I have partnered with OB/GYN providers and have worked to provide them with the tools they need to efficiently screen and assess risk in their patients during an office visit.   By working with OB/GYN physicians, we are able to identify women with disease who might otherwise go un-noticed and untreated.  As a society, we must continue with education, advocacy efforts and research such as those sponsored by the AHA Go Red For Women campaign next month.  Make sure to wear RED next Friday February 3rd to support the cause!

2 responses to “Women and Cardiovascular Disease: Disparities in Care

  1. Thanks so much Dr. C for this terrific overview. But there’s another category unmentioned here alongside women’s reluctance to seek immediate help and their vague cardiac symptoms.

    Before being finally hospitalized for an MI, I had earlier presented with textbook “Hollywood Heart Attack” symptoms to Emergency (central chest pain, nausea, sweating and pain down my left arm) yet I was sent home – feeling supremely embarrassed for having made a fuss over nothing – with a GERD misdiagnosis and “normal” test results.

    Male patients presenting with identical symptoms are kept in hospital for observation as treatment protocols require – but women are sent home with misdiagnoses ranging from indigestion to anxiety to menopause (a handy all-purpose Dx). Diagnostics that work pretty well in identifying heart disease in men can be far less accurate for women (consider the treadmill stress test, for example). Research (Pope et al, NEJM, 2000) has found that women heart patients are in fact up to seven times more likely to be misdiagnosed and sent home from the E.R. compared to our male counterparts – and that includes women like me with symptoms clearly screaming out ‘heart attack’, not just those with “vague and easily dismissed” signs. My first ER doc had no trouble easily dismissing mine.

    There’s a systemic and pervasive problem within medicine itself that helps to contribute to women being “under-served and under-treated”. As the American Heart Association found when it surveyed physicians in 2005, just 8% of all family practitioners were aware that more women than men die from heart disease annually (a stat that, as you know, has been true since 1984). But the truly shocking survey result was among cardiologists – only 17% of whom were aware of that statistic. SEVENTEEN PER CENT! This is their business. This is all they do.

    If your medical colleagues themselves continue to think of heart disease as a man’s problem, then all women will continue to be in peril.

    • Thanks so much for your comment on my blog. You are ABSOLUTELY correct and I agree with your summation. Women are undertreated and underserved and the medical system needs to spend more time addressing women’s healthcare needs.

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