Women and Cardiovascular Disease: Addressing Disparities in Care

Over the last 6 years, I have developed an educational symposium for healthcare providers to address women and cardiovascular disease, particularly prevention of sudden cardiac death. This symposium has been well received and I have produced it all over the country. The focus of the event has been to specifically address disparities in care–men are much more likely to receive more advanced, more aggressive and more cutting edge therapy than women in identical circumstances. Many hypotheses have been put forward to explain and address these disparities. Some include access to care, patient concerns and education about CV disease, social stereotypes and patient denial of symptoms or risk. During the development of the symposium, I realized that many women in the US today regularly see OB/GYN physicians as their only healthcare provider. OB/GYN physicians are not always well equipped to provide comprehensive primary care and may have little time to devote to screening for cardiovascular disease–these are highly trained women’s health experts. Most women who see an OB/GYN are more concerned with dying of breast, uterine or ovarian cancer than with CV disease or sudden cardiac death. WIth the OB/GYN, I saw an opportunity to really impact disparity in care. I began to target OB/GYN physicians and developed a quick and easy office screening tool that can be used to pre screen patients for CV disease. A simple waiting room questionnaire is filled out by the patient and handed to the nurse at intake. This questionnaire would then prompt a busy OB/GYN provider to more aggressively screen at risk women. I also produced educational events specifically for OB/GYN physicians and invited cardiologists to attend in the hopes of facilitating interactions between very dichotomous specialties. In some cases this worked well and OB/GYNs and cardiologists began to develop referral relationships following the event.

However, gender disparities in care continue to exist. Despite my best efforts (and the efforts of countless others) over the last 6 years, women with cardiovascular disease continue to be undertreated and underserved. Although we are making significant progress there is still much work to be done. A review article published in July 2012 in Women’s Health by McSweeny et al examined disparities in congestive heart failure (CHF) and other CV diseases in women. In this review, the authors identify reasons why outcomes in women with CHF are poorer as compared to men. Lack of aggressive treatment of the underlying causes of CHF such as coronary artery disease as well as a lack of adherence to medical therapy, late presentation and multiple comorbidities are identified as significant contributors to these poor outcomes. A complete lack of social support is also labelled as a major factor in the outcome of women with CHF.

In 2012, the Minnesota Women’s Heart Summit was held to address issues surrounding disparities in care. Four major points of emphasis were identified:
1. Community Awareness and Prevention. Women’s knowledge of risk of CV disease is improving but is still inadequate. Local events to raise awareness among the general public is an important part of reducing CV deaths in women. We must engage clinicians, healthcare consumers as well as government policy-makers in order to make a difference
2. Symptom recognition and delays in seeking treatment. Often women present atypically with CV disease and we must work to educate women. Public service informational campaigns are needed to promote symptom recognition in women as well as the importance of seeking timely treatment. A parallel campaign to educate primary care physicians and ER providers about the atypical nature of symptoms in women with a focus on avoiding therapy delays should be conducted.
3. Closing the Survival Gap. Women are less likely to receive evidence based therapies such as beta blockers and ACE inhibitors that have been proven to decrease mortality. Women are less likely to have coronary artery bypass surgery, cardiac catheterizations and revascularization. Goal should be to impact this fact through advocacy, better training of physicians and inclusion of more women in research and clinical trials.
4. Patient-Provider Connections. Physicians must strive to develop better relationships and have better communication with patients. Often depression, socioeconomic status and other issues become barriers to care. By seeing the whole patient and addressing some of these issues, a physician may be able to better partner with female patients and improve care.

Disparities in care for women continue to exist. It is a significant public health problem today. More women than men die from cardiovascular disease each year. Although many have worked very hard to reduce these disparities, there is much work yet to be done. We must continue to communicate, advocate and educate in order to improve outcomes in the future.

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

  1. Kevin. Great article. I’m a bit technology challenged and can’t figure out how to copy the URL from facebook. Can you email the link so that I can share with our team working on the Disparities in Care initiative? Thx. Jacy

  2. Hallelujah! As a heart attack survivor who was misdiagnosed and sent home from the ER in mid-MI despite textbook “Hollywood Heart Attack” symptoms (crushing chest pain, nausea, sweating, pain radiating down my left arm), I have to say how refreshing it is to read such a comprehensive overview from a real-live cardiologist!

    My ER doc that day pronounced happily: “You’re in the right demographic for GERD!” My misdiagnosis, as I later learned while attending the ‘WomenHeart Science & Leadership Symposium for Women With Heart Disease’ at Mayo Clinic, is not unique. As the NEJM reported back in 2000, women < age 55 are seven times more likely to be misdiagnosed and sent home from the ER compared to our male counterparts! Why aren't we seeing more progress 12 years down the road?

    But even to get misdiagnosed or under-treated in the first place, we have to show up and seek help – which as you know, women are notoriously reluctant to do. That's why I encourage all heart patients to participate in the Yale Heart Study which is investigating treatment-seeking delay behaviours that are contributing to deadly outcomes. https://heartstudy.yale.edu/hacs/

    Meanwhile, your pro-active efforts to help spread the word among your colleagues is fantastic. Thanks so much for this.

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