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Tailoring Cardiac Care for Women

Joe Cantlupe, for HealthLeaders Media, December 13, 2013
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Success key No. 1: Specialized centers

Cardiac care centers for women often target subspecialties of need. For instance, Allegheny General Hospital is putting a concentrated effort on pulmonary hypertension and follow-up care for patients. The 664-bed Rush University Medical Center's Rush Heart Center for Women in Chicago is examining atrial fibrillation and its impact on women.

While these centers have a different focus, they incorporate a multidisciplinary team to ensure a coordinated framework with primary care and other specialists.

At Rush Medical Center, the multi-disciplinary teams include psychologists because many women who have had heart attacks experience stress and anxiety as they fear having another cardiac episode, says Annabelle Volgman, MD, FACC, medical director of the Rush Heart Center for Women. The center includes mostly women cardiologists and nutritionists in its programs. Female patients often feel more comfortable with physicians of the same sex, although not exclusively, Volgman says. One reason is that for too long, women were not treated in care as aggressively as men, she says.

Rush Heart Center's conce tration on atrial fibrillation issues reflects increasing concerns among women about the most common type of arrhythmia, an abnormal heart rhythm. An estimated 2.6 million people had atrial fibrillation in 2010, and about 12 million may have the condition by 2050.

Volgman says the Rush Heart Center is exploring not only a host of therapeutic procedures to prevent atrial fibrillation but also ways to ensure safe management of the disease once it is diagnosed.

Among the therapies being used: adding blood thinners for women, sometimes as often as men receive them, and consistently monitoring anticoagulation therapy to avoid excessive bleeding, Volgman explains. Prescribing a blood thinner also has been effective in stroke care, she says. The hospital determined that while older women were twice as likely to receive aspirin as the blood thinner warfarin in treatment, warfarin reduced stroke risk by 84% in women and 60% in men, she adds. They adjusted treatment accordingly.

Those continued evaluations of medications are important as the heart center assesses women's cardiac care, Volgman says.

Today, Volgman reports seeing more female cardiac patients coming through the hospital's doors. "A decade ago, I was only seeing patients one half day a week, and now I have to limit my time to see patients to three full days a week," Volgman says of her clinical practice. "I also now have two other female cardiologists helping to see women patients interested in being seen in the center."

In Pittsburgh, Allegheny General Hospital is focusing on a different aspect of women's cardiac care: pulmonary hypertension, or high blood pressure in the arteries that affect the lungs or the right side of the heart. The condition can be easily missed in women, who may not understand why they have shortness of breath, says Poornima, director of the women's heart center.

Pulmonary hypertension "specifically impacts more women than men and can present itself quite differently," Poornima says. "Sometimes, it is not diagnosed until it becomes quite severe. You definitely need a full spectrum of experts to treat and monitor the condition."

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