A few months ago, while researching an article about women's cardiac care for this month's issue of HealthLeaders Media magazine, I kept hearing female physicians telling me that male doctors don't always pick up the fact that their female patients may have a cardiac issue because often no pain is reported.
Certainly, we're not talking about a majority of physicians, but there are still some out there who treat women differently in cardiac care, and not in a good way. There is not only a great need for women patients to learn more about heart issues, and the differences with men in that regard, as well as some physicians themselves.
Cardiac disease is a top killer of women, but too often patients don't know how important their symptoms are, and aren't conveying them properly to doctors. While chest pain, for instance, may be a telling sign of a heart problem for men, the symptoms for women may be more subtle, such as jaw pain or simply feeling sluggish.
If we are going to learn more and be more instructive about women's heart health, there need to be more clinical trials in the pipeline for women. As of now, there are still too few women enrolled in cardiovascular-related clinical trials.
Physicians, many of them female, are prodding hospitals to do a better job in improving cardiac outcomes for women, through education programs, as well as reaching out to their colleagues to recognize the potential warning signs or symptoms of heart disease in women versus men. The lack of awareness often results in less aggressive treatment by healthcare providers for women and that has to change.
"Most women who died from heart attacks never had chest pains in the manner in which men often report chest pains prior to a heart attack," says C. Jennifer Dankle, DO, the vascular specialist who supervises the University of Minnesota Physicians Heart at Fairview Southdale Hospital's women's clinic in Edina, MN. "The idea is to raise awareness among hospital staff as well as patients themselves that the presentations for a possible heart condition is different for men and women.
A 2006 survey conducted by the American Heart Association found that 43% of women are unaware that heart disease is the leading cause of death among women. Among primary care physicians, only 8% knew that more women than men die each year from cardiovascular disease, according to the AHA.
There are other disparities. Although women of color and of low socioeconomic status are disproportionately affected by heart disease, according to the AHA, only 31% of black women and 29% of Hispanic women knew that heart disease was their greatest health risk, compared to 68% of white women.
Recently, Dankle tells me she has been working more to get the word out to providers and patients alike about women's cardiac issues. In February, Fairview Southdale Hospital hosted its "first annual" Women's Cardiology Care Conference – Matters of the Heart," which Dankle says was "very well attended and received by community providers"
"We continue to host several patient educational events to reach out to the community and increase awareness of heart disease in women," she says. "I am starting a women's support group for perimenopausal women who suffer a heart attack or are diagnosed with heart disease."
Such programs are important because "this particular group of women has been shown to have the lowest rate of followup care – cardiac rehab – which has proven effectiveness in reducing the recurrence rate of cardiovascular disease," Dankle says.
"I believe part of the reason for this is lack of support" Dankle said the other day. "I have so many young women that have suffered heart disease, tell me they felt 'out of place' at cardiac rehab because they were the youngest attending. I want these women to understand they are not alone."
One of the problems in healthcare is the relatively small number of women included in clinical trials about cardiac disease, which would increase understanding of cardiac care for women.
Rebecca Ortega, director of Women In Innovations, a Washington DC-based program launched by the Society for Cardiovascular Angiography and Interventions to educate interventional cardiology community about heart disease in women, says women account for only 30% of patients enrolled in most cardiovascular disease trials. That percentage should be about 40%, she says.
A WIN study also cites data that shows differential treatment between men and women. For instance, when showing heart attack symptoms, women are often less likely than men to have an electrocardiogram done within 10 minutes, to be cared for by a cardiologist during their inpatient admission, or to be given heparin or another medication, according to WIN.
"We don't have a lot of data with men vs. women when it comes to these various cardiovascular issues," Ortega says. There are complications to be overcome in the clinical trial process, she says. For instance, when women exhibit pain related to heart conditions in their jaws or exhibit fatigue, "by then their (heart) condition may be further along and they will not be eligible for enrollment" in a clinical trial, Ortega says. In addition, some women may be more reluctant to be enrolled in clinical trials than men, Ortega says. "From where I'm sitting, it's a multipronged problem and there's no one solution."
One of the ways to improve care has been through legislation, says Dankle.
Senators Debbie Stabenow, D-MI, and Lisa Murkowski, R-AK, have reintroduced a measure that would, among other things, require the Department of Health and Human Services to submit an annual report to Congress on the quality and access of care for women with cardiovascular disease.
That, says Dankle, is a beginning toward resolving the inequities of cardiovascular care for women. Still, there is a long way to go.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
