Are we doing enough for women with cardiovascular disease? Better education could be the answer 

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Are we doing enough for women with cardiovascular disease? Better education could be the answer

By Niamh Mangan, Executive Vice President, Managing Director, dna, part of The Weber Shandwick Collective

 

Heart disease remains the biggest killer of women – and thousands of lives would be saved if women received the same standard of care as men 

Reflecting on World Heart Day yesterday gave me an opportunity to think about the progress that has been made in the care of cardiovascular disease (CVD). Yet, despite all the advances, one significant challenge remains: the disparity in care between women and men, resulting in a lack of diagnosis, late diagnosis, misdiagnosis and undertreatment of women compared to men. British Heart Foundation-funded research suggested that between 2002 and 2013, 8,243 women’s lives were needlessly lost in England and Wales because they did not receive the same standard of care as men (1). CVD remains the biggest killer of women, globally, and there are a few factors contributing to this …

 

Is public awareness and education doing enough?

Campaigns such as ‘Go Red for Women’, an initiative by the American Heart Association (AHA) launched in 2004, look to address general public understanding of the cardiovascular (CV) risk in women, often by highlighting risk factors and symptoms that could be related to CVD, or spotlighting the impact menstruation, pregnancy and menopause can have on CV health in women. For a long time, CVD has been seen as a ‘male disease’ due to the higher absolute risk compared with women. This is despite the relative risk in women of CVD morbidity and mortality being higher (2). In spite of efforts like these, a survey by the AHA showed that women’s awareness of CVD as the leading cause of death in women had declined from 65% in 2009 to 44% in 2019, with the lowest levels of awareness seen in women aged 25-34 years (3).

 

Gathering more data specific to women and heart health would help improve our knowledge and communications

An ongoing issue that has been identified is the need for greater involvement of women in trials: a 2020 review of CV trials from 2010 to 2017 shockingly found women made up only 38.2% of participants in studies of coronary artery disease (4). While that figure is improving, there is still an opportunity to make meaningful change and balance this representation so that we can gain a better understanding of the CV outcomes associated with different interventions in women.

In addition, a more expansive analysis of existing data might also build a fuller picture of the specific impact of CVD on women and help identify measures to improve its diagnosis and management.

 

General practitioners and even cardiologists do not feel confident in assessing heart health in women

The Women’s Heart Alliance published results from a US survey that showed only 22% of primary care providers and 42% of cardiologists felt extremely well prepared to assess CVD risk in women (5). In many medical schools, women’s CV health is currently an optional component, with many healthcare professionals (HCPs) choosing not to attend (6).

 

There are female-specific challenges in heart health that we need to be better aware of

A topic that deserves additional education is symptom identification, as women can present with different symptoms than men. Women are more likely to report nausea, fatigue and breathlessness – symptoms that are currently referred to as ‘atypical’ but some might suggest are simply ‘understudied’.  There is also a need to increase the awareness of three types of heart attacks that women experience more than men – myocardial infarction with nonobstructive arteries (MINOCA), spontaneous coronary artery dissection (SCAD) and stress cardiomyopathy (broken heart syndrome) (7).

In addition to differing symptoms, there are female-specific risk factors. Pregnancy puts unique stress on the heart and circulation, to the extent that cardiologists have described pregnancy as a heart and circulatory ‘stress test’. The combination of metabolic, hormonal and inflammatory factors in polycystic ovary syndrome (PCOS) also increase CV risk. There is also an increased risk of CVD for women post-menopause due to reduced oestrogen levels (1).

 

Possible solutions include involving women with lived experience of heart disease in updates to training and guideline

The recent report published by the Global Heart Hub following their roundtable on late, missed and misdiagnosed heart disease in women has suggested some robust solutions to the challenge of inadequate education in this space. Suggestions include involving women with lived experience in the design of medical education curricula and CVD clinical guidelines; inclusion of specialist educational modules on improving detection and diagnosis of CVD in women as part of core medical training; and implementing a training programme designed to raise awareness of gender biases, fostering a culture of sensitivity of women’s health issues (6).

Neil Johnson, Executive Director, Global Heart Hub, adds: ‘Involving women with lived experience of CVD in the development of medical education for HCPs could transform the way that programmes are taught and received, fostering a more inclusive pathway to diagnosis and treatment of women with this condition’.

If all stakeholders from industry, patient organisations and HCPs work together, we can address these fundamental gaps in knowledge, awareness and education, and close the disparity in care between women and men in CVD.

 

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For discussions around, or support with, impactful education, speak to dna Communications, our specialist medical communications team.

 

References

  1. British Heart Foundation. Bias and Biology: How the gender gap in heart disease is costing women’s lives. [Report], 2019. https://www.bhf.org.uk/-/media/files/heart-matters/bias-and-biology-briefing.pdf. Accessed 24 September 2024.
  2. Möller-Leimkühler AM. Gender differences in cardiovascular disease and comorbid depression. Dialogues Clin Neurosci. 2007;9(1):71-83. DOI: 10.31887/DCNS.2007.9.1/ammoeller.
  3. Beussink-Nelson L, Baldridge AS, Hibler E, et al. Knowledge and perception of cardiovascular disease risk in women of reproductive age. Am J Prev Cardiol. 2022;11:100364. DOI: 10.1016/j.ajpc.2022.100364.
  4. Jin X, Chandramouli C, Allocc B, et al. Women’s participation in cardiovascular clinical trials from 2010 to 2017. Circulation. 2020;141:540-548. DOI: 10.1161/CIRCULATIONAHA.119.04359.
  5. Nanette KW, Lloyd-Jones DM, Elkind MSV, et al. Call to action for cardiovascular disease in women: Epidemiology, awareness, access, and delivery of equitable health care: A presidential advisory from the American Heart Association. Circulation. 2022;145:e1059-e1071. DOI: 10.1161/CIR.0000000000001071.
  6. Global Heart Hub. Global Heart Hub International Roundtable Discussion on Late, Missed and Misdiagnosis of Heart Disease in Women. [Report], 2024. https://globalhearthub.org/women-and-heart-report/. Accessed 24 September 2024.
  7. Corliss J. The heart disease gender gap. Harvard Health Publishing. [Online] Harvard Medical School, 1 September 2022. https://www.health.harvard.edu/heart-health/the-heart-disease-gender-gap. Accessed 24 September 2024.