Matters Of The Heart Women Need A Different Approach To Cardiac Care
The numbers are sobering.It is estimated that 8 million American women live with heart disease — 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of those in the 45-to-64 age range, and 25{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of those 65 and over. Nearly 13{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of women age 45 and over have had a heart attack, and 435,000 will have one this year.
Heart disease, in fact, is the leading cause of death in American women, killing 32{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of them. And heart attacks themselves kill six times as many women as breast cancer.
This is a significant risk for women that they tend to downplay for lots of reasons,” said Bobbie Orsi, an RN and director of the Accent on Health education program at Berkshire Medical Center. “Breast cancer is associated with pain and wasting and dependency — fearful experiences for sure — but more women die from heart disease than all the cancers combined, not just breast cancer.”
While their risk factors and typical time frames for heart disease are different from men, in many ways heart disease is a greater scourge for women. However, women’s heart conditions haven’t always received the same attention as men’s — and the medical community may be coming around to some of the reasons why.
“Women with heart disease, when compared to men, have a harder time committing to exercise, rehabilitation, and education programs,” said Dr. Reed Shnider, director of Preventive Cardiology and Wellness at Baystate Medical Center. “Women are under-represented in cardiac rehab — they tend to drop out.”
Another obstacle is a social one, Shnider added. Married women and men have no problem caring for each other during an acute cardiac period, but when it comes time for rehabilitation, women are often expected to dive headlong into their former caregiving roles. “Men have a harder time letting women take care of themselves than vice versa,” he said.
Because of less-accurate screening tools for women, leading to greater acuity of heart disease when it does present, means women should be taking care of themselves even more carefully than men with similar conditions do, but that’s often not the case, Shnider told The Healthcare News. But doctors are aware of the discrepancy, and they’re trying to close the gap.
Dark Picture
The results of a national study of female heart-disease patients seem to bear out the perception of women not receiving adequate resources for heart-disease recovery.
According to the survey, published in Women’s Health Issues and funded by WomenHeart, a national patient-advocacy organization for women with heart disease, 52{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of women are dissatisfied with some aspect of their health care, and most report difficulty making necessary lifestyle changes due to inadequate information and social supports, or lack of insurance coverage for nutrition-counseling and weight-management services.
In addition, many women in the survey describe feeling socially isolated or not having social support systems, and that no one understands what they are experiencing. In addition, 57{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} report clinical depression or anxiety as a result of their heart disease, and 27{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} said their relationships with their families had deteriorated following their cardiac diagnosis, often because they could not adequately perform their responsibilities at home — but were expected to anyway.
“This survey is a wake-up call for health care professionals who need to understand how much their attitudes and communication styles influence their female patients’ willingness to ask questions, participate in medical decisions, and adhere to recommended treatment and lifestyle modification,” said Dr. Sharonne N. Hayes of Mayo Clinic, who co-authored the study. “It also underscores the need to recognize and treat the anxiety and depression that so often accompany heart disease in women.”
Part of the problem in treating heart disease in women, Shnider said, is that, while men typically manifest heart problems in their 40s, women often don’t show symptoms until their 50s. Furthermore, common screening methods aren’t as accurate in women, and their symptoms, when they do arise, are often so different from the norm in men that they’re shrugged off.
“They have more unusual symptoms,” Shnider said. “A man might have crushing pain radiating down his left arm, but women might experience ear pain, jaw pain, back pain, or stomach pain. These symptoms are not classically felt to be related to the heart, and, as a result, they can simmer for a longer period of time before they’re diagnosed. So, when women present, they tend to be further into the course of their illness.
“I encounter many women whose symptoms are minimized by their spouses and even their own physicians,” he continued. “As a result, they begin to doubt their own symptoms.”
“Women are often the primary caregivers, and they don’t always pay attention to their own symptoms and act on them as quickly,” Orsi agreed.
All this leads to a big problem: when women are diagnosed with heart trouble, the disease is often more advanced than it typically is upon first diagnosis in men.
Again, the statistics bear this out. For example, 38{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of women, vs. 25{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of men, will die within one year of a first recognized heart attack. And 35{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of female heart attack survivors, vs. 18{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of men, will have another heart attack within six years. Meanwhile, 46{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of those survivors, vs. 22{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of men, will be disabled with heart failure within six years. Finally, women are almost twice as likely as men to die after bypass surgery.
The WomenHeart survey revealed that only 35{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the female patients initially recognized their symptoms as heart-related, and 45{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} felt their heart disease ‘came out of the blue.’
“These are very disturbing results,” said Nancy Loving, WomenHeart’s executive director and a heart attack survivor herself. “Women need to realize heart disease is their number-one killer and seek out health care professionals who are well-versed in women’s cardiac risks and symptoms, as well as which diagnostic tests and treatments work best in women.”
Breaking ThroughConsidering the unique cardiovascular risks women face, physicians and other health professionals are increasingly turning to targeted programs to better educate, treat, and support women with heart problems.
For instance, Shnider said, Baystate offers the Women’s Healthy Heart Program, which provides a practical framework of specific actions women can initiate to decrease their odds of developing heart disease. The hospital also offers a more intense cardiac program called Change of Heart, in which both men and women meet once each week for four and a half hours over the course of one year.
Orsi has organized educational efforts in the Berkshires, such as a partnership with the American Heart Association called Tell Your Story, in which heart-attack survivors speak to a radio audience about their own experiences; and a community-outreach program to educate African-American women, whose cardiovascular risks are even higher than the average woman’s.
Orsi has also helped launch her hospital’s Scorekeeper program, in which nurses meet with patients one-on-one and discuss the modifiable risks to their heart health. The goal is to make five lifestyle changes: eat five servings of fruits and vegetables each day, walk 30 minutes most days, stop smoking and reduce exposure to secondhand smoke, maintain an ideal weight, and know one’s health numbers.
Universal screenings are also valuable, even from a very young age, Shnider said — not screenings for heart disease, but for the risk factors that lead to cardiovascular problems later in life, such as obesity, high cholesterol, and high blood pressure. Meanwhile, general stress tests with pictures or nuclear isotope stress tests are two ways to get around other tests that have proven more effective in men than in women.
The more aware women are of what their own risk factors are, he said, the more likely they are to catch problems in time. And that’s crucial, considering that women also fare more poorly in heart surgery than men, due partly to their smaller coronary arteries, and tend to have more difficult recoveries.
Catching women’s heart problems more aggressively has actually led to some changes in the perception of cardiovascular disease, Shnider said.
“Young women aren’t supposed to have heart disease, but we’re finding more and more of them,” he said. “Women coming to the hospital with heart attacks at age 45, that used to raise eyebrows, but not anymore.”
And that’s all the more reason to continue improving not only the screenings and treatments available to women, but also their support systems. After all, good intentions never stopped a heart attack.
