Women remain underserved in cardiovascular disease treatment despite advances

Women in the UK, and elsewhere, are still missing out on vital treatment for their No. 1 killer-;cardiovascular disease-;despite significant progress in the medical management of heart disease and stroke, concludes a consensus statement published online in the journal Heart.

They continue to be underdiagnosed, undertreated, and underrepresented in clinical trials in all areas of cardiovascular disease, says the statement. Among other things, it calls for dedicated women’s heart champions and heart hubs, plus a women’s health strategy, to stop the needless death toll from what is essentially, preventable disease.

The consensus statement was drawn up by representatives from UK cardiovascular, nursing, and patient bodies affiliated with the British Cardiovascular Society, with the aim of addressing unmet needs, ensuring parity of care, and improving the health outcomes of women with cardiovascular disease in the UK, and worldwide.

Conventional cardiovascular disease risk factors, such as high blood pressure and high cholesterol, are often not treated as promptly or as appropriately as they are in men, despite accounting for around half of all preventable cardiovascular disease deaths, says the statement.

And women face particular cultural, societal, and financial issues, which magnify their heart disease risks, as well as enduring the influence of hormones, pregnancy, and the menopause, across their lifespan, notes the Statement.

And their biology, physiology, and body shape not only affect their risks of cardiovascular disease, but also the effectiveness of diagnostic procedures and treatment, it adds.

Healthcare professionals and the public mistakenly believe that women’s risk of cardiovascular disease is lower than men’s, says the statement. “Myths and unconscious biases within clinical practices and societal perceptions further obscure the reality that heart disease does not discriminate by sex,” it says.

And all too often women’s voices are unheard and their heart symptoms aren’t taken seriously enough, it adds.

The statement sets out a series of actions for clinicians and their professional bodies in each of the major cardiovascular disease areas of: coronary artery disease; valvular disease; heart failure; inherited heart disease; congenital heart defects; and heart rhythm disorders.

These include:

• Raising awareness of traditional and women-specific risk factors for all types of cardiovascular disease
• Ensuring that women are included in cardiovascular disease research
• Making sure that the public and clinicians know that coronary artery disease is the leading cause of death for women
• Ensuring equitable access to specialist cardiac care, genetic testing, and family screening for women with inherited heart disease
• Addressing the under-representation of women in clinical trials of new cancer immunotherapy treatments
• Setting up registries to monitor cardiac toxicity as a result of cancer chemotherapy for everyone, and specifically for women
• Enhancing women’s participation in cardiac rehabilitation programmes by offering flexible hybrid/virtual options
• Increasing clinician awareness of the strengths and limitations of each diagnostic method in women with confirmed or suspected cardiovascular disease
• Making women’s cardiovascular disease health ‘everyone’s responsibility’ by including this in primary care clinicians’ contractual obligations
• Leveraging influence to highlight and address sex biases in healthcare

Patients and those advocating on their behalf also have a role in advancing women’s cardiovascular disease care, says the statement.

For example, they should:

• Call for a holistic woman-centred approach to heart care that incorporates women’s experiences and insights
• They should engage the media, among others, to raise awareness about the importance of cardiovascular health for women. 
• Tailor information to the unique needs of women
• Highlight heart conditions that predominantly or exclusively affect women
• Co-design training for healthcare professionals to become more attuned to women’s specific needs

The statement also calls for the establishment of women’s heart champions to offer peer to peer support and dedicated women’s heart hubs to check on conventional risk factors, such as blood pressure, cholesterol, and weight, and provide lifestyle advice on diet and exercise. And a dedicated women’s health strategy should be created, it suggests.

Health professionals, professional bodies, charities, and the NHS can do their bit by mounting coordinated campaigns with unified messaging to raise the profile of women’s heart health, it says.

“Despite significant progress in the management of [cardiovascular disease], it remains the UK’s number one killer for women. Unfortunately, women are underdiagnosed, undertreated, and under-represented in all [cardiovascular disease] areas,” says the statement. 

If its recommendations are followed, these will “address the sex disparities in everyday care of patients in all settings, aiming at saving many women from losing their lives unnecessarily from preventable conditions in the UK and also worldwide,” it concludes.

Professor André Ng, President of the British Cardiovascular Society, which co-owns Heart with BMJ Group commented: “The joint British Cardiovascular Societies’ consensus document is the first to comprehensively detail the many layers of inequalities that exist in relation to cardiovascular disease in women, who clearly need better access to early and accurate diagnosis and timely treatment. Raising awareness across the medical profession, to patients and the general public is an important first step. 

“The British Cardiovascular Society will work with our affiliated societies in all areas of cardiology as well as other stakeholders, including patient organizations and NHS leaders, to identify key work packages that will bring transformative change to improve care and achieve better outcomes for cardiovascular care in female patients.”