Know Your Heart: Love Yourself
Every 20 minutes a woman in Canada dies from heart disease.- Five times more women die from heart disease than from breast cancer.
- Two-thirds of heart health research focuses on men
- Only 20% of women’s doctors talk to them about heart health
These are just a few of the startling statistics contained in the 2018 Heart Report released by the Heart and Stroke Foundation on February 1st for Heart Month. Appropriately titled, “Ms. Understood”, the report highlights the challenges women with heart disease face in a system ill-equipped to meet their needs. It is a sobering read.
If you’ve been paying attention to women’s health, you won’t find anything new in the report. However, it appears that not many pay attention to women’s health, including women themselves. Despite years of Red Dress and various other awareness campaigns, 78% of women and their doctors miss or dismiss their symptoms of heart attack:
- Pain
- Shortness of breath
- Weakness
- Fatigue
- Dizziness
Delay is deadly and misdiagnosis leads to delay.
What is most welcome about the report is the comprehensive nature of the information; the easy-to-read scientific narrative is interspersed with survivor stories that highlight patient narratives that back up the statistics.
What are the issues?
It’s been 20 years since the government changed the guidelines to ensure that women are included in clinical trials, yet women are still not enrolled in clinical trials to the same extent that men are. This is important because women are not the same as men, we are typically smaller; pregnancy, hormonal changes and menopause impacts us throughout our lives; women do not react the same to certain heart medications, we are at twice the risk of bleeding; and the socio-economic impacts of our gendered existence are more evident than for men. The report states: "when it comes to heart disease, women are under-researched, under-diagnosed and under-treated, under-supported and under-aware." (pg 4)
But what about the research we already have? How do we get new research under busy clinicians eyes? How do we empower women in their engagement with the health care system?
Where is CME around women’s heart health? Is it central to the offering or is it tacked onto the discussion about heart health as an afterthought? Or maybe addressed in a question from the audience? Is it one session on a menu of many, or a keynote opening a conference? Where is women's heart health in grand rounds? Who attends women's health research presentations? A quick glance around the room at any women's health conference would leave one with the impression that men do not provide care for women, their attendance at these conferences is so small.
Where is women’s heart health in the health science curriculum? How is it presented? Alongside the information about men? Or as a footnote to a scenario? There is no doubt that the medical school curriculum is a crowded one. However, extra attention needs to be directed at women's heart health to correct the dominant narrative that defines men's heart health. It's been a successful campaign educating people on the symptoms of a heart attack, the problem is, women present differently.
Women don’t know what they don’t know
Raising awareness of women’s heart health is particularly challenging in that despite years awareness campaigns, women remain remarkably unaware of their heart health risks. Risk awareness among younger women aged 19-29, visible minorities and women in Quebec is low.
What can be done?
The report concludes with the work that the Heart and Stroke Foundation is doing to address the gap in heart health care and includes recommendations for Canadians to improve their heart health.
It's clear that addressing the challenges in women's heart health demand action from all players: women, physicians, care providers, health systems, educational institutions, and researchers.
- Clinicians/researchers can be aware of local studies on heart health and promote enrollment in research studies to the women in your practice
- Curriculum planners and medical education directors can build space for women’s heart health in medical school
- Accrediting bodies can consider super-accreditation status for women’s CME heart health events
- Attend women’s health CME events and gender-based analysis workshops
- Read patient narratives written by women to counter the dominant male-driven narrative
- Researchers can consider how to accommodate women in their research protocols by including gender-based incentives, like daycare or personal services certificates.
- Consider your own gender bias and how it impacts patient care
- Talk to your female patients about heart health
- Promote heart healthy lifestyle changes along with medications
- Encourage women to download and read the report – stock it in your waiting room as a jump starter for heart health conversations. Hard copies can be obtained from the Heart and Stroke Foundation.
We can change the narrative of women's heart disease.
Resources:
Link to: Gender and Medicine curriculum
Link to: FMWC Heart Health AGM presentation - Dr. Jodi Heshka