Are Females at a Higher Risk of Cardiovascular Disease?

Studies show that women with heart disease are more likely than men to be misdiagnosed, and if they do have surgery, the results will be worse. Why is this bias happening, and how can it be fixed?

As a result, women continue to have a disproportionately high rate of undiagnosed or delayed heart disease. Women who present to hospitals with heart attack symptoms are consistently and tragically let down by the medical establishment. It has been a hard road for me as a professor of cardiac science with 40 years of expertise to get to the root of the issue, which is a mix of professional, systemic, and technical prejudices. Individual patients’ experiences are difficult to analyse and interpret, but we can now see the cumulative effects on a far larger scale.

Misdiagnosis of a heart attack is more common in women, increasing the risk of death by up to 50%. Initial misdiagnosis increases mortality risk by 70%. Similar to previous research, recent studies have indicated that female patients fare worse than male patients after undergoing heart surgery, specifically valve replacements and peripheral revascularization. Women are less likely to receive a correct diagnosis, the best surgical treatment, and the optimal set of medicines before being discharged from the hospital. Although none of this can be justified, is it at least comprehensible?

Seeing a woman having a heart attack is “unexpected,” it is said because women are less likely to get heart disease than males. Women may indeed be more likely to ignore the warning signs of a heart attack because they don’t think they’ll experience one. Yet the explanations I frequently hear from doctors leave me dubious. Although younger women may experience a lower incidence of heart disease, this condition is by no means uncommon. There are around 30,000 female heart attack hospital admissions in the UK annually.

Three to five young women can be seen by a doctor for every 10 young men diagnosed with heart disease, and the ratio improves with age. It’s not like a general practitioner will see more than a couple of instances of meningitis in their entire career, for example. About 21% of women die from heart disease throughout their lifetime, which is not too far from the 24% proportion for males. Seeing a female patient in casualty who is suffering from heart disease is not an unusual occurrence for doctors.

275 million women were diagnosed with cardiovascular disease (CVD) in 2019. Acknowledging sex and gender-specific risk factors is the key to understanding #CVD in women and reducing the 🌍 burden.

Read the #LancetWomenCVD Commission: https://t.co/DDB97FX5Mc pic.twitter.com/WhlQYEOcGs

— The Lancet (@TheLancet) May 17, 2021

The second common justification is that women’s symptoms are inexplicable. However, the truth is that there is a lot of crossover between the sexes in terms of the symptoms people feel. Common symptoms include nausea, sweating, and dizziness, as well as the typical feeling of crushing chest pain, which can spread to the arms and jaw. This discomfort is the most prevalent symptom in both sexes, albeit it occurs more frequently in the back of women than males. Again, many people who visit the emergency room report feeling exhausted or short of breath, but women have a higher chance of presenting with these symptoms than males do. There is no reason to be uninformed about the wide variety of symptoms associated with heart attacks in women, given the large majority of patients who will be female.

Once a heart attack has been suspected, the patient’s care must adhere to strict norms and standards. If a doctor suspects a woman has heart disease, she should treat her with the utmost care. This, however, is not the case. Rather than using the current arsenal of treatments, clinicians are less likely to follow the standards when treating women. Despite being the most effective treatment available, women are less likely to undergo catheter-based angioplasty to unblock blocked blood arteries.

Nearly twice as many men as women survive hospitalisation, according to a study of more than 100,000 patients, and males receive 20% more of these reperfusion therapies than women do. Women are less likely to receive immediate care, even when they do. Each additional five minutes it takes to get to the catheter laboratory where reperfusion therapy can be administered raises the patient’s chance of death by 5%. The study also indicated that the greater mortality rate was due in part to the fact that women were transferred to the catheter laboratory far more slowly than men.

However, the study’s most shocking statistic was that this only happened if the doctor was male. Why should this be?

Approximately 1.3 million Floridians who had just been hospitalised for a heart attack provided the data for the largest study on physician gender and treatment. Female patients treated by female physicians fared better than female patients treated by male physicians by a factor of two to three. Doctors who had previously had success with female patients found a statistically significant improvement in survival rates with each new female patient they met. What’s more intriguing is that the ratio of women to men on the clinical team made a significant difference. The team’s overall performance and the men’s ability to care for women patients both improved when there were more women doctors on the team. The study found that rather than waiting for individual male doctors to gain expertise via their early failures, having a gender-balanced team was the best method to aid female patients.

Are Females at a Higher Risk of Cardiovascular Disease
Are Females at a Higher Risk of Cardiovascular Disease

Why do male doctors seem to have a double standard when it comes to how they handle female patients? Why does the doctor feel this way, and what kinds of actions or traits bring it on? Where sex and gender differences come into play in this situation. We all, regardless of our biological gender, exhibit a variety of characteristics that are stereotypically associated with either sex and, more crucially, that may be valued differently depending on the gender displaying them. How about you? Are you reserved, kind, and kind, or bold, brave, and unique? The Bem sex-role inventory is a test that can help you determine where on the spectrum between “man” and “female” you fall; most people, including yourself, will score in the middle.

Being the primary breadwinner, making a lot of money, or doing most of the housekeeping all contribute to how we are perceived in our personal lives. All of these factors combine to determine whether we project an image of masculinity or femininity. Comparing the effects of perceived gender to those of actual gender revealed that the stronger the “female” score was relative to the “male,” the more it influenced treatment and result.

For instance, “feminine” patients (whether male or female) were over four times as likely to re-visit the hospital with persistent symptoms after being released. To put it bluntly, if you act in a way that is stereotypically associated with women, your doctor is more likely to view your distress as exaggerated, wrong, or hysterical.

Women’s inability to regulate their emotions has historically been seen as a mental or physical illness. Only after Freud’s time was a similar pattern of behaviour recognised in men. The Greeks called it hysteria (or wandering womb, hysteria being the word for womb). American doctor Alyson McGregor writes in her book Sex Matters that it can be difficult for a female patient to convey the severity of her discomfort to the doctor treating her.

The more they argue with the doctor, the more hysterical they seem. More demonstrative women from other cultures have it especially rough. It can backfire in a casualty situation if they were raised to always express themselves strongly emotionally. If you’re a woman, McGregor advises, bring a man along to help you explain things.

Whether or whether these trends hold true for other marginalised groups besides women can provide insight into whether or not they are the product of bias. As it turns out, the same pattern of improved outcomes for minority patients when matched with a doctor of the same race or on a team with a significant representation of minority doctors also holds true for doctor-patient matching based on race. Good matching increases the efficiency with which healthcare resources are used and the level of satisfaction felt by those who receive treatment as a result. This is only one example of a growing awareness of the racial disparities that exist in access to healthcare in the United States and the United Kingdom. For minority women, who face additional barriers to care, the trend is straightforward to foresee.

Why aren’t gender-balanced teams being used to solve this issue in cardiology if they work so well? Clinical cardiology has historically been a male-dominated field, earning the nickname “boys and toys” for the numerous implantable gadgets that can be used to treat cardiac conditions. Over the course of nearly a decade, my university implemented various changes to decrease bias in hiring and promotion practises as part of the UK Athena Swan gender equality scheme for institutions.

There were rough as many female as male cardiac science professors by 2020, thanks to our efforts. However, the percentage of female clinical cardiology professors at our affiliated institutions has remained stagnant at around 10% of the male population. More than half of U.S. medical students are women, while women make up only 4.5% of practising “interventional” cardiologists (the ones using catheters to treat heart attacks). This distinction appears to have a crucial role in the subpar care that women with cardiac symptoms receive in hospitals.

Is there anything we can do in the meanwhile to help bring about gender equality in cardiology? Clinical symptoms, cardiac measures, and blood test results from over 13,000 patients admitted to hospitals with heart problems were recently combined using data science. The researchers used AI to create an algorithm that was both more accurate at diagnosing heart attacks in general (nearly 84% accuracy in sending patients for additional tests compared to roughly 50% accuracy for conventional diagnostics) and more equitable across men and women.

We can only pray that developments like these will help reduce horrific figures like the estimated 8,200 women in England and Wales. They died of cardiac disease between 2002 and 2013 due to incorrect diagnoses. It is hoped that data science’s examination of big patient populations would shed light on the problem and demonstrate how AI-generated algorithms might help.

Cardiac pharmacology professor emeritus Sian Harding is a London resident. On September 20 (for $25) her newest book, The Exquisite Machine: The New Science of the Heart, will be released by MIT Press. Buy a copy from guardianbookshop.com to show your support for the Guardian and Observer. Additional fees may be incurred for delivery.

Stay tuned for more updates at journalization.org

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