Aside

I just can’t! No..

bright cardiac cardiology care

Photo by Pixabay on Pexels.com

She’s calling! No Mom, please, don’t call the Doctor. , please!

She never listens to me, never ever.

Sitting at the round maple dining table holding that yellow receiver of our wall phone in her  hand . It’s over stretched curly cord hanging nearly to the floor. Right in front of the big picture window she sits, again. It’s her perch . She sits looking over the rear yard and up the street. Every day, sometimes for hours talking on that phone!

I love Mom but I don’t trust her. I want to, but I can’t. When I told her about these ugly things growing on my left foot she promised me she wouldn’t touch them. She knows how awfully sensitive my feet and lower legs are to touch. But she had to touch it anyway. To hold my leg and touch them just as soon as she saw the six ugly  things growing on the bottom of my left foot.

These ugly things look like a family of spiders! Reddish brown and even hairy, but hard like stones. A couple of them had grown huge. About the size of a quarter! They have been growing there for a while, I didn’t tell anyone. Now I had to, walking, rather limping was getting hard to hide. Once I tried to pick at them when there were only a couple, and they were smaller. Just in case they were stones. Stones that I may have stepped on. They weren’t and I screamed.

Mom had made other promises too. She promised us when we moved into our last house. A small three Bedroom  bungalow in Bay View. It.set up high on a hill which made cutting the grass to hard for me to do. Mom was going to make the house over for us and maybe put a terrace in the front yard. Then it would be easier to mow and it would be real pretty. She promised us we would stay there for a long time! Years even. If we just accepted the move nicely, again!

It’s March and I am only eleven years old, and I won’t be 12 until July. And I have lived in 10 houses since I was born! I am the oldest child still at home. There are seven of us altogether, the oldest three girls were married now and moved out. My one and only brother Jerry is in the Air Force. The older girls and their husbands  were expected to help us move, whenever. Rumor had it recently that my brother in laws were furious at all this moving around. We all had heard the same promise to us when we moved here. According to Mom and Dad we had to move out now because they had fixed up the Bay View house so special the owner wanted to move back in to it with his family. Broken promises littered my life. There was no terrace either.

So now we had moved into a little yellow 4 bedroom Cape Cod with white trim and shutters. The house is cute and is on the corner of Holt and 83rd St. In the Southwest corner of Milwaukee. A nice suburban neighborhood with a pond katty corner across the street.

The Bay View house we only lived in for 9 months.  We can’t live like normal people Dad told us because he works two jobs to support us already and Mom gets us a break on the rent where we live by fixing the places up real pretty for the owners. My parents started doing this shortly after the war. It made sense since all 9 of us were home then. Today things are different its 1956. Someone would come buy our house or the landlord had somebody to live in it that would pay more rent than we could afford. It wasn’t fair but it was what it was my Granny would say. No matter what I didn’t trust the promises my parents gave us, not anymore.

It seems I was born broken too. When I was just four I had to go to the hospital due to a hearing problem. I was partially deaf. I had to have surgery. Apparently some glands  , Adenoids  were growing so big that my ear drums were being covered  Mom and that darn Doctor said the surgery wouldn’t hurt! Wrong again! It hurt me like the dickens!. I can still smell the ether when I think about it. To make matters worse no one came to see me after the day of surgery.  I felt alone and scared that whole time! They were right about getting Popsicles, but that was all, so I don’t trust what they say anymore.

When I was 10 (just last year) The Doctor put me in another hospital, for six weeks!. Almost all last summer vacation I had to lay in a  hospital bed in a hospital that smelled to me like ether!  My legs and toes had hurt, and I was having headaches. I was achy  of all over. Mom said it was just growing pains cause I was getting pretty tall .I grew about 2 inches that year . I was now almost 5’8″. So growing pains made sense to me, even though my younger sisters hadn’t got them. The sister just 11 months younger than me was almost 5’7″. (Her name is Jacqueline. Jacky for short). Well Dr. Wonder (the doctors name,) had Mom bring me into his office for an exam cause I was running a low grade fever. He insisted that I had to go to the hospital that same day. I heard him tell Mom my heart was enlarged on the xray, and he heard a murmur in there. He decided I had Rhuematic fever.

Again with the promises. “Honey you will have Lots of company and presents. I’ll get you a bunch of books and magazines to read,  a coloring tablet and new colored pencils! You won’t be gone long and you will be ok.”Mom said.” We’ll all come visit , even Granny.” . She just wanted me to stop crying.

I was in Lakeview hospital for 6 weeks! Almost Every day except weekends the nurses would come with big needles and take  blood out of me. They put fat needles in my veins with liquid running into me from a bottle that looked like pickles should be in it.  Every time I wanted to get up I had to get unhooked from the tubes coming out of the bottle. I had to call for a nurse, to unhook me. They often tried to ignore me! I had to go potty a lot with water running in me. So I  told the nurses if they didn’t want to come  when I called to go potty I would just wet the bed, cause I wasn’t faking! Then they could clean  that mess up!  It was a kind of contest, that was the only fun I had in all six weeks. Family did come see me and I did get some flowers from Granny, from her garden but they died really quick. The family that did come only came once. Mom or Dad came once a week! I was on bed rest only!  I hated the bed pan and refused it.t I really hated  that I believed what Mom and the others told me to get me here! ” oh it will be fun!” I would never trust anyone ever again. Except God cause He doesn’t ever lie or break promises

I am assuming today the nurse at Dr. Wonders office had told Mom he would call her back when he could. That made our phone  taboo to everyone until the Doctor called back. I kept begging Mom not to talk to him , I promised” that I would try to use Jerry’s (my brother ) old crutches”. I could still walk to the bus stop and go to school. I wouldn’t complain again, really!”. She ignored me. With seven kids Ignoring was something you would get really good at.

The phone started to ring and I jumped startled out of my chair. When I was startled I bumped my sore foot and let out a warhoop.

I hobbled to my bedroom that was just down the hall from the dinette where Mom was 0n the phone. The stupid yellow wall phone with its droopy cord.  I didn’t want to hear Mom’s conversation, but I still could.  I heard her say a lot of OK’s, and yes and tomorrow morning is fine! Once she asked if something was really necessary, apparently it was because there was another OK right after that. The long pauses were the worst. Then the phone was hung up. A few minutes later Mom walked into my room and sat next to me. I had a double bed with a pretty white chenille bedspread. Soft with little blue and red roses all over it. Pale green walls. There were oak hardwood floors in here and a white throw rug by my bed side. I had put one of my bed pillows down on the rug so I could rest my sore foot on something soft. Mom said, ” we have to go to his office tomorrow morning at 10:30. He will look at your foot, he thinks it’s Plantar s Warts. He agrees they are painful.” So I asked Mom,” is he going to put my foot in a cast, like he did my arm when I fell off the monkey bars ?” She just sat there, pretty quiet and just nodded no. So I started to cry. Certain that Dr. Wonder would have to cut my foot off.!  I asked Mom about that, and she shook her head no again, and then she gave me a hug. She never gives hugs! This must be bad. So now I was hideously crying. I hate ugly crying but I couldn’t help it. I was so scared! Mom spoke next and said, ” Dr. Wonder says he may have to burn them out. These things have long roots, so he has to burn deep to kill them. Or they could come back”.  Mom, ” no. I don’t want my feet touched you know I can’t. And not with fire!” She then smiled and said,” no he will burn them with chemicals and electricity”. “You’ll be as good as new in a couple of weeks, maybe less if you heal fast,” Mom added. Then I lost it. I really yelled” no, I’m not…. going”! “You can’t make me I don’t trust you or him, no I won’t go! I just can’t”. I was slobbering and looking grotesque. Mom stood up, all 5’2″ of her, with her dark hair pulled back in a low braided bun, and said,” watch your attitude young lady!” then nothing was spoken for what seemed like a long time. She used her yellow apron to wipe my face and said,” You can eat supper in your room if you want..” We’ll get you a TV table, don’t spill on the bedding”. Then she left and went to the kitchen.

I crawled into my bed, clothes and all. My eyes were swollen with only narrow slits to see out of. Pretty soon my head was aching too. Jacky walked in and sat on the side of my bed, and asked,”are you ok?” I answered,’ no’. She said, ‘ok’ and left the room. Shortly I got up and headed for the bathroom. Carefully and trying to find a way to walk without pain. Why me? Why always me?sirio-ihNJNyuz8nk-unsplash

I hobbled to the bathroom. At first I just sat there crying quietly. How long I don’t know. And then I began to think and remember stories I had heard from Mom and  Granny about miracles and angels. I recalled some of my Sunday school lessons and decided to pray. At first I was sitting on the toilet I decided that was probably inappropriate so I closed the lid and knelt down in front of it. I prayed, nothing special. Except the Lords Prayer is what I started with, then I just talked to Jesus about everything. Told Him what was going on, how touchy my legs and feet were and how scared I was. I told him how I was sorry but didn’t trust anybody anymore, except Him. I even asked Him if it would be ok if He just would send an angel for me tonight and take me home by Him. I begged Him to take me home tonight, I knew in heaven I wouldn’t hurt anymore, or have a murmur or get sick. I knew he raised Lazarus from the dead .I told God that I didn’t expect anything so grand. I just didn’t want to go through anymore of this broken world with all my broken parts. But if He didn’t want me to come to His house yet I would try to understand. I was crying again/ Eventually said good night to God and I hope to see you soon!  Jacky was knocking on the bathroom door and told me Mom wanted to know what I was doing in there so long. She also said my supper had gotten cold. Which was ok with me since my tummy was to sick to eat anyway. I rinsed out a cold wash cloth for my eyes and hobbled back to my bed. Still clothed I crawled in it.

Since it was March it got dark early and dusk had come and gone while I was in the bathroom. When Jacky walked past my door with the phone in her hand heading to the bathroom I asked her to shut off my light and close the door, please. She did, then I heard the bathroom door close. I eventually fell asleep, it took a while but that cold wash cloth helped a lot.

The next thing I knew it was morning and I was still here! Jesus had decided not to come to get me or even to send an angel!. The next thought was that today is the day, the day I dread. Mom had said 10:30. I had no idea what time it was now but I heard my sisters in the kitchen and bathroom getting ready for school. Jacky and Darlene left about 7:30. Darlene to 3rd grade and Jacky to 5th, they walked together. I was in 7th at  Walker Junior high. I had to take a bus. It picks me up on the corner on 84th st and Morgan, about a two block walk. I laid there awhile wishing I was still asleep. I prayed some more and cried too. Quieter now.

Not sure exactly how much longer I had laid there, but eventually I threw my blankets back and swung my legs off the side of the bed. There I sat not wanting to stand up, the right foot on the floor the left one about an inch or two above it. Finally,  I needed to move, I needed to hobble to the bathroom. The house sounded quiet. It was a sunny day, The window shades had not been pulled down in my room last night so my room was quite bright. Any other day it would be considered cheery. My windows faced east and North so I got the sunrise.

I prepared myself to stand up. I stood up and stood there for a few long seconds, both feet on the hardwood floor, no bed pillow. Still standing there, then it hit me.

Something wasn’t right.  Oh no, now what?

My foot didn’t hurt, neither of them! So I plunked myself down on the bed again! Stymied! Then I stood up again, a little more brusquely this time. Nothing. So I did the unthinkable I stomped that foot on the floor. Hard. Again….nothing. Now I began to shake, I don’t know why, fear, nerves, whatever. I sat down again. This time I lifted my left leg, turned it and rested it over on the right leg, so I could see the bottom of it. I looked and I stared for a pretty long time. The warts were a different color and there was no hair on them. The hair was on the floor where I stomped my foot. So I decided to touch them, I did and no pain. So I started poking on them and around them and still no pain! As I continued to poke and prod one of the middle size ones above my toe line. Closer to the ball of the foot, fell out! Unto the floor and it had a pitch black tail hanging on it! There was no blood in the hole where it was. All fresh new skin and no hole where the root had been lodged. I began to scream.” MOM!! MOM?? MOM hurry,” Mom  ….all the while poking around on the others now also. Within a few seconds I had a handful of black, very black spidery looking warts with attached rat tail looking roots, and no blood. With the one I picked up from the floor I had all six in my hand. Mom opened my door and asked what in the blazes was going on, what was all the yelling about? I handed her the warts, then showed her my foot! We both just stood there in awe.

She knew right away that God had intervened. That’s when I told her about my praying and begging, while we stood there on that hardwood floor together hugging and crying and rocking and praising! Thanking our Lord. It was such a wonderful feeling, knowing God heard me and helped me. I was so filled with an unexplainable joy, that I still can’t find words for.

Then Mom said, ‘ this will be fun telling the doctor why were not coming in today, but first you should call Granny she’s been worrying. And so I did. She was joyful but not as surprised or shocked as most of the others were, including Dr. Wonder.!

I learned to trust God, that we all make mistakes and are not dependable. But He is!

Psalm 107:19 ” Then they cried to the Lord in their trouble, and He saved them from their distress.     angelic-2743045_1920

 

 

 

Well Excuse Me All to Heck, Doctor!

Recently the disturbing results of a study on women and heart disease were released, attracting media headlines like Women and Heart Disease: New Data Reaffirms Lack of Awareness By Women and Physicians.

The study’s lead author, cardiologist Dr. Noel Bairey Merz, of  Cedars Sinai Heart Institute in Los Angeles, announced that “increasing awareness of cardiovascular disease in women has stalled with no major progress in almost 10 years”, and (far more intensely disturbing, in my opinion): “Little progress has been made in the last decade in increasing physician awareness or use of evidence-based guidelines to care for female heart patients.”

No wonder I had to lie down. I had to go have a wee lie-down after I read this paper in the Journal of the American College of Cardiology.(1) But taking to one’s bed in response to yet another discouraging study about cardiology’s gender gap is not enough. Perhaps it’s time for female heart patients like me to simply throw our collective hands in the air while banging our heads against the nearest wall. But I won’t, actually I can’t.

The study’s grim conclusions felt distressingly familiar because I and many others have been discussing all the serial bad news on women’s heart health for years. Researchers have been essentially repeating “More studies are required” as their concluding disclaimer.blah blah blah

So that’s what we get: more studies saying more of the same. But although some role models of care are emerging (consider for example the growth of distinct women‘s heart clinics in many teaching hospitals), I’m wondering when we’re going to see boots-on-the-ground changes in diagnostics and treatment, not just more studies.

A heart sister (and SCAD heart attack survivor) Laura Haywood-Corey has a pithy way to sum up studies like this recent one:

“Sucks to be female. Better luck next life.”

I used to suspect that lack of research focused specifically on women’s heart health was the key culprit behind the cardiology gender gap. We know that this reality has in fact been true for decades. Just one chilling example: the 2011 Canadian Cardiovascular Congress in Vancouver interviewed researchers working on women’s heart disease issues, I was stunned to learn that out of over 700 scientific papers presented at this medical conference, I could count on one hand how many had anything even remotely to do with women’s heart health. See also: The Sad Reality of Women’s Heart Health Hits Home

I will never get used to researchers blaming women for our lack of awareness of cardiac symptoms, (it is BS for cryingoutloudagain) or for our dangerous treatment-seeking delay behaviour.( we are nuturers, caregivers, we don’t run at every twinge forcryingoutloudagain) Many studies suggest  physicians are significantly more likely to misdiagnose female heart patients compared to our male counterparts. We are considered anxious. Menopausal. Hormonal. Intolerant to pain! (There is not a woman within screaming distance who would not argue that point, Who has the priveledge of giving birth?

But this study goes beyond even those sorry conclusions, now questioning the inability of some doctors to even discuss risk factors.  It found, for example, that only 22 percent of primary care physicians and only 42 percent of cardiologists felt “prepared to assess cardiovascular risk in women”, which of course begs the question:

If the majority of physicians – including cardiologists! – feel unprepared to appropriately assess women’s risk factors for developing heart disease, who exactly IS able to do this?

In case you too need a wee lie-down (or a good head-banging), here’s just a smattering of the range of work over the past decade that seem to confirm Laura’s thought:

♥  Gender differences in diagnosis and management of heart disease reported that the reasons for the significant under-use of standard heart attack treatments in women and higher in‐hospital mortality “need to be investigated further”. Heart, 2007.That was 12 years ago! Think about that.

Prevention of coronary heart disease in women a Chicago study determined that misdiagnoses result in higher coronary heart disease mortality rates in women than in men. Therapeutic Advances in Cardiovascular Disease, 2008. Nothing significantly changed since then, 11 years waiting and dying!

♥  Women wait longer for emergency angioplasty during heart attacks was the conclusion of this Yale University-based study, adding that “time to treatment should be as short as possible”. BMJ, 2009. My last CVE took 24 hours to receive  the angiogram and 2 new stents!

  Many healthcare providers fail to recognize heart disease in women, and diagnosis and treatments are often delayed due to misdiagnosis. These delays can result in increased morbidity and mortality in women. National Center for Health Statistics, Circulation, 2009  I am battling every day the low quality of life that arrived since I developed MicroVascular Disease, aka Small Vessel Disease!

♥  Gender equity in treatment for cardiac heart disease: Women receive notably fewer procedures during heart attack compared to male counterparts, women are significantly more likely to die during hospitalization even with equal treatment, gender differences against women are higher for emergency admissions, and women are more often admitted to cardiology through emergency departments. Social Science and Medicine, 2010.

  New guidelines warn of link between pregnancy complications and heart disease. The American Heart Association’s effectiveness-based guidelines recommend that healthcare professionals who meet women for the first time later in their lives should take a careful and detailed history of pregnancy complications, with focused questions about a history of gestational diabetes, preeclampsia, preterm birth, or having a low birth weight/full-term baby. Circulation, 2011.

 Bridging the gender gap: sex-related differences in the treatment and outcomes of patients with acute coronary syndromes. A Canadian study found that women with acute coronary syndrome are still more likely to be treated conservatively due to underestimation of patient risk, and to have worse in-hospital outcomes. American Heart Journal, 2012.

♥  The sobering fact is that more young women die of heart disease than breast cancer. We remain 35 years behind in understanding female pattern heart disease as well as we understand it in males. Cardiologist Dr. Noel Bairey Merz, Cedars Sinai Heart Institute, 2013.
.

♥  Women fare worse than men after a heart attack, with longer hospital stays and a greater likelihood of dying in the hospital afterward. Journal of the American College of Cardiology, 2014.

♥  Sex bias in referral of women to cardiac rehabilitation: Research suggests that “women are significantly underrepresented in cardiac rehabilitation, programs which are shown to reduce recurrent cardiac events and related premature death.” European Journal of Preventive Cardiology, 2014.

♥  Female cardiologists are rare, and earn less than men. “Women make up over half of medical school classes, yet gender differences in compensation cannot be explained by differences in workplace performance.” Journal of the American College of Cardiology, 2015.Now this is really hard for me to grasp.

♥  Women’s heart attacks are under-diagnosed and under-treated even when appropriately diagnosed compared to our male counterparts. First ever scientific statement on women and heart attacks in the 92-year history of the American Heart Association, 2016.

Prevention of coronary heart disease in women: a Chicago study determined that misdiagnoses result in higher coronary heart disease mortality rates in women than in men. Therapeutic Advances in Cardiovascular Disease, 2

♥  Women wait longer for emergency angioplasty during heart attacks was the conclusion of this Yale University-based study, adding that “time to treatment should be as short as possible”. BMJ, 2009.

  Many healthcare providers fail to recognize heart disease in women, and diagnosis and treatments are often delayed due to misdiagnosis. These delays can result in increased morbidity and mortality in women. National Center for Health Statistics, Circulation, 2009

♥  Gender equity in treatment for cardiac heart disease: Women receive notably fewer procedures during heart attack compared to male counterparts, women are significantly more likely to die during hospitalization even with equal treatment, gender differences against women are higher for emergency admissions, and women are more often admitted to cardiology through emergency departments. Social Science and Medicine, 2010.

♥  The sobering fact is that more young women die of heart disease than breast cancer. We remain 35 years behind in understanding female pattern heart disease as well as we understand it in males. Cardiologist Dr. Noel Bairey Merz, Cedars Sinai Heart Institute, 2013.
.

♥  Women fare worse than men after a heart attack, with longer hospital stays and a greater likelihood of dying in the hospital afterward. Journal of the American College of Cardiology, 2014.

♥  Women’s heart attacks are under-diagnosed and under-treated even when appropriately diagnosed compared to our male counterparts. First ever scientific statement on women and heart attacks in the 92-year history of the American Heart Association, 2016.

♥  Focused cardiovascular care for women: “The public health cost of misdiagnosed or undiagnosed cardiac disease in women is significant.” This study warned that recognition of women who are at high risk of heart disease is not only important in providing appropriate care, but can avoid reflexively blaming women’s symptoms on non-cardiac causes. Mayo Clinic Proceedings, 2016.

♥  Gender Differences in Coronary Heart Disease – U.K. cardiologist Dr. Ramzi Khamis’ comprehensive look at the areas in cardiovascular disease where women are still either underdiagnosed, undertreated even when appropriately diagnosed, or both – published in the British Medical Journal Heart, 2016.  See image below:

Screen Shot 2016-07-07 at 6.46.33 PM

 

Sex Differences in Young Patients with Acute Myocardial Infarction – Researchers in the U.S. and Spain report that young women (under age 55) with AMI represent a distinct, higher-risk population that is different from young male counterparts. This includes lower quality of life, more co-morbidities, higher clinical risk scores, less likely to undergo revascularization procedures like stents during hospitalization, and more delays in seeking emergency medical help. European Heart Journal: Acute Cardiovascular Care, 2016.

♥  Low income heart attack survivors fare worse, especially women: Women often have lower income and less complete medical coverage than men, and care for multiple generations of family, and that this may in part explain why young poor women have worse outcomes following a heart attack compared with similarly aged men. Journal of the American Heart Association, 2016.

Women fare worse than men after heart attack – Australian researchers found that characteristics of coronary artery plaque varied significantly between the sexes. Plaque in women, for example, was more evenly distributed through the arteries and contained less cholesterol — a major risk factor for heart disease.  Circulation: Cardiovascular Imaging, 2016.

Women and heart disease: new data reaffirms lack of awareness by women and physicians – While 74% of women reported having at least one risk factor for heart disease, just 16% were told by their doctor that they were at risk. Journal of the American College of Cardiology, 2017.

Women’s hearts are victims of a broken system that is ill-equipped to diagnose, treat and support themDisturbing update from Canada’s Heart and Stroke Foundation’s 2018 Heart Report called Ms. Understood, including: early heart attack signs missed in 78% of women, five times more women die from heart disease than from breast cancer, two-thirds of all heart disease clinical research focuses only on men. February 2018.

Fewer lights and sirens when a female heart patient is in the back of the ambulance – This study found that after calling 911, female heart patients were not only less likely than male counterparts to have flashing lights/sirens turned on in the ambulance, but were also less likely than men to receive recommended treatments (including even the minimal basics such as aspirin or cardiac monitoring). December 2018.

Thank you for all your help and wonderful research my Heart Sister, Carolyn Thomas.

(1) C. Noel Bairey Merz, Holly Andersen, Emily Sprague, Adam Burns, Mark Keida, Mary Norine Walsh, Phyllis Greenberger, Susan Campbell, Irene Pollin, Cassandra McCullough, Nancy Brown, Marjorie Jenkins, Rita Redberg, Paula Johnson, British Robinson. “Knowledge, Attitudes, and Beliefs Regarding Cardiovascular Disease in Women”,

 

:)

Well Excuse Me All to Heck Doctor!

 

Last week,  a study on women and heart disease was released, that was very disturbing. It attracted media headlines like Women and Heart Disease: New Data Reaffirms Lack of Awareness By Women and Physicians. This information is disconcerting at the least. Frightening actually.

The study’s lead author, a renown cardiologist Dr. Noel Bairey Merz, of  Cedars Sinai Heart Institute in Los Angeles., She announced that “increasing awareness of cardiovascular disease in women has stalled with no major progress in almost 10 years”, and (what is far more intensely disturbing, in my opinion): “Little progress has been made in the last decade in increasing physician awareness or use of evidence-based guidelines to care for female heart patients.” This situation needs our immediate attention.

No wonder I had to lie down after reading this. But taking to one’s bed responding to yet another discouraging study about cardiology’s gender gap is not the answer . Perhaps it’s time for female heart patients like me to simply throw our collective hands in the air while banging our heads against the nearest wall. Or not!

The study’s grim conclusions felt distressingly similar to all those prior studies done.  I  Many of us have been discussing  the serial bad news on women’s heart health for years. Researchers have been essentially repeating “More studies are required” as their concluding disclaimer.blah blah blah, Actions speak louder than words. It is due time for action!

Enough,  more studies saying more of the same is not helping any of us. Although some role models of care are emerging (consider for example the growth of distinct women’s heart clinics in many teaching hospitals, more in Canada), I’m wondering when we’re going to see boots-on-the-ground changes in diagnostics and treatment, not just more studies. We need to be bolder in our advocacy for ourselves.

A heart sister (and SCAD heart attack survivor) Laura Haywood-Corey has a pithy way to sum up studies like this recent one:

“Sucks to be female. Better luck next life.”

I used to suspect that lack of research focused specifically on women’s heart health was the key culprit behind the cardiology gender gap. We know that this reality has in fact been true for decades. Just one chilling example: the 2011 Canadian Cardiovascular Congress in Vancouver interviewed researchers working on women’s heart disease issues, I was stunned to learn that out of over 700 scientific papers presented at this medical conference, one could count on one hand how many had anything even remotely to do with women’s heart health. See also: The Sad Reality of Women’s Heart Health Hits Homedoctor-2761701_1280

We’re getting arguably used to researchers blaming women for our lack of awareness of cardiac symptoms, (blaming us is BS for cryingoutloud) or for our dangerous treatment-seeking delay behavior.(we are nurturers, caregivers, we don’t run at every twinge forcryingoutloud) And many studies suggest that physicians are significantly more likely to misdiagnose female heart patients compared to our male counterparts. Likely out of habit

But this study goes beyond even those ludicrous conclusions, now questioning the inability of some doctors to discuss risk factors.? Whaaat?  It found, for example, that only 22 percent of primary care physicians and only 42 percent of cardiologists felt “prepared to assess cardiovascular risk in women”, which of course begs the question:

If the majority of physicians – including cardiologists! – feel unprepared to appropriately assess women’s risk factors for developing heart disease, who exactly IS able to do this?

In case you too need a wee lie-down (or a good head-banging), here’s just a smattering of the range of work over the past decade that seem to confirm Laura’s summary:

♥  Gender differences in diagnosis and management of heart disease reported that the reasons for the significant under-use of standard heart attack treatments in women and higher in‐hospital mortality “need to be investigated further”. Heart, 2007.

Prevention of coronary heart disease in women: a: a Chicago study determined that misdiagnoses result in higher coronary heart disease mortality rates in women than in men. Therapeutic Advances in Cardiovascular Disease, 2008.

♥  Women wait longer for emergency angioplasty during heart attacks was the conclusion of this Yale University-based study, adding that “time to treatment should be as short as possible”. BMJ, 2009.

  Many healthcare providers fail to recognize heart disease in women, and diagnosis and treatments are often delayed due to misdiagnosis. These delays can result in increased morbidity and mortality in women. National Center for Health Statistics, Circulation, 2009

♥  Gender equity in treatment for cardiac heart disease: Women receive notably fewer procedures during heart attack compared to male counterparts, women are significantly more likely to die during hospitalization even with equal treatment, gender differences against women are higher for emergency admissions, and women are more often admitted to cardiology through emergency departments. Social Science and Medicine, 2010.

  New guidelines warn of link between pregnancy complications and heart disease. The American Heart Association’s effectiveness-based guidelines recommend that healthcare professionals who meet women for the first time later in their lives should take a careful and detailed history of pregnancy complications, with focused questions about a history of gestational diabetes, preeclampsia, preterm birth, or having a low birth weight/full-term baby. Circulation, 2011.

 Bridging the gender gap: sex-related differences in the treatment and outcomes of patients with acute coronary syndromes. A Canadian study found that women with acute coronary syndrome are still more likely to be treated conservatively due to underestimation of patient risk, and to have worse in-hospital outcomes. American Heart Journal, 2012.

♥  The sobering fact is that more young women die of heart disease than breast cancer. We remain 35 years behind in understanding female pattern heart disease as well as we understand it in males. Cardiologist Dr. Noel Bairey Merz, Cedars Sinai Heart Institute, 2013.
.

♥  Women fare worse than men after a heart attack, with longer hospital stays and a greater likelihood of dying in the hospital afterward. Journal of the American College of Cardiology, 2014.

♥  Sex bias in referral of women to cardiac rehabilitation: Research suggests that “women are significantly underrepresented in cardiac rehabilitation, programs which are shown to reduce recurrent cardiac events and related premature death.” European Journal of Preventive Cardiology, 2014.

♥  Female cardiologists are rare, and earn less than men. “Women make up over half of medical school classes, yet gender differences in compensation cannot be explained by differences in workplace performance.” Journal of the American College of Cardiology, 2015.

♥  Women’s heart attacks are under-diagnosed and under-treated even when appropriately diagnosed compared to our male counterparts. First ever scientific statement on women and heart attacks in the 92-year history of the American Heart Association, 2016.

!♥  Women wait longer for emergency angioplasty during heart attacks was the conclusion of this Yale University-based study, adding that “time to treatment should be as short as possible”. BMJ, 2009.

  Many healthcare providers fail to recognize heart disease in women, and diagnosis and treatments are often delayed due to misdiagnosis. These delays can result in increased morbidity and mortality in women. National Center for Health Statistics, Circulation, 2009

♥  Gender equity in treatment for cardiac heart disease: Women receive notably fewer procedures during heart attack compared to male counterparts, women are significantly more likely to die during hospitalization even with equal treatment, gender differences against women are higher for emergency admissions, and women are more often admitted to cardiology through emergency departments. Social Science and Medicine, 2010.

  New guidelines warn of link between pregnancy complications and heart disease. The American Heart Association’s effectiveness-based guidelines recommend that healthcare professionals who meet women for the first time later in their lives should take a careful and detailed history of pregnancy complications, with focused questions about a history of gestational diabetes, or pre-eclampsia, preterm birth, or having a low birth weight/full-term baby. Circulation, 2011.

 Bridging the gender gap: sex-related differences in the treatment and outcomes of patients with acute coronary syndromes. A Canadian study found that women with acute coronary syndrome are still more likely to be treated conservatively due to underestimation of patient risk, and to have worse in-hospital outcomes. American Heart Journal, 2012.

♥  The sobering fact is that more young women die of heart disease than breast cancer. We remain 35 years behind in understanding female pattern heart disease as well as we understand it in males. Cardiologist Dr. Noel Bairey Merz, Cedars Sinai Heart Institute, 2013.
.

♥  Women fare worse than men after a heart attack, with longer hospital stays and a greater likelihood of dying in the hospital afterward. Journal of the American College of Cardiology, 2014.

♥  Sex bias in referral of women to cardiac rehabilitation: Research suggests that “women are significantly underrepresented in cardiac rehabilitation, programs which are shown to reduce recurrent cardiac events and related premature death.” European Journal of Preventive Cardiology, 2014.

♥  Female cardiologists are rare, and earn less than men. “Women make up over half of medical school classes, yet gender differences in compensation cannot be explained by differences in workplace performance.” Journal of the American College of Cardiology, 2015.

♥  Women’s heart attacks are under-diagnosed and under-treated even when appropriately diagnosed compared to our male counterparts. First ever scientific statement on women and heart attacks in the 92-year history of the American Heart Association, 2016.

♥  Focused cardiovascular care for women: “The public health cost of misdiagnosed or undiagnosed cardiac disease in women is significant.” This study warned that recognition of women who are at high risk of heart disease is not only important in providing appropriate care, but can avoid reflexively blaming women’s symptoms on non-cardiac causes. Mayo Clinic Proceedings, 2016.

♥  Gender Differences in Coronary Heart Disease – U.K. cardiologist Dr. Ramzi Khamis’ comprehensive look at the areas in cardiovascular disease where women are still either under diagnosed, under treated even when appropriately diagnosed, or both – published in the British Medical Journal Heart, 2016.  See image below:

Screen Shot 2016-07-07 at 6.46.33 PM

 

Sex Differences in Young Patients with Acute Myocardial Infarction – Researchers in the U.S. and Spain report that young women (under age 55) with AMI represent a definite, higher-risk population that is different from young male counterparts. This includes a lower quality of life, more co-morbidities, higher clinical risk scores, less likely to undergo revascularization procedures like stents during hospitalization, and more delays in seeking emergency medical help. European Heart Journal: Acute Cardiovascular Care, 2016.

♥  Low income heart attack survivors fare worse, especially women: Women often have lower income and less complete medical coverage than men, and care for multiple generations of family, and that this may in part explain why young poor women have worse outcomes following a heart attack compared with similarly aged men. Journal of the American Heart Association, 2016.

Women fare worse than men after heart attack – Australian researchers found that characteristics of coronary artery plaque varied significantly between the sexes. Plaque in women, for example, was more evenly distributed through the arteries and contained less cholesterol — a major risk factor for heart disease.  Circulation: Cardiovascular Imaging, 2016.

  Gender bias in how female physicians are introduced by their male colleagues at Internal Medicine Grand Rounds (less likely to be addressed as “Doctor” than are men introduced by men). Journal of Women’s Health, 2017.

Women and heart disease: new data reaffirms lack of awareness by women and physicians – While 74% of women reported having at least one risk factor for heart disease, just 16% were told by their doctor that they were at risk. Journal of the American College of Cardiology, 2017.

Women’s hearts are victims of a broken system that is ill-equipped to diagnose, treat and support themDisturbing update from Canada’s Heart and Stroke Foundation’s 2018 Heart Report called Ms. Understood, including: early heart attack signs missed in 78% of women, five times more women die from heart disease than from breast cancer, two-thirds of all heart disease clinical research focuses only on men. February 2018.

Fewer lights and sirens when a female heart patient is in the back of the ambulance – This study found that after calling 911, female heart patients were not only less likely than male counterparts to have flashing lights/sirens turned on in the ambulance, but were also less likely than men to receive recommended treatments (including even the minimal basics such as aspirin or cardiac monitoring). December 2018.

Thank you for all your help and wonderful research my Heart Sister, Carolyn Thomas.

(1) C. Noel Bairey Merz, Holly Andersen, Emily Sprague, Adam Burns, Mark Keida, Mary Norine Walsh, Phyllis Greenberger, Susan Campbell, Irene Pollin, Cassandra McCullough, Nancy Brown, Marjorie Jenkins, Rita Redberg, Paula Johnson, British Robinson. “Knowledge, Attitudes, and Beliefs Regarding Cardiovascular Disease in Women”,