Women and heart disease forum

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Heart Foundation staff and Happy Heart mascot
Julie Anne Mitchell, Sophie Scott and A/Prof Lynne Pressley
Julie Anne Mitchell, National Heart Foundation Spokesperson on Women’s Heart Health, writes on her reflections following the inaugural women and heart disease forum in Sydney on the 14th June.

For over 10 years the Heart Foundation has championed a program to raise women’s awareness of heart disease, but it’s been a hard slog. We know that most women fear breast cancer and that heart disease is often categorised as a male only concern.

At our recent women and heart disease forum however, it felt different.  The interest shown in the issue by those present was uplifting and generated hope.

Heart disease in women is complex.  Women are physically and hormonally different to men in various ways and this creates a unique set of challenges which in the past have largely been ignored.  This has, to a large extent, rendered women virtually invisible when it comes to heart disease and we now need to right this wrong.

A large part of the problem rests with female under representation in clinical trials that are used to determine the best way to diagnose and treat heart conditions.  Historically much of the evidence has been based on data from men and then extrapolated to women.  This has obscured differences and has characterised the male heart disease pattern of crushing chest pain and large coronary artery blockages as the default image of what heart disease looks and feels like.

Of course, there are various reasons while female participation in clinical trials has been traditionally lower, these include age, pregnancy, child bearing, the presence of other conditions or just simply not having the time to participate.  However, this disparity in women is borne out by the fact that less than four in 10 see heart disease as personally relevant. More women are likely to ring a friend or family member than call Triple Zero if they think they are having a heart attack. Health professionals can also be slower in diagnosing heart problems in women.  Even after hospital discharge, women are less likely to attend cardiac rehab, take medication as prescribed, or make lifestyle changes needed as they prioritise the needs of their family and others over themselves.

The path for action is clear.  Firstly, we need to achieve more female representation in clinical trials to understand the subtle but significant gender differences that exist in heart disease.  Secondly, we need to draw on other disciplines of medicine. This will improve gaps in knowledge, particularly in the fields of obstetrics, oncology, endocrinology, midwifery, general practice and research.  Thirdly, we need more dedicated investment in gender specific research.  We have seen the benefits that this focus has had on survival rates for breast cancer and we are confident that similar insights could be applied to benefit heart health outcomes for women.  Fourthly, we need to recognise that gender disparity in heart disease is not only a health concern but also a social and economic concern with rates higher among Aboriginal, rural and lower SES women.

Which brings me to an explanation of why I feel positive.  For the first time, we brought together 170 of the country’s leaders in cardiology, obstetrics, emergency medicine, oncology and public health to address gender disparities in heart disease from a multi-disciplinary perspective.  Over the course of the day, case studies were presented and debated from a range of viewpoints.  The global and local nature of heart disease in women was described.  Attention was paid to the vascular complications of gestational diabetes and hypertension in pregnancy and how this can be a clarion call for heart disease risk later in life.  Focus was paid to the cardiotoxic nature of some breast cancer treatments and how this can increase heart failure risk.  Health system improvements were debated and workforce issues were discussed.  We also heard of community initiatives to raise awareness of heart disease amongst rural women, Aboriginal women, female refugees and migrant women who fight social, physical and cultural isolation in many aspects of their lives. This in turn impacts on their heart health.

The day was stimulating, challenging, and ultimately energising. Connections were made, ideas shared and enthusiasm for working more closely together was freely expressed. Collectively attendees express their views on what priorities needed to be pursued and the five key actions arising are described below:

PRIORITY FOCUS

ELEMENTS

1. Awareness Raising

Commonwealth funding for a National awareness campaign about heart disease in women

2. Health System Change

Sustainable prevention and management programs that support improved heart health outcomes for women

3. Research

Greater investment in gender specific cardiovascular research and definitive studies into gender specific cardiovascular disease risk

4. Clinical Guidelines

Commitment that future CVD guidelines specifically address gender related issues e.g. documentation of pregnancy complications to become a routine part of a female heart health check

5. Health Professionals

Review of relevant undergraduate and post-graduate education & training for medical, and nursing students to include gender related CVD issues in the curriculum.

In holding this inaugural event it feels like something has fundamentally shifted.

A repeat conference two years from now will be the true measure of whether this instinct is a false dawn or a sign of something greater. However, with the amount of feedback and engagement we have received since the forum, I am optimistic that this issue is moving from the shadows into the light.

Our mascot Happy Heart with Angela Hehir, Sophie Scott, Prof Chris Semsarian, Prof Gemma Figtree, Julie Anne Mitchell, Prof Garry Jennings, A/Prof Lynne Pressley and Prof Elizabeth Sullivan.

To learn more about women and heart disease visit the Making The Invisible Visible website. 

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