Typical for Whom? Assessing the Data

Joe Cantlupe, for HealthLeaders Media , June 13, 2011
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Hospital systems are working to improve cardiac care for women by focusing on the gender differences between men and women, where there has been a traditional disparity of care, according to C. Jennifer Dankle, DO, cardiovascular specialist who supervises the University of Minnesota Physicians Heart at Fairview Southdale Hospital’s women’s clinic.

“Most women who died from heart attacks never had chest pains in the manner in which men often report chest pains prior to a heart attack,” Dankle says. “The idea is to raise awareness among hospital staff as well as patients themselves that the presentation for a possible heart condition is different for men and women.”

Dankle says hospitals are coordinating more programs for primary care physicians especially about the women’s symptoms related to heart disease.

One of the problems in addressing women’s cardiac care is the relatively small number of women included in clinical trials about cardiac disease, with much of the research focusing on men, according to Mary Anne Graf, vice president of women and children’s services at Bon Secours Virginia Health System.

“Basically, the National Institutes of Health really didn’t recognize men as genetically different until the last decade,” Graf says. At one point, men’s symptoms were described within the system as “typical” symptoms of a heart attack, while women’s were characterized
as “atypical,” she says. “Women were labeled atypical
by default.”

Women are “very underutilized right now [in studies], with just a fraction of women in the research trials that are going on in cardiology,” Dankle says. “That needs to improve. With the data coming out over the last five to 10 years, there’s definitely a different vascular disease with men and women, and we are underestimating the importance of stress and hormones. We are going to see the evolving of more recognized risk factors with women developing cardiovascular disease.”

“Uncertainty in diagnosis of a female’s symptoms may require the assistance of a provider who specializes in women’s cardiology,” Dankle says. “It may be a future direction of healthcare to provide such a hospital-based service. However, I believe the downside to that may be that primary health care providers will not know whom to refer and may not receive experience or training in how to deal with women’s heart-related symptoms.”            

Joe Cantlupe is a senior editor with HealthLeaders Media Online.

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