By: Jean Johnson for Heart1Aging is hard enough, but being female in a patriarchy makes it doubly difficult – especially when it comes to heart disease.
| Helpful Hints |
Tips for discussing heart disease concerns with your physician:
1. Make notes on your symptoms including the times and situations in which they occur and take this record into your appointment as a basis for discussion.
2. Try to have a family or friend sit in on your physician’s visit. An advocate can be a powerful aid in ensuring that a patient’s concerns are addressed.
3. Know that most insurance companies do pay for second opinions, and that good physicians are not offended.
4. Be informed. Having information on heart disease and various treatment options enables patients to more successfully discuss diagnoses and treatment in the clinical setting.
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Still, older women’s chance of receiving adequate diagnosis and treatment for coronary heart disease (CHD) is on the rise. That’s cause for hope as currently within America’s aging population of females, 500,000 die annually of heart disease. Cardiac disease is the number one threat to women and takes more lives than breast cancer.
Lower socioeconomic status is one of the risk factors in heart disease, and women often find themselves on lower rungs of educational, social, and economic ladders than their male counterparts. This situation aggravates both women’s ability to identify and communicate their symptoms to health care professionals.
In December, Health and Human Services Secretary Tommy Thompson recognized the American Heart Association’s hospital-based Get With The Guidelines with the 2004 Innovation in Prevention Award. The hoopla means that healthcare teams in hospitals will have a more carefully prescribed plan of action in evaluating heart patients and in “closing the gap between what we know in cardiovascular care and the care that is delivered to patients,” said Get With the Guidelines Steering Committee Chair, Gray Ellrodt M.D. The guidelines also zero in on teachable moments after cardiac events, and educate patients on beneficial lifestyle changes.
Older women are a particularly vulnerable part of the population and “should be targeted for a full range of risk-reduction strategies” read a new report by the Journal of American Medical Women’s Association. The report underscores that atypical symptoms women present place an extra burden on healthcare providers, but nonetheless one that if conservative regimes are followed, is within the purview of the medical community.
That said diagnostic testing in females presents problems that inhibit physicians’ best intentions. Not only do women’s smaller coronary arteries respond less favorably than men’s to invasive procedures, accuracy on non-invasive exercise and imaging tests tends to bring mixed results. Thus, the JAMWA report calls for the use of a variety of conservative assessments, including assessing the presence of c-reactive proteins (CRP) associated with the health of artery walls to fully capture the presence of heart disease in females.
Treatment regimes focus on combinations of drug therapy including statins to reduce LDL cholesterol levels, anti-platelet agents like aspirin for inhibiting blood clots, beta-blockers to control high blood pressure, and ACE inhibitors found in a 2000 HOPE (Heart Outcomes Prevention Evaluation) study to lower deaths in high-risk patients with pre-existing vascular disease.
Still, in females generally, predisposing risk factors figure more significantly than they do with men. Thus women with diabetes, high cholesterol and obesity need special consideration. Also, according to the JAMWA report, “cardiac rehabilitation continues to be underused in the United States and women are particularly underrepresented, they benefit from education and rehab more than men do.” Studies also point to widespread depression and anxiety in females with coronary heart disease, but conclude that there is not adequate referral for psychological counseling and support.
