Putting More Heart into Women’s Cardiac Care

Carolyn Yohannes might have known better. Some would say her doctors certainly should have. Overweight and age 60, Carolyn had been treated for type 2 diabetes and high blood pressure for a decade, all of which she knew put her at high risk for a heart attack. Yet when she was struck by sudden fatigue one Friday afternoon in July of 2005, she thought little of it. When she developed a pain in her shoulder and couldn’t sleep, she still didn’t think it was serious enough to call her doctor. The next morning she went to a walk-in clinic, where she was diagnosed as having pneumonia and given antibiotics.

Carolyn’s symptoms persisted, so she went to see her internist the following Monday. During the exam, her heartbeat became wildly irregular. She was rushed to the emergency room, where an angiogram revealed blockages in her coronary arteries and Carolyn was told she had suffered a heart attack. “I didn’t have any of the classic symptoms of a heart attack, like chest pain,” she recalls. “I had not been feeling sick. So it took me completely by surprise.”

Unfortunately, Carolyn’s experience is all too common, says cardiologist Nieca Goldberg, M.D., Associate Professor of Medicine and Medical Director of NYU’s new Women’s Heart Program. Dr. Goldberg launched the program to overcome barriers to effective cardiac care that women like Carolyn too often encounter.

Most studies on cardiovascular disease (CVD) have been conducted among men, fostering the perception that heart disease is a “man’s disease,” says Dr. Goldberg. A 2005 study by the American Heart Association (AHA) found that even only 56 percent of cardiologists correctly identified women as being at high risk when the women had the same risk profile as men; similar numbers of referrals were made by primary care physicians and gynecologists. Physicians were also less likely to recommend preventive treatment for women. Other studies show that cardiologists are twice as likely to refer men for angioplasty or bypass surgery than they are to refer women with the same risk profile.

In fact, more women than men die of CVD—462,000 women annually, 410,000 men. Yet only 17 percent of cardiologists knew this, according to the AHA 2005 study.

“There has been progress in understanding the differences in cardiovascular disease between men and women, but not in treating women,” says Dr. Goldberg. “We need to do better.”

“Many women who come to see me have had previous evaluations, often from multiple specialists, but were told nothing is wrong. They feel their doctors dismiss their symptoms. Well, if ‘nothing is wrong’ why do they still have symptoms?”

Even when a woman does have classic chest pain, it may be attributed to other causes, such as anxiety. What’s more, says Dr. Goldberg, some routine diagnostic tools such as stress tests and angiograms, may not detect signs of coronary disease because of recently recognized anatomical differences. For example, women tend to have more evenly distributed plaques in coronary arteries, which can make them appear clear on an angiogram, and more blockages in smaller blood vessels that cannot be seen on angiography.

Drawing on cutting-edge research, clinicians at the NYU Women’s Heart Program will investigate--and treat--women’s symptoms more aggressively. For example, the complete medical records of women in the program will be accessible by computer, so that a woman with heart-related symptoms and risk factors would immediately be flagged and evaluated appropriately.

The program will also create a network of physicians from other specialties within NYU to deliver more-effective care to the total woman.  Says Dr. Goldberg: “A shared medical records database will make it easier to study the links between CVD and other diseases, such as lupus, that primarily affect women, developing new clinical practice models to improve the entire spectrum of women’s healthcare.”

“Our goal in creating the Women’s Heart Program is to establish a comprehensive, patient-friendly center for the diagnosis and treatment of women at risk of cardiovascular disease,” says Glenn I. Fishman, M.D., Chief of the Division of Cardiology. “Moreover, we hope to integrate the Heart Program into a complete multi-disciplinary Women’s Health Care Network, including patient-care, educational, and research components. This will represent nothing less than a paradigm shift in our approach to women’s healthcare issues at NYU Medical Center.”

Article originally published in News & Views, Fall 2007.