Article

3-minute case study: Preventing heart attacks in women

By Katherine J. Igoe | February 12, 2020

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Across the athenahealth network and beyond, healthcare organizations are designing and implementing simple interventions with outsized impact on outcomes, satisfaction, and success. Here's another. 

The problem 

It’s known in the medical field that the presentation of heart disease in women can differ from that in men, and can differ from what the public might expect as “typical” symptoms such as chest pain. Atypical symptoms like neck pain, shortness of breath, jaw pain, arm pain, and weakness are more prevalent in women than men. And EKG response to exercise isn’t as reliable for diagnosing heart disease in women.  

Women may also have risk factors for heart disease that men don’t, such as gestational diabetes and pregnancy-associated high blood pressure. Some conditions more common in women can increase heart disease, such as breast cancer treatment that involves radiation to the heart. Certain conditions, like spontaneous coronary artery dissection and stress-induced cardiomyopathy, seem to be more prevalent in women.  

The Women’s Heart Center at Tufts Medical Center in Boston has a specialized interest in women and how heart disease can be unique to them. According to current director Ayan Patel, M.D., “The purpose is to provide care focused on these unique aspects and provide expertise in diagnosing and treatment — particularly those [patients] that present differently.” 

The solution 

The center sees a fair amount of patients who are seeking expert care for a variety of reasons: from symptoms that healthcare professionals haven’t been able to diagnose through more traditional means of testing, to control of existing symptoms, to the management of risk factors and prevention. By and large, patients are interested in getting and staying healthy, but sometimes don’t have accurate or up-to-date information for their conditions. The center can provide the specialized care they seek.  

Physicians may also refer high-risk patients; the center works with primary care physicians on treatment, testing, and education. The center can help identify best diagnostic tests or treatment for female patients, especially when newer testing modalities might be available. Patel remembers a particular patient whose stress test had come back negative, but for whom a recommended CT scan that measured blood flow detected a narrowing in her coronary artery. The patient required a stent — and it resolved her symptoms.  

The outcome

By and large, the women treated at the center say they feel reassured by the focus on patients like themselves and the ability to be heard and taken seriously. Despite improvements, though, there’s still work to be done to educate female patients and their providers. Cardiovascular disease is the leading cause of death of American women. A 2011 survey asking women about how they perceive heart disease, however, saw that only 53% of women surveyed would call the hospital if they felt themselves experiencing a heart attack.  

“There are also wide ranges in terms of age-adjusted death rates across different states around the country. There’s work to be done in terms of education and access to healthcare,” says Patel.  

Long-term, the center’s goal is to continue to provide expert care to women seeking consultation, participate in the education of patients and physicians, and collaborate with research colleagues to understand women and vascular health.