2022 : Act rather than suffer

Economic or social vulnerability both hinders prevention and accelerates the onset of disease!

Reflecting the cardiovascular and gynecological health status of women in vulnerable situations in French cities, this unique study was carried out on a panel of 1,065 women aged between 15 and 90 (average age 52).

First red light: women at high cardiovascular, metabolic and gynecological risk!

This study highlights the fact that hypertension remains largely under-diagnosed and under-treated in this population, and confirms the findings of the ESTEBAN study (Santé publique France. Health study on the environment, biomonitoring, physical activity and nutrition (Esteban) 2014-2016. Bulletin Epidémiologique Hebdomadaire, April 24, 2018 n°10).

A total of 43% of women in the Women's Heart Bus study have uncontrolled hypertension, above 140/90. More than a third of women discover it during screening. Among women already being treated for the condition, 72% are not controlled, highlighting a serious deficit in terms of management. Nearly one woman in 5 has severe grade 2 or 3 hypertension, a critical risk factor for cardiovascular events. Yet measuring blood pressure is a key step in cardiovascular prevention for women in the three key hormonal phases of their lives (contraception - pregnancy - menopause).

The pandemic, with its confinements, has had a severe impact on this vulnerable population, with 68% of women overweight or obese. A further 73% are abdominally obese (abdominal circumference > or = 88 cm), which may be present despite a normal body mass index (BMI= weight/height 2). This is higher than the national average (http://beh.santepubliquefrance.fr/beh/2016/35-36).

Another consequence of this vulnerability aggravated by Covid, 67% of women report feeling in a state of stress, 26% have a depressive syndrome, major risk factors for cardiovascular accident (J Am Heart Assoc. 2014).

Among young women taking contraception with synthetic estrogen, 76% have at least one contraindication to their prescription: age > 35 years, BMI > 30 kg/m², active smoking. Contraception should not kill, but protect against unwanted pregnancy. (www.sfhta.eu/recommandations/ HTA, Hormones and women. 2018).

While 90% of women have at least 2 cardiovascular risk factors, 43% have at least 2 gyneco-obstetrical risk factors and 2 cardiovascular risk factors.

Second red light: vulnerable women at high cardiovascular and/or gynecological risk, yet inadequately cared for!

In the population of women screened, 11% no longer have a GP.
70% of women with at least 2 cardiovascular risk factors are not followed by a cardiologist and/or vascular physician.
31% of women have not had a gynaecological consultation in the last 3 years.
22% of women are not up to date with their mammograms, which are more than 2 years old.

The COVID pandemic has indeed accelerated the onset of cardiovascular disease, delaying diagnosis and accentuating the vulnerability of these women, 81% of whom are more concerned about the health of their loved ones. This trend is reflected in medical reality: 70% of them will postpone care scheduled for them (Elabe study for AXA Prévention 2021).

But also... green lights that should encourage preventive medicine!

99% were very satisfied with their time on the Bus, understanding the prevention messages, becoming aware of the importance of their health and thus will talk about the importance of screening to those around them. Screened and vulnerable, they become relays, formidable hummingbirds of active and offensive prevention to save other lives in their turn.

What can we learn from the Women's Heart Bus study?
Intersecting views from the 2 co-founders,
Pr Claire Mounier-Véhier & Thierry Drilhon

As of today, it is urgent to continue these large-scale awareness-raising, prevention, screening and educational actions in a benevolent manner.

"When we know that in women, classic risk factors such as weight, high blood pressure, cholesterol, smoking and stress have a more deleterious impact on their arteries, we understand the urgency of developing these screening campaigns, as a priority towards women in vulnerable situations, for whom all the figures are in the red (report by the Haut Conseil à l'Egalité Hommes-Femmes 2017). Saving a life means screening for at least one cardiovascular or gynecological risk factor, and thus preventing a woman from suffering a sometimes fatal, yet avoidable, complication.
But staying in one city for three days a year is obviously not enough. That's why screening is carried out by local health professionals at each stage of the Women's Heart Bus, in partnership with the social services of the towns that pre-register the women. At the end of the screening, these women are put back on a health pathway, with appointments scheduled for them. The Caisse Primaire d'Assurance Maladie, which is contacted in each town, helps to update women's rights and find them a GP if necessary.
We're creating a virtuous ecosystem around cardiovascular and gynecological health. Together, local healthcare professionals, both liberal and hospital-based, are building cardio-vascular and gynaecological care pathways, while waiting for the bus to return the following year! Our ambition is not to offer a one-off screening, but to encourage long-term, adapted care with a recurring approach."
Claire Mounier Vehier, co-founder of Agir pour le Cœur des Femmes, cardiologist at Lille University Hospital and Professor of Vascular Medicine at Lille University.

"The results of this study are far more alarming than we had anticipated. We estimate that we saved the lives of over 900 women, since 90% of the women screened had at least two cardiovascular risk factors. The Women's Heart Bus provided these women with the keys to a better understanding of their health, as well as concrete tools: integration into a care pathway when necessary, provision of an automatic blood pressure monitor, and education on self-measurement to develop self-monitoring. Another key criterion for success: 99% of the women were "satisfied and very satisfied" with their experience on the bus, and will talk to their friends and family about the importance of getting tested. On the strength of this 1st edition, our ambition is to accelerate our action from 2022, covering 20 cities, and to extend this operation until 2025. The success of our action relies on the strong involvement of cities, the expertise of local healthcare professionals and the associative ecosystem.
This collective action restores meaning, links, positive listening and benevolence after the complicated period of COVID, which weakened us all. Thierry Drilhon, co-founder of Agir pour le Cœur des Femmes, board member and company director, President of the Franco British Chamber.

A 2022 tour in 20 cities from March 9,
to screen at least 4,000 vulnerable women.

The Women's Heart Bus boasts ambitious development goals. The 2022 tour will be launched on March 9 in Cannes. In addition to screening, the aim is to facilitate cardio-gynecological follow-up for these women within an ecosystem of local healthcare professionals trained in the specificities of cardiovascular disease in women.