Delayed diagnosis and treatment of cardiovascular disease in women, unfortunately still an issue

Cardiovascular disease has become the leading cause of death among women worldwide, yet it remains under-studied, under-recognized, under-diagnosed and under-treated.

Evidenced facts
In 2021, a major medical journal (The Lancet) published a paper describing the state of women's cardiovascular health. It summarizes existing evidence, identifies gaps in knowledge and makes recommendations with the aim of reducing the global burden of cardiovascular disease in women.
This evidence is long-standing, but while attempts have been made to address some of these concerns, reality and experience in the field show that things remain largely unchanged.

A European forum
The European Society of Cardiology (ESC) has a patient forum which recently set up a working group on cardiovascular disease in women, two of whose members, after an initial action on International Women's Day, March 8, to raise awareness via social networks, have just published an editorial calling for action (1).

For all these pathologies, the women members of the forum too often feel that their gender leads to delays in diagnosis and treatment, resulting in frustration among patients and their families.
While medical literature has come a long way in taking women's particularities into account, there seems to be no noticeable change in the field.

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There are also some quite appalling testimonials...
These range from the doctor who did not see fit to hospitalize a patient suggesting that she was having an anxiety attack and could "stay at home" when this spokeswoman for the working group actually had coronary artery disease with an arterial dissection fortunately diagnosed in the aftermath, to a teenager, whose family doctor repeatedly said that her constant exhaustion was linked to puberty which explained her abnormally rapid heart rate, blamed on nervousness or anxiety. For years, she suffered from almost permanent tachycardia before finally consulting a specialist and being correctly diagnosed and treated.

Patients themselves are accustomed to hearing such stories of misdiagnosis or delayed cardiovascular diagnosis and minimization of symptoms when they were in fact having a heart attack, being told that they were simply anxious, and some find it increasingly difficult to control their emotions in the face of misdiagnosis, be it anger, frustration, disappointment or the feeling of being neglected.

Concordant statistics
It's worth noting that the statistics prove that these patients' experiences are sadly accurate, and these statistics represent just the "tip of the iceberg" of gender disparities in healthcare systems, and sadly highlight the shortcomings of care pathways from GP surgeries to emergency departments.

Having cast aspersions on the medical profession, it's worth noting that some doctors, most of whom are... women, are doing a great deal to raise awareness and take action in this area.

Social and cultural explanations.
However, the medical profession is not the only one at fault, and women themselves are slow to seek treatment, not understanding the urgency of preventing and acting on heart problems.
One of the group's explanations is that women still play the central role in family life. They often have to juggle a multitude of tasks in their working lives and shoulder the burden of domestic responsibilities, leaving them little time to reflect on their own health and well-being needs.
What's more, "culturally, women have been conditioned to be 'good girls', not to disturb or make a fuss!"

A call to action
There are many possible levels of intervention, and each needs to be addressed, from public health messages to health education, from training doctors to funding research.
When asked about possible solutions and measures to be taken, one of the members of the working group said: "Better knowledge builds confidence and increases awareness of heart health. Women are less likely to be 'fooled' or fear 'upsetting' their healthcare provider if they have more information from a reliable source about their condition."
"To help combat this and other injustices, we need better education to identify cardiovascular disease in women, educational programs for doctors, scientists, allied health professionals and in our communities."
May she be heard...

And in France ?
Agir pour le Cœur des Femmes is there with identical testimonials accessible on its website "www.agir pour le cœur des femmes.com", and has been committed to the prevention of women's cardiovascular disease around its three flagship missions: Alert, Anticipate and Act for almost 5 years.
The results are starting to make themselves felt, with a National Observatory on Women's Health enabling analysis of over 12,000 women screened to date on the Heart Bus and on Women's Heart Day, numerous conferences for the general public, numerous publications in the general press and the Agir health networks;
And most recently, the Assurance Maladie is planning to offer a cardiovascular risk assessment at menopause. This already represents significant progress.
Let's hope that, once the necessary awareness has been raised, we can finally reverse the epidemic of cardiovascular disease affecting women in France!

Reference:
1 : Galbraith M., Drossart I. : Disparity in diagnosis and treatment of cardiovascular disease in women: a call to joint action from the European Society of Cardiology Patient Forum.
European Heart Journal. Volume 45, Issue 2, 2024, 79-80.