Women’s Health and Cardiac Care: A Call to Action for Healthcare Providers

Healthcare providers are dedicated to delivering equitable and effective care to all patients. However, historical biases and gaps in medical research have led to disparities in how we diagnose and treat diseases across different groups. Healthcare equity is a broad concept that encompasses not only sex differences but also racial, ethnic, and age-related disparities in care offered.

These disparities are particularly pronounced in cardiovascular medicine. Women often present with different symptoms of heart disease than men, which can result in misdiagnosis or delayed treatment. According to the WHO, cardiovascular diseases (CVDs) are the leading cause of death globally, accounting for one in three female deaths each year¹.

Yet, women are 50% more likely than men to receive an incorrect initial diagnosis following myocardial infarction². These staggering statistics underscore the critical need to address sex disparities in cardiovascular care with urgency and commitment.

As we continue to celebrate Women’s Health Month, this article explores the history of sex disparities in medicine, highlighting the specific challenges in cardiovascular care for women, and the role that innovative solutions like artificial intelligence can play in bridging these gaps. Moreover, it offers actionable steps that healthcare providers can take to improve outcomes for their female patients.

Dark History of Sex Disparities in Medicine

The disparity in cardiovascular care for women has been well-documented in the medical literature, revealing a longstanding sex bias influencing research, diagnosis, and treatment protocols. Historically, medical research has predominantly focused on male subjects, often excluding women from clinical trials³. This sex bias has led to a lack of understanding of how diseases manifest differently in men and women.

The classic symptoms of Acute Coronary Syndrome (ACS), such as chest pain radiating to the left arm, are based on studies conducted predominantly on men. Women, however, often experience subtler symptoms such as fatigue, nausea, and shortness of breath, which are easily misattributed to less serious conditions⁴.

Women May Experience ACS Differently

Women are more likely than men to present with atypical symptoms, leading to diagnostic challenges and delays in treatment⁵. For example, while men typically present with crushing chest pain during ACS, women may experience more atypical symptoms apart from chest pain such as:

• Fatigue: Feeling of an overwhelming sense of fatigue that is not relieved by rest.
• Dyspnoe: Experiencing shortness of breath, difficulty breathing or feel out of breath with minimal exertion.
• Nausea or Vomiting: Gastrointestinal symptoms such as nausea, vomiting, or indigestion are more commonly observed in women during ACS.
• Back or Jaw Pain: Pain can radiate to the back or jaw rather than the chest, leading to misinterpretation as musculoskeletal or dental issues.
• Dizziness or Lightheadedness: Feel dizzy or lightheaded, which can be mistakenly attributed to less serious conditions like dehydration or vertigo.
• Anxiety or Unusual Weakness: Feelings of anxiety or an unexplained sense of weakness can precede ACS.

This clinical ambiguity highlights the need for heightened awareness and education among healthcare providers to recognize and respond to these non-classical presentations in women⁵.

It goes on

Biological Differences

Hormonal differences play a crucial role in how CVD manifest and progress in women compared to men. Estrogen, which has protective cardiovascular effects, significantly influences these differences, particularly during peri-menopause. Estrogen contributes to maintaining the vascular elasticity, improving blood flow, and reducing the likelihood of atherosclerosis. However, as women approach menopause and estrogen levels decline, their risk of developing CVD increases significantly⁶.

In addition to hormonal influences, women tend to have smaller coronary arteries than men, which can affect the presentation and detection of CVD. Smaller arteries are more challenging to visualize and treat during procedures such as coronary angiography and stenting. This anatomical difference can contribute to the underdiagnosis and undertreatment of ACS in women⁵.

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Diagnostic Bias

Diagnostic bias significantly contributes to sex disparities in healthcare, often affecting clinical decision-making processes and resulting in women receiving less prompt and aggressive treatment compared to men⁷. 

Studies have consistently shown that women experiencing ACS are less likely to receive evidence-based treatments and critical procedures¹². For instance, women are less likely to be prescribed life-saving medications such as lipid-modifying agents, antiplatelet agents and ACE-inhibitors, and they are also less likely to undergo interventions such as angiography, angioplasty, and coronary artery bypass surgery ^8,9,10,14.

Healthcare providers may unconsciously prioritize male patients for advanced diagnostic procedures and treatments, partly due to the traditional presentation of ACS symptoms that are more common in men. 

There is a tendency to underestimate the severity of cardiovascular symptoms in women, leading to delays in seeking care and subsequent treatment. This delay can have grave consequences, as timely intervention is critical in improving outcomes for ACS patients^{8,13,14,15,16}. Addressing this diagnostic bias requires ongoing education and awareness to recognize and respond to the unique presentation in women⁵.

Despite this awareness, progress in addressing these disparities has been slow. 

What Can We Do About It?

To effectively address the sex disparities, it is essential to implement targeted strategies that provide women with the same quality and timeliness of care as men. Current research shows that women often experience longer “ECG-to-balloon” (E2B) and “door-to-balloon” (D2B) times compared to men, leading to delayed treatment and poorer outcomes¹¹. For instance, women experiencing ACS may wait significantly longer for angiography and reperfusion therapy, which can be detrimental to their prognosis¹¹.

Here are several steps you can take to help bridge this gap and improve care for female patients:

• Review Hospital Data: Analyze your hospital’s data to identify any sex disparities in treatment times and outcomes. Are women waiting longer for critical interventions at your institution? Identifying and understanding these gaps can help you target specific areas for enhancement.

• Educate Staff: Ensure that all healthcare providers in your facility are educated about the different ways ACS can present in women. This includes recognizing atypical symptoms such as fatigue, nausea, back pain, and shortness of breath, which are often overlooked or misattributed to less serious conditions. Emphasize the importance of early intervention and the unique risk factors women face. Regular training and updates on the latest research and guidelines can help keep staff informed and prepared.

• Advocate for Research: Support and participate in research studies that focus on understanding sex differences in CVD. Advocate for the inclusion of more women in clinical trials to guarantee that research findings are applicable to females too.

• Stay Informed: Keep yourself and your team updated on the latest research and guidelines on sex differences in cardiovascular care. Stay on top of the American Heart Association’s guidelines on heart disease in women and other articles that discuss the unique challenges they face in cardiovascular health¹². Continuous learning will help you apply the most current and effective practices in your clinical setting.

• Implement Latest Technologies: Integrate new diagnostic innovations into routine practice. The adoption of AI tools such as PMcardio can significantly reduce diagnostic delays and improve overall health outcomes, making it an essential strategy for any institution committed to healthcare equity. It is not swayed by stereotypes or historical biases, meaning it can provide objective assessments. This makes AI an indispensable tool in reducing disparities and advancing equitable healthcare practices.

• Promote Awareness: Increase awareness among your female patients about the unique risks and symptoms they might face. Encourage women to seek medical attention promptly if they experience symptoms, and educate them on the importance of not dismissing subtle signs of heart disease. Providing educational materials and hosting informational sessions within your community can help empower women to advocate for their health.

Actively closing the gap

Artificial intelligence holds significant potential in addressing disparities in healthcare by eliminating the biases that influence human decision-making. Tools like PMcardio can significantly improve the timely diagnosis of cardiac diseases by analyzing complex ECG patterns that human practitioners might miss. Importantly, PMcardio algorithms focus solely on the waveform itself, without being influenced by the patient’s age, sex or race, thereby providing unbiased and objective assessments. This ensures that high-risk patients are identified and treated promptly, regardless of demographic factors.¹⁷

The continuous learning capabilities of AI systems mean that they can adapt and improve over time as more data becomes available, further refining their diagnostic accuracy and effectiveness. This adaptability is vital in creating a more equitable healthcare environment where all patients receive timely and appropriate care. Implementing AI in clinical practice is a significant step towards bridging the diagnostic equity gap, ultimately leading to better health outcomes.

At Powerful Medical, we are actively conducting research into bias in diagnostic processes, focusing not only on sex bias but also on racial and ethnic biases, and working towards developing AI solutions that secure equitable care for all patients. Our commitment to this cause underscores the potential of technology to transform healthcare and reduce disparities.

Conclusion

Addressing sex disparities in cardiovascular care is an urgent and ongoing challenge. By understanding the unique ways that heart disease manifests in women and by implementing targeted strategies, healthcare providers can make significant strides in improving outcomes for female patients.

By leveraging the power of innovative technologies and a renewed focus on sex-specific healthcare, we can work towards a future where health outcomes are no longer influenced by sex. Through concerted efforts in education, research, and the implementation of unbiased diagnostic tools, we can ensure that women receive the equitable care they deserve.

Feeling Activated and Willing to Go Beyond? Please do!

With our innovative technologies and dedicated efforts, we are making strides toward true diagnostic equity through innovation.  Contact our team at omi@powerfulmedical.com for guidance on how to effectively review and interpret your data to uncover valuable insights or if you would like to learn more about how AI can improve cardiovascular care for women at your institution.