systemic change in how we treat cardiovascular disease is key to addressing care gaps, particularly among female patients, says top cardiologist

lorelei downes’ life took a dramatic turn when she suffered a heart attack at the age of 29. a primary school teacher at the time, she felt ill during a workshop. “i went to the bathroom and saw i was the colour of pavement,” she recalls.   

trained in first aid, downes immediately recognized the signs of a heart attack. however, when she arrived at the emergency department, “they kept asking if i’d had a panic attack like this before.  then i passed out and woke up on a gurney with faces all around me. i was finally admitted for cardiac arrest.”  

an encouraging trend in the health-care system that we are now seeing, since the time downes’ had her heart attack, says dr. beth l. abramson, cardiologist and director of cardiac prevention and women’s cv health at st. michael’s hospital in toronto, is that health-care providers are becoming increasingly aware of the factors putting women at higher risk.   

“cardiovascular disease (cvd) is the leading cause of premature death and disability in canadian women and in women worldwide,” says dr. abramson, associate professor of medicine and the paul albrechtsen professor in cardiac prevention and women’s health at university of toronto. “we all need to take this seriously; women need to make sure they are aware of the risks and are taking steps to mitigate them. ongoing dialogue with health-care providers is essential. being proactive about your health and knowing what questions to ask – even if you don’t know the answers – can help a patient navigate our complex system.”  

“in addition to the commonly known factors, such as high blood pressure or cholesterol, diabetes, smoking, and family history of coronary disease, there are additional sex-specific factors for women, relating to pregnancy and menopause, that may increase risk. there are also unique aspects of women’s cardiac health that are sometimes more difficult to evaluate and diagnose.”   

what’s more, if a patient has already had a first event, their risk of having a second one is even higher, says dr. abramson. “this makes it even more important to recognize signs and have proper follow-up care. this is an issue that requires changes to our existing health-care system.”   

an additional system challenge for women is the tremendous geographic variability in access to health care in canada, says dr. abramson. “regional variation in access can be seen all over the world. women living in remote communities and those women with lower socioeconomic status who may not have the safety net of others, are among those at greater risk. addressing those care gaps is going to take time and a rethink of the system as a whole. while there have been some gains in education and awareness, system change is a very important next step.”  

“when it comes to cardiovascular health, the reality is that disease is largely preventable. but women, who face distinct risk factors at various stages of their lives, are at increased risk,” says helen trifonopoulos, vice-president of cardiovascular health at novartis pharmaceuticals canada inc. “this is an issue that touches everybody who has a woman in their life, so we need to bring attention to it for our friends and family members. at novartis, we’re eager to collaborate with the heart health community to address this challenge, and to hear from women with lived experience as we look to meet the needs of this underserved population.”  

an approach that favours collaboration among health-care system stakeholders and that is focused on secondary prevention will enable equitable access to care and improve outcomes for cvd patients, she adds. “there is an urgent need for action to address the challenges faced by cvd patients that includes input from health-care providers, industry, and community services. women with lived experience should also be included in the dialogue.”  

dr. abramson points to the canadian women’s heart health alliance website as an important resource that engages both health-care providers and women with lived experience to help deal with issues relating to cvd.    

as a woman who has lived through a major heart event, downes has learned the importance of collaboration within the medical community and support groups. she also encourages women to educate themselves as much as they can, so they ask the right questions. “you can’t be shy about learning the signs and symptoms and speaking up.”  

it has been more than 25 years since downes had her heart attack. since then, she has had triple bypass surgery, three defibrillator implants, and attends ongoing physiotherapy and cardiac rehabilitation sessions. she is also on a steady regimen of preventative medications to control her cholesterol and other related issues, and she follows a heart-healthy diet.  

“so far, i have not had a second event. yes, i had a major heart attack that caused significant damage and came out doing okay, thanks to the support of organizations such as the heart & stroke foundation, my cardiologist, and the medical team at st. michael’s hospital who have been tireless advocates for women. bringing the health-care system and people together to approach the issue from a women’s perspective has shown me that the more we are able to connect with each other, the more successful the outcomes.”  

this story was created by content works , postmedia’s commercial content division, on behalf of novartis canada.  

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systemic change in how we treat cardiovascular disease is key to addressing care gaps, particularly among female patients, says top cardiologist

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