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Dr Stéphane Manzo-Silberman (interventional cardiologist, Department of Cardiology Hôpital Lariboisière APHP)
A Canadian study shows a marked improvement in outcomes for women with heart disease when they step out of a traditional pathway to attend a women’s health center.
Attending a health center dedicated primarily to women could well save the lives of many of them. This is according to a study published in the Canadian Journal of Cardiology this September 7, in which researchers at the University of Medicine in Vancouver report that attending a multidisciplinary center dedicated to women can increase the likelihood of an accurate diagnosis and significantly improve clinical outcomes, especially when it comes to heart disease. An important finding, considering that cardiovascular disease (CVD) continues to be one of the leading causes of hospitalization and death among women.
Better tracking, better suited to female characteristics
To reach this conclusion, the team focused on two pathologies detected more in women than in men, by chest pain: INOCA syndrome, proven myocardial ischemia without obstructive coronary disease, and MINOCA , or myocardial infarction. 154 patients attending the Vancouver Women’s Cardiac Center were followed for one year.
At the start, 64% of INOCA patients and 43% of MINOCA patients had no specific diagnosis in their usual course. Following investigations in the center, 71% of INOCA patients established a new diagnosis or a change in diagnosis (of which the most common was coronary microvascular dysfunction at 68%), while 60% of MINOCA patients established a new diagnosis or a change in diagnosis. At one year, participants had significantly decreased chest pain, improved quality of life, and improved mental health.
Underdiagnosed heart disease in women
Why was follow-up more effective in a women’s center? The reason is not based on the medical abilities of the different doctors, but rather on an overly gendered approach to cardiac medicine.
“Most heart health studies consist primarily of male participants, and therefore many clinical outcomes such as patient symptoms and treatments may not apply to women with certain types of heart disease,” explained lead researcher Tara L. Sedlak, author of the study. Thus, the study suggests, many women with cardiac chest pain and ischemia or heart attack do not have significant blockages in their large coronary arteries, but may have narrowing or dysfunction of their small coronary vessels or spasms of their blood vessels, which may be missed during the initial diagnosis.
Consult a cardiologist online
Should we move towards a more gendered cardiac medicine?
For Dr Stéphane Manzo-Silberman, cardiologist at Pitié-Salpêtrière consulted on the subject, it is indeed urgent to communicate better on the cardiac particularities concerning women, whether this concerns risk factors, clinical presentations, as well as the need for further explorations than a simple coronary angiography. “A more advanced algorithm and additional examinations (cardiac imaging, specific tests) are now necessary to obtain appropriate treatment and improve the lives of its patients” she confirms.
However, it is not useful to refer different care centers back to back:
“The important thing is not to compartmentalize the advances, but to understand the differences that exist between men and women to improve the care of each. But in order to be able to understand, it is necessary to specifically study cardiac damage in women. This can initially take place in these dedicated centers, to obtain specific training and more advanced explorations, but ideally there should be no inequality in the territory,” she confides. .