Dawn Weinberger, Freelance Writer

Delays, misdiagnoses beset women with heart disease

By Dawn Weinberger

In 1984, the American Heart Association had this advice for women: Make sure your man's diet is heart-healthy.

"They had a dietary brochure for women that said ... how to feed your man," said Dr. Suzanne Hall, of Providence Health System, explaining that at the time heart attacks and health problems linked to them were largely perceived as a problem among the male population (and, until the mid-'90s, many heart-related medical studies looked at men only).

Cardiologists and the AHA now know otherwise. In 2002 alone, cardiovascular disease -- which includes coronary heart disease, heart failure and stroke -- claimed the lives of nearly 500,000 women in the United States, about half of which were specifically the result of coronary heart disease, meaning cholesterol buildup and artery blockage. This makes cardiovascular disease the No. 1 cause of death among women, with more victims than the next seven leading causes of death combined, including certain types of cancer.

Comparatively, about 433,000 American men died of cardiovascular disease that same year.

And while those numbers might give the impression that cardiovascular disease, especially coronary heart disease, strikes women slightly more often, the reality is more women die because they don't recognize symptoms, don't seek treatment swiftly or are misdiagnosed. Also, the onset is often later in life (mid-60s for women, mid-50s for men) and sometimes women experience different symptoms than men.

Furthermore, some physicians lack specific knowledge about women and heart disease, said Hall, medical director for the women's cardiovascular program within the Providence Heart and Vascular Institute. It wasn't until 2003 that the AHA published science-based guidelines for the prevention and treatment of heart disease in women.

Anne Rosenfeld, an associate professor in the school of nursing at Oregon Health & Science University and spokesperson for the Pacific Mountain Affiliate of the AHA, said there is an effort under way to change all this. One aspect of this effort, known as the Go Red For Women campaign, involves spreading the word by encouraging people to wear red pins.

"We need to get the message out to health care providers," said Rosenfeld, adding that primary care physicians need more education on women and heart disease.

Many doctors, Rosenfeld said, mistakenly send women home with diagnosis of acid reflux or anxiety when what they really need is a referral to a cardiologist or emergency medical intervention. And that is only when women actually see a physician. Often, symptoms are ignored -- for weeks, months, even years -- until it is too late. Symptoms like nausea, fatigue, abdominal discomfort, weakness and confusion.

"Or, they may just have a sense of impending doom, like something isn't quite right," Hall said.

Men, on the other hand, are more likely to have the so-called "Hollywood heart attack," with symptoms like pressure, burning and sweating coupled with sudden and severe chest pain (though less common, women can and do experience this as well).

The seemingly less-urgent warning signs women typically experience could very well be indicators of a relatively minor problem, but they also could be symptoms of a heart attack. And because they wait too long to get to the hospital, they are putting themselves at an ever greater risk.

"They wait about 30 to 60 minutes longer [than men], which is an important time frame. The longer you wait, the less likely you are to be alive in two years," said Rosenfeld, who conducted interviews with female victims of coronary heart disease with the intent of finding out why they tend to delay medical care.

"We wanted to know what they were thinking and doing during that time period," she said.

Her findings indicate that aside from those who do get to the hospital right away, women fall into one of several categories: those who assume the problem is something else and will correct itself, those who know right away that something is wrong but fail to act on it, those who wait to go until it is convenient, those who let other people (like husbands or children) take over and make decisions for them and finally, those who let symptoms fester overnight or all weekend because they don't want to bother anyone.

And women in all categories had one thing in common: their predisposition toward putting everyone else's needs before their own.

"When everyone in the house is sick, who gets up to take care of [the family]? It's mom," Rosenfeld said.

Through her involvement with the AHA's Go Red campaign, along with presentations and seminars around the Northwest, Rosenfeld is working hard to spread the word to women about heart, disease, their risk, and what they can and should do about it.

"We are trying to change women's future behavior," she said.

And this isn't limited to teaching women what to do after heart disease strikes -- it all starts with prevention. "It is basically trying to eat healthy, exercise, keep your weight down and if you have any of the risk factors (high cholesterol, diabetes, obesity, family history, smoking), treat them. Don't let them go," Hall said.

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