Revise the Story of Missed Opportunities: A Call for Actions Needed Now

The scientific statement on preventing and experiencing ischemic heart disease as a woman is a timely reminder that we have come a long way in the recognition, identification and treatment of ischemic heart disease (IHD) in women.¹ However, the abundant gaps in knowledge and disparities of women relative to men, and minority women, especially Black women, relative to white women, in the burden of disease and risks for disease are flagrant reminders that much work remains. The continued increase in deaths of younger women from IHD² signals that all is not well. We have more to learn, much to do, and a long, long way to go to advance the science underlying the care of women with IHD and to stimulate the public awareness necessary to act to prevent the morbidity and untimely deaths of women with heart disease.

A Call to Action

The statement summarizes the state of the science across many important domains and shores up the knowledge in the field in such a way that scientists and practitioners alike should be able to hear an alarm sounded and a call to action within its text. It is a call to attention; it is a call for actions needed now.

The pages of the new scientific statement are filled line after line with data pointing to the disparities in disease burden and care of women relative to men. Although it is concluded that women experience ischemic heart disease differently than men experience the disease, this is not an ample excuse for the disparities, but rather it is a call to action to continue research to understand sex and gender specific mechanisms and symptoms and to develop interventions to address them. The evidence related to the low degree of public and professional awareness calls for community and professional education programs in this area to heighten awareness of the public and health professionals so that women can receive more timely care and cut delay in women’s receipt of care for acute cardiac events.

Room for Improvement—Need for Transformation

As documented in the statement, findings of research programs having interventions designed to decrease delay in the receipt of care for acute coronary heart disease have not reduced delay---results that have been disappointing.^3,4 New strategies are desperately needed to improve awareness of risks for the disease and to provide accurate information to women about their risks for IHD. In view of the evidence, nothing short of a transformation in the way we think about the disparities and way we go about science, practice and social policy to address these disparities is needed.

It is encouraging to note that an estimated 80% of premature heart disease and stroke is preventable.⁵ In these data, we can hold hope for dramatic decreases in morbidity and mortality through research, education, healthcare practice, and policy changes that aggressively address the social and behavioral determinants of disease. The responsibility to respond to this scientific statement does not rest on a single person or group; it rests on all of us, and on our society.

Embedded in the scientific statement is our roadmap. The work to reduce or eliminate disparities must begin with attention to the risks of females at an early age; it must be present across the continuum of women’s care; and it must continue across the lifespan.⁶ Throughout adulthood, practitioners need to be alert to and treat risks for IHD early; practitioners need to be aware of potentially atypical presentations of the disease in women and address; they need to not underestimate the risk, but to manage the disease with vigilance to prevent its progression. Women themselves need to have an accurate perception of risk and coached to take action to reduce risks with the aid of such programs as AHA’s Life’s Simple 7.⁷ Social and political actions can be taken to provide: healthy, affordable nutrition; community structures, spaces and programs that foster physical activity; social media to promote public awareness; sufficient funding of programs that offer ready access to healthcare; and education for primary care providers, including women’s health care providers to ensure that they are made aware and are well prepared to care for women to prevent and manage IHD.^6,8 When primordial and preventive care fail, women must know their risks and how to take action to seek treatment in more timely ways. Healthcare must be available to aggressively treat and provide optimal care such as through adherence to programs such as AHA’s Get with the Guidelines.9 In the aftermath of cardiac events, care must be taken to ensure that more women receive rehabilitative care.¹⁰ It is clear that more funding is needed to support programs of investigation that can elucidate mechanisms responsible for development of disease and factors responsible for the disparities in incidence, treatment and outcomes of IHD.¹¹

Instead of a story of missed opportunity to save lives and prevent untimely deaths of women from IHD, it is time to dream and envision; now is the time to conduct research to transform practice and together to create a conclusion of the story of women with IHD that is consistent with the AHA vision to imagine a world without heart disease,¹² including a world without heart disease in women.