Even though more than 30,000 women less than 55 years of age suffer from heart attacks every year in the United States alone, young women remain a vulnerable, yet understudied group with worsening risk profiles and worse outcomes as compared with men. These healthcare disparities in heart disease are persistent over the last decade. Here are some trends for heart attacks in young women in the past decade in the US:
- Young women with heart attacks, and black women in particular, have higher disease burden including high blood pressure, high cholesterol, heart failure, chronic kidney disease, and diabetes. These have been increasing among young women in the US in the past decade.
- It takes much longer for young women to get the right treatment for heart attack when they are hospitalized compared with men. They also remain hospitalized for much longer as compared with men.
- Young women have significant excess mortality than young men hospitalized for heart attacks.
Next Steps for health organizations, providers and policymakers:
- Better data collection:
To better understand healthcare disparities, collection of high-quality data is key. An American Heart Association national survey showed that only 1 in 5 hospitals collect comprehensive patient demographic data at first patient encounter. Good quality clinical data is imperative to quantify the contribution of social, economic, biological and genetic factors responsible for healthcare gaps based on gender and race. Such efforts would help guide redirection of our resources appropriately.
- Spread of awareness among public, patients, physicians and policymakers alike:
Several campaigns including the Go Red for Women and The Heart Truth were launched in the previous decade to increase awareness of cardiovascular disease prevention among women. A subsequent survey showed that only half of the young women included in the survey were aware of heart disease as the leading cause of death. This issue is even more relevant at the global level, as I imagine the situation may be worse.
- Role of Health Policy:
With the ever-changing health insurance portfolio, there may be several opportunities to focus on health care disparities. In particular, expanded payments for primary care can really benefit Medicaid beneficiaries, many of whom are minorities. In the face of worsening trends of co-morbidities including diabetes, high blood pressure and high cholesterol in the young, there is tremendous scope for improved primary prevention in this segment of the population.
- Better Risk Stratification Tools and Implementation in Primary Care:
It is concerning that prevalence of cardiovascular risk factors like high blood pressure, high cholesterol, chronic kidney disease, and diabetes has consistently been increasing in the past decade. Risk-based detection tools should form the core of targeted preventive strategies in cardiovascular prevention. Further efforts in this direction could be very high-yield for cardiovascular prevention.
Finally, I would emphasize that there have been substantial declines in mortality from heart disease in the past decade. This achievement may be attributed to several positive developments in the past decade including improved awareness, better access to care, better preventive strategies, and improved procedures. Having said that, women continue to have significant excess mortality after heart attack as compared with men. Our first step toward reducing health disparities and achieving health equity should be to spread the message.
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