activism

Failures in the US Medical System in the Treatment of Women

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I was planning on saving this article for later in 2017, but with the passing of Carrie Fisher due to a massive heart attack I felt this needs to be talked about right now.

Phyllis Lambert had made significant positive changes in her health.[1]  At age fifty, when her granddaughter gave her a “magic rock” that would help her quit smoking, she stopped ‘cold turkey’.  Yet, damage to her heart and arteries had already occurred and as a result she underwent bypass surgery and had a pacemaker inserted into her chest a few years later.  Twenty-years later her granddaughter again encouraged her to make changes in her lifestyle for health and Phyllis lost fifty pounds, walked on her treadmill daily, gardened and made healthier dieting choices.  Phyllis Lambert saw her cardiologist yearly for check-ups, following each instruction they had given and taking each prescribed medication religiously.

Late in 2003, despite the positive changes in her lifestyle her cardiologist informed her that she would need to undergo surgery to repair the mitral valve in her heart.  Everything went well.  Or at least it appeared to have gone well.  Her cardiologist prescribed high doses of potassium for the months following her surgery.  She began to suffer from new symptoms she had not experienced before and regardless of each visit to the cardiologist was informed that she was healthy, that she was just overexerting herself.  One week after Mother’s Day in 2004, Phyllis was re-admitted to the hospital on the discovery that her aortic valve was damaged and would need to be repaired.  The damage to the valve had been missed during the initial surgery.  Phyllis lay in the hospital intensive care unit for one month following the repair to her aortic valve but the high doses of potassium had caused her kidney’s to fail.  She died on June 28, 2004 surrounded by her family.  Phyllis is one example of how the medical system has mismanaged differences that occur in female heart health and have thus failed women.  The practices and procedures that have been implemented by the medical systems of the United States have failed to address many of the primary issues of importance to increase the positive outcomes of treatment for women.  This paper will discuss the failures of the medical system and possible solutions to ensure a better program of treatment for women in the United Stataes.

Cardiovascular disease (CVD) is the number one cause of death in men and women worldwide and is responsible for fifty-percent of deaths in women over age fifty in developing nations.[2]  Mortality and incidence rates of CVD have been steadily decreasing in men yet remain stable for women.  What factors contribute to the development of the disease in women and why have the different needs of women with cardiovascular disease been largely ignored?  Exactly, what are the differences that occur in women as opposed to men when cardiovascular disease begins to develop and present?   How do the outcomes of treatment differ between the two sexes?  What is being done to ensure that physicians create methods of prevention and treatment specific to women?  Physicians have only begun to understand the gender, sex, behavioral, psychosocial and socioeconomic factors that play a significant role in the development of cardiovascular disease in women in contrast to the development and presentation of the disease in men.

Women must first and foremost be given access to resources from physicians and health related organizations regarding the factors that influence the development of cardiovascular disease.  Numerous factors exert influence on the development of cardiovascular diseases in women, many of which are controllable while some are biologically based.  Biological factors include basic human physiology.  Since men and women have basic physiological differences it makes sense that disease development may take different paths in each of the sexes.  Women, by nature, are generally smaller in height and weight.  This simple size difference influences the size of a human’s heart and blood vessels.  Women have “proportionally smaller hearts than men.” [3]  The small size of the vessels may be responsible for the creation of a more “insidious form” of cardiovascular disease which forms in the micro vessels of the human body and is much more common in women.[4]  In addition to size sex hormones play an important role in a woman’s cardiovascular health.  Post-menopausal women have significantly higher risks of developing cardiovascular disease as estrogen appears to protect the body by aiding in the elevation of HDL (good) cholesterol levels.[5]  Lipoproteins associated with CVD are usually much higher in post-menopausal women.  A high amount of plasma fibrinogen, which “increases with menopause, pregnancy and use of oral contraceptives,”[6] is also indicative of a greater risk in the development of CVD.  Although these biological factors play an important role in CVD, socioeconomic and lifestyle factors can be far more easily managed and changed when the need arises provided that the women affected have access to needed resources.

Women living in the “lowest social strata are 2.6 times more likely to die from cardiovascular disease” as  “diabetes, obesity, sedentary lifestyle, smoking and hypertension (which are all factors for the development of cardiovascular health problems) are more prevalent at low socioeconomic levels.” [7] African-American women are at the greatest risk in regards to these factors as they have the highest prevalence of overweight and obesity and are more likely to live in lower socio-economic classes according to the Canadian Medical Association Journal (CMAJ)[8].  The prevalence of overweight and obesity in all women is compounded by the fact that women often report that they have a significant lack of time that can be directed toward physical activity. Men, according to a survey in Massachusetts were active for nearly forty minutes more than women during summer days.

“Among women age 18 and older, the following are sedentary (have no leisure-time physical activity):

25.9 percent of all women

  • 6 percent of non-Hispanic whites
  • 9 percent of non-Hispanic blacks
  • 6 percent of Hispanics
  • 0 percent of Asians/Pacific Islanders
  • 8 percent of American Indians or Alaska Natives”[9]

 

As a result, high body weight and lack of physical activity increase the possibility for CVD related risk factors such as high blood pressure, high cholesterol and diabetes.[10] Despite these changeable lifestyle factors the most significant factor affecting the risk of heart disease in low-income women is access to proper medical care.

According to CMAJ “recent studies indicate that there may be a gender-socioeconomic status interaction in terms of CVD mortality.” For example, the article states that:

“Women are more likely to visit their physician but are less likely to be referred to a specialist or admitted to a hospital…in the United States; women are less likely to be able to afford essential medications” as they are less likely to work for organizations that offer private health insurance and are more likely to depend on government funded health programs. [11]

 

Each of these factors leads us full circle back to one vital issue in women’s health.  A recurring theme in all medical models is that “all research on prevention and treatment has been by men on men.”[12]  As a result of the lack of access to proper health care national groups have recently begun to focus on women’s health issues as vital in preventing cardiovascular disease.  The National Institute of Health (NIH) created the Office of Research on Women’s Health to include women in federally funded research programs beginning in 1994.  Since that time significant research has been conducted with women as primary subjects in the studies resulting in a massive breadth of new information that is saving the lives of women with CVD daily, however, a recent study still shows that “men continue to receive better care for heart disease.”[13]  The results of this recent research indicate that a great deal of public awareness education still needs to take place, particularly in regards to health insurance providers who still believe that the focus for women’s health lies primarily with prenatal and breast care.

The future of now lies with researchers, physicians and women who have recognized the growing need to educate the public regarding the specific issues of women’s heart health.  Local, federal and global organizations must be willing to provide basic health education in order that physicians and patients can recognize not only the specific needs of women but also the different symptoms that manifest between the genders in cardiovascular disease as well as the varied results from available treatments.  Health care plans must be willing to provide gender-specific heart care and ensure that a woman’s heart is protected against the growing rates of cardiovascular disease.  Helping hands must be reached toward ethnic groups of women such as African and Hispanic Americans to provide the highest quality of health care for those who are living with the greatest risk of cardiovascular diseases.  Awareness is simply the beginning, active steps to stop CVD is the only way to truly save the lives of the women affected.

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WORKS CITED

 

BRFSS, 2004. MMWR, Vol.54, No.39, Oct. 7, 2005

 

Conway, M. Margaret. David W. Ahern & Gertrude A. Steuernagel. Women and Public Policy: A Revolution in Progress.CQ Press. Washington, D.C. 2005.

 

Gerber, Jaime M.D. Estrogen: its Role in Protecting Women Against Heart Disease. Yale New Haven Health System. http://www.ynhh.org/healthlink/womens/womens_4_99.html.April 12, 1999.

 

Grady, Denise. Women are Not Small Men. The New York Times. Pgs D3 & D8. Tuesday, April 18. 2006.

 

Pelote, Louise, Dasgupta, Kaberi et al. Canadian Medical Association Journal. A comprehensive view of sex-specific issues related to cardiovascular diseas., CMAJ 2007; 176 (6 SUPPL):S1-S44.

 

Semler, Tracy Chutorian. All About Eve: The Complete Guide to Women’s Health and Well-being. Rutledge Hill Press. Nashville, TN. 2001.

 

Women to Women. http://www.womentowomen.com/heartdiseaseandstroke/cardiovasculardiseases.asp

 

Young, Donna. Gender Disparities in Cardiac, Diabetes Care Persist for Women. ASHP News, http://www.ashp.org

[1] Phyllis Lambert was my grandmother.  I lived with my grandparents since my parents divorce in 1999 and had spent a great deal of time with them over the years.  During my time living with my grandmother I frequently took her to her cardiologist appointments and shared my frustration with family members after each attempt to have her treated properly by her doctors.  After her death, I have taken a deep interest in women’s heart health issues and have taken care to ensure that the women in my family are educated about heart disease as we are at higher risk for medical problems due to family history.

[2] Women to Women: Cardiovascular Diseases and Women.  Cardiovascular disease is composed of several different problems associated with the heart and circulatory system including angina, arrhythmia, atherosclerosis, cardiomyopathy, congestive heart failure (CHF), coronary artery disease (CAD), high blood pressure, heart attack (myocardial infarction or MI) and stroke.  http://www.womentowomen.com/heartdiseaseandstroke/cardiovasculardiseases.asp, July 2, 2007. & Louise Pilote et al, A comprehensive view of sex-specific issues related to cardiovascular disease, Canadian Medical Association Journal, CMAJ 2007; 176 (6 SUPPL): S1-S44. Pg, S1.

[3] Denise Grady. Women are Not Small Men, pg 3, The New York Times, Tuesday, April 18. 2006.

[4] Ibid.

[5] Jaime Gerber, M.D., Estrogen: its Role in Protecting Women Against Heart Disease, Yale New Haven Health System, http://www.ynhh.org/healthlink/womens/womens_4_99.html, April 12, 1999. It should be noted “In 2001, the American Heart Association updated its recommendations for HRT suggesting that hormone therapy should not be used for purposes of preventing a second heart attack or death among women with established heart disease. In 2002, the AHA advised women not start or continue combined HRT for the prevention of coronary heart disease. It remains essential that each woman discuss with her doctor the risks vs. the benefits for taking HRT.”

[6] Pilote et al. A comprehensive view of sex-specific issues related to cardiovascular disease, Canadian Medical Association Journal, pg. S20.

[7] Ibid.  61% of women in lower classes compared with 29% of men have an increased risk of CVD mortality.

[8] Ibid. Pg S12-S13.

[9] BRFSS, 2004. MMWR, Vol.54, No.39, Oct. 7, 2005

[10] Pilote, Louise et al, pg S13.

[11] Ibid, pg S20.  CMAJ associates this inability to receive essential medications with a 50% increase in the incidence of angina, non-fatal AMI and non-fatal stroke; Conway, M. Margaret, David W. Ahern & Gertrude A. Steuernagel, Women and Public Policy: A Revolution in Progress, CQ Press, Washington, D.C., 2005, pg. 46.

[12] Tracy Chutorian Semler, All About Eve: The Complete Guide to Women’s Health and Well-being, Rutledge Hill Press, Nashville, TN, 2001, pg. 3

[13] Young, Donna, Gender Disparities in Cardiac, Diabetes Care Persist for Women, AJHP News, http://www.ashp.org/s_ashp/article_news.asp?CID=167&DID=2024&ID=20722, July 1, 2007.  The article states, “most health care plans told researches that they were unaware that gender disparities existed.”

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