Women And Cardiovascular Disease: Addressing Disparities In Care by Kevin R Campbell


Women-And-Cardiovascular-Disease-Addressing-Disparities-In-Care.jpg Author Kevin R Campbell
Isbn 9781783265008
File size 973.6 KB
Year 2014
Pages 148
Language English
File format PDF
Category healthcare


 

Women and Cardiovascular Disease Addressing Disparities in Care P952_9781783265008_tp.indd 1 4/9/14 3:04 pm May 2, 2013 14:6 BC: 8831 - Probability and Statistical Theory This page intentionally left blank PST˙ws Women and Cardiovascular Disease Addressing Disparities in Care Kevin R Campbell, MD, FACC University of North Carolina, USA ICP P952_9781783265008_tp.indd 2 Imperial College Press 4/9/14 3:04 pm Published by Imperial College Press 57 Shelton Street Covent Garden London WC2H 9HE Distributed by World Scientific Publishing Co. Pte. Ltd. 5 Toh Tuck Link, Singapore 596224 USA office: 27 Warren Street, Suite 401-402, Hackensack, NJ 07601 UK office: 57 Shelton Street, Covent Garden, London WC2H 9HE Library of Congress Cataloging-in-Publication Data Campbell, Kevin R., author. Women and cardiovascular disease : addressing disparities in care / Kevin R. Campbell. p. ; cm. Includes bibliographical references and index. ISBN 978-1-78326-500-8 (hardcover : alk. paper) -- ISBN 978-1-78326-501-5 (pbk. : alk. paper) I. Title. [DNLM: 1. Cardiovascular Diseases--therapy. 2. Women. 3. Healthcare Disparities. 4. Sex Factors. 5. Treatment Outcome. WG 166] RA645.C34 616.10082--dc23 2014034450 British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. Copyright © 2015 by Imperial College Press All rights reserved. This book, or parts thereof, may not be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system now known or to be invented, without written permission from the Publisher. For photocopying of material in this volume, please pay a copying fee through the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA. In this case permission to photocopy is not required from the publisher. Typeset by Stallion Press Email: [email protected] Printed in Singapore “6x9” b1886 Woman and Cardiovascular Disease Dedication This book is dedicated to the women in my life. My wife and daughter inspire me on a daily basis. They have endured countless days of writing and revising manuscripts and have supported me throughout my journey to completion. It is my hope that this book will educate and engage others and ultimately improve cardiovascular care for women all over the world. My daughter, Bek, designed and created the cover art for this book. As one of millions of people throughout the world with type 1 insulin-dependent diabetes, she battles chronic disease on a daily basis and handles all of the challenges diabetes brings with a maturity beyond her years as well as a quiet grace. This book is my gift to Bek — when I am no longer here to advocate for her, it is my hope that there will be healthcare professionals that are armed with the information they need to aggressively treat and prevent needless cardiovascular deaths and disease in women. Moreover, I hope that this book will serve to engage and motivate other women to take control of their own heart health. v b1886_FM.indd v 05-09-2014 11:01:54 May 2, 2013 14:6 BC: 8831 - Probability and Statistical Theory This page intentionally left blank PST˙ws “6x9” b1886 Woman and Cardiovascular Disease About the Artist Bek Campbell is a middle-school student in Raleigh, NC. She enjoys the visual and performing arts, including drawing, digital art, photography, singing in the school show choir and playing guitar. While leaving her career choices open at this point, Bek has a strong interest in film making. Bek also enjoys animals and volunteers at a local animal shelter assisting the shelter veterinarian with prepping and caring for cats undergoing surgical procedures. Bek is the proud parent of four rescue animals: three cats and a dog. vii b1886_FM.indd vii 05-09-2014 11:01:54 May 2, 2013 14:6 BC: 8831 - Probability and Statistical Theory This page intentionally left blank PST˙ws “6x9” b1886 Woman and Cardiovascular Disease About the Author Dr Kevin R Campbell, MD, FACC is an assistant professor of medicine at the University of North Carolina at Chapel Hill in the division of cardiovascular medicine. Dr Campbell received his undergraduate degree in biochemistry from North Carolina State University and his medical degree from Wake Forest University. He then completed his residency training in internal medicine at the University of Virginia and fellowships in cardiology and cardiac electrophysiology at Duke University. Dr Campbell is an internationally recognized expert in the prevention of sudden cardiac death in women. Inspired by his wife and daughter, Dr Campbell is passionate about addressing gender disparities in cardiovascular care and speaks to healthcare providers all over the US in order to raise awareness for the treatment of heart disease in women. In addition to his clinical activities, Dr Campbell is an on-air media expert and is the in-studio medical expert for WNCN TV in Raleigh, NC. He also is an on-air contributor for Fox News Channel and the Fox Business Channel, and appears live on national television to provide insight into breaking medical stories as well as commentary on healthcare policy. ix b1886_FM.indd ix 05-09-2014 11:01:54 May 2, 2013 14:6 BC: 8831 - Probability and Statistical Theory This page intentionally left blank PST˙ws “6x9” b1886 Woman and Cardiovascular Disease Contents Dedication v About the Artist vii About the Author ix Chapter One: Introduction 1 Epidemiologic Considerations in Cardiovascular Disease 7 Gender Differences in Disease Manifestation and Presentation 17 Gender Differences in Testing and Evaluation 25 Gender Differences in the Treatment of Coronary Artery Disease 33 Chapter Five: Exploring the Root Causes 43 Chapter Six: Closing the Gap: Strategies to Effect Change 51 Chapter Two: Chapter Three: Chapter Four: xi b1886_FM.indd xi 05-09-2014 11:01:54 b1886 Woman and Cardiovascular Disease “6x9” xii Woman and Cardiovascular Disease Chapter Seven: Chapter Eight: Chapter Nine: Chapter Ten: The Role of the OB/GYN in Improving Women’s Cardiovascular Health 63 Taking Control: Battling Obesity through Exercise 71 Taking Control: Battling Obesity through Dietary Change and Stress Management 81 Special Considerations: Women and Sudden Cardiac Death 95 Chapter Eleven: Women and Congestive Heart Failure 103 Chapter Twelve: Empowering Women to Take Control 115 Chapter Thirteen: Women and Atrial Fibrillation 123 Index 131 b1886_FM.indd xii 05-09-2014 11:01:54 “6x9” b1886 Woman and Cardiovascular Disease Introduction Cardiovascular disease is the number one killer of both men and women in the US and in the UK today. Many of us are unaware of the risk factors and potential impacts of this potentially fatal disease and most are unprepared when it strikes. Due to advances in medical science and technology over the last 20 years, cardiovascular disease is now a very treatable condition and cardiovascular death is often preventable. Nonetheless, it remains a serious public health problem of epidemic proportions. It is imperative that both caregivers and patients understand the various ways in which cardiovascular disease may present and progress throughout the disease process — particularly when it comes to differences based on gender. In order to illustrate this broad range of clinical presentations, I believe it is important that we begin our discussion, and this book, with two very dichotomous cases. Bob is a 50-year-old man with a family of three. He owns a small office supply business in town. A long-time fixture in the community, he provides office supplies and equipment to companies all over the city. He has many long-standing customers and provides personalized services such as delivery and set up. Over the last several years, it has become increasingly difficult to compete with the big “chain” office supply stores. The larger corporate stores are able to undercut his pricing and he has begun to lose 1 b1886_Introduction.indd 1 05-09-2014 11:02:40 b1886 Woman and Cardiovascular Disease “6x9” 2 Woman and Cardiovascular Disease customers. He watches his profit margins fall and his expenses rise. His work hours increase as he is forced to lay off several employees. He no longer exercises and begins to smoke more heavily. Over the last six months he has gained nearly 25 pounds. He is no longer able to afford health insurance and has not seen a physician in over two years. This morning, he rushes into the office to meet with suppliers who no longer want to provide his store with inventory. As he sits at his desk, he begins to sweat. He is breathing heavily and begins to feel a tightness in his chest. The pain in his chest intensifies and then he slumps face first onto his desk. The staff quickly calls 911 and begins an attempt at CPR. Bob is transported to the local emergency room and is found by the emergency medical system (EMS) first responders to be in ventricular fibrillation with evidence of ST elevation in the anterior leads. Luckily he is revived with defibrillation en route. On arrival at the hospital, the cardiologist is alerted and the cardiac catheterization laboratory is prepared for urgent primary percutaneous coronany intervention (PCI). Bob arrives in the catheterization laboratory and is found to have a 99% lesion in his left anterior descending (LAD) artery and undergoes primary stenting with an excellent result. A few days later, he is fully recovered with normal left ventricular function and is released from the hospital with a good medical regimen and a plan for secondary prevention. Cindy is a 47-year-old mother of three and wife to a banking executive. Formally, Cindy worked as an attorney but retired in order to be a full-time mother to her children. She is active in the community and volunteers at her childrens’ schools and also enjoys gardening in her yard. She exercises regularly and is in relatively good shape. She has had “borderline” high blood pressure for several years but her physician has not yet initiated drug therapy. Her dad died suddenly in his 50s but no one ever knew why or what happened. Lately she has been feeling a bit fatigued but she has attributed it to her busy schedule with the kids. In addition, Cindy has noticed a feeling of “dread” from time to time over the last few weeks. Sometimes she feels as though something is just “not right” and easily becomes anxious. Sometimes when she is b1886_Introduction.indd 2 05-09-2014 11:02:41 “6x9” b1886 Woman and Cardiovascular Disease Introduction 3 exercising, she notices a heaviness in her chest that seems to get better when she takes a deep breath and rests for a bit. She notices a similar sensation in her chest when she is rushing around in the morning trying to help her three kids get ready for school. Her symptoms continue to occur and begin to increase in frequency. She begins to think that she is just “run-down” from her busy schedule and makes an appointment to see her gynecologist (who she uses as a primary care doctor) because she thinks she may have the flu. After three days, she is able to see her doctor. Her doctor quickly prescribes her an antidepressant as well as an anxiolytic and postulates that she maybe nearing an early menopause and experiencing symptoms of a mid-life crisis. He tells her that her chest heaviness may be related to panic attacks or hormonal imbalances. He draws blood tests to evaluate her for evidence of menopause and schedules an appointment in six weeks to assess the effects of the antidepressants. That night, Cindy is cooking dinner when she suddenly falls to the floor. EMS is alerted and when they arrive, she is pulseless and they are unable to revive her. Due to the unexplained death, an autopsy is performed where Cindy is found to have a 75% left-main lesion with what appears to be a freshly ruptured plaque. Cause of death was determined to be a massive myocardial infarction. Two scenarios with two very different outcomes — one happy ending and one very unfortunate result leaving three children without a mother. Why? How could Cindy’s outcome have been impacted and her life spared? Traditionally, cardiovascular disease and sudden cardiac death has been thought of as a disease of men. Public perception of the classic cardiac patient in the US today is that of a middle-aged, overweight male who smokes and works long hours in a stressful job. This image is supported by the way in which media portrays the victims of cardiovascular disease to the public. For instance, when watching medical dramas on television the character that is most often rushed to the emergency room with classic symptoms of chest pain only to arrest and die after heroic resuscitative efforts by the ER staff is almost always male — leaving behind a grieving b1886_Introduction.indd 3 05-09-2014 11:02:41 b1886 Woman and Cardiovascular Disease “6x9” 4 Woman and Cardiovascular Disease wife and child. However, both men and women are at risk for cardiovascular disease and its related complications. Although our biology is different hormonally, much of the way in which coronary artery disease develops is similar in both sexes. The fact is that more women than men die each year from cardiovascular disease. Data from the American Heart Association has shown that mortality rates for men with heart disease have improved where those of women have either declined or remained the same. The same statistics are seen in the UK as well as in the other industrialized nations in Europe. Advocacy and educational efforts continue to lag far behind the ever-expanding gender gap in cardiac care. Government agencies and policy makers in both government and industry are not doing enough to help close the gap. Former First Lady Laura Bush addressed the American College of Cardiology in 2004 and got it right when she stated, “with the many risk factors for cardiovascular disease, a woman’s greatest risk is ignorance”.1 The undeniable truth is that women are undertreated and underserved with respect to prevention, diagnosis and treatment of cardiovascular disease. Women’s symptoms are often minimized and attributed to stress, anxiety or other psychiatric diseases. In order to impact this disparity in care and effect change we must educate and improve awareness amongst physicians, physician extenders and other caregivers. We must improve awareness of risk for cardiovascular disease in women (and their families and loved ones) all over the world. Why is this? Who is responsible? How can we as healthcare providers and healthcare consumers impact this chasm in care? Over the last 20 years, much has been done to improve survival rates from cardiovascular disease. Technological advances have 1 Former First Lady Laura Bush’s Plenary Address to the American College of Cardiology Meetings in New Orleans, March 2004. b1886_Introduction.indd 4 05-09-2014 11:02:41 “6x9” b1886 Woman and Cardiovascular Disease Introduction 5 provided physicians and healthcare workers with tools that can significantly reduce morbidity and mortality. Now, when a patient presents with an acute coronary syndrome (ACS), the cardiac catheterization laboratory can be activated and the patient can undergo percutaneous revascularization (primary stenting) within 45 minutes from the time of presentation. Data supports the improved outcomes and myocardial salvage in ACS when prompt revascularization occurs. However, as you will come to discover through the course of this book, data over the last ten years demonstrate a gender gap. Men tend to be treated with more aggressive tools and procedures when presenting with a similar clinical scenario as compared to women. In addition, preventative efforts have expanded to address risk factors such as hyperlipidemia, hypertension, tobacco abuse and sedentary lifestyle much earlier. However, these preventative efforts are not always applied to both men and women with similar urgency and aggressiveness. There are many advocacy efforts underway in the US today such as the American Heart Association’s “Go Red for Women” campaign — but this is not enough. The majority of women still do not realize that their greatest risk of death is coronary artery disease. Most women still believe that they will ultimately succumb to breast or uterine cancer instead. More importantly, the medical community as a whole does not do enough to narrow the gender gap we see in cardiovascular care. As healthcare professionals, we all learn best when we approach problems in a case-based fashion. Much research in medical education over the last 20 years has shown that we learn better and retain more information for practical use when we learn it in association with a clinical scenario or patient interaction. In fact, many medical schools in the US today have moved to a blended case-based curriculum rather than a lecture hall format. As clinicians, we are all trained to focus on the patient and on the clinical signs and symptoms that have led that particular person to seek evaluation. In each chapter I will present realworld cases in order to illustrate points of emphasis and relate our b1886_Introduction.indd 5 05-09-2014 11:02:41 b1886 Woman and Cardiovascular Disease “6x9” 6 Woman and Cardiovascular Disease discussion to the reason we all practice (or hope to practice) medicine — the patient. During the course of the book, we will explore the scope of the problem and attempt to understand why disparities exist. We will discuss the biological differences in coronary artery disease in men and women, how presentations vary and how specific types of testing and diagnostic evaluations are more or less accurate in men versus women. We will discuss the impact that OB-GYN physicians can have on improving women’s cardiovascular health. Although traditionally, OB-GYN physicians have focused on reproductive health, these practitioners may, in fact, be the key to narrowing the gap in care. As we go through the issues associated with the gender disparities in cardiac care, we will postulate as to the root causes and offer potential solutions. Most importantly, we will discuss ways in which we can empower women to impact their own cardiovascular health throughout their lives. This book is intended to make a difference. This book is personal. This book is for my daughter Bek. At age five, Bek developed insulin-dependent diabetes. Unless a cure for diabetes is provided in her lifetime, she will certainly experience the ravages of cardiovascular disease one day. I want to make it my business to ensure that there are well-educated, non-biased medical professionals to care for her in a non-gender-biased way when she develops symptoms or disease. The goal of this book is to be a first step in narrowing the gender gap in cardiovascular care. Ultimately, this book is designed to open the eyes of healthcare providers — medical professionals and practitioners and policy makers — it should serve as a “call to action” to promote better cardiovascular care for all individuals, irrespective of gender. b1886_Introduction.indd 6 05-09-2014 11:02:41 “9x6” b1886 Woman and Cardiovascular Disease Chapter One Epidemiologic Considerations in Cardiovascular Disease Cardiovascular disease is the number one killer of both men and women in the industrialized world today. Even if we combine all deaths from all types of cancers and HIV-related illness there are more deaths from heart disease. No longer a disease exclusive to men, just over half of all cardiac-related deaths are in women. In the last year, nearly 8.5 million women worldwide died of heart disease and this accounted for one third of all female deaths. Heart disease and heart-disease-related deaths are epidemic: one person dies of heart disease every 33 seconds in the US today. Obviously, heart disease and its complications remain a major international public health problem. Although great progress has been made over the last 20 years, too many people are dying. Medicine has made great strides in diagnosis, prevention and treatment of cardiovascular disease. However, as healthcare providers, we are not doing enough. Efforts at prevention before disease and risk factor modification after disease presentation are not going far enough — patients are still not being screened and risk factors are not being modified. We must do more to prevent disease and identify those at risk, whether male or female. Awareness and advocacy efforts are lacking and patients are going untreated. In fact, most 7 b1886_Ch-01.indd 7 05-09-2014 10:49:01

Author Kevin R Campbell Isbn 9781783265008 File size 973.6 KB Year 2014 Pages 148 Language English File format PDF Category Healthcare Book Description: FacebookTwitterGoogle+TumblrDiggMySpaceShare Cardiovascular disease is the number one killer of both men and women in the US and Europe today. Over the last 20 years, many innovations in technology have allowed for improved therapies for heart attack and stroke and overall outcomes have significantly improved. Death rates from cardiovascular disease in men are declining.   However, even with these improvements in care, death rates for women remain unchanged. This book will explore these gender disparities in care in depth — specific sections will be devoted to answering the questions of why they are occurring and what healthcare providers and women can do to effect change and narrow the gender gap in cardiovascular care.   Ultimately, this book is designed to open the eyes of healthcare providers, medical professionals and policy makers — as well as potential female patients — and should serve as a “call to action” to promote better cardiovascular care for women. Through education, awareness and advocacy women worldwide will benefit, the gap will begin to close and better cardiovascular care can be provided for all.     Download (973.6 KB) Hypercholesterolemia Ed A Concise Review Of Molecular Pathology Of Breast Cancer Ed. Nutritional Management Of Diabetes Mellitus Surviving the Medical Meltdown: Your Guide to Living Through the Disaster of Obamacare The Business of Baby Load more posts

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