UK: the Guardian:Women dying unnecessarily from heart disease

Today's Guardian article.

Who knew women's symptoms were dismissed ? .......

Women dying ‘unnecessarily’ of heart disease, say experts https://www.theguardian.com/society...f-heart-disease-say-experts?CMP=share_btn_url

 

I'm sure I read a few years ago that in the USA heart disease in its various forms was actually causing more deaths in women than men. But patients and doctors all assumed that it killed many more men than women.

I don't know if the figures have changed since I read this.

 

I've posted a few articles here on how men and women's symptoms present themselves very differently in heart disease.

One research I can't find at the moment that says gender of the ER doctor might affect female patients’ chances of survival. Research shows women are also twice as likely as men to die within six months of serious heart attack.

 

Some of those biases are unconscious. Most are definitely conscious. They're even taught at medical school, encouraged within the culture of health care, voiced out loud and put in writing. They're very overt, in fact. More often than not they're said in places and circumstances where they think the general public doesn't notice, but the Internet has changed that. Now there are decades of those easily available, and more of it is produced every single day. But point it out and it's defended because "it's the truth". The same thing bigots say. Not coincidentally. After all, people from X are obviously superior to the uncultured swine from Y. It's just a fact, everyone knows it.

A big reason why they hate the Internet where it relates to their job. It's still a convenient thing to blame their failures on, but then too many go on and share it on public forums, or their own work, and it just exposes the whole thing. Not really different than the protestant split over the secretive processes of the Catholic church. Times change, but humans don't.

 

Today on r/medicine:

Locked post, because of course.

And remember the #1 (officially #2, but whatevs) rule there is "No personal stories or situations. No requests for medical advice or information."

Nevertheless the current top post is —

 

I've been reading the replies to that thread posted by @SNT Gatchaman immediately above. These are two of the best I've read.

Unfortunately, I don't know how to copy replies from Reddit without losing all the formatting.

 

It's a bit wild how they're noticing how there are no structures in place to make such complaints, but can't connect the dots as to why this is the reason those are mostly voiced on public forums like newspapers and social media. With patients, there are loads of factors that come into play for why the offending clinician isn't directly told those things, mostly having to do with it being pointless since it never changes anything. But they usually are told. Just not in the same terms as people use later on. Because offending a physician is a great way of degrading your own future care, and most people know this. The power imbalance is total, and yet it's MDs who seem to feel the most powerless here.

The thread overall isn't that bad. It's basically ignorant of everything that doesn't happen during a consult, but it's baffling that the thread got locked where there is in fact quite a lot of agreement that this is a problem, although vastly understating it and its real-life consequences.

But what they're really missing out here is that the problems lie in the systems, not in the individuals. The individuals comply with the system's demands, and they are part of the problem in the sense that those systems will only change when those who work in it make it change. Systems and culture. Bureaucracies can be so much more harmful and just as psychopathic as vengeful mobs, especially when they are pretty much immune from legal repercussions.

 

Another thing I've noticed is that if a doctor makes a diagnosis (that is, in reality, a misdiagnosis) he/she assumes that since the patient rarely comes back they (the doctor) must have been right when, of course, such perfection rarely exists.

Why is there no standard method of letting doctors know that their original diagnoses was wrong?

 

Another article on women and the heart :

Title : 8,000 UK women die due to unequal heart attack care
Link : https://www.itv.com/news/2018-11-22/8-000-uk-women-die-due-to-unequal-heart-attack-care

I tried to find the study the article was based on, but couldn't find it.

 

It might be

Advancing the access to cardiovascular diagnosis and treatment among women with cardiovascular disease: a joint British Cardiovascular Societies’ consensus document
Upasana Tayal; Graziella Pompei; Ian Wilkinson; Dawn Adamson; Aish Sinha; David Hildick-Smith; Richard Cubbon; Madalina Garbi; Thomas E Ingram; Claire L Colebourn; C Fielder Camm; Tomasz J Guzik; Lisa Anderson; Stephen P Page; Eleanor Wicks; Petra Jenkins; Stuart D Rosen; Stavros Eftychiou; Eleri Roberts; Helen Eftekhari; Heather Probert; Aynsley Cowie; Raj Thakkar; Jim Moore; Colin Berry; Gaby Captur; Aparna Deshpande; Sarah Brown; Roland Malkin; Mary Harrison; Claire Lawson; G Andre Ng; Vijay Kunadian

Despite significant progress in cardiovascular pharmacotherapy and interventional strategies, cardiovascular disease (CVD), in particular ischaemic heart disease, remains the leading cause of morbidity and mortality among women in the UK and worldwide.

Women are underdiagnosed, undertreated and under-represented in clinical trials directed at management strategies for CVD, making their results less applicable to this subset. Women have additional sex-specific risk factors that put them at higher risk of future cardiovascular events. Psychosocial risk factors, socioeconomic deprivation and environmental factors have an augmented impact on women’s cardiovascular health, highlighting the need for a holistic approach to care that considers risk factors specifically related to female biology alongside the traditional risk factors. Importantly, in the UK, even in the context of a National Health Service, there exist significant regional variations in age-standardised mortality rates among patients with CVD.

Given most CVDs are preventable, concerted efforts are necessary to address the unmet needs and ensure parity of care for women with CVD. The present consensus document, put together by the British Cardiovascular Society (BCS)’s affiliated societies, specifically portrays the current status on the sex-related differences in the diagnosis and treatment of each of the major CVD areas and proposes strategies to overcome the barriers in accessing diagnoses and treatments among women.

This document aims at raising awareness of the scale of the current problem and hopes to stimulate a multifaceted approach to address sex disparities and enable future comprehensive sex-and gender-based research through collaboration across different affiliated societies within the BCS.


Link | PDF (Heart) [Open Access]

 

Looks very likely. Thank you.

 

This is from 2018. The paper is "Sex differences in quality indicator attainment for myocardial infarction: a nationwide cohort study"

Link | PDF

 

I wonder why ITV decided to report on a paper that was published six years ago. It's not exactly been a slow news week!

Edit : Actually, it was me that cocked up. How embarrassing!

 

Haha, I didn't look to notice the ITV piece was from 2018 either. That Heart paper is hot off the press tho.