D587 Task 1 Gender and Health Analysis Example

Recognized Later, Treated Less: Heart Disease in Women, the Biological, Social and Health System Causes of the Gap, and Prevention Strategies for a Composite County

Student Name

Leavitt School of Health, Western Governors University

D587: Gender and Health, Task 1

Course Instructor

Month Day, Year

Recognized Later, Treated Less: Heart Disease in Women, the Biological, Social and Health System Causes of the Gap, and Prevention Strategies for a Composite County

The Issue

Heart disease is the leading cause of death for women in the United States, as it is for men (Martin et al., 2024). Yet for decades it has been described as a men's disease, and women's heart disease is still more likely to be missed, recognized late or treated less aggressively. In Harlan County, a composite county of about 210,000 people, heart disease caused more deaths among women last year than breast, lung and colorectal cancer combined, and the county health department's review of emergency records found that women with heart attacks waited longer than men for their first electrocardiogram. This paper describes the issue, analyzes the causes of the gender gap and recommends prevention strategies.

Biological Factors

Some differences are biological. Women more often develop heart attacks at older ages, and although chest discomfort is the most common symptom for both sexes, women more often also report shortness of breath, nausea, fatigue or pain in the back or jaw, which can lead patients and clinicians to consider other causes first. Conditions specific to women also raise risk. Adverse pregnancy outcomes, including hypertensive disorders of pregnancy, gestational diabetes and preterm delivery, are associated with higher later risk of cardiovascular disease, which makes pregnancy an early window for identifying women who need prevention (Parikh et al., 2021). Menopause brings changes in blood pressure and cholesterol that add to risk in midlife.

Social Factors

Social factors shape whether women recognize heart disease as their concern. In national surveys, the share of women who knew that heart disease is the leading cause of death among women fell from 65% in 2009 to 44% in 2019, with the largest declines among Hispanic women, Black women and younger women (Cushman et al., 2021). Caregiving responsibilities can lead women to delay seeking care for themselves. Even in an emergency, gender affects treatment by strangers: in a registry of out-of-hospital cardiac arrests, men in public places had higher odds of receiving bystander CPR than women (Blewer et al., 2018), which researchers have linked to bystanders' discomfort with touching a woman's chest.

Health System Factors and Equity

The health system adds its own gaps. Much of the evidence on which treatment is based has come from trials in which women are underrepresented: among 740 cardiovascular trials completed from 2010 to 2017, women made up 38.2% of participants, with especially low representation in trials for acute coronary syndrome (Jin et al., 2020). Clinicians trained on typical presentations described in male-dominated studies may be slower to suspect heart disease when a woman's symptoms are less typical.

These factors produce inequity, not only difference. Equality would mean the same protocol for every patient with chest symptoms; equity means making sure that protocol actually reaches women as quickly as men, and that prevention reaches the women at highest risk, including younger, Black and Hispanic women whose awareness has fallen most. Harlan County's longer wait for women's first electrocardiogram is an equity problem because it arises from how care is organized, not from biology.

Prevention Strategies

Each strategy answers one of the causes identified above.

Strategy 1, for low awareness: a county campaign built with churches, beauty salons and community health workers, aimed at women 25 to 54 and especially Black and Hispanic women, that teaches the range of heart attack symptoms and the message to call 911 rather than wait.

Strategy 2, for pregnancy-related risk: with the county's two hospitals, flag women who had hypertensive disorders of pregnancy or gestational diabetes in the electronic health record, schedule a blood pressure check within ten days of delivery and ensure a cardiovascular risk review at the first postpartum primary care visit.

Strategy 3, for delayed emergency care: adopt a single chest symptom protocol in both emergency departments that triggers an electrocardiogram within ten minutes for any adult with chest discomfort, shortness of breath or other possible cardiac symptoms, and report door-to-electrocardiogram times by sex every quarter.

Strategy 4, for the bystander gap: include explicit instruction and practice on performing CPR on women in all county-sponsored CPR classes, using training manikins that represent women's bodies, and address bystanders' hesitation directly.

Strategy 5, for gaps in evidence: ask the county's hospitals to report sex-specific outcomes for cardiac care in their quality reports and to encourage women's enrollment when they take part in clinical research.

Measuring Progress With an Equity Lens

Each strategy has a measure, and every measure will be reported separately for women and men and, where numbers allow, by race, ethnicity and age, since an average can improve while the gap stays the same. For awareness, the county will add three questions on heart attack symptoms to its community health survey and compare responses from women in the campaign's target groups before and after two years. For pregnancy-related risk, the hospitals will report the share of women with hypertensive disorders of pregnancy who had a blood pressure check within ten days of delivery, with a target of 80%. For emergency care, the target is equal median door-to-electrocardiogram times for women and men within one year. For bystander CPR, the county's emergency medical services will track the share of women and men in public cardiac arrests who received bystander CPR, a figure that moves slowly and needs several years of data before it means much.

The health department will publish these results each year in a short women's heart health report and present them to the hospitals' boards, so that the gap becomes something leaders see and are accountable for rather than a finding in a study.

Conclusion

Heart disease in women is recognized later and treated less aggressively than in men for reasons that are partly biological and largely social and systemic. Because most of the gap arises from how people think and how care is organized, most of it can be closed. Harlan County's strategies, from postpartum follow-up to sex-specific emergency reporting, target the causes directly and can be measured, so the county will know whether women are being reached sooner.

References

Blewer, A. L., McGovern, S. K., Schmicker, R. H., May, S., Morrison, L. J., Aufderheide, T. P., Daya, M., Idris, A. H., Callaway, C. W., Kudenchuk, P. J., Vilke, G. M., & Abella, B. S. (2018). Gender disparities among adult recipients of bystander cardiopulmonary resuscitation in the public. Circulation: Cardiovascular Quality and Outcomes, 11(8), e004710. https://doi.org/10.1161/CIRCOUTCOMES.118.004710

Cushman, M., Shay, C. M., Howard, V. J., Jiménez, M. C., Lewey, J., McSweeney, J. C., Newby, L. K., Poudel, R., Reynolds, H. R., Rexrode, K. M., Sims, M., & Mosca, L. J. (2021). Ten-year differences in women's awareness related to coronary heart disease: Results of the 2019 American Heart Association national survey. Circulation, 143(7), e239-e248. https://doi.org/10.1161/CIR.0000000000000907

Jin, X., Chandramouli, C., Allocco, B., Gong, E., Lam, C. S. P., & Yan, L. L. (2020). Women's participation in cardiovascular clinical trials from 2010 to 2017. Circulation, 141(7), 540-548. https://doi.org/10.1161/CIRCULATIONAHA.119.043594

Martin, S. S., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Barone Gibbs, B., Beaton, A. Z., Boehme, A. K., Commodore-Mensah, Y., Currie, M. E., Elkind, M. S. V., Evenson, K. R., Generoso, G., Heard, D. G., Hiremath, S., Johansen, M. C., Kalani, R., . . . Palaniappan, L. P. (2024). 2024 heart disease and stroke statistics: A report of US and global data from the American Heart Association. Circulation, 149(8), e347-e913. https://doi.org/10.1161/CIR.0000000000001209

Parikh, N. I., Gonzalez, J. M., Anderson, C. A. M., Judd, S. E., Rexrode, K. M., Hlatky, M. A., Gunderson, E. P., Stuart, J. J., & Vaidya, D. (2021). Adverse pregnancy outcomes and cardiovascular disease risk: Unique opportunities for cardiovascular disease prevention in women. Circulation, 143(18), e902-e916. https://doi.org/10.1161/CIR.0000000000000961