Studies have been conducted regarding the several sides affecting the disparities in the
cardiac care of women as opposed to men’s. In women, the mortality rate of cardiovascular
disease (CVD) has remained greater compared to men for the past 47 years. In the United States,
it accounts for the greatest mortality rate in women accounting for as many as 900,000 in 2003
(Kent, Patel, & Valera, 2012, p. 557). Although mortality rates have decreased in the past decade
related to the increased awareness, focus on women’s cardiovascular disease risks, and the
establishment of evidence-based treatments, women still are more likely to be undertreated
compared to men. This assignment will discuss a small fraction of aspects that have an effect on
women’s cardiac health and clinical presentations and treatment along with nursing
interventions.
Coronary heart disease (CHD) is amongst the few cardiovascular risks that afflict 6.6 million
women in the United States every year. It is the primary cause of morbidity and mortality in
women. From this total, 2.7 million have a history of a Myocardial Infarction (MI) with a total
amount of 53,000 deaths (Mehta et al., 2016, p. 2). Also, women are most likely to have unusual
pathophysiological mechanisms of CHD. This unusual mechanism is in part due to estrogen
influences in CHD. The American Heart association states that population studies show that
estrogen depletion at menopause increases endothelial dysfunction and lipid disposition in the
vasculature, which precipitates the development of atherosclerosis over time. Despite the effects
of atherosclerosis, evidence-based guidelines do not recommend post-menopausal hormone
therapy for treatment because it does not prevent the progression of the established disease and it
precipitates CHD in older post-menopausal women. Although there is a slightly lower prevalence
of Heart Failure in women than men, women are usually older having more likely a preserved
systolic function heart failure.
Scientific statements by the American Heart Association explain that there is a higher prevalence
of CVD due to risk factors such diabetes mellitus, hypertension, cigarette smoking and
depression in women compared to men. Many of these risk factors go undiagnosed and
undertreated by health care providers. One-third of women in the united stated are slightly obese
and 7% are extremely obese with a BMI greater than 40 (Mehta et al., 2016, p.6). Obesity is
most prevalent in 69% of African-American women. The prevalence of obesity is increased by
6.6% among women over the age of 60. Cigarette smoking is the single most preventable and the
foremost cause of heart disease in women under the age of 55. The risk is reduced within 1 to 2
years from smoking cessation and falls to the level of nonsmokers within 10 to 15 years.
Hypertension (HTN) is another major risk factor for MI in 36% of women. In older women,
isolated systolic hypertension is the most common form of HTN. Women with a systolic blood
pressure greater than 185 mm Hg had a 3-fold increase in cardiac death compared with men. Yet
national surveys still show lower rates with a slow increase of HTN awareness and treatment in
women. Lastly depression and other psychological factors that influence the onset of ischemic
heart disease in women. A study conducted by INTERHEART states that exposure to risk factors
including depression, home/work stress, and major life events are significantly associated with
acute MI in women with an adjusted odd ratio of 3.5(Mehta et al., 2016, p. 7). Another study
conducted by VIRGO Young women compared with men had higher stress scores. The women
were more likely to report stressful life events. Young women have 60% greater odds of having
significant depressive symptoms compared with young men. MI risks increased by at least 50%
with a 2-fold increased prevalence related to depression (Mehta et al., 2016, p. 7). A national health interview survey conducted in 2009, showed a gender difference in the use of
preventative care with 25% of men having no medical office visits compared to 12% of women.
Although women are more proactive than men in the use of preventative care, there are still
disparities between both genders when it comes to the diagnosis and treatment options.
According to the journal of clinical nursing, several studies have found that women receive less
treatment regardless of the risk of mortality in their heart condition. It was found that there is a
delay in the procedures received in women with CVD. For example, a study was conducted to
patients with acute coronary syndromes in the Medical complex of Navarra Spain’s emergency
department. 596 patients were treated with a total of 71.8% (n=428) being men and the
remaining 28.2% (168) being women concluded this matter. The study showed that a stress test
performed to detect ischemia was requested for 47.3% of men and 12.7% of women. In relation
to emergency treatment, antiplatelets were administered to 68.4% of men 22.7% of women, beta
blockers given to 70% of men and 25.4% of women and so forth. A big delay in the treatment of
women is observed, primarily being associated with advanced age, sex, and the onset of
symptoms. Women tend to present with atypical or non-angina pain than men, and women are
more likely to present with neck, jaw, or back pain, fatigue, and dyspnea (Kent, Patel, & Valera,
2012, p. 557). Women are less likely to receive invasive or noninvasive testing following
presentation to the ER with symptoms of chest pain. The Sinai Journal of Medicine states that in
terms of treatment for Coronary Artery Disease, men with symptoms of chest pain are
approached and treated more aggressively and are more likely to be admitted to the intensive
care unit than women with similar complaints.
The difference may be due to medical differences of gender disparities that include
under-recognition of atypical symptoms and under-appreciation of risk factors by practitioners.
Nursing interventions in increasing the awareness of women and healthcare providers regarding
atypical symptoms and clinical presentations may promote a solution. The nurse should maintain
awareness in identifying risk factors of female patients so that appropriate teaching and referrals
can be made if needed. Nurses have the power to raise awareness of the female patient at risk.
The nurse should also share evidence-based practice knowledge about risk factors and atypical
symptoms of CVD with the patient’s healthcare provider so appropriate diagnosis, lab test, and
treatments are performed. Prevention and teaching are key to reduce the risk of cardiovascular
disease. The nurse should teach health promotion actions that will assist in reducing risks. These
promotions include quit smoking, maintaining a normal weight, eating right, limiting alcohol,
exercise, and controlling diabetes.
In conclusion understanding, gender differences can help improve prevention and
treatment among women. Women should not be afraid to ask questions to they healthcare
providers and collaboration with physician maybe help reduce the mortality rate and disparities
involving women's cardiovascular diseases. References
Feldman, D. E., Huynh, T., Des Lauriers, J., Giannetti, N., Frenette, M., Grondin, F., …
Pilote, L. (2013). Gender and other disparities in referral to specialized heart failure
clinics following emergency department visits. Journal of Women's Health, 22(6), 526531. doi:10.1089/jwh.2012.4107
Kent, J. A., Patel, V., & Valera, N. A. (2012). Gender disparities in health care. Mount Sinai
Journal of Medicine, 79, 555-559. doi:10.1002/msj.21336
Mehta, L. S., Beckie, T. M., DeVon, H. A., Grines, C. L., Krumholz, H. M., Johnson, M. N., …
Wenger, N. K. (2016). Acute myocardial infarction in women. Circulation, 133(9), 916947. doi:10.1161/cir.0000000000000351
Murray, S. S., & McKinney, E. S. (2014). Foundations of maternal-newborn and women's
health nursing (6th ed.). St. Louis, Missouri: Elsevier.
Worel, J. N., & Hayman, L. L. (2015). Cardiovascular disease prevention in women. The
Journal of Cardiovascular Nursing, 30(1), 5-7. doi:10.1097/jcn.0000000000000222

 

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