The treatment gap is the result of doctors' misperception that a woman's risk is lower, even when her actual risk is calculated to be the same as a man, according to the study presented today at The State Of The Heart: Go Red For Women news conference in New York City.
The principal investigator of the study, Lori Mosca, M.D., Ph.D., director of preventive cardiology, NewYork-Presbyterian Hospital and associate professor of medicine at Columbia University in New York City, and colleagues conducted a national online survey to investigate whether physicians treat women differently than men with respect to cardiovascular disease preventive therapy.
Specifically, the researchers were interested in differences in preventive recommendations for men and women with the same heart risks, and if physicians followed national guidelines. Last year the American Heart Association, in collaboration with two dozen other government and professional organizations, released joint guidelines for cardiac preventive care in women based on a woman's risk level (high, intermediate and lower).
In this study, 500 physicians (100 cardiologists, 100 obstetrician-gynecologists [OBGyns], and 300 primary care physicians [PCPs]) were randomly selected from around the country. Physicians were given patient profiles in which risk levels were the same but the gender of the patients differed. They were asked to make recommendations regarding lifestyle management and drug therapy for blood pressure, cholesterol, aspirin and other forms of preventive care.
Even when a woman's risk was the same as a man's, women were significantly more likely to be classified as at a lower risk than men. When the researchers adjusted for the differences in the perception of risk, the differences in treatment of women were resolved in most cases.
"The finding that differences in the perception of risk of heart disease accounted for differences in preventive care is critical," said Mosca. "These data suggest that if we educate physicians to more accurately assess risk in women, they will be more likely to receive appropriate preventive care. Preventive measures, including lifestyle and drug therapy, have been shown to save lives in both men and women."
Furthermore, less than one in five physicians (8 percent of PCPs, 13 percent of OBGyns, and 17 percent of cardiologists) recognized that more women die of heart disease than men each year.
"This striking finding underscores the need to raise awareness about the importance of women and heart disease among healthcare providers as well as the public," said Mosca.
Insight about barriers to heart disease prevention was gained from the survey. A substantial number of physicians (28.7 percent of PCPs, 37 percent of OBGyns, and 18 percent of cardiologists) strongly agreed or agreed that factors controlled by the patient were the greatest barrier to preventing heart disease.
"This may reflect a perceived difficulty in influencing crucial lifestyle factors within the patient's control, not the physician," said Mosca. "Lack of time to practice prevention was also a commonly cited barrier among OBGyns and PCPs, as was lack of insurance coverage for lifestyle interventions. This suggests that policy makers and insurers need to address system constraints to better serve public health." Cardiologists, OBGyns, and PCPs did not rate themselves as very effective in helping patients prevent cardiovascular disease and managing their risk factors. OBGyns, in particular, did not consider themselves as very effective in helping patients achieve lifestyle changes, such as weight management, smoking cessation and physical activity. They felt even less effective managing patients' lipids, controlling blood pressure, and preventing heart disease, compared to PCPs and cardiologists.
Mosca and her colleagues believe that their study provides important insights into cardiovascular disease prevention, especially in women. Despite the limitation that the study may not represent all physicians, wrote the researchers, "Our data may represent a best-case scenario among full-time practitioners since survey respondents may be more likely to be aware of and adhere to guidelines than non-respondents."
Therefore, the researchers concluded that interventions are needed to raise awareness and encourage healthcare providers to adopt heart disease prevention guidelines. In particular, educational efforts should be targeted to assist physicians in heart disease risk assessment, which may help reduce sex-based disparities in preventive care. The American Heart Association has developed an educational tool kit for physicians to address the treatment gap in the findings of this study.
Education and support needs to be targeted to women as well. "Lifestyle is the fundamental method to prevent heart disease," Mosca said. "Therefore, it is vital that we continue to address barriers to help women stop smoking, get regular physical activity, eat heart healthy, and maintain a healthy weight. This will prevent the development of risk factors in the first place so any gender gap in treating them would become moot."
In a separate online study of a sample of 1,000 nationally representative women conducted by the American Heart Association, the data showed that there is a growing awareness of the risk of heart disease among female consumers. Fifty-seven percent correctly identified heart disease or a heart attack as the leading cause of death in women overall. Caucasian women (62 percent), more so than African-American (38 percent) and Hispanic women (42 percent), made this link. "This is a significant finding because racial and ethnic minorities are known to have a greater likelihood of diabetes and death from heart disease," explained Mosca. "We need to ensure that all women are aware of what their risk factors levels are, what they should be, and how best to achieve the American Heart Association goals for women."
Co-authors are Allison H. Linfante, Ed.D.; Emelia J. Benjamin, M.D., Sc.M.; Kathy Berra, M.S.N., A.N.P.; Sharonne N. Hayes, M.D.; Brian W. Walsh, M.D.; Rosalind P. Fabunmi, Ph.D.; Johnny Kwan, M.S.; Thomas Mills, M.A.; and Susan Lee Simpson, Ph.D. This survey was partially funded by an unrestricted educational grant to the American Heart Association from KOS Pharmaceuticals.
Statements and conclusions of study authors that are published in the American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect association policy or position. The American Heart Association makes no representation or warranty as to their accuracy or reliability.
NR05-1011 (Circulation/Mosca)
(Note: This information will be presented in a news conference at the Marriott Eastside, New York)