Identifying Gender and Racial Disparities in Heart Attack Care

Heart attack prevention and treatment are continually improving, but research shows that young women and Black people don’t fare as well as other patients.

For example, a young woman (between ages 35 and 50) who has had a heart attack is twice as likely to die compared with a young man, according to preliminary research led by UNC Health cardiologist Rick Stouffer, MD, and UNC School of Medicine interventional cardiology fellow Sameer Arora, MD, MPH.

One of their earlier studies also found that women in this age group are having more heart attacks, while all other groups are experiencing fewer. And on top of that, young women aren’t receiving the same standard of care as men.

Similarly, another study they conducted shows that Black patients were less likely than white patients to receive aggressive treatment, and also less likely to be given certain medications commonly prescribed under current treatment guidelines.

Dr. Stouffer and Dr. Arora explain their research and share what you can do to advocate for yourself and your loved ones.

Young Women and Black People Face Hurdles to Care

While there are multiple factors leading to disparities for young women and Black people, a key contributor is limited access to preventive care.

“It’s important to visit to the doctor when you are younger to make sure you are doing everything you can to prevent poor health as you age,” Dr. Arora says. “For both young women and Black people, access to a primary care doctor and the ability to get to or pay for routine office visits can be challenging.”

Without these checkups, there’s no way to know if someone is at a higher risk of heart disease or heart attack, and no opportunity to turn things around if they are at risk. This leads to another cause of health disparities: increased comorbidities (coexisting health conditions) in disadvantaged groups.

“In our studies, we found that Black and female patients tend to have more comorbidities, or other medical conditions, in addition to their heart issues. So when these patients come to the hospital for heart disease or a heart attack, their overall health is often poor, which presents complications for treatment,” Dr. Arora says.

Someone with comorbidities may not be as good a candidate for interventional cardiac procedures or surgery, or they may not respond as well to the same medication as an otherwise healthy person. Because of that, physicians are less likely to give a heart attack patient with comorbidities the same treatment as a patient with fewer or no comorbidities.

Reducing Disparities in Heart Attack Care

Several approaches are needed to change the way vulnerable populations receive treatment, the doctors say. Improving access to primary care would help disadvantaged groups get regular medical care and reduce their comorbidities if a heart issue does arise.

One way to do this is through the expansion of nonhospital cardiology clinic sites, such as federally qualified health centers, which provide affordable healthcare to uninsured people. Research led by Dr. Stouffer shows that embedding cardiology care from academic medical centers into existing federally qualified health centers helps underserved populations identify undiagnosed heart disease.

In 2010, Dr. Stouffer and his team set up a UNC Health cardiology clinic at Piedmont Health, a federally qualified health center in Carrboro, North Carolina. His team studied data from all patients seen there and found that they were more likely to be female, a member of a racial minority group and uninsured compared with new patients seen at a cardiology clinic associated with a medical school. Abnormal echocardiograms (ultrasound tests that show how well the heart and heart valves are functioning) were found in 48 percent of patients at the health center, with 12 percent of those patients having significant heart disease.

“The study of our clinic shows that if you go to disadvantaged populations where they are, you’ll likely find a higher rate of heart disease than in more affluent areas,” Dr. Stouffer says. “This comes down to access. Many people lack access to transportation, experience language barriers or don’t have insurance, making it difficult for them to seek out the routine care they need.”

Additionally, more research is needed on what a heart attack looks like in women and how they should be treated. Participants in research studies and clinical trials are often disproportionately male, and more women should be included to develop better knowledge on how to prevent heart attacks and treat them specifically in women, Dr. Arora says.

How to Advocate for Your Own Heart Health

Researchers and doctors like Dr. Stouffer and Dr. Arora are working to change the way healthcare providers everywhere approach treating disadvantaged groups. But if you are a member of one of those groups or you’re just concerned about heart health, you can take steps to keep your heart as healthy as possible and ensure you get the best care.

1. Establish healthy habits.

Try to get into a routine of heart-healthy habits, including proper nutrition, regular exercise, sufficient sleep and stress management.

“The habits you form in your 20s and 30s pay dividends in your 60s and 70s,” Dr. Stouffer says. “Make sure your blood pressure and cholesterol are under control, as that can help prevent heart disease.”

2. Keep up with your primary care

Your primary care provider can help you catch the signs of heart disease early. To help make the most of your appointments, ask your provider how to prepare for your appointment and know what to expect.

While at your appointment, be sure to ask your provider for your ASCVD (atherosclerotic cardiovascular disease) risk score. This score provides an estimate of your likelihood of developing cardiovascular disease. If your risk score is high, ask if there are changes you can make to what you eat or certain medications you can take to help reduce your risk of having a heart attack.

3. Take someone with you to your primary care appointments.

It can be overwhelming to hear your health information all at once from your doctor. Bringing a friend or loved one with you to the appointment to act as a health advocate can help, Dr. Stouffer says. They can remind you of questions you wanted to ask and help you make sure you feel confident about your care plan. If you can’t bring a support person, you can ask your doctor for a written summary of important information.

4. Keep a log of questions you have and symptoms you are experiencing.

Keeping a list of the symptoms you experience or questions you have for your physician can help make your appointments more productive and efficient. It also helps your physician better understand the symptoms you’re having in your daily life. The log can be kept as a digital note on your phone or in a notebook.

5. Take advantage of cardiovascular screening if you have access.

Screenings for heart disease risk factors are offered at some health fairs, churches, community agencies or your local health department. In North Carolina, the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program is offered by the North Carolina Department of Health and Human Services. It provides cardiovascular screening and services for women enrolled in the WISEWOMAN breast and cervical cancer control program.

6. If something feels off, don’t wait to reach out for help.

It’s important to know the symptoms of heart disease, particularly if you are part of a vulnerable group.

Pay attention to your body during physical activity that gets your heart rate up, such as running, biking or climbing stairs. If you notice tightness in your chest or shortness of breath during exercise, especially low levels of exercise, schedule a cardiovascular screening with your provider.

If you have any risk factors for heart disease, including diabetes, renal failure, high blood pressure or high cholesterol, tobacco use or a family history of heart disease, be vigilant about looking for heart disease symptoms and reach out to your provider right away if anything feels off.

7. Know the symptoms of a heart attack.

It’s important to know the symptoms of a heart attack so you can seek help immediately if you start to experience one. Symptoms can include:

  • Chest pain or discomfort
  • Feeling weak, lightheaded or faint
  • Cold sweats
  • Pain or discomfort in the jaw, neck or back
  • Pain or discomfort in one or both arms or shoulders
  • Shortness of breath
  • Unusual or unexplained tiredness
  • Nausea or vomiting

Not everyone experiencing a heart attack has all of these symptoms, and not everyone has chest pain. All patients, especially women, can experience different symptoms, such as indigestion, lightheadedness, back pain, or numbness or tingling in the left arm.

Call 911 right away if you think you are having a heart attack.

Want to know more about your risk of heart disease? Take a free HeartAware online risk assessment. Need a doctor? Find one near you.