Four major medical societies released a female-specific framework for cardiovascular disease prevention, detection and management.
The framework, published as three papers in the American Heart Association (AHA) journal Circulation, was developed by the AHA, the American Academy of Pediatrics, the American College of Obstetricians & Gynecologists and the Society for Maternal-Fetal Medicine. The framework calls for identifying risk earlier and improving care coordination between specialties.
Cardiovascular disease, including heart disease and stroke, remains a leading cause of death in women. These conditions kill more women annually than breast cancer, lung cancer and chronic lung disease combined, according to the AHA. It is also the leading cause of medical-related deaths during pregnancy. Yet only 41% of women recognize it as their greatest health threat.
Progress on prevention has stalled over the past two decades, while care gaps remain. For example, only about 60% of U.S. women who experience hypertensive complications during pregnancy get blood pressure follow-up care within six months of delivery, per the AHA. The association forecasts that if things continue, the portion of women aged 20 years and older living with high blood pressure will increase from 49% in 2020 to 59% in 2050.
The newly published Presidential Advisory introduces the Female Life Stage framework and the impact distinct biological transitions have on cardiovascular health in women. For example, menstrual cycle patterns, pregnancy complications like preeclampsia and menopause are identified as important markers of cardiovascular risk. The framework takes a holistic approach by considering cardiovascular, hormonal and emotional health together.
“Heart health begins long before adulthood,” Amanda Marma Perak, M.D., vice-chair of the collaborative writing group and a pediatric cardiologist at Lurie Children’s Hospital in Chicago, said in an announcement. “As pediatric clinicians, we have the opportunity to help every girl start strong and to ensure that what we learn about her health follows her as she grows.”
The Scientific Statement offers a clinical rationale for the Female Life Stage construct and clinical guidance based on a science advisory group spanning specialties convened by the AHA. The paper identified existing guideline recommendations to determine evidence-based, stage-specific guidance. This includes ongoing assessment of menstrual cycle regularity; screening for cardiovascular risk at diagnosis of PMOS; documenting age at menopause; and routine depression and anxiety screening starting at 12 and 13, respectively.
“Sometimes it feels like these problems are so big,” Sadiya Khan, M.D., chair of the collaborative writing group and professor at the Northwestern University Feinberg School of Medicine, told Fierce Healthcare. “Oftentimes, we’re not thinking about heart health until somebody has an event … let’s take stock of where your heart health is right now and what are the potential things that could be influencing it.”
Meanwhile, the Science Advisory proposes a national infrastructure of Comprehensive Centers of Excellence for Women’s Cardiovascular Care. These would be interdisciplinary care models reaching across clinical care, professional training, research and community engagement to tackle the issue.
“One of the things that I think is really important is that the clinicians and patients have this shared playbook and shared language, and that it’s understandable for any clinician of any specialty and any patient,” Khan said.
These centers’ goal would be to reduce fragmentation, enable earlier risk identification and increase representation of women in clinical research. These centers could also encourage surrounding health systems to promote greater awareness of female risk. This concept was based, in part, on a survey of clinician leaders at women’s cardiovascular centers or programs. The proposed national infrastructure builds on the benefits, challenges and gaps identified in the survey.
The group has also begun developing educational materials, including how to apply the Female Life Stage framework to a case-based approach, according to Khan. To track outcomes, the group is considering establishing a network to evaluate and implement specific changes in care pathways. Khan also noted that external efforts to understand the patient experience, such as surveys on how often women feel dismissed by their providers, will be an important measure of the framework’s impact.
Khan acknowledged that funding for women’s health research is lacking, and the framework doesn’t allocate capital toward the changes it advocates for. Building out things like the centers of excellence and finding sustainable ways to change clinical models will take collaboration across stakeholders in the system. There is also a business case: preventable events are cost-saving, Khan said. She suggested there may be more attention at the national level due to President Trump’s recent executive order establishing a new division of women’s health at the National Institutes of Health. The division will aim to increase scientific review of women’s health conditions, advance research and promote innovation.
The papers were all prepared by the volunteer writing group on behalf of the four medical societies.