In the World Congress of Cardiology in Dubai last week, Prof Sidney C Smith president of World Heart Federation said that women with Acute Coronary Syndrome the world over are not getting the same treatment as men. In fact, women with ACS receive inferior treatment. They also reach hospitals later, are older and because of less-aggressive treatment have worse outcomes than men. This is truer for women in India, agrees Dr Ramakant Panda chief of Asian Heart Institute.
This, we may read, as gender bias even when it comes to heart health of women. True, women do neglect their health in their preoccupation with their household chores leading to a lack of physical exercise, poor nutrition and excessive stress. Compounded with the stress and strains within the family, they are prone to sickness and are generally in a condition of less than peak health. It is also discovered that women are the sick gender, meaning that they are more prone to disease and have more events of illness than men.
All this is more than complicated in the case of Indian women; somehow she has come to be the martyr of the family. She will ensure immediate attention to other members of the family but won’t even express her discomfort when the illness and its extent in both cases is the same. Consequences of this sacrifice get pronounced when subtle diseases hound.
In case of heart-related diseases, the awareness itself is so less and as Dr Salim Yusuf (McMaster University, Hamilton, Ontario) pointed out, the absence of a system in India for managing patients who get heart attacks delays implementation of effective therapies.
The CREATE registry study in India concludes that fewer women are admitted to hospitals with ACS. That women are also being neglected in hospitals and receive inferior treatment seems to be a rather alarming disclosure.
Unequal treatment of women for heart ailments at home can be because of a general disregard for women’s health in the Indian social setup; but the accusation that the same treatment is meted out to them by even doctors may perhaps be a gross exaggeration of a flaw in standard procedure.
It is a proven fact that female hormones have a protective action on the heart and so females are not regularly screened for heart ailments. But after menopause when they are no longer protected by hormones, women are as susceptible as or more so than men.
There maybe those rare cases in whom the disease may have set in much earlier but diagnosed very late leading to bad prognosis, higher morbidity and mortality. And as to inferior or less-aggressive treatment, the treating physician’s mindset is that he is only supplementing the natural protective mechanisms and does not need to establish a completely new protective setup as it is thought required for men.
The advantage of the declaration by Prof Smith may have brought centre stage the fact that disease incidence trends may be fast changing and, preconceived notions must not compromise the quality of health care particularly so where women are concerned.
Wellbeing of patients must not be compromised because of generalised opinions.
In the light of the increasing incidence of such cases clinical approaches must be suitably upgraded to better handle such cases. Chronic cardiological pathology must not be overlooked in women and all women must be screened for heart ailments irrespective of age.
The writer works for Postnoon.