Associate Professor Monique Watts, Cardiologist at The Alfred Hospital, Victoria.

Cardiovascular disease is a leading cause of death among women in Australia and a significant cause of premature death being the single biggest killer of women aged 45-84. Despite this, most women are unaware of their risk. A large portion of women will have silent but deadly risk factors untreated, and many will ignore symptoms, missing the opportunity to prevent potentially devastating outcomes.

The face of cardiovascular disease has historically been a male one; resulting in heart disease being dismissed and missed in women. Research has shown us that when experiencing heart disease, women often present with different symptoms to men. While classically chest pain signals a heart attack, women may instead experience arm pain or jaw pain, or their pain may be associated with additional distracting symptoms such as nausea, dizziness, fatigue and clamminess which can distract the patient and investigating team from the time critical emergency at hand. Further to this, research informs us that women frequently delay seeking help when experiencing a heart attack, moreover when they do finally seek help, women often wait longer for or never receive the full spectrum of evidence based and life-saving investigations and treatment.

Not surprisingly, data shows women to have generally worse outcomes following cardiac events than men, this is especially true for young women.

Such discrepancy in presentation and outcomes has highlighted the need for female specific research which in turn has identified female specific risk factors for heart disease.

While classical risk factors such a smoking, hypertension, high cholesterol and a family history of early heart disease remain risk factors, female specific risk factors that signal a woman to be at higher risk of early onset heart disease include premature menopause and pregnancy complications including preeclampsia, gestational hypertension, gestational diabetes, multiple miscarriages and still births. Inflammatory conditions which are more frequently experienced by women are also a potent risk factor with atherosclerosis being accelerated by inflammation. In addition to specific risk factors, the type of disease affecting women’s hearts is also often unique with disease processes such as heart failure with a preserved ejection fraction (HFpEF), spontaneous coronary artery dissection (SCAD), myocardial infarction with non-obstructed coronary arteries (MINOCA) and coronary vasospasm and microvascular dysfunction being much more common in women.

It follows that with female specific risk factors, symptoms, disease processes and an unacceptable gender gap in outcomes, that there be available to Australian women, as in other parts of the world, female specific cardiac care. This, along with each of the experiences shared with me by women whose heart disease had been misunderstood, misinterpreted or sadly just missed, was the driving force behind the development of the Women’s Heart Clinic at The Alfred. Opened in 2018, this multidisciplinary clinic provides access to female specific cardiac care, offering expertise in cardiac conditions more frequently experienced by women and facilitating much needed local research to better inform our management of women with heart disease. The clinic also works to increase the profile of heart health in women, encouraging greater education and awareness at a social, political and health care provider level without which, outcomes in women will never change.

Associate Professor Monique Watts is a Cardiologist and Heart Failure Specialist at The Epworth Hospital and Alfred Hospital. A passionate advocate for Women’s Heart Health, A/Prof Watts developed and continues to lead Victoria’s first Women’s Heart Clinic at the Alfred Hospital providing much needed access to female specific cardiac care for many Victorian Women.

https://www.alfredhealth.org.au/services/womens-heart-clinic