Does living in regional\/remote Australian communities pose a risk for women with heart disease<\/i><\/b><\/p>\n
Interview carried out with Prof Linda Worrall-Carter (Founder & CEO of Her Heart) and Dr Jennifer Coller, Clinical Director of Cardiology, Goulburn Valley Health, Shepparton, Victoria & Director, Connected Cardiology\u00a0<\/i><\/b><\/p>\n
Why are you so passionate about Women\u2019s Heart Health and in particular for women in rural and remote areas?<\/b><\/p>\n
As a cardiologist working in the field of women\u2019s heart health, I have been passionate about making a difference. We know that cardiovascular disease affects more than half a million women in Australia and many of these women reside in regional and remote areas. Having recently moved to a rural town in the heart of central Victoria, I can attest to the fact that these women often face significant barriers to accessing the cardiac care they need. This can, in itself, impact on their heart health in the longer term. For example, we know that delays in getting care can result in poorer outcomes \u2013 such as an unexpected hospital admission, a larger heart attack, or persistent issues like heart failure. It\u2019s important, therefore, that we have systems in place to provide women with the care they need in a timely manner so we can support them in having the best heart health and quality of life possible.\u00a0<\/span><\/p>\n Can you provide some examples of specific challenges that women in rural and remote areas face when trying to access cardiac care?\u00a0<\/b><\/p>\n Women in rural and remote areas often face unique challenges when accessing cardiac care. Some of these challenges include limited access to healthcare facilities, lack of transportation to medical appointments, and a shortage of healthcare professionals who specialize in heart disease.\u00a0<\/span><\/p>\n We also know that there is a general perception that women face a lower risk of heart disease than men, and there are many reasons for this – including a lack of awareness of women\u2019s heart issues.\u00a0<\/span><\/p>\n Women may potentially dismiss cardiac symptoms as being due to other causes, and delay seeking care from their general practitioner or local hospital. It may also be difficult for women to take time away from work or their roles as carers in order to seek medical advice for themselves.\u00a0<\/span><\/p>\n Even when recognising the need to seek advice from a cardiologist, there may be substantial delays to getting a review due to limited specialist access in regional areas. Research also shows that when women do reach out, they are not always listened to, so women can face unconscious bias when being assessed for cardiac symptoms \u2013 meaning their health care providers may perceive their cardiac risk as lower than it is in reality. This can also delay treatment and impact on recovery from a heart event.\u00a0<\/span><\/p>\n I will share a story, as an example – who for anonymity* we will call Rachel.\u00a0<\/span><\/p>\n Rachel* lives in regional Victoria and developed chest and throat discomfort at midnight, but she didn\u2019t attend the hospital until the next morning because she \u201cdidn\u2019t want to bother anyone\u201d and dismissed her symptoms as \u201cindigestion\u201d. Treatment included giving a \u201cclot-busting\u201d medication but this failed to open up the blocked artery, and she was transferred to Melbourne for an angiogram. Unfortunately, due to the delay in seeking help, she had already had a large heart attack, causing weakening of her heart that could not be reversed with a stent. She still experiences shortness of breath despite a stent and medications, and has had a cardiac defibrillator inserted because of the potential risk of serious rhythm disturbances.<\/span><\/i><\/p>\n You can see how important it is that we increase awareness as any delay is critical and it isn\u2019t always due to women not being aware of the symptoms. There can be a lack of access to resources and delays in getting to a major hospital with the necessary infrastructure to be able to treat the condition appropriately.\u00a0<\/span><\/p>\n Are there other issues or risk factors for women who live in rural and remote areas?<\/b><\/p>\n Women living in these areas have a higher prevalence of risk factors such as smoking, physical inactivity, and obesity. There are multiple reasons for this \u2013 including living in a low-income household or having limited access to affordable, healthy food options, particularly in more remote areas of Australia. Long work hours in physically and emotionally demanding jobs can also put them at higher risk. These factors, combined with limited access to cardiac care, can increase the risk of heart disease for women in rural and remote areas.<\/span><\/p>\n Geographical factors in regional and remote communities can impact further on outcomes \u2013such as Rachel* who needed a transfer to a larger centre for further emergency treatment. The delay in being able to receive an emergency stent can result in a larger heart attack and longer-term health issues like heart failure.\u00a0<\/span><\/p>\n Referral rates to cardiac rehabilitation are also lower for women. Women are less likely than men to attend cardiac rehabilitation. Rehabilitation programs are generally focused on coronary artery disease and are less able to flex to the needs of patients with Takotsubo cardiomyopathy or spontaneous coronary artery dissection (who are predominantly female). These patients can face significant anxiety around the safety of returning to exercise and the risk of recurrent cardiac events.<\/span><\/p>\n There\u2019s some research that indicates if you have a female cardiologist you get better outcomes, do women search you out?<\/b><\/p>\n Absolutely, Linda. I\u2019ve had patients travel over 300km (or more recently, catch the train to Shepparton from Melbourne!) just to see a female cardiologist. This is often because they feel they aren\u2019t getting the answers they need regarding their condition. Female doctors are generally perceived as spending more time with their patients, offering more reassurance and answering patient\u2019s questions. It is not at all uncommon to hear patient feedback of feeling dismissed when asking questions. As a female cardiologist, I am often referred to such patients \u2013 or these patients find me themselves.\u00a0\u00a0<\/span><\/p>\n I recently thought there must have been a mistake when I saw a referral for a female patient living over 3 hours away from Shepparton, who was booked into our clinic. I checked with our secretaries \u2013 \u201cWhy is she coming all that way? Is she moving to Shepparton?\u201d The answer was no, she had difficulty finding a female cardiologist she felt comfortable with. It seems extreme to drive all that way \u2013 but I\u2019m also glad to hear that patients like this are taking their health into their own hands.<\/span><\/i><\/p>\n Women are increasingly doing their research, expecting and asking for more. Here are some tips:<\/span><\/p>\n Her Heart also has their online <\/span>Find a Female Cardiologist<\/span><\/i>, this is a great resource and can be very helpful for finding a women\u2019s cardiovascular health clinic or female cardiologist.<\/span><\/p>\n What can healthcare providers do to better support women in rural and remote areas who are at risk for heart disease?\u00a0<\/b><\/p>\n I believe we can better support women in rural and remote areas who are at risk for heart disease by implementing training programs and initiatives that raise awareness of the unique challenges these women face. This can include training healthcare professionals in rural\/remote areas to identify and manage gender-specific as well as traditional risk factors for heart disease and improve access to specialist care with telehealth clinics that allow women to access cardiac care remotely.\u00a0<\/span><\/p>\n Additionally, we can work to increase awareness of the importance of heart health and encourage women to take an active role in their own care. For example, we can encourage women to request the current Heart Health Check \u2013 allowing their GPs to take a proactive approach to optimising their heart health \u2013 potentially preventing heart attacks and strokes down the track. It involves allows women to get advice on how to reduce cardiac risk in the future. These are available for people over the age of 45 years, or Aboriginal and Torres Strait Islander patients over age 30 years.<\/span><\/p>\n We also need to take into account the support women need after a cardiac event and cardiac rehabilitation programs need to evolve to be more inclusive of women\u2019s cardiovascular issues.<\/span><\/p>\n Finally, do you have suggestions as to how women can advocate for their own heart health?\u00a0<\/b><\/p>\n Women in rural and remote areas can advocate for their own heart health by staying informed about the risk factors for heart disease and taking steps to manage these risks. This can include making healthy lifestyle choices such as eating a balanced diet and staying physically active, as well as quitting smoking. From a prevention point of view, one of the most difficult things women can face is reducing stress and finding time for themselves. Following a healthy diet and incorporating exercise into their day goes a long way toward reducing the risk of heart problems down the track.\u00a0<\/span><\/p>\n It\u2019s important that women advocate for themselves (or bring an advocate along) \u2013 it\u2019s not always easy but it can have substantial benefits.\u00a0<\/span><\/p>\n For example, last year we received a message from another female patient we will call Deborah*:<\/span><\/p>\n \u201cFive weeks ago I had a heart attack, I was taken to hospital and then airlifted to [a hospital several hundred km away] \u2026. upon discharge it feels as though any follow up has been left for me to organise \u2026 I was referred to a cardiologist nearly two hours away from me. I had that appointment today and was very disheartened by his attitude. I\u2019ve been very depressed and have so many unanswered questions \u2026 the cardiologist simply said \u201cyou\u2019re fine, come back in 6 months and I\u2019ll do a treadmill test\u201d. My daughter mentioned [I was out of breath] and he replied to me \u201close weight\u201d.\u00a0<\/span><\/i><\/p>\n In this instance, Deborah* reaching out like this resulted in a call the next day from our practice nurse, who answered many of her questions and alleviated much of her anxiety. Though she did not seem depressed, she was made aware of potential support that is available through the Australian Centre for Heart Health. This centre provides counseling for patients after a heart health when suffering with anxiety of low mood, and can be accessed by a GP referral where appropriate.<\/span><\/p>\n In regional areas, including Victoria, the options for seeking further support may be limited. Cardiac rehabilitation is important and can be very helpful in making the necessary adjustments, as can support from important advocacy and support groups such as Her Heart.<\/span><\/p>\n It\u2019s important to plan ahead for any meetings with your GP or specialist and take with you any results or information. Don\u2019t be afraid to ask questions – like Deborah* above, take someone with you such as a family member or friend. Think about asking questions such as,<\/span><\/p>\n Additionally, women can use online resources such as the Her Heart website to learn more about heart health and access tools such as Her Heart Risk Assessment Tool and healthy recipes as well as their (closed) online Facebook community group.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":" Does living in regional\/remote Australian communities pose a risk for women with heart disease Interview carried out with Prof Linda Worrall-Carter (Founder & CEO of Her Heart) and Dr Jennifer Coller, Clinical Director of Cardiology, Goulburn Valley Health, Shepparton, Victoria & Director, Connected Cardiology\u00a0 Why are you so passionate about Women\u2019s Heart Health and in […]<\/p>\n","protected":false},"author":1,"featured_media":13450,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","pmpro_default_level":0,"footnotes":""},"categories":[171,10],"tags":[28,180,45,75],"class_list":["post-13449","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-key-opinion-leader-series","category-womens-health","tag-cardiovascular-risk-factors","tag-rural-health","tag-womens-health","tag-womens-heart-disease","pmpro-has-access","grve-entry-item","grve-blog-item"],"acf":[],"yoast_head":"\n\n
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