Clinic opens to fill ‘gender gap’ in cardiac care

A heart clinic specifically catering for women has opened in Melbourne, with the aim of improving access and comfort, particularly around having an echocardiograph, or stress echo test.
 
The female-specific service, ‘Her Victoria Heart’, has opened within the Victoria Heart cardiology practice, and has been developed by a team of female heart specialists, following feedback from GPs and their female patients.
 
Associate Professor Monique Watts is a heart failure cardiologist at the Epworth and Alfred hospitals and was part of the team who launched the state’s first women’s heart clinic in 2019.
 
Based on that feedback, she trialled a new process to encourage more women to have stress echo tests as part of preventive healthcare.
 
‘This was driven by the increasing awareness of a gender gap in cardiac care and outcomes and my own anecdotal experience of women reporting humiliating experiences during stress tests, and feeling dismissed and disregarded all too often,’ Associate Professor Watts told newsGP.
 
‘Patients were telling me, “No, I don’t want to do a stress test, I’ve had one before and it’s humiliating. It was awful, not getting on a treadmill again”.
 
‘For men, it’s easy to run on a treadmill without a top or a gown on. It’s not a big deal, but the moment you put a breast into it, it’s a big deal … and often women aren’t told they have to remove their bra for the echo, which can be confronting.
 
‘To have a female in that situation is just often nicer and more comfortable.’
 
Unique to the service is the use of special bras for women to wear during the stress echoes – a simple offering that Associate Professor Watts says has so far been ‘incredibly successful’ and made women feel more comfortable.
 
‘Standard practice is for no bra for echo or stress echo, which involves walking on a treadmill briskly, maybe even running,’ she said.
 
‘We sourced these bras for women to wear on the treadmill, because … women may be uncomfortable doing that, especially in a room full of men.
 
‘The bras we have allow not only modesty, but comfort, meaning women can perform better on the treadmill, increasing the sensitivity of the test.’
 
In addition to having a high proportion of female cardiologists – five women – alongside seven men, the practice has developed a female-specific diagnostic service, meaning that patients can elect to have their testing done by a completely female team, including the technician, sonographer and cardiologist. 
 
According to Associate Professor Watts, this is particularly relevant for echocardiography and stress echo, where imaging of the heart requires removal of a bra and a technician to be in close proximity to the patient, and their left breast particularly, for a considerable period of time.
 
Given that 14% of cardiologists in Victoria are women, her clinic is ‘well over-represented’ with female staff and is able to routinely offer female lists.
 
‘We have at least one list a week, sometimes two lists a week, and we’ve had overwhelmingly positive feedback from both patients and GPs,’ she said.
 
‘It is important more women have access to this service – most GPs are unaware of how vulnerable patients can feel during this testing and are unaware of our uniquely female service.’
 
GPs can write a patient referral to attend the clinic for a stress echo without the need to refer for a cardiologist, by indicating ‘female list’.
 
While she acknowledges GPs’ role in detecting heart disease in women, Associate Professor Watts said it is often under-detected, under-diagnosed, under-treated.
 
‘Women are under-aware of this, health practitioners are under-aware, and even policy makers,’ she said.
 
‘We’ve got to make changes at every level, but this is just one way of improving access to female-specific care.’
 
Cardiovascular disease (CVD) is a leading cause of illness and death among Australian women.
 
In 2017–18, an estimated 510,000 women aged 18 and over reported one or more heart, stroke and vascular diseases, and more than 22,200 died from CVD in 2016, more than any other disease group for females during that year.
 
CVD also has a significant impact among younger age groups, with almost one in 10 deaths (8.4%) of females aged under 45.
 
Despite heart disease impacting more younger women and often with worse outcomes than their male counterparts, Associate Professor Watts says younger women in particular find having a heart health test more confronting, leading her on a mission to raise better awareness about services such as female-specific clinics to help boost screening rates.
 
‘It’s really important we don’t shy away from doing these tests in women because of their hesitation or because of our own [healthcare providers’] hesitation, because we are finding more and more disease in younger women,’ she said.
 
‘A woman is more likely to die the 12 months after a heart attack than a man. So, this is part of my overall push to get better cardiac care for women, to try to break down those barriers.
 
‘Too often women don’t know this is an option, gaining access to a specialised service … where you can get a bra fitted for a stress test.
 
‘It’s just a lovely service, and a long time overdue.’
 
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cardiology cardiovascular disease CVD echocardiograph heart health stress echo women’s health