Melissa Walton-Shirley, MD


November 08, 2015

Dr Holly Andersen's presentation on data from the Women's Heart Alliance at the American Heart Association 2015 Scientific Sessions brought a flood of memories of a painful visit I had with one of my favorite patients. This noteworthy campaign encourages women to speak to their healthcare providers and others in the medical community about their heart-attack risk, but it prompted me to consider again the "other women." You know them, the ones who transport their mothers to their office visits, remind and accompany their spouses, boyfriends, and partners to keep their appointments and take their meds. They are often silent, interjecting only occasional salient points that might help us facilitate an assessment and plan. Their hope is that we will protect and maybe even save their loved ones from a premature death from heart attack or heart failure. They are often familiar faces we attach to our patients and ones we look forward to seeing at each visit. Then one day, their chair is empty.

My patient depended on his wife for everything. She cooked his meals, selected his clothing, reminded him to take his pills, and hauled him into my office a bit unwillingly, but he took it all in stride. She knew everything about him, even his allergies, and could recount how many stents he had. He knew nothing and attended each office visit as passively as possibility, cooperating only to hold his breath for a carotid bruit check, taking deep breaths when instructed and presented his belly for examination dutifully assuming the directed supine position.

That day, his belly was smaller, his countenance downfallen, and the chair beside him for the first time in 10 years was empty. The pain in the room was palpable. His life partner of 40 years had died in the weeks preceding this appointment of an apparent heart attack. He had tried in vain to save her with that fresh bottle of nitro I had prescribed for him. By the time the EMS had arrived, she was no longer clutching her chest. Resuscitative efforts had failed, and in my mind it was devastatingly apparent I had failed her, too.

Although she was never my patient, she was a constant in the office visits with her husband. I had ignored ample opportunity to intervene. Why did I not ask her how she was doing, if she had undergone a calcium score or checked her cholesterol? Had I worried more about decorum and courtesy or the unspoken rule of waiting to be asked for help by those who have not yet employed us? I knew in my heart of hearts that if I'd just mentioned her obvious risk factor of postmenopausal status as an invitation for a heart attack, she might have acted to save herself and therefore save her husband from 10 more years of life alone.

Today's presentation proved that seven in 10 women almost never talk to their physicians about heart health. Thirty-eight percent report having a moment when they thought there might be something wrong with their hearts, but only 5% admitted they would consider calling 911. Thirty-two percent reported they would wait and see if concerning heart symptoms would go away on their own, and 45% were not aware that heart disease is the number-one cause of death of women in the US. Young women, African American women, and Hispanic women are least aware of heart-disease risk, and we as a nation of providers need to care more that young, black, and Hispanic hearts matter.

Today's presenter invited us "to determine the barriers to find opportunities to provide personalized awareness of this epidemic." As a healthcare provider, I became aware of this disparity between fact and awareness many years ago. After that most painful office visit with a patient who was in deep mourning for the absence of his spouse, one that I still feel so guilty about, I vowed to never again ignore the "other women" in the room. As providers, we must be bold about engaging everyone around us—in a tactful and thoughtful way, of course, but with the determination that we should disperse as much information as possible to save and improve the lives of all of the women around us.


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