In February, romance may cause a woman’s heart to flutter and her pulse to race. Not coincidentally, it is also the American Heart Association’s month to concentrate on heart disease. This year, the exam light is on women. The belief that heart disease mainly afflicts men is outdated. Cardiovascular disease claims more women’s lives than the next seven causes of death combined — nearly 500,000 women a year. It is the No. 1 killer of women.
To get that message out, the Heart Association has launched Go Red For Women, a nationwide awareness campaign. Heart ailments killed 931,108 Americans in 2001, reports the American Heart Association’s “Heart Disease and Stroke Statistics – 2004 Update.” Other major causes of death in 2001 were cancer, 553,768; accidents, 101,537; Alzheimer’s disease, 53,852; and HIV, 14,175. The report also shows that CVD is the No. 3 cause of death for children under age 15, behind certain conditions originating in the perinatal period and accidents. Cardiovascular diseases include high blood pressure, coronary heart disease (heart attack and angina), congestive heart failure, stroke and congenital heart defects.
In spite of the statistics, cardiovascular disease is mostly preventable, and the No. 1 prevention is education. The responsibility of education lies mostly on the shoulders of medical providers.
When it comes to matters of heart health, there’s a whole lot for women to watch for. Cholesterol, high blood pressure, smoking, obesity and sedentary lifestyles all contribute to cardiac disease. It is more difficult to diagnose cardiac disease in women, doctors explain, because they present much different symptoms. For example, women get chest pain symptoms for a variety of reasons, many unrelated to a heart attack, while heart problems may show up as nausea, stomach pain, shortness of breath and exhaustion.
“Unfortunately, most people don’t actually know they’ve got heart disease,” says Dr. Dennis Goodman, Scripps Memorial’s chief of cardiology. “It’s only when they have an event that they first make the discovery. One of the biggest tragedies is that only when people have a heart attack or bypass surgery do they get motivated. They could have made lifestyle changes and modified their risks before (the attack) and possibly prevented it.”
   Dr. Denise Hermann, associate clinical professor of medicine in the division of cardiology at UCSD, says during visits patients need to bring up cardiovascular health if their doctors don’t.
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UCSD Improving Awareness
UCSD is working to get more centrally organized to link suspect patients to screening and to treatment.
Dr. Denise Hermann, associate clinical professor of medicine in the division of cardiology at UCSD, says doctors tend to focus on reproductive health and ignore cardiovascular health. “If doctors aren’t bringing it up, patients need to bring it up,” Hermann says.
Working in the field for seven years, Hermann says the rate of women with cardiovascular disease is increasing. “At Thornton Hospital, at least two-thirds of the patients are women,” she says. She attributes this to ignorance. “Women typically identify cancer, specifically breast, as the most significant health problem. In fact, seven out of 10 women will choose cancer.”
Success of the breast cancer campaign in the ’90s led to this belief. “More awareness is needed about heart care. We must get the word out to women. Once they are aware, they can get early treatment or prevent it. Unless genetically inclined, cardiovascular disease is preventable. The risk factors are known. It’s preventable, but people need to start early.”
The UCSD Cardiovascular Center operates UCSD Medical Center, Hillcrest; UCSD Medical Center, Thornton Hospital in La Jolla; and VA Medical Center.
Because it is a training facility, UCSD’s students, residents and fellows are encouraged to question and analyze patient symptoms, to be aware that a simple complaint such as nausea or heartburn might be a much greater problem requiring cardiac expertise. The hospital says patients are treated equally, with men and women receiving the same care in diagnosis and treatment with the understanding that women present different symptoms. State-of-the-art diagnostic care includes: electrocardiogram, Holter monitors, treadmill stress testing, stress transthoracic and transesophageal echocardiography, cardiac MRIs, angiography and nuclear imaging.
Also, UCSD screens women at its menopause clinic and refers them to a heart specialist when necessary. Physicians supervise house staff in managing patients and perform procedures and interpret hemodynamic data, electrophysiology, management of heart failure and cardiac transplant patients. All the cardiac catheterization laboratories have active interventional cardiology programs. These laboratories are hooked to computers and “intelligent terminals” that are actively used for clinical hemodynamic and angiographic research.
UCSD calculates it saw 18,883 cardiac patients last year; 9,309 were women.
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The Palomar Pomerado Beat
In North County, doctors for Palomar Pomerado Health treat patients for cardiac disease at both hospitals. Cardiac surgery is performed at Palomar and follow-up care is provided in an active cardiac rehabilitation program at either hospital and through the patient’s doctor’s office.
Palomar Medical Center in Escondido is the first hospital in San Diego County to twice receive the American Heart Association’s Get With The Guidelines – Coronary Artery Disease Performance Achievement award. Most recently it is the only hospital in the county to receive the Crusade Outstanding Care Award from Duke University.
The guidelines award recognizes PMC’s commitment to and success in implementing a higher standard of cardiac care that effectively improves treatment of patients hospitalized with coronary artery disease. Under the program, patients are started on aggressive risk reduction therapies such as cholesterol-lowering drugs, aspirin, ACE inhibitors and beta-blockers in the hospital and receive smoking cessation and weight management counseling and referrals for cardiac rehabilitation before they are discharged. Hospitals that receive the award have demonstrated that at least 85 percent of their coronary patients (without contraindications) are discharged using the AHA’s recommended treatments.
The Crusade Award is given for achieving outstanding cardiac-patient outcomes in the national Crusade Quality Initiative. With this recognition comes data that shows PPH “has no bias in treating men vs. women,” says Dr. Robert Stein, medical director of cardiac services. Stein explains that the first issue in cardiac care is that women present differently. The second, and more important, is that bias in treatment is a major problem. Death in women with coronary disease is 30 percent higher than men yet therapy is correspondingly lower, he explains. “Women just aren’t getting treated,” Stein says. “The Crusade moves to change this. At Palomar all services are completely gender neutral.”
To Heal At Scripps
Scripps offers treatment of a wide range of cardiac diseases and conditions at Scripps Memorial Hospital La Jolla, Scripps Green Hospital, Scripps Mercy Hospital and Scripps Memorial Hospital Encinitas. Only routine and emergency EKGs are performed at Scripps Chula Vista.
New catheterization labs opened last year at Encinitas and Chula Vista. The procedure involves a tiny tube painlessly inserted into arteries and blood vessels. Crucial for accurate diagnosis of a variety of heart conditions, it gives physicians an inside look at the heart.
Scripps has an internationally renowned cardiac arrhythmia center, a dedicated heart, lung and vascular center and new minimally invasive surgical procedures.
Scripps Memorial La Jolla was named one of America’s best for cardiac care by U.S. News and World Report in 2003. It was the only San Diego County hospital recognized for that specialty.
In addition to performing a wide range of cardiothoracic surgical procedures, La Jolla has a cardiac treatment center with a range of electrophysiology services, and is home to one of the busiest catheterization labs in Southern California. Scripps La Jolla also was one of the first sites in the nation to utilize a new drug-eluding stent and has performed more than 450 procedures since the life-saving device received approval from the FDA in April.
Scripps Memorial La Jolla also is renowned for a smattering of firsts. The Scripps Regional Cardiac Arrhythmia Center is an international leader in the management of heart rhythm disorders (cardiac arrhythmias). The center cares for thousands of patients every year and performs more than 1,000 arrhythmia studies annually. It is recognized as the:
- First in San Diego to utilize catheter ablation to cure arrhythmias.
- First in Southern California to surgically correct Wolff-Parkinson-White syndrome, a condition that can cause extremely rapid heart rates.
- First in Southern California to perform open heart surgery to cure arrhythmias.
- First in the United States to implant a dual-chamber defibrillator.
At Scripps Shiley Pavilion, the Center for Integrative Medicine’s cardiac care includes offering patients treatment that highlights education, prevention and lifestyle changes.
It’s not enough to fix the heart, explains Dr. Erminia Guarneri, medical director and founder of the Scripps Center for Integrative Medicine. “Mentality is where acute care works,” Guarneri says. “There are many paths to healing. It can be anything from attending a yoga class to the simple things like taking a deep breath.”
Scripps has seen a 30 percent increase in the number of female cardiac patients in the past year, resulting in more than 5,700 women of 14,339 patients treated for heart-related illnesses at its five hospitals in 2003.
 Dr. Elizabeth Noll, a senior staff cardiologist at Sharp Memorial Hospital. warns that the American population is increasing its abdominal girth at an astronomical rate.
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The Full Truth
“The American population is increasing its abdominal girth at an astronomical rate,” says Dr. Elizabeth Noll, a senior staff cardiologist at Sharp Memorial Hospital. “It’s an epidemic. Obese patients develop coronary heart disease more easily.”
Noll says people are counting on technology to save them. “There’s this fantasy or delusion that science will be available in the future to fix them,” she explains. “They think, ‘It’s OK to eat that doughnut today. By the time I have an attack they will be able to fix it.’” Even patients with documented disease come back and admit they are still smoking. “There often is no day-to-day reminder that the heart has a problem.”
About half of Noll’s patients are women. A large number are overweight with other health problems. She says it’s common to see a patient who smokes, is overweight and in the onset stages of diabetes.
Sharp HealthCare provides the full spectrum of care for those with heart disease at its Grossmont, Chula Vista and Memorial hospitals. Services and programs include prevention and education, as well as complete diagnostic evaluations, surgery and research. Grossmont Hospital also has just formed a partnership with the American Heart Association to offer a series of educational lectures titled “Women and Health,” which begin in February.
In Chula Vista, the Women’s Cardiac Disease Prevention Program encourages gynecologists to ask women a short series of heart-related questions during the annual exam. If something out of the ordinary is detected, the gynecologist makes a direct referral to a cardiologist.
Coronado Hospital holds free blood pressure clinics twice a month (and during the month of February free cholesterol screening is available at the blood pressure clinics). Sharp Coronado’s Motion Center, which is a community fitness center, encourages regular exercise by offering low-cost memberships. Professional dietitians are available to conduct nutritional analysis, including dietary recommendations and tips on shopping and dining out.
In general, Sharp says its cardiologists are current with evidence-based guidelines and are equally aggressive in treating cardiac disease be it in a man or a woman. Specifics include:
- Grossmont Hospital follows the “Get With The Guidelines” (American Heart Association Protocol) and offers a Cardiac Training and Rehabilitation Center;
- Sharp Memorial Hospital offers a “Fit for Life” class, which is a cardiac risk factor modification and supervised exercise program for both men and women to assist in reducing the risk of heart disease. In addition, the Cushman Wellness Center Health Screening Program on the Metropolitan Medical Campus is specifically designed to look at the cardiac risk factors (for both men and women) and provide meaningful lifestyle-enhancement plans of care.
- Chula Vista is the largest provider of off-pump surgeries in the county.
- Coronado Hospital follows “Get With The Guidelines” as well as offering cardiac training and rehabilitation.
- Sharp HealthCare hospitals treated more than 8,700 women for heart disease in 2003 — excluding the number of women who underwent non-invasive diagnostic procedures.
Partnering With Scripps
Kaiser Permanente contracts out its cardiac catheterization laboratory and cardiovascular surgery programs. The hospital maintains an arrangement with Scripps to perform angiograms and interventional procedures. A contract also exists with the Scripps physicians to do open heart surgery and valve replacements if needed. Kaiser has its own cardiologists who perform angiograms and interventional cardiology, but if patients need open-heart surgery, a contracted Scripps surgeon is used.
In house, Kaiser Permanente provides comprehensive cardiac and cardiovascular prevention, diagnosis, acute care and treatment, chronic disease management, and both inpatient and outpatient education. Stress echo tests; exercise ECG (treadmill); risk assessment; health appraisals, including health history and lifestyle factors are provided at each hospital.
In addition, specialized classes and educational presentations in congestive heart failure, living with an implanted cardiac defibrillator, pacemaker clinic, menopause, stress management for women, healthy eating and smoking cessation are available. Kaiser says its patient and member health education department focuses particular attention on women’s health. Brochures, posters and a variety of handouts are provided. Classes, lectures, videos and an informative Web site (www.kp.org) are accessible.
In 2003, about 48,500 patients were seen in Kaiser’s cardiology department. Of those, 3,050 were first-time consultations, and the remainder were established cardiology patients, many of whom had multiple visits during the year. Of those patients, 40 percent were female cardiac consults.
Paradise Dot-Calm
Paradise Valley Hospital in South San Diego promotes exercise and proper nutrition as the keys to good health. The hospital helps women (and men) reduce their risk of heart disease and stroke by providing free monthly diabetes, cholesterol and weight management classes, free smoking cessation classes and free exercise and nutrition programs. In its focus on cardiovascular disease in women, Paradise Valley Hospital offers a complete array of diagnostic services including stress tests, echocardiograms, nuclear cardiac tests, diagnostic cardiac catheterization, electrophysiology testing and cardiac MRI screening. The cardiac catheterization lab and electrophysiology program have been open since 2001 and focus largely on heart disease diagnosis.
Much like the arrangement between Kaiser and Scripps, Paradise Valley has an agreement with Sharp Chula Vista to perform open-heart surgeries.
To promote exercise, Paradise Valley offers Club Walk, the hospital’s oldest and most popular exercise program. The club offers participants the opportunity to lose weight, receive free health screenings, hear health lectures and make new friends. In its 16th year, Club Walk has more than 300 active members who meet weekly for self-paced mall walking and low-impact aerobics at Westfield Shoppingtown Plaza Bonita. In addition, the hospital’s Center for Health Promotion organizes a free six-week smoking cessation class, monthly diabetes management classes, individual nutrition counseling, cholesterol/nutrition/hypertension classes and weight management classes. Classes are offered in both English and Spanish, which is important because cardiovascular disease is particularly a problem among minority women, according to the AHA.
New at Paradise Valley is Body Works.calm, a health center that focuses on prevention by offering low-cost exercise classes including kickboxing, yoga, tai chi and Pilates.
PVH also produces a quarterly health and fitness newsletter written in both English and Spanish that goes to more than 80,000 households in South County.
In 2003, Paradise Valley treated 6,055 patients with cardiac disease; 3,773 of those were women.
North Coast Care
Tri-City Medical Center in Oceanside provides cardiovascular services that include state-of-the-art diagnosis, treatment and rehabilitation for cardiac conditions and diseases. The center offers education, nutrition and exercise programs, a network of North County coastal paramedic services, advanced imaging services and diagnostic procedures, invasive and non-invasive cardiac procedures, comprehensive cardiovascular and cardiothoracic surgery and cardiac rehabilitation services.
Rehabilitation is done at the Cardiac Wellness Center. At the center, patients recovering from open-heart surgery, heart attack or angioplasty receive cardiac rehabilitation services. Individually tailored exercise, telemetry monitoring, education and psychological and social support are provided.
Tri-City’s program is designed to help patients and their families understand the disease and educate them on the risk factors.
As a lifestyle change is required for recovery and health, Tri-City provides a lifetime maintenance program.
At Tri-City Medical Center last year about 4,614 patients were treated for illnesses whose principal diagnoses related to heart disease. Females made up more than 2,100 of the patients or 46 percent of that patient population.
The Diabetes Link
Alvarado Hospital Medical Center treats cardiac patients through its San Diego Heart Institute. Providing a multidisciplinary approach to the diagnosis, treatment and rehabilitation of cardiac and cardiovascular disorders, the institute offers each patient personalized care. Equipped with advanced monitoring, imaging and testing technologies, diagnostic services of the heart institute provide a comprehensive approach to detecting and tracking cardiac and cardiovascular irregularities.
The hospital says some patients may not require surgery, benefiting instead from a combination of medication, diet and lifestyle changes. Others may require coronary angioplasty or placement of intracoronary stents. For patients who require cardiovascular surgery, SDHI surgeons have experience in coronary bypass surgery, valve repair and replacement and pacemaker implantation.
Alvarado has a cardiac rehabilitation program that is designed for individuals who may be at risk for an acute cardiac event, who are recovering from a cardiac episode such as a heart attack or who have undergone coronary angioplasty, bypass surgery, valve replacement surgery or other heart related procedures. The goal of the program is to help patients achieve a better quality of life through diet and exercise. Personalized treatment programs are created, reflecting each patient’s unique characteristics and limitations.
One of the links to heart disease is diabetes. The medical center has a Diabetes Center that received education recognition from the American Diabetes Association. The center’s objective is to offer programs and personal consultation for diabetes self-management education.
Walking The Talk
Most cardiac doctors agree it is time for the medical field to make a change and put education in front of treatment. Women should know about themselves and their family history and keep up on their health. If awareness brings enough attention to the heart disease risks, women can change their own statistics and reduce the number of deaths. Hospitals say they are working to do their part. The rest is up to the people to learn and live a healthy lifestyle.
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