P3456'Heart, arteries and women', an innovative healthcare pathway based on collaboration between gynecologists and cardiologists for women at cardiovascular risk: design and evaluation at five years

Abstract

Abstract Introduction In women, cardiovascular diseases are the leading cause of death worldwide. Prevention and diagnosis typically occur at late stages and less frequently than is men and treatments are not optimal in women. Preventive measures must be implemented, and management approaches improved. To this end, an innovative coordinated healthcare pathway was initiated at the our University Hospital for women at risk of cardiovascular diseases. Purpose The objective of this study was to describe the design of the healthcare pathway and to assess its relevance to improve prevention, diagnosis and treatment in women at cardiovascular risk. Methods The healthcare pathway “Heart, arteries and women” implemented at our University Hospital since January 1st, 2013 is based on collaboration between gynecologists and cardiologists. Women after an adverse pregnancy outcome and women at menopause with increased cardiovascular risk were referred by the gynecologist to the cardiologist for complete cardiovascular evaluation if eligible (Figure 1). Screening for both traditional and nontraditional cardiovascular risk factor and cardiovascular diseases if indicated, lifestyle counseling and adjustment of medical treatment were performed for each woman. The present study focused on post-menopausal women at risk or high cardiovascular risk according to American Heart Association (AHA) classification who had a complete cardiovascular evaluation through the healthcare pathway between January 1st, 2013 and December 31st, 2017. Results We included 690 post-menopausal women with a mean age of 58±8 years. According to AHA classification, 339 women (50,8%) were at high risk and 351 (49,2%) at risk. Cardiovascular risk control was poor with 146 current smokers (21,2%) and 264 obese women (38,3%). Only 320 women (46,4%) reached the targeted blood pressure of <140/90 mmHg and 169 (24.5%) attained their low-density lipoprotein (LDL)-cholesterol target. Among the 212 women treated for diabetes, 45,3% achieved the glycated haemoglobin (HbA1c) target of <7.0%. Lower extremity artery disease was newly diagnosed in 46 women, renal artery disease in 51 women and ischemic heart disease in 62 women. Statins, renin-angiotensin system inhibitors and antiplatelet agents were significantly more prescribed according to guidelines after the cardiovascular evaluation (p<0.001). Conclusion Our coordinated healthcare pathway based on partnership between gynecologists and cardiologists allowed to improve assessment of specific cardiovascular risk, screening, prevention and treatment of cardiovascular diseases in women. Enhanced collaboration between gynecologists and cardiologists offers a real opportunity to improve cardiovascular heath in women.