Abstract
BackgroundThere is increasing knowledge of sex-specific differences in cardiovascular disease and recognition of sex disparities in management. In our study, we investigated whether a cardiovascular programme tailored to the specific needs of women could lead to improved outcomes.MethodsWe randomised 100 female patients to receive cardiology follow-up with the conventional sex-neutral cardiac programme (control), or the sex-tailored Women’s Heart Health Programme (intervention). The intervention group was managed by an all-women multidisciplinary team and received culture-centred health intervention workshops, designed through in-depth interviews with the participants. The primary outcome was cardiovascular risk factor improvement at 1 year. Secondary outcomes include cardiovascular event rates, quality of life scores, and self-reported improvement in knowledge, attitudes, intentions and practices. Generalised structural equation model analysis was used to determine if the intervention group had better outcomes at alpha level 0.1.ResultsThe mean age was 67.3 ± 12.7 years, with an ethnic distribution of 70% Chinese, 18% Malays, and 12% Indians. The majority of these patients had no formal or primary level of education (63%), and were mostly unemployed (78%). Patients in intervention group had better control of diabetes mellitus (lower HbA1c of 0.63% [CI 0.21-1.04], p = 0.015) and lower body-mass-index (0.74 kg/m2 [CI 0.02-1.46], p = 0.092) at 1 year, but there was no significant difference in blood pressure or lipid control. Overall, there was a trend towards better risk factor control, 31.6% of intervention group versus 26.5% of control group achieved improvement in at least 1 CV risk factor control to target range. There was no significant difference in incidence of cardiovascular events, quality of life, or domains in knowledge, attitudes, intention and practices.ConclusionThis pilot study is the first of its kind evaluating a new model of care for women with heart disease. The potential to improve outcomes needs to be studied in a larger trial with longer follow up.Trial registrationThis trial was prospectively registered clinicaltrials.gov on 6 May 2013. Trial Number: 2013/00088. Identifier: NCT02017470
Highlights
There is increasing knowledge of sex-specific differences in cardiovascular disease and recognition of sex disparities in management
The women’s heart health promotion workshop, which was provided free to the participants, only had a 40% attendance rate
Demographic characteristics were similar between the control and intervention groups (Table 1)
Summary
There is increasing knowledge of sex-specific differences in cardiovascular disease and recognition of sex disparities in management. Over the past two decades, there has been a wealth of data illustrating sex differences in cardiovascular (CV) disease. There has been paucity of data examining how we can change the way we manage or try to alter any sex-specific patient outcomes. Some CV conditions have a greater propensity to affect women more than men, such as apical ballooning syndrome and pulmonary arterial hypertension. There are sex differences in sensitivity with regard to multimodality imaging in the detection of coronary ischemia [4]. Women are known to have altered risks for the same condition such as increased stroke risk for female sex in the CHA2DS2-VASc score used in atrial fibrillation [5]
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