What is being done to help keep women, and their hearts, healthy?

By Heather Nelson managing director of Life Sciences and Health Care, and Sheryl Jacobson, US Consulting Medtech Practice leader, Deloitte Consulting LLP

Heart disease is the leading cause of death among men and women.¹ Despite its prevalence, heart disease in women is often misdiagnosed or overlooked due to biological differences that can cause it to manifest and progress differently.² Discrepancies in diagnoses and treatment can be further compounded by a lack of awareness among women and insufficient training for clinicians to recognize gender-specific symptoms.

We wanted to understand what is being done to help keep women, and their hearts, healthy. We first spoke with Nina Goodheart, president of the Structural Heart and Aortic Operating Unit at Medtronic, a large medical device manufacturer. We then had a conversation with two cardiologists: Dr. Stacey Rosen is executive director the Katz Institute for Women’s Health, senior vice president of Women’s Health at Northwell Health Partners Council, and Women’s Health professor of Cardiology at the Zucker School of Medicine; Dr. Jennifer Mieres is a cardiologist and senior vice president for equity of care at Northwell. She is also a filmmaker and co-author of books on this topic.

This two-part series seeks to highlight heart-disease symptoms that are unique to women and explore what is being done to improve their health outcomes. 

Part 1: A conversation with Nina Goodheart, president of the Structural Heart and Aortic Operating Unit at Medtronic

Heather: Heart disease is the leading cause of death for women in the US; more than 60 million women are living with some form of the disease.³ There seems to be a gender-agnostic approach in medicine, particularly in cardiovascular disease. Do you think that orthodoxy changing?

Nina: I think it’s starting to change. In the 1960s and ‘70s, many treatment decisions were based on male mice in animal studies. From there, early feasibility trials on humans were all conducted on men.⁴ There was a general belief that if we studied the general male population, the results could be extrapolated to all populations. We have since learned that is not the case. Medical societies, thought leaders, and government agencies around the world are now helping to show there are significant physiological differences between men and women. (See An economic case for a more women-centric health care system.)

Sheryl: Can you explain some of the differences between a male heart and a female heart? Women tend to have smaller hearts, right?

Nina: That’s right. Their hearts are typically smaller, their heart valves are smaller, their blood vessels tend to be narrower, and they often present differently. Clinicians are trained to recognize chest pain and pain radiating down the left arm as symptoms of a heart attack. But that often isn’t the way women present. A woman with the same condition might experience fatigue or shortness of breath.

Heather: Just to build on that point. Heart disease affects men and women differently. Are medical technology companies starting to change the way they develop devices?

Nina: We are starting to see [medical technology] companies alter the way they develop devices to accommodate these [biologic-specific] differences and use clinical trials to look more closely at the [physiological] differences between men and women. I’m involved with a stakeholder community called the Heart Valve Collaboratory, which includes thought leaders from medtech companies, the American College of Cardiology, and government agencies [e.g., the National Institutes of Health, the Food and Drug Administration, the Center for Medicare and Medicaid Services].⁵ We want to ensure that everyone has access to life-saving technologies and treatments. We also want to make sure that diagnostics, drugs and devices are developed for all people. Medtronic, for example, has a study that is using artificial intelligence to help identify patients in need of heart-valve-disease treatment.

Sheryl: Are clinical trials in cardiology beginning to include more women? Why do you think that is important?

Nina: Our SMART Trial compares the two most commonly used transcatheter aortic valve-replacement devices; 87% of the enrollees are women. It has garnered a lot of attention from physicians who are very interested in the results. I think it could encourage new clinical research. The industry is also working to help ensure that PIs [principal investigators] for clinical trials are diverse. PIs at the national level, and at the participating hospitals, have typically been men.

Heather: Women are 35% more likely than men to say they’ve skipped or delayed medical care over a 12-month period, according to our research (see Why US women skip or delay health care?). What do you see as some of the challenges in attracting more women to clinical trials?

Nina: There are many things to consider. Some women might feel more comfortable at their local community hospital versus an academic medical center. People want to be treated in their communities by people they know and trust. Additionally, the need for follow-up appointments can be a barrier for some women, particularly if they need to secure childcare, take time off work, or manage transportation logistics to get to the hospital. We have to make changes in the way clinical trials are conducted and encourage women to be a part of them. The result will be more complete and accurate information that physicians can use when treating women.

Sheryl: Could data that is specific to women lead to more gender-appropriate medical devices and better cardiac treatment?

Nina: That’s my hope. That is one reason we wanted to do this SMART Trial that looked at how specific physiologies responded to a device. And they did in a statistically significant way. Now that we have differential data, we hope that physicians will use it and make different and appropriate treatment decisions. Sometimes women have their symptoms dismissed, or they aren’t taken as seriously by clinicians. That should change. (See What's causing US women to skip or delay medical care?)

Sheryl: Providing information to clinicians is important. What about getting that information out to women and their communities?

Nina: We are doing a lot of work to help women recognize symptoms they may be feeling. We try to provide information to them at a level that's understandable so that they can seek appropriate treatments when needed. We know that when we treat women, we also treat their families and their communities.⁶ Women tend to be the ones in charge of their family's health care. When women get sick, it's not just the woman who suffers. There is often a whole ecosystem of people who can be affected.

Heather: What role can medtech companies play in helping women be even better advocates for their own health?

Nina: We can provide women with information that can help them become better advocates. By going to targeted groups, women in particular, we can help them recognize symptoms and understand their treatment options. They can say to their doctor ‘here is clinical research you should be aware of’ and ask the right questions. This empowerment enables women to demand gender-appropriate care and ensures they have the information needed to make informed decisions about their health.

Sheryl: We are researching trends among medtech investors. Most of the investors we interviewed said there is a lot of interest in devices that address cardiac health. Why is that?

Nina: Heart disease is the number one killer of women and men,⁷ and there is still so much to be discovered. Some of the most compelling innovations in medtech are taking place in cardiovascular disease. Consider how many patients worldwide have uncontrolled hypertension. It's the number one issue that leads to strokes and other health issues.⁸ Atrial fibrillation is another area that is attracting a lot of interest from investors.⁹ When you think about diseases related to aging, there is an enormous amount of opportunity.

Heather: Can artificial intelligence (AI) play a role in addressing issues that can lead to heart disease like hypertension and high cholesterol?

Nina: AI could help humanize medical care. That might sound odd. But I think AI could free up physicians to spend more time with their patients and have longer conversations with them. We are seeing more preventive approaches to medical care. I think we're at the forefront, but we are just scratching the surface.

Sheryl: Along with gender-specific medical devices and therapies, what else could improve cardiac health among women?

Nina: I would like to see more female cardiologists. Data has shown that when women are treated by women, their health outcomes are better.¹⁰ We need to get more women trained as clinical investigators, and we need more women to participate in clinical trials. We need to study how women are affected by hypertension, aortic stenosis, heart failure, and other illnesses. We need to arm physicians with that data and encourage women to be their own health advocates. Ten years from now, we could see women who are healthier, more informed, and seeking the treatment they need.

Conclusion

The gender-agnostic approach to cardiovascular medicine might be changing. This shift is important to help ensure that women receive appropriate and effective treatments for heart disease. Initiatives like the Heart Valve Collaboratory and targeted clinical trials are helping to obtain more gender-specific data, which can lead to more effective medical devices and treatment protocols that are tailored to women's needs. However, challenges remain in attracting more women to clinical trials and ensuring representation among principal investigators. Raising awareness, providing targeted training, and encouraging women to continue to advocate for their own health can foster an environment where gender disparities in heart disease are significantly reduced, ultimately leading to improved health outcomes for women.

The executive’s participation in this article is solely for educational purposes based on their knowledge of the subject and the views expressed by them are solely their own. This article should not be deemed or construed to be for the purpose of soliciting business for any of the companies mentioned, nor does Deloitte advocate or endorse the services or products provided by these companies.

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Endnotes

^{1_{About women and heart disease, Centers for Disease Control and Prevention, May 15, 2024}}

^{2_{About women and heart disease, Centers for Disease Control and Prevention, May 15, 2024}}

^{3_{About women and heart disease, Centers for Disease Control and Prevention, May 15, 2024}}

^{4_{Policy and guidelines on the inclusion of women as subjects in clinical research, National Institutes of Health, November 28, 2017}}

^{5_{Heart Valve Collaboratory}}

^{6_{Families often have chief medical officers – and they're almost always women, American Heart Association, April 17, 2024}}

^{7_{Heart disease facts, US Centers for Disease Control and Prevention, October 24, 2024}}

^{8_{How high blood pressure can lead to stroke, The American Heart Association}}

^{9_{An increased investment in arrhythmia treatment, University of Missouri, August 24, 2024}}

^{10_{Comparison of hospital mortality and readmission rates by physician and patient sex, Annals of Internal Medicine, April 23, 2024}}

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