Women’s health at risk: A call to action on heart surgery complications
By Dr. Avi Verma, MD(h)
A recent study published in JAMA has highlighted a pressing health disparity affecting women undergoing high-risk cardiovascular surgeries. Researchers have discovered that women are more likely to die from complications post-surgery than men, even though both genders experience similar complication rates. This troubling trend underscores an urgent need to address gaps in recognition and treatment of women’s post-operative needs, often referred to as a “failure to rescue” by the medical community.
The Study Findings: Disparities in Outcomes
The study analyzed the health records of over 860,000 patients who had heart-related surgeries, including heart bypasses, valve replacements, and aneurysm repairs. Complications like heart attacks, blood clots, and infections were reported in about 15% of all cases. However, while 8.6% of men died from these complications, the figure was significantly higher for women, reaching nearly 11%. The higher mortality rate in women appears to result from delays in recognizing and addressing life-threatening complications.
Dr. Catherine Wagner, a lead author and cardiac surgery resident at the University of Michigan, noted that these findings suggest a systemic issue in how women’s symptoms and complications are managed. Many women in the study received treatment at larger teaching hospitals, often seen as providing higher-quality care, yet this disparity persisted across all types of facilities.
Potential Causes: Unconscious Bias and Lack of Female-Centric Research
One contributing factor may be unconscious bias in medical settings. Dr. Andrei Churyla, a cardiac surgeon at Northwestern Medical Group in Chicago, pointed to research indicating that women’s reports of pain are sometimes taken less seriously than those of men. A 2022 study from the Journal of the American Heart Association found that young women with chest pain waited 29% longer than men to receive a heart-attack evaluation. This delay could result in a failure to diagnose and treat complications early, increasing the risk of fatal outcomes.
Another factor is the historically male-centric approach to cardiovascular research. For decades, studies on heart health and diagnostic benchmarks have primarily involved men, often leading to diagnostic criteria that may not fully account for women’s physiological differences. For instance, high levels of the heart muscle protein troponin are commonly used to signal an impending heart attack. However, the threshold for what qualifies as “high” troponin is based on men’s baseline levels, potentially resulting in misinterpretation of women’s symptoms.
Moving Forward: Gender-Specific Approaches in Cardiac Care
Dr. Brittany Zwischenberger, a cardiac surgeon at Duke Health, emphasized the need for an evolved understanding of women’s unique cardiovascular needs. “Our current focus on sex and gender will hopefully result in tailored approaches to surgery and postoperative care, which could ultimately reduce these disparities,” she said. Such a shift toward personalized care may benefit all patients by enhancing early detection and intervention strategies.
This study serves as a wake-up call for both healthcare providers and patients to recognize the importance of gender-based differences in medical care. By fostering an environment where complications are addressed promptly and thoroughly in all patients, regardless of gender, we can work toward closing this health gap.
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