Women less serious about heart health, miss crucial follow-up treatment, say doctors

Moreover, women need more care and cardiac rehab, or CR, before they leave the hospital after a heart surgery because their arteries are of smaller calibre. But they seldom avail CR.

What is CR? Why have women-centric guidelines been evolved?

CR is an outpatient management programme for those with cardiovascular disease (CVD)-related issues. It offers patients several sessions of follow-up care either twice a week, or monthly once for few months, depending on the need and condition of the patient.

Now, given the fact that fewer women tend to avail CR, a clinical practice guideline has been developed to provide women-focused CR for those with CVD. The guideline has appeared in the Canadian Journal of Cardiology.

It has been developed by a panel of experts set up by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) and has been endorsed by 24 clinical societies worldwide.

“It has long been established that women are significantly less likely to access and complete cardiac rehab, and that their outcomes are often poorer, despite greater need than men,” said lead author Sherry L Grace, PhD, CRFC, faculty of health, York University.

First guidelines on #women -focused #cardiacrehab by @ICCPR_GlobalCR published in @CJChandle: https://t.co/pQAxBiFK5Q. Endorsed by 24 associations working with us on #implementation @sherrylgrace @gabrielamghisi @SusanMarzolini @JenPrice2549 pic.twitter.com/6FWyLhHi7V

— ICCPR (@ICCPR_GlobalCR) August 31, 2022

CR critical for complete recovery

The problem is, say cardiologists, though cardiac rehab programmes are critical for complete recovery, there are few takers for it in India.  Only 10 to 25% of the heart patients access the cardiac rehab programmes, says Dr Abhijit Vilas Kulkarni, cardiologist with Apollo Hosptials.

“Women do not come for cardiac rehab as this involves follow-up visits, plus additional expenses for the check-ups and counselling,” Dr Manjunath explained.

“They also find it time-consuming and feel guilty to be leaving their work and attend these programmes after post-surgery rests.”

Most of the times heart diseases are chronic and without cure, says Dr Vivek Jawali, Chief Cardiothorasic and Vascular surgeon at Fortis Hospital in Bengaluru.

“They often result in further cardiac events needing readmission, a stent, etc.,” Dr Jawali told South First. “However, chances of such events can be reduced with cardiac rehab approach.”

In fact, he says, cardiac rehab has become a norm in the developed world for patients recovering from a heart attack or a cardiac procedure like stenting or cardiac surgery.

India CR guidelines: Nothing women-focused

Here in India, guidelines are tailored to each patient according to their ventricular functions, their body size, their age, their sex, and also the kind of procedure that is done and also their neuropsychiatric situations, says Dr Jawali.

“The patient is given a detailed exercise regime, diet is planned, their tobacco and alcohol use is discussed, medical adherence is ensured and even their psychiatric issues like anxiety, depression, stress, sleep disorder are all discussed. This makes the recovery surer and swifter and it also provides long-term benefits,” adds Dr Jawali.

Doctors South First spoke to also feel cardiac rehab needs to be popularised in India, and even extended to district and rural hospitals.

“It should be included in health insurance schemes also,” Dr Kulkarni adds.