Book Review: Women and Cardiovascular Disease

In this interview with Dr. Kevin Campbell, we ask him about his newly published book, Women and Cardiovascular Disease: Addressing Disparities in Care. Dr. Campbell is a cardiac electrophysiologist with North Carolina Heart and Vascular and UNC Healthcare, and Assistant Professor at the UNC Department of Medicine, Division of Cardiology. He is also Director of Electrophysiology at Johnston Health, and President of K-Roc Consulting, LLC.

What was your motivation in publishing this book? For what audience is the book intended?
My inspiration for this book was my daughter Bek — my daughter (she is 13 years old now) developed insulin-dependent diabetes at age 4 and has battled the disease for 9 years. Given her risk for heart disease (since she will have lifelong diabetes), I want to make sure that she will be aware of heart disease in women and that healthcare providers will do a better job of identifying and treating women at risk. We know that women are undertreated and underserved, and that more women than men die of heart disease each year. I have made it my mission to help close the gap — through education, increasing awareness efforts, and advocating for women. The book is intended to help women take control of their own heart health.

The audience of the book is quite broad — it is intended for healthcare professionals as well as women who want to learn more about heart disease and their own risk. It is written to give women the information they need to take control of their own heart health.

What are some of the main causes of gender inequality in cardiac care?
I think there are several reasons for the gender gap in care. First of all, there are societal factors — heart disease is thought to be a disease of men. The general population does not always think of heart disease as being equally distributed in women. Moreover, women are often involved in multiple social roles — professional, mom, and wife — this results in women doing things for everyone else before they get around to thinking of their own heart health. Many times, women put their own needs last on the list, which can result in delays in diagnosis and can certainly limit any efforts at prevention of disease. In addition, there are biologic factors — women present differently than men. Women present later and with more advanced disease. In addition, symptoms in women can be very different than in men — symptoms may include anxiety, feelings of dread, or flu-like symptoms — these are vague and often lead to misdiagnosis. Finally, there are physician-specific factors — for example, in many of the early PCI trials, women were found to have more risk for complications than men — I believe that many practitioners are more likely to take a less aggressive approach in women due to fear of complications.

Tell us about some of the gender-specific differences that occur during testing and evaluation. Because of these differences, what are the best ways for evaluating women for heart disease?
We know that certain tests are less accurate in women as compared to men. For example, nuclear stress testing can produce more false positives in women. In addition, body habitus and breast tissue can limit some imaging techniques such as nuclear scanning and stress echo. Because women often present with atypical symptoms that may not always be consistent with traditional coronary artery disease (CAD), we must be vigilant when assessing risk. For women, it is important that we interpret atypical symptoms and presentations in the context of risk — for example, how many risk factors do they have, and what is their family history? These may provide clues that lead us to a more aggressive workup. In general, we should apply the same criteria and guidelines for evaluating women as we do for men. We must also be careful to avoid dismissing those with atypical symptoms.

What strategies do you recommend for closing the gender gap in cardiovascular care for women?
I think that first and foremost, we must educate both women and healthcare providers. We must reach out to non-traditional referral sources such as OB/GYN physicians — for many women, the only doctor they see is their gynecologist, so we must help these doctors understand how to screen for CAD and refer when appropriate. We must also educate women and help women engage in their own heart health. They must understand risk and understand how to modify risk. Women must take control of their own heart health. Engagement is critical and has been shown to result in improved outcomes in many studies of chronic disease. In addition, we must advocate for the women in our lives. We must make sure that everyone understands their risk and what to do to impact change.

What are some of the ways in which interventions such as ICDs impact women differently compared to men? What can be done to minimize risk?
Interestingly, there are studies that show that ICDs have a bigger impact on survival in women as compared to men. Unfortunately, it appears from other studies that ICDs are underused in women as compared to men. We must make sure that we apply guidelines for ICD implantation equally in both men and women, and afford women the same survival benefit that men receive.

How can outcomes be improved for women with atrial fibrillation (AF)?
Women have similar rates of AF as compared to men. In many cases, AF may be the first presentation for women with heart disease. It is important to remember that women can benefit from AF ablation just as men do. We must continue to apply guidelines to both men and women, and make sure that appropriate anticoagulation is provided to both genders if CHA2DS2-VASc scores indicate.

What advice about improving care to women can you offer to physicians and other healthcare providers?
Most importantly, we must look at women the same way that we look at men with respect to CAD. We must interpret atypical symptoms in women in the context of risk factors. We must apply guidelines equally, and we should aggressively apply both primary and secondary prevention strategies in both sexes. We also must strive to educate both women and men about heart disease, and help women understand their own risk. We need to help them develop strategies for reducing risk, and also partner with women to improve their own heart health. It is only through engagement and empowerment that we will be able to reduce cardiac deaths in women.

In addition to this book, you contribute a regular blog. What inspires you to write? Who, if anyone, has influenced your writing?
I enjoy writing — it is a wonderful way to express my thoughts and feelings concerning the doctor-patient relationship, healthcare reform, and policies that affect my ability to care for my patients. I am a big believer in technology and how technology can help us reach and impact patients that may otherwise go unnoticed and untreated. I am inspired by my patients to write these pieces. While some of my writing may be controversial and may draw differing opinions and criticisms, it is my intention to start a conversation and create debate — this is what will help us affect change and improve the lives of patients.

Where will the book be available for purchase?
The hardback copy is available now on Amazon as well as on the publisher’s website. The book is also available on Kindle.
I will be releasing the book in Europe at a book signing event in February in London. The paperback will be available this spring.
Here are the links to the purchase sites. The publisher site is offering substantial discounts and shipping rates through January. Please contact them through the site for details: www.worldscientific.com/worldscibooks/10.1142/p952. The link to the book on Amazon can be found at: https://tinyurl.com/n2amcje.

What’s next for you? What projects do you have coming up?
I am excited to be currently working on my second book. It is my hope to have it released in late 2015. The second book examines how the Affordable Care Act and healthcare reform have affected the doctor-patient relationship. It is a collection of essays that address the numerous issues associated with the ACA and how the practice of medicine — for both the doctor and patient — will be forever changed.

I continue my work at Fox News and Fox Business, where I appear weekly on national television discussing healthcare policy and analyzing the healthcare news of the day.

This March, I will be leading a special session on The Future of CV Medicine at the American College of Cardiology meeting in San Diego. In my session, we will explore the impact of social media on the practice of medicine. We will have a TED-style talk, debates, and audience interaction throughout the 70 minutes.

In May 2015, I will also be part of a new academic session at the Heart Rhythm Society meeting in Boston, presenting a special session on “How Doctors Can Interact with the Media.” We will briefly provide media 101 training, and teach attendees how to effectively communicate on television and radio in order to impact viewers and patients. ■

For more information about Dr. Campbell, please visit:
www.DrKevinCampbellMD.com
www.Facebook.com/DrKevinCampbell
www.Twitter.com/DrKevinCampbell