Interventional Cardiology Society Champions Female Physicians and Patients

To educate the interventional cardiology community about heart disease in women, the Society for Cardiovascular Angiography and Interventions (SCAI) launched an initiative titled Women in Innovations (WIN). Heart disease is the number one killer of women, killing twice as many women annually as all cancers combined, and though there are many public campaigns working to address this issue, there are few physician-led efforts that do the same. WIN is a physician-driven, international initiative with a dual mission: to encourage and facilitate more effective diagnosis and treatment of women with cardiovascular disease, and to foster the professional development of female interventional and invasive cardiologists in practice and training. To do this, WIN focuses on four main project areas: education, professional development, research and innovation. WIN originated through female interventional cardiologists Roxana Mehran, MD, FSCAI, of Mount Sinai School of Medicine in New York, NY, and Alaide Chieffo, MD, FSCAI, of San Raffaele Hospital in Milan, Italy. With the encouragement of Past President Dr. Bonnie Weiner, SCAI eagerly agreed to champion the cause of its female members and improve the care provided to women with heart disease. “We believe the issues of female physicians and female patients go hand-in-hand,” explains Dr. Mehran, Chair of the WIN program. “As we advance the care of female patients by way of female physicians, we ultimately serve both causes.”

Education as a Cornerstone

WIN’s educational goals are many. WIN hosts numerous educational symposia and main program sessions at cardiovascular conferences all over the world. Through partnerships with groups such as WomenHeart: The National Coalition for Women with Heart Disease and Abbott Vascular’s Women’s Heart Health Initiative, WIN is piloting new programming on a regional level in the United States. Perhaps most importantly, WIN also hosts an all-women CME meeting titled “Women in Interventional Cardiology.” The event provides female interventional cardiologists with a network of peers to collaborate with and learn from. WIN has plans to expand this program overseas in 2012, with a similar event in the United Kingdom. “Education is a cornerstone of what we want to accomplish,” Dr. Mehran continues. “The global physician community needs to be informed with the latest knowledge in interventional therapies and techniques, specific to their female patients. We now know there are disparities in care and outcomes. The focus of our educational events is disseminating practical, solution-based information physicians can take back with them and consider as they practice day-to-day.” A prime example of this practical knowledge can be seen through WIN’s latest educational series in partnership with Abbott Vascular’s Women’s Heart Health Initiative. WIN and Abbott are working to bring cardiology and OB/GYN physicians together for collaborative events. The programs are a result of what started as a patient screening tool, designed by WIN physicians and provided to OB/GYNs by Abbott, to screen patients for heart disease symptoms. The purpose of both the educational programs and the screening tool is to open the referral pathway between OB/GYNs and cardiologists. Many women see their OB/GYN as their primary care physician. WIN and Abbott both believe that OB/GYNs and cardiologists should be working more closely together, educating each other on women’s health issues related to the other’s specialty. The goal is to screen 3,000 OB/GYN patients for heart disease. Findings from this pilot project will be used for future projects and publications.

Radiation Safety for Women in the Cath and EP Lab

WIN aims to continue publishing scientific papers on an ongoing basis. Most recently WIN published, “SCAI Consensus Document on Occupational Radiation Exposure to the Pregnant Cardiologist and Technical Personnel.”¹ This consensus paper is particularly important as scrutiny on radiation dosage and effects grows parallel to the increasing complexity of minimally invasive procedures, resulting in greater fluoroscopy time and increased chance of radiation exposure to medical staff. The paper addresses reservations about the safety of female interventional cardiologists and other medical staff exposed to radiation in the cath lab during pregnancy or while of child-bearing age. Even with promising scientific data suggesting no increased risk to the fetus from occupational radiation exposure, the paper reinforces that pregnant cath lab employees should take appropriate measures to reduce radiation exposure, including:

• Completing formal education and training in radiation protection.
• Notifying proper institutional radiation safety personnel of pregnancy to ensure adequate monitoring.
• Using lead shields and personal protective equipment, including maternity lead or lead-equivalent protective garments.
• Using a direct reading dosimeter and radiation monitoring badge, worn at the waist level under the lead garment, in addition to the typical radiation monitoring badge worn at the collar.

The paper also addresses legal issues surrounding exposure protections, reinforcing that in the United States, all exposure protection policies must be applicable to all employees, regardless of age, gender or pregnancy. Still, many institutions enact their own policies prohibiting women from working near radiation after revealing pregnancy. The authors of this paper and SCAI would discourage that practice, as it may prevent women from disclosing their pregnancy status, thus hindering proper monitoring of radiation exposure during pregnancy. “Maintaining the safety of our patients and staff is always our number one priority. Radiation exposure is a very legitimate concern in our industry, but standard safety guidelines, protocols and tools have been designed to ensure radiation exposure is kept to a safe minimum in all staff and patients, regardless of gender,” said Patricia J.M. Best, MD, FSCAI, of the Department of Internal Medicine and Cardiovascular Diseases, Mayo Clinic, Rochester, MN, and lead author of the consensus paper. “We hope this paper encourages women considering a career in the cath lab to review the available scientific data and make an informed career choice. We also encourage institutions to make their radiation safety policies clear to all staff in an effort to ease women's fears about any occupational exposure they may encounter.” Radiation exposure is believed to be an issue that has contributed to a disparity in the number of women who practice in the field. Women make up almost 50 percent of medical students in the United States, and yet less than 10 percent of the total number of board-certified interventional cardiologists are women. By increasing the number of women in the field of interventional cardiology, the WIN leadership believes there will be a subsequent improvement in the state of care provided to female patients.

Research Focus Areas

Also believed to be important to the care of female patients is an increase in the number of female principal investigators of clinical trials. Historically, most trials have been under-enrolled with female patients. Consequently, results from these studies are not powered to adequately answer questions specific to women. In 2010, SCAI and WomenHeart launched a survey titled, “WINHeart,” in an effort to learn more about the needs of female patients and the gaps in patient care. The survey had more than 300 respondents, all female members of WomenHeart and heart disease survivors, and found that 80 percent of women who had cardiovascular disease never considered participating in clinical trials because they were not aware that clinical trials were recruiting patients. The respondents were also concerned about the effects of treatment or lack of effects if given placebo (31 percent), or reported there were logistical issues that kept them from participating in clinical trials, such as transportation issues, geographic barriers, financial barriers or lack of time (20 percent). In addition, only 10 percent of the respondents said their physician spoke with them about participating in a clinical trial when they were first diagnosed with heart disease or a heart attack. WIN hopes that a large step toward addressing this problem will be its development of a forum that will bring together major cardiovascular clinical trial investigators from around the world. The forum, in partnership with the American College of Cardiology (ACC) and slated for fall of 2011, will provide an opportunity for these principal investigators to present the gender-based data from their trials. The data will be analyzed and discussed by a group of regulatory body, industry, patient group and physician representatives in an effort to create tangible change in the way clinical trials are designed in the future so that they can appropriately address questions related specifically to women. “This data forum will provide an unprecedented opportunity to take a hard look at the trial data as it relates to women,” Dr. Mehran emphasizes. “I am thrilled that the ACC has agreed to partner with us to see this idea come to life.”

A Global Collaboration

With such a large array of goals and projects, WIN engages an active and involved membership of female interventionalists in order to maintain momentum. Current members hail from over 20 countries and counting including Serbia, Denmark and South Korea. This base of members is working to spread the word to physicians around the world on heart disease in women. In addition to its sponsored educational events, WIN members assist one another in developing educational programs at their own national conferences. Recent examples include educational sessions on gender disparities in heart disease at the national conferences in Japan, Indonesia, and later this year, Saudi Arabia. Because there are similar statistics in countries outside of the United States related to the overall percentage of women practicing interventions, WIN launched as an international effort in order to build as large a network as possible. WIN aims to create strength in numbers, and the only way to do that is by connecting the global community of female interventionalists, not just those in any given country. The strategy is working, and WIN members convene regularly at the major cardiovascular conferences to discuss new projects. “With an international leadership, and programs in every corner of the world, it becomes very important to use our resources efficiently,” explains WIN Co-chair Alaide Chieffo. “We meet regularly to strategize, and are very committed to seeing our ideas through to completion. It is by keeping our eyes and ears open that we are able to grow quickly and effectively. I can only see us on an upward trajectory, and hope that together with our peers we will continue to make a difference.”

EP Statistics:

• On the basis of 2006 mortality data, there were 432,709 female deaths due to CVD; this is more than were claimed by cancer, Alzheimer’s disease, and accidents combined.²
• In 2008, there were 25,901 active cardiologists in the United States, of which 1,856 were electrophysiologists.³

WIN is always looking for new ways to grow and collaborate. For more information on how you can get involved with Women in Innovations, please contact WIN Director Rebecca Ortega at rortega@scai.org or visit the WIN website at www.scai-win.org.

References

1. Best PJ, Skelding KA, Mehran R, et al., for the Society for Cardiovascular Angiography & Interventions' Women in Innovations (WIN) group. SCAI consensus document on occupational radiation exposure to the pregnant cardiologist and technical personnel. Catheter Cardiovasc Interv 2011;77:232–241. doi: 10.1002/ccd.22877. Epub 2011 Jan 28.
2. WRITING GROUP MEMBERS, Lloyd-Jones D, Adams RJ, et al. Heart disease and stroke statistics — 2010 update: A report from the American Heart Association. Circulation 2010;121:e46–e215. Epub 2009 Dec 17.
3. Rodgers GP, Conti JB, Feinstein JA, et al. ACC 2009 survey results and recommendations: Addressing the cardiology workforce crisis. A report of the ACC board of trustees workforce task force. J Am Coll Cardiol 2009;54:1195–1208.