Sex differences in Cardiac Diseases, Chapter 29 - Women’s Heart Programs

Specialized cardiovascular care for women, delivered in “women’s heart programs” (WHPs) focus on the cardiovascular needs of women. This chapter reviews the historical background leading to their development, their structure and specialized areas of focus including referral criteria for unique cardiovascular disease (CVD) risk factors in women, and CVD disorders resulting in acute coronary syndromes (ACS) with pathophysiologies seen exclusively, and/or more commonly in women including spontaneous coronary artery dissection (SCAD), myocardial infarction with nonobstructed coronary arteries (MINOCA), coronary microvascular dysfunction, and Takotsubo (stress) and pregnancy-related cardiomyopathies. The collaborative and multidisciplinary nature of WHPs is stressed, with key partners including those in obstetrics and gynecology, internal medicine, family medicine, maternal-fetal medicine, and cardiac rehabilitation specialists, specifically dieticians, physiotherapists, psychologists, and exercise physiologists. Finally, the roles of WHPs in education (clinical training programs and public awareness campaigns) and research in women with CVD are briefly discussed. The overarching goal of WHPs is to improve cardiovascular outcomes for women, through an enhanced awareness of sex-specific symptoms, cardiovascular risk factors, diagnoses, and treatments. Ultimately, successful achievement of reduction of glaring knowledge gaps in CVD care for women, with incorporation of evidence-based sex- and gender-specific cardiovascular guidelines into widespread and routine clinical practice, may reduce the need for these programs.