Women's health plan 2021 to 2024: final report

Heart Health

Priority: Reduce inequalities in health outcomes related to heart disease

Aims:

1. Opportunities for optimisation of cardiovascular health and risk reduction will be taken across a woman’s life course.

2. Healthcare professionals will be aware of sex-related differences in presentation and management of heart disease in women and act to reduce inequality of care and improve outcomes.

3. All women will have access to information on the risk factors for and symptoms of heart disease enabling them to quickly and confidently describe their own symptoms when speaking to healthcare professionals.

4. All women with heart disease will receive appropriate support in managing their risk factors, recovery and living with a long-term cardiac condition through appropriate follow up and access to cardiac rehabilitation and psychological support.

5. All women with heart disease will be provided with individualised advice and co-ordinated care to access safe contraception, abortion, assisted conception, pregnancy and gynaecological care.

Short Term Actions

Action: In all heart health consultations, opportunities should be taken to provide individualised advice and care to women, and; in all pregnancy and pre-pregnancy discussions and interactions opportunities should be taken to optimise women’s heart health to optimise women’s holistic health as part of the life course approach.

Spontaneous Coronary Artery Dissection (SCAD) Pilot: SCAD is a tear on the wall of a coronary artery (a large blood vessel), which supplies blood to the heart. It can cause angina, heart attack and cardiac arrest. SCAD affects a younger, predominantly female, population.

• The Scottish Government have funded a SCAD pilot project with the aim of building expertise in Scotland to support equitable care. This includes consideration of female-specific management elements such as contraception, pregnancy, HRT, cyclical chest pain etc.
• CVD and Reproductive Health Guidance for Health Professionals. The Women’s Health Champion, in collaboration with cardiology and reproductive health colleagues, is leading work on the development of guidance and information for health care professionals on the following issues:
• Contraception advice for women with cardiac disease
• Menopause management for women with cardiovascular disease
• Menstrual Health Conditions.

Scottish Obstetrics Cardiology Network

The Scottish Obstetric Cardiology Network seeks to improve care for women with a heart condition who are thinking about or who have a pregnancy.

Information and resources are available for women and families and healthcare professionals.

Action: Where research shows there are sex-related differences in prevention, diagnosis, investigation or treatment of CVD these should be detailed in i) guidelines and ii) pathways.

• The Women’s Heart Health Subgroup input into the finalised Heart Failure and Acute Coronary Syndrome pathways, developed as part of the delivery of the Heart Disease Action Plan.
• European Society for Cardiology 2023 guidelines (Acute Coronary Syndrome, Endocarditis, Cardiomyopathies, CVD and Diabetes) all include a section on sex differences.
• The HIS Congenital Heart Disease standards were published in November 2023 and reflect sex-specific aspects of care, including pre-conception counselling and pregnancy.

Action: Improve information and public awareness of heart disease symptoms and risks for women.

• Development and delivery of an awareness campaign for heart month in February 2023.
• Outreach posters highlighting the impact of heart disease on women in Scotland were placed in 1,000 pharmacies and 1,600 organisations (such as GPs and community centres).
• The posters included a link to the NHS Inform Women’s Heart Health page, recently updated.
• The evaluation of the campaign showed that it was positively received and drove an increase in traffic to the NHS Inform page on Women’s Heart Health.
• The Alliance created a video focusing on women’s lived experience of heart disease and a webinar ‘Mythbusting Women’s Heart Health’.

Medium Term Actions

Action: Ensure women with CVD have access to mental health support, regardless of whether they are accessing a cardiac rehabilitation programme

Cardiac Computerised Cognitive Behavioural Therapies (cCBT) Tool: A cardiac cCBT tool is used in cardiac rehabilitation services in several NHS boards . The Scottish Government supported a review of the tool to ensure that it better reflected women’s lived experience of heart disease, and that there was a gender balance of user stories in the tool, which are designed to give users practical examples of application of the psychological concepts

Action: Establish appropriate representation of women in clinical research and where appropriate pregnant and postpartum women should be included in clinical trials.

The Chief Scientist Office (CSO) runs two response mode committees that operate across the clinical spectrum and have worked to ensure gender balance across the committees.

In addition, the CSO is looking to encourage researchers to consider as part of their study design and recruitment plans the diversity and representativeness of their recruitment cohort to the intended target population/the population that could benefit from the research and placing greater emphasis on this as part of the committee appraisal of applications.

CSO have been involved and support the MESSAGE project (Medical Science Sex & Gender Equity (messageproject.co.uk)) which aims to improve the integration of sex and gender considerations across data collection, analysis and reporting in biomedical, health and care research in the UK.

The MESSAGE initiative is bringing stakeholders from across the UK together to co-design a sex and gender policy framework for funding and regulatory organisations and supporting policy implementation across the UK research sector. CSO is following the development of this.

Action: Establish a peer support forum for women with lived experience of CVD.

Chest, Heart & Stroke Scotland have established an online support group for women with heart health conditions. More information is available here.

Long Term Actions

Action: Improve awareness and education among healthcare professionals of sex-related differences in presentation and management of heart disease in women of all ages.

• Chest, Heart & Stroke Scotland have created an educational resource with a specific focus on women’s heart health. This is a unique module as it is the first CHSS eLearning resource aimed at both health care professionals and those with lived experience.
• Pregnancy-specific considerations are included in the Joint Royal Colleges of Physicians Training Board cardiology curriculum across the core specialty capabilities in practice in all domains (adult congenital heart disease, coronary artery disease, arrythmia, heart failure, valvular disease)
• European Society for Cardiology 2023 guidelines (Acute Coronary Syndrome, Endocarditis, Cardiomyopathies, CVD and Diabetes) all include a section on sex differences.
• Scottish Obstetrics Cardiology Network provide information resources for healthcare professionals on pre-conception and pregnancy for women with cardiac disease Healthcare Professionals – Scottish Obstetric Cardiology Network (nhs.scot)
• NHS Education Scotland created a Heart Failure learning module for pharmacists. This includes a section on pre-conception and pregnancy considerations.
• Work to develop cardiology nursing competencies to support Transforming Nursing Roles: Paper 8, Clinical Nurse Specialists, included the statement ‘Consideration of the socioeconomic, racial and sex-based inequalities within cardiac disease’ as a core competency to be demonstrated by cardiology clinical nurse specialists.

Action: As part of Cardiac Rehab, provide an individualised biopsychosocial assessment and a shared decision care plan with interventions specific to women’s needs and choices.

• The Scottish Government is working with the National Cardiac Rehabilitation group, and the Scottish Cardiac Audit Programme to standardise data collection for these services. This will enable a better understanding of patient journeys through cardiac rehabilitation and make evidence-based improvements to service delivery.
• SIGN 150: Cardiac Rehabilitation provides a guideline for delivery of services in Scotland. It recommends that all patients referred to cardiac rehabilitation should undergo an individualised assessment leading to a care plan and interventions specific to their needs.

Action: Encourage increased representation of women clinicians by promoting diverse role models and encourage mentoring for trainees.

Activity on this action has not yet formally commenced. As a long-term action, it will continue beyond the lifetime of this phase of the Women’s Health Plan.

Action: Every cardiology department will have access to a clinician with expertise in women’s heart health.

• The Scottish Government has funded a SCAD pilot project with the aim of building expertise in Scotland to support equitable care. This includes consideration of female-specific management elements such as contraception, pregnancy , HRT, cyclical chest pain etc .

Action: Establish appropriate representation of women clinicians on i) guideline committees and; ii) within research design and development teams.

Activity on this action has not yet formally commenced. As a long-term action, it will continue beyond the lifetime of this phase of the Women’s Health Plan.