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Women face ‘striking inequalities’ in NHS heart care, study shows

Women are less likely to get the treatment recommended in clinical guidelines if they have a heart attack or are diagnosed with heart failure

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Women face stark inequalities in diagnosis and treatment of four of the most common heart conditions in the UK, new research has shown.

The study, published in The Lancet Regional Health – Europe, found that women are less likely than men to undergo coronary angiograms, a crucial procedure to look inside their heart’s arteries, after a heart attack, and are less likely to be prescribed preventative treatments for heart attacks.

The findings, led by the University of Leeds and funded by the British Heart Foundation, highlighted an estimated 500 potentially avoidable deaths in the UK each year among patients waiting for treatment for aortic stenosis, a narrowing of the heart’s aortic valve which restricts blood flow around the body.

The British Heart Foundation said the research paints a “concerning picture of unequal care”, reinforcing the need for all political parties to prioritise efforts to tackle cardiovascular disease and health inequalities.

Professor Chris P Gale, professor of cardiovascular medicine at the University of Leeds and honorary consultant cardiologist at Leeds Teaching Hospitals NHS Trust who led the study, said: “We need urgent action to revive heart care.

“The NHS is full of fantastic people who make truly monumental efforts every day to do the very best for their patients. Despite this, the NHS is creaking at the seams and we see this played out in cardiovascular care and outcomes.

“Past efforts to transform heart care and drive down waiting lists were hugely successful and we must build on the lessons from these to move forward.”

He added: “It’s clear that we’re not making the most of NHS data and we’re missing vital opportunities for this to inform policy and help target investment.

“We need a systematic approach to collect data and report on all aspects of treatment, care and outcomes. Only then will we be able to improve patient’s experiences and outcomes across the board.”

Researchers brought together evidence from studies published over the last 20 years that explored how a person’s age, sex, ethnicity and postcode are linked to the heart care they receive and their outcomes.

The team focused on heart attacks, heart failure, atrial fibrillation and aortic stenosis as these conditions lead to significant pressure on the NHS.

Prompt treatment is crucial after a diagnosis of severe aortic stenosis, as around 50 per cent of patients will die within two years of symptoms beginning.

The review showed that older people and women are less likely to receive the treatment recommended in clinical guidelines if they have a heart attack or are diagnosed with heart failure.

While the evidence for age, sex and geography was clear, the researchers said it is harder to draw conclusions about the experiences of patients of different ethnicities due to a lack of evidence.

However, from the studies available they concluded that disparities do exist. For example, there was evidence that black patients with atrial fibrillation, a common type of abnormal heart rhythm, are less likely to receive blood thinning treatment to prevent stroke than white patients.

Dr Sonya Babu-Narayan, associate medical director at the British Heart Foundation and consultant cardiologist, said: “These findings should sound the alarm bell for the state of heart care in the UK.

“This concerning review is further evidence that people’s experience of heart care was far from equal even before the pandemic began. The pandemic underlined and amplified existing health inequalities and we fear these are worse than ever now that we are firmly in the grip of a heart care crisis.”

She continued: “To stop this crisis in its tracks and address the unjust inequalities in heart care, we need bold action from the government. Protecting our hearts by tackling risk factors will help to prevent heart disease and strokes happening in the first place.

“Prioritising NHS heart care will allow people to get the help they need more quickly, preventing avoidable death and disability. And powering up research will unlock the treatments and cures of tomorrow to give more people hope for a bright and healthy future.”

Sorina Mihaila is the Femtech World editor, covering technology, research and innovation in women's health. Sorina is also a contributor for the neuro-rehabilitation magazine NR Times.

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Femtech must acknowledge the risk of perpetuating medical racism, say campaigners

Campaigners have warned that health tools could overlook women from marginalised communities

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Femtech must acknowledge the risk of perpetuating medical racism, campaigners have warned, amid concern that the sector could perpetuate long-standing racial inequities.

Femtech is already showing promise to help clinicians make better diagnoses and support women with managing their health.

But as excitement grows, campaigners have warned that these powerful tools could overlook women from marginalised communities and perpetuate long-standing racial inequities in how care is delivered.

“Any technology meant to help people track and improve women’s health outcomes must be inclusive and anti-racist,” Dr Regina Davis Moss, president and CEO of In Our Own Voice, told Femtech World.

“Black women have historically been disregarded, overlooked and undermined by the medical technology industry. It is past time for our interests and needs to be prioritised in clinical trials and other forms of scientific research.

“Femtech companies must ensure that their research and clinical trials equitably involve communities of all backgrounds.”

Around 2,000 femtech companies and apps have sprung up in the last decade to address women’s needs, including tracking apps, fertility solutions and menopause platforms.

These new tools are often built using machine learning, a subset of AI where algorithms are trained to find patterns in large data sets like billing information and test results.

The data these algorithms are built on, however, often reflect inequities and bias that have long plagued the healthcare system. Research shows clinicians often provide different care to white patients and patients of colour. Those differences in how patients are treated get immortalised in data, which are then used to train algorithms.

“When our research omits subsets of the population, the accuracy and potential benefits of that research do not extend to those who disproportionately bear the burden of disease,” said Dr Monique Gary, breast surgical oncologist at Grand View Health.

“We are seeing already how AI can harm marginalised communities, where biased algorithms require racial or ethnic minorities to be considerably ‘more ill’ than their white counterparts to receive the same diagnosis, treatment, or resource. This is perilous and avoidable.”

To create responsible and equitable technologies that include BIPOC (Black, Indigenous, and people of colour) women, Gary said companies could start identifying and recruiting experts of colour, via pipeline programmes and incubators.

“We need to start listening to, believing and supporting the voices of Black women,” she said.

“In 2024, women of all ages and races, ethnicities and orientations are telling us out loud what they need to actualise a better version of healthcare which incorporates significant tech utilisation. It’s now up to us to listen.”

Ashley Jones, creative director of Tones of Melanin, said femtech must acknowledge the risk of perpetuating medical racism and prioritise inclusivity.

“Companies in femtech should actively seek out diverse perspectives and experiences, particularly from BIPOC women, in both their datasets and research.

“This includes collaborating with BIPOC brands, stakeholders and organisations to ensure that their products address the specific needs and concerns of BIPOC women.”

Tech developers, Jones said, could address racism by implementing robust diversity and inclusion initiatives within their teams, actively seeking out BIPOC voices in decision-making processes and educating themselves on the unique experiences of BIPOC women in healthcare.

Sylvia Kang, co-founder and CEO at Mira, pointed out that femtech companies should also focus on affordability, as cost can be preventing women from marginalised communities from accessing healthcare.

“Most of the people that can access femtech tools for their health are white mid-to-high income women,” Kang explained.

“Unfortunately, there are some communities, including BIPOC that do not have enough resources to purchase these tools.

“I believe it’s our responsibility to take action and democratise our data and tools in specific ways.”

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US start-up raises US$4.3m to address maternal mental health

The funding is hoped to help FamilyWell scale throughout New England and expand nationally

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The US mental health start-up FamilyWell Health has raised US$4.3m in seed financing to support women facing maternal mental health challenges.

FamilyWell Health is a behavioural health company that integrates specialised mental health services, such as coaching, therapy and psychiatry, into OB/GYN practices.

The platform aims to provide pregnant and postpartum patients with specialised support for depression, anxiety and other perinatal mental health concerns.

New mothers face dire maternal mental health challenges in the US, with a staggering one in seven women suffering from postpartum depression.

Individuals who seek treatment typically wait for months to be seen by a mental health provider and instead turn to their obstetricians, who are often hesitant to screen for mental health conditions knowing there is a shortage of therapists and psychiatrists.

“I had difficulty finding support when I experienced postpartum depression and have cared for countless new moms struggling to access mental health care during one of the most vulnerable periods of their lives,” said Dr Jessica Gaulton, founder and CEO of FamilyWell.

“My experience, both as a survivor and as a practicing neonatologist, inspired me to start FamilyWell to provide equitable, affordable, and accessible mental healthcare for new mothers.”

By partnering with OB providers, Gaulton said FamilyWell would increase access to mental health support for pregnant and postpartum individuals where and when they need it.

The funding, led by .406 Ventures with participation from GreyMatter Capital and Mother Ventures, is hoped to help the start-up scale throughout New England and expand nationally.

Payal Divakaran, partner at .406 Ventures, said: “Given our team’s deep experience backing innovative behavioural health and women’s health companies, we had been looking at this intersection for quite some time.

“FamilyWell offers an elegant solution that is a win-win for all stakeholders, including obstetric practices. Dr Gaulton and her team have built an incredible, mission-driven company poised to address a critical need in women’s mental health.”

Dr Melissa Sherman, medical director and obstetrician at Essex OB/GYN Associates, a FamilyWell customer, added: “When you’re pregnant or caring for a newborn, you can’t afford to wait months for help.

“With FamilyWell, patients get help within days and have ongoing support through one of the biggest transitions of their lives.”

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‘Women crave the quick fix of a silver bullet’: menopause experts have their say on talking therapies

Talking therapies could reduce symptoms that may not be otherwise relieved through HRT, specialists have argued

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The recent research showing talking therapies could help women through menopause is a “fantastic step forward” in the advocation of choice, experts have said, warning that HRT alone will not reduce all symptoms.

Talking therapies, such as mindfulness and cognitive behavioural therapy, have been found to effectively treat menopause symptoms, such as low mood and anxiety.

Researchers from University College London have shown that the practices, which focus on developing behavioural patterns, coping strategies and relaxation techniques, could have benefits beyond those of HRT, including improved sleep, memory and concentration.

The techniques, experts told Femtech World, could help dampen down women’s physiological system, reducing symptoms that may not be otherwise relieved through HRT.

“Our ability to regulate the stress hormone is hampered during menopause, meaning we sit further up the stress scale than we did before,” said Dr Bev Taylor, psychologist and menopause educator.

“Stress also makes many menopausal symptoms worse, either in frequency or severity. These techniques reduce symptoms by dampening down our physiological system and bringing us back down the stress scale.”

The beauty of them, Taylor said, is that they can be used by anyone.

“Whether you can or want to take HRT or whether you want to use them alongside treatments like HRT, you can. This research is a fantastic step forward in the advocation of choice.”

Catherine Harland, menopause educator, coach and founder member of MenoClarity, said talking therapies had received a lot of backlash since the UK’s National Institute for Health and Care Excellence (NICE) recommended them in their updated guidelines.

“Whilst I understand how life-changing talking therapies can be, I fully appreciate why so many women crave the ‘quick fix of a silver bullet’ in the form of HRT as we have been taught this from a young age,” she said. “We have been taught to turn to pharmaceuticals for any symptoms we experience.”

Modern women, Harland said, live stressful, fast-paced lives, juggling a multitude of things and often feel too busy to fit talking therapies into the mix.

“Menopause is a highly sensitive time and it’s vital women begin to understand the importance of self-care which includes talking therapies and mindfulness.

“HRT alone will not reduce symptoms of stress, trauma and metabolic disease caused by living in a high cortisol state for long periods of time.”

Around 15 per cent of women aged 45 to 64 in England are currently prescribed HRT, which has increased rapidly in the last two years from around 11 per cent and continues to increase.

The main benefit of HRT, according to the NHS website, is that it can help relieve most menopause and perimenopause symptoms, including hot flushes, brain fog, joint pains, mood swings and vaginal dryness.

Draft NHS guidelines recommend offering cognitive behavioural therapy, alongside or instead of HRT.

Dr Shahzadi Harper, menopause specialist and founder of The Harper Clinic, said talking therapies could benefit women experiencing menopause symptoms and help them feel more in control. However, she said they should not be it at the forefront of the menopause conversation.

Dr Shahzadi Harper, menopause specialist and founder of The Harper Clinic

“Talking therapies do not address the inherent hormone deficiency that arises due to perimenopause and menopause and the long-term consequences of declining hormone levels,” Harper explained.

“I don’t think they should be at the forefront and definitely not instead of HRT. However, I do think they could be a useful tool, especially as the symptoms of menopause can be quite debilitating and affect mental health and mood.”

Dr Clare Spencer, menopause specialist, GP and co-founder of My Menopause Centre, said while HRT could help many women manage symptoms of the menopause, there would be some women who may continue to experience symptoms, such as poor sleep, low mood and anxiety, despite being on it.

“Women may face other difficulties at the time of the menopause that may be additional causes of stress which can also impact on experience of symptoms of the menopause.

Dr Clare Spencer, GP, menopause specialist and co-founder of My Menopause Centre

“In these cases, there is a place for talking therapies, such as cognitive behavioural therapy and mindfulness, to help break some of the vicious cycles that can then exist.

“There is also a role for talking therapies in helping women who have been advised not to take HRT or do not wish to.”

She said, however, that long NHS waiting lists could prevent women from getting the support they need.

“There is an issue with access to cognitive behavioural therapy and mindfulness-based therapies through the NHS which does need resolving to allow more women access timely support,” she added.

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