Research: Developing Solutions for Misdiagnosis of Heart Disease in Women.

Research Developing Solutions for Misdiagnosis of Heart Disease in Women.

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Research funded by the Agency for Healthcare Research and Quality examines the problem of misdiagnosis of heart disease in women from multiple perspectives and develops solutions to make a difference.

 

Heart disease is the leading cause of death among women, yet studies have shown women are far more likely than men to be misdiagnosed. 


MedStar Health Research Institute and the National Center for Human Factors in Healthcare are studying the complex web of factors behind gender-based cardiovascular misdiagnoses, which include:

  • Female-specific risks, such as an increased chance of developing high blood pressure later in life if you had it during pregnancy
  • Heart attack symptoms are different in women and men, leading to confusion among patients and providers
  • Heart disease is perceived as a “man’s disease,” so even patients can assume their symptoms are something else 
  • Inadequate training for providers makes it more challenging to spot women-specific symptoms and make a correct diagnosis
  • Guidelines designed for men and their symptoms don’t help diagnose cardiovascular disease in women

Women are nearly twice as likely as men to receive an incorrect diagnosis after a heart attack, and they are 30% more likely to see their stroke symptoms misdiagnosed in the emergency department. And when it comes to cardiovascular disease (CVD) clinical trials, women are under-represented and understudied. As a result, diagnostic and treatment guidelines are centered around the primary enrollees: older white men. 


We employed a health systems science approach to examine and address this multi-faceted problem. Funded by the Agency for Healthcare Quality and Research, our work brings multiple stakeholders into a collaborative process that aims to deliver actionable solutions.


Our team identified factors that lead to errors in CVD diagnosis and treatment in women, and we are implementing and assessing the human-centered solutions we designed in real-world and simulated environments.


Studying misdiagnosis from all angles.

Our researchers studied a large body of existing data, such as patient-reported experiences, safety learning system data reported by healthcare professionals, and patient safety event reports. To gain first-hand experience, we conducted qualitative interviews with patients, health educators, and providers—including cardiologists and primary care providers—to understand their perspectives on CVD diagnosis.


A system-wide approach made it clear that solving this complex problem requires multiple solutions.

 

Findings point to AI and communication interventions.

Among our most important findings was the central role of communication. Nearly every patient identified “listening” as a priority. Memorably, one patient told us, “I don’t care if I’m being seen in the parking lot, I just want the doctor to listen to me.”


Highlights of the data have pointed toward solutions, supported by AI, to disrupt existing communication patterns and power information-sharing:

  • One-quarter of patient reports identified diagnostic breakdowns such as accuracy, timeliness, or communication. Some reports noted more than one breakdown
  • Artificial intelligence algorithms can help identify diagnostic errors
  • Patients need new tools that enable them to be better advocates for their health
  • Health information technology solutions can boost general awareness among providers
We’ve already begun to implement solutions that can help reduce the burden of CVD misdiagnosis in women. For example:


  • Improved patient education materials that describe heart attack symptoms in women, incorporated in clinics, discharge instructions, and social media
  • Developed tools to help patients prepare for appointments, cutting the pre-visit questionnaire from 22 questions to five
  • Building health IT solutions to help primary care providers consider the impact of sex/gender on screening for CVD
  • Identified challenges with substandard facilities in underserved communities through the Built Environment Team
  • Implemented mobile, adjustable laptop tables to facilitate better face-to-face conversations between patients and providers

Our next steps include building a partnership with the MedStar Women’s Heart Health Program, continuing to collect data, and exploring ways to improve telediagnosis. This is the latest in our overall portfolio of work to create new knowledge to inform better clinical operation and train our physicians on ways to prevent diagnosis.


Improving diagnosis for everyone.

To solve the complicated problem of misdiagnosis of CVD among women, we must employ a broad-based approach to making change. It will be necessary to reconstruct the diagnostic process, revise the diagnostic team, and achieve widespread commitment.


Diagnosis is everyone’s entry point into the healthcare system. When we improve diagnosis, we improve treatment and outcomes for all patients. At MedStar Health, we’re committed to making systemic changes to eliminate disparities wherever we find them.


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