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Multidisciplinary management of cardiovascular disease in women: Delphi consensus
José M Gámez1,2, Milagros Pedreira Pérez3, María Rosa Fernández Olmo4
1Servicio de Cardiología, Hospital Universitario Son Llatzer, Departamento de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Spain.
Insights
Expert consensus highlights the need for tailored cardiovascular disease (CVD) management in women, addressing risk factors, diagnosis, and treatment disparities. Further research and training are needed to reduce inequalities in women's heart health.
Area of Science:
- Cardiology
- Women's Health
- Public Health
Background:
- Current cardiovascular disease (CVD) clinical guidelines lack specific recommendations for the female population.
- Expert consensus is needed to address the management of CVD in women.
Purpose of the Study:
- To determine expert opinions on the management of cardiovascular disease (CVD) in women.
- To identify areas of agreement and disagreement regarding CVD in women.
Main Methods:
- A Delphi consensus method was employed with 31 cardiologists, 9 gynecologists/obstetricians, and 14 primary care physicians.
- Experts evaluated 44 items related to CVD in women, categorized into risk factors/prevention, diagnosis/manifestations, and treatment/follow-up.
Main Results:
- Consensus was reached on 27 out of 44 items (61.4%).
- Key agreements included monitoring blood pressure during pregnancy for hypertensive disorders and controlling gestational diabetes.
- Panelists agreed on lower statin intensity for women than men, but consensus on differential drug efficacy was lacking.
Conclusions:
- High consensus indicates awareness of sex-based differences in CVD management and the need for interventions.
- Low consensus, particularly in treatment and follow-up, highlights knowledge gaps and the need for further education and training.
Background:
Current clinical guidelines on cardiovascular disease (CVD) do not specifically address the female population. The aim of this consensus is to know the opinion of a group of experts on the management of CVD in women.
Methods:
Through a Delphi consensus, 31 experts in cardiology, 9 in gynecology and obstetrics, and 14 primary care physicians, showed their degree of agreement on 44 items on CVD in women divided into the following groups: (1) risk factors and prevention strategies; (2) diagnosis and clinical manifestations; and (3) treatment and follow-up.
Results:
After two rounds, consensus in agreement was reached on 27 items (61.4%). Most of the non-consensus items (31.8%) belonged to group 3. The lack of consensus in this group was mainly among gynecologists and primary care physicians. The panelists agreed on periodic blood pressure control during pregnancy and delivery to detect hypertensive disorders, especially in women with a history of preeclampsia and/or gestational hypertension, and diabetes mellitus control in those with gestational diabetes. Also, the panelists agreed that women receive statins at a lower intensity than men, although there was no consensus as to whether the efficacy of drug treatments differs between women and men.
Conclusions:
The high degree of consensus shows that the panelists are aware of the differences that exist between men and women in the management of CVD and the need to propose interventions to reduce this inequality. The low level of consensus reveals the lack of knowledge, and the need for information and training on this topic.
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