Challenges to Cardiovascular Health Among Female U.S. Veterans and Future Implications: A Scoping Review

Cardiovascular disease (CVD) is the leading cause of death for women in the United States, and U.S. female Veterans have higher rates of CVD compared to civilian women. With an increasing number of women joining the military, the number of female Veterans is expected to rise; therefore, providing appropriate cardiovascular care must be a top priority for the DoD and the Veterans Health Administration (VHA). This scoping review will answer the question: "Among U.S. female Veterans, what are the challenges faced in cardiovascular health, and what are potential future implications and interventions?" We designed this scoping review to identify common themes and gaps in the literature, guide further investigations, and contribute to developing targeted interventions and policies to enhance cardiovascular outcomes among female Veterans.

On May 1, 2024, a modified PRISMA-ScR search was performed using the following online databases: PubMed, CINAHL, and OVID. The inclusion criteria included U.S. female Veterans, CVD, and data collected from VHA database sources. Results from any literature source published in the past 10 years and written in English were considered. The search identified 107 studies. Two independent reviewers screened titles and abstracts and then performed full-text reviews.

We identified 34 studies assessing challenges to cardiovascular care among female Veterans in areas of racial/ethnic and gender-specific disparities regarding the prevalence of nontraditional CVD risk factors, access to health care services, awareness and knowledge of CVD risk factors, and willingness to receive cardiovascular care. The review also identified potential areas for improvement initiatives in education, peer support, and future research.

This review highlighted 3 main challenges female Veterans face in accessing CVD care from the VHA: perceived barriers, unique risk factors, and gender/racial disparities. It emphasized the need for improved CVD research, screening, education, and social support for female Veterans. The authors propose two main strategies to address these challenges: (1) pre-transition education from the DoD and (2) enhanced CVD training in the VHA. Cardiovascular disease risk factor recognition and prevention education should occur in military settings, allowing medical providers in DoD clinics to engage female service members in discussions and screenings before transitioning to VHA care. The VHA should educate providers on the barriers female Veterans face, the identification of nontraditional risk factors, and existing health care disparities. Additionally, it should continue to support successful initiatives focused on improving CVD care for female Veterans, such as the Women's Health Research Network, the Quality Enhancement Research Initiative, and the Enhancing Mental and Physical Health of Women through Engagement and Retention program.