The AHA reports that approximately 82.6 million people in the United States currently have one or more forms of cardiovascular disease (CVD). Though traditionally considered a man’s disease, it is estimated that 1 in 16 women who are over 20 years old have coronary heart disease making it something women of all ages should be aware of. Findings suggest that nearly half of all adults over 40 may have “hidden” heart conditions that go undetected.[i]
Several factors contribute to the prevalence of undiagnosed CVD:
- Lack of Symptoms and Silent Nature of CVD
One major challenge in diagnosing CVD lies in its often-silent progression. Many individuals with early-stage CVD might not exhibit obvious symptoms (like chest pain) until the disease has advanced significantly. Symptoms can also be non-specfic and temporary (swelling, fatigue, dizziness, shoulder and neck pain etc.). People as well as their doctors, often don’t consider themselves to be at risk and don’t seek care in time.
- Limited Awareness
Another critical factor is the lack of awareness and education about cardiovascular health. Many individuals, particularly those who are younger or don’t have a family history of CVD, might not prioritize regular health check-ups or screenings. Moreover, misconceptions about who is at risk for CVD can deter people from seeking preventive care. A study published in the American Journal of Preventive Medicine found that only 52% of respondents recognized all major heart attack symptoms and knew to call 911. The Centers for Disease Control and Prevention (CDC) reported that about 11 million adults with hypertension (high blood pressure) were unaware of their condition in 2017-2018.
- Inadequate Access to Healthcare
Limited access to healthcare, particularly among marginalized and underserved populations, can result in delayed diagnosis or no diagnosis at all. Lack of health insurance, transportation, and financial constraints can all hinder individuals from seeking medical care, including necessary cardiovascular screenings. In 2020, the Kaiser Family Foundation estimated that approximately 29 million non-elderly adults in the U.S. were uninsured.
- Stigma Surrounding Healthcare Seeking
The CDC’s Behavioral Risk Factor Surveillance System found that some individuals avoid seeking medical care due to a lack of transportation, cost, and fear of a diagnosis, among other reasons. This avoidance behavior perpetuates the problem of undiagnosed CVD, allowing the disease to progress unchecked.
A US national study reported that one third of respondents claimed to actively avoid seeing a doctor[ii]. A 2014 study identified [iii] three main categories of reasons for avoiding medical care. First, over one-third of people reported unfavorable evaluations of seeking medical care, such as factors related to lack of confidence in physicians, a feeling of being dismissed or not listened to, disappointment in dealing with health care organizations, and affective concerns such as fear of bad news or procedures. Second, a subset of participants reported low perceived need to seek medical care (12.2%), Third, many participants reported traditional barriers to medical care (58.4%), such as high cost (24.1%), and time constraints (15.6%). The findings indicate that, alongside convenience, a patient’s perceived lack of agency is a material barrier. This includes concerns about ineffective or strained communication with providers and concerns about unnecessary tests and lack of confidence that the care they need will not be provided. Four out of five women report that they have felt that healthcare professionals often don’t listen to them,[iv] especially when their symptoms are being dismissed or downgraded.
- Fragmented Healthcare System
The fragmented nature of the U.S. healthcare system can also contribute to undiagnosed CVD. With different medical providers and facilities, individuals might not receive consistent care or comprehensive screenings. Lack of coordination between primary care physicians, specialists, and other healthcare professionals can result in missed opportunities for early diagnosis and intervention. A study published in the Journal of the American Heart Association found that a significant number of individuals who experienced a heart attack had not been previously diagnosed with high cholesterol or diabetes, suggesting missed opportunities for early intervention.
CVD is the primary cause of death in both men and women in the United States and worldwide.[v] [vi] Multiple lines of research convincingly demonstrate that early detection or outright prevention of CVD is economically, socially, and humanly superior to even the best medical treatment of manifest CVD.[vii] [viii] [ix] Studies indicate that management of CVD risk factors, including early detection before an event would have prevented or postponed 33% of deaths. This is compared with prevention of only 8% of deaths if “perfect care” was used during an acute event. This data provides strong support for the importance of self‐care in preventing CVD and further events. iii The concept of self-care recognizes that patients have a role in maintaining and monitoring their own cardiovascular health including possible early detection or progression of disease. This is role is particularly relevant when one considers the predominance of disease in the population and the scale of undiagnosed or misdiagnosed cases.
Some great reference sites worth checking out
- American Heart Association (AHA): https://www.heart.org/
- Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/
- American Journal of Preventive Medicine: https://www.ajpmonline.org/
- Kaiser Family Foundation: https://www.kff.org/
- Journal of the American Heart Association: https://www.ahajournals.org/journal/aha
- American College of Cardiology: https://www.acc.org/
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[1] Subclinical Coronary Atherosclerosis and Risk for Myocardial Infarction in a Danish Cohort, A Prospective Observational Cohort Study Andreas Fuchs, MD, PhD, Jørgen Tobias Kühl, MD, PhD, DMSc
[1] Kannan VD, Veazie PJ. Predictors of avoiding medical care and reasons for avoidance behavior. Med Care. 2014;52:336–345. doi: 10.1097/MLR.0000000000000100.
[1] Subclinical Coronary Atherosclerosis and Risk for Myocardial Infarction in a Danish Cohort, A Prospective Observational Cohort Study Andreas Fuchs, MD, PhD, Jørgen Tobias Kühl, MD, PhD, DMSc
[1] Kannan VD, Veazie PJ. Predictors of avoiding medical care and reasons for avoidance behavior. Med Care. 2014;52:336–345. doi: 10.1097/MLR.0000000000000100.
[1] Why do People Avoid Medical Care? A Qualitative Study Using National Data Jennifer M. Taber, Ph.D., Bryan Leyva, B.A, and Alexander Persoskie, Ph.D. J Gen Intern Med. 2015 Mar; 30(3): 290–297. Published online 2014 Nov 12. doi: 10.1007/s11606-014-3089-1, PMCID: PMC4351276 PMID: 25387439
[1] Women’s Health Strategy for England, 30 August 2022, CP 736 ISBN 978-1-5286-3665-0
[1] WHO Regional Office for Europe . Data and statistics. The challenge of cardiovascular disease—quick statistics. Available at: http://www.euro.who.int/en/health-topics/noncommunicable-diseases/cardiovascular-diseases/data-and-statistics. Accessed December 22, 2016.
[1] WHO Regional Office for Europe . The European health report 2015. Targets and beyond—reaching new frontiers in evidence. 2015. Available at: http://www.euro.who.int/__data/assets/pdf_file/0008/284750/EHR_High_EN_WEB.pdf. Accessed December 16, 2016.
[1] Kottke TE, Faith DA, Jordan CO, Pronk NP, Thomas RJ, Capewell S. The comparative effectiveness of heart disease prevention and treatment strategies. Am J Prev Med. 2009; 36:82–88.
[1] Goldman DP, Cutler D, Rowe JW, Michaud PC, Sullivan J, Peneva D, Olshansky SJ. Substantial health and economic returns from delayed aging may warrant a new focus for medical research. Health Aff (Millwood). 2013; 32:1698–1705.
[1] Goldman DP, Gaudette E, Cheng WH. Competing risks: investing in sickness rather than health. Am J Prev Med. 2016; 50(5 suppl 1):S45–S50.