In the following interview, Beatrix Jasper, an expert in cardiology medical technology with many years of experience, talks about the particular challenges of women's heart health. She sheds light on gender-specific differences in the diagnosis and treatment of cardiovascular diseases and shows how telemonitoring can contribute to better care. Read more about the importance of prevention, early education and technological support for female heart patients here.

**About**

Beatrix Jasper is an expert in the field of cardiology medical technology. With her many years of international experience, she has successfully launched innovative products in various markets and opened up new sales areas for her employer. As a certified business coach, she uses customized methods to work with her clients to develop their personal resources and use them in a goal-oriented manner. Her coaching approach makes it possible to promote emotional and cognitive self-management and uncover individual desires and motivations. She is particularly committed to the visibility and individuality of women in medical technology, both in therapeutic areas and in terms of influencing corporate organizations.

Good morning, Ms. Jasper. Thank you for taking the time to talk to us. We would like to devote today's interview entirely to the topic of heart health in women. In February, you wrote an exciting article on your LinkedIn profile in which you emphasize the importance of education and targeted therapy for women's heart health...

Yes, this topic is particularly important to me, as I have had the experience in my private life that the symptoms of a heart attack in women are very different from those in men and that knowledge of this is extremely low in this target group. My grandmother might have been more likely to see a doctor or call the emergency services if she had been aware of the specific symptoms of a heart attack in women. (Note SEMDATEX: You can read about the typical symptoms of a heart attack in women here)

Cardiovascular diseases are the most common cause of death among women in Germany. Can you explain why women are so likely to be affected by heart failure (HF) during their lifetime?

Heart attacks are still often seen as a typical male disease, but cardiovascular diseases are also the number one cause of death in women. 19,000 women die of a heart attack in Germany every year. Overall, men die more frequently, but the risk of dying in the first year after a heart attack is 1.5 times higher in women than in men. The reasons for this are the different symptoms, delayed diagnosis or incorrect medication. Women also have an increased risk of heart failure due to changes in hormone levels during the menopause, in addition to the multiple stresses of work and family in our western society.

For a long time, little attention was paid to women's hearts in research. Today we know that they "beat differently" - can you explain which factors need to be given special consideration when it comes to women's heart health? Are there gender-specific differences in the medical treatment of heart failure?

Women have an increased risk of cardiovascular disease due to the drop in oestrogen levels after the menopause. This hormone not only acts as a sex hormone, but also as a messenger substance for regulating blood pressure and heart rate. Many factors that become particularly apparent with the onset of the menopause, e.g. weight gain, sleep disorders and difficulty concentrating, which in turn contribute to increased stress levels, can have a negative impact on female heart health.(1) There can be increased fatty deposits in the coronary arteries as the vasodilating effect of oestrogen diminishes.(2)

Even in the 21st century and despite many new findings, multiple stresses and their influence on physical health are still not fully accepted. More and more women are working full-time, while still earning on average 16% less than men. The birth of a child is an enormous feat of strength for a woman's body and can even lead to dissections in the coronary arteries. Furthermore, women with gestational diabetes - even if they do not subsequently develop type 2 diabetes - have a 40% higher risk of heart attacks, and with manifest diabetes the risk is five times higher than for women without gestational diabetes.(3) The double burden of care work and a full-time job can lead to further mental stress factors and have an impact on a woman's heart health in the form of cardiovascular disease.

A pioneering step towards effective health management for women is the increasing relevance of gender medicine. As a result, the focus is shifting to different symptoms, and consequently diagnoses and therapeutic treatments, for cardiovascular diseases. To date, women have been underrepresented in scientific studies on treatment - only 25% of study participants are women. However, the effects of many (identical) treatments and side effects are different for women and men.

How do you assess the long-term effects of telemedical care for women with heart failure, particularly in terms of survival and quality of life? How can telemedicine approaches help to reduce hospitalizations in patients with heart failure?

Women need to be informed at an early stage, preferably as early as school age, about the gender-specific symptoms of heart attacks, what to do to prevent them and how to act in an emergency. Stress prevention is also an important component. How does stress arise, how can I avoid it and what effects does it have on heart health? Key health policy decision-making bodies can contribute to this by anchoring preventive check-ups for women over 40 in the health care catalog by law.

Prevention is more effective and cost-effective than cure. In addition, it is important to actively minimize the multiple burdens on women and the discrimination against women that still prevails in many areas of our society and to strengthen the solidarity of women and men with modern role models.

An essential and yet little-noticed factor is self-efficacy - i.e. independent health management that every patient can take on for themselves with the support of remote patient monitoring, which is often used in hospital and health insurance programs. This gives patients the opportunity to monitor vital parameters and symptoms themselves after a heart attack or as a preventative measure when heart failure is indicated and to recognize them at an early stage and, if necessary, consult the treating doctor or experts in a clinic.

In addition to telemedical care, it is crucial to use Behavior Change Techniques (BCT) in a targeted manner to motivate women and patients with heart failure to integrate healthy behaviors such as regular exercise/sporting activity, stress reduction and smoking cessation into their everyday lives in the long term. This can be supported by personalized, digital interventions that are tailored to the specific needs and life realities of patients and help them to achieve their health goals on their own responsibility.

What challenges do you see in the implementation of telemonitoring programs for heart failure patients, especially in terms of acceptance and access to technology?

One challenge in implementing telemonitoring programs for heart failure patients is the willingness of patients to use the technology regularly and correctly. In addition, acceptance of the technology and integration into GP practices is also a significant hurdle. Even though patients are now increasingly informing themselves about indications and forms of therapy and are often already equipped with smartwatches, the treating doctor is still the first person of trust and point of contact in the 70+ age group. Even with an increasingly younger heart failure patient clientele, this view may only change marginally. It is extremely important to provide information about the benefits, as well as application support and "trouble shooting". Trouble shooting in this context refers to supporting patients in the event of problems or uncertainties in the use of their therapy or medical devices. This includes, for example, clarifying technical difficulties or the correct interpretation of measured values.

Furthermore, it is also the task of health insurance companies to recognize and financially support this suitable remote monitoring as a support and supplement to medical care by a doctor. The question that also arises is what happens to the collected data, what warning systems are available, and how and where they are analyzed and evaluated. Another key factor in terms of the health care structure is the balance between care in urban and rural areas. I come back to the example of my grandmother, who had a neighbor drive her to the nearest hospital, which in turn was 20 km away.

What role does continuous monitoring of vital signs play in the early detection of deterioration in the health of heart failure patients?

A large and growing role, I think. The monitoring of vital parameters such as heart rate, blood pressure, body weight, pulse rate and oxygen saturation can provide early warning signals if these change.

By transmitting these values, the attending physician can make early adjustments to the treatment and use the patient as her own health manager by discussing and defining the individual limit values and having them checked by the patient using telemonitoring. This early monitoring and the resulting treatment adjustments and self-monitoring can reduce hospital stays and improve the patient's quality of life.

Which current telemedicine technologies or platforms do you consider to be particularly effective in the management of heart failure in women?

There are already some very good and established telemedicine technologies that have led to a reduction in mortality by monitoring vital signs and evaluating them in terms of treatment. Here I would like to refer to the Fontane study (2013- 2018), in which the mortality rate was reduced by 20% and the hospitalization rate by 30% using telemedicine platforms, with 1,500 study participants. An excerpt: "An algorithm-supported evaluation of the data allows a statement to be made after just 60 seconds about the patient's risk situation and the need for interventions: Calling back and advising the patient, informing the nearest GP/specialist in the periphery through to the deployment of a rescue helicopter in a life-threatening emergency."(4)

What future developments do you see in the area of remote patient monitoring for heart failure, particularly with a focus on female patients?

At this point, I would like to quote the demands of Healthcare Frauen e.V. in their call to politicians: Statutory health insurance companies should be given incentives to offer specific prevention programs for women with an increased risk of cardiovascular disease that are specifically tailored to the particular needs and risks of this group. This also includes the prevention of secondary diseases. These programs could make an important contribution to reducing gender-related inequalities in health opportunities, as provided for in Section 20 SGB V (1) - an objective that has not yet been adequately addressed.

I also see the need to include gender-specific symptoms and measurements and to prepare and visualize these analysis results in a patient-friendly way. In addition - and as part of health insurance programs - remote patient monitoring could start in the prevention phase. In phase 0, so to speak, before heart failure occurs. It is essential to raise awareness of the risk factors and how to minimize them, as well as to recognize that one's own health is the most valuable asset and that one can only be there for others in a healthy state.

Thank you very much for the informative interview!

Sources:

(1) https://www.bhf.org.uk/informationsupport/support/women-with-a-heart-condition/menopause-and-heart-disease#:~:text=If%20your%20oestrogen%20levels%20fall,risk%20of%20coronary%20heart%20disease.

(2) https://herzstiftung.de/infos-zu-herzerkrankungen/herzinfarkt/anzeichen/herzinfarkt-frauen-symptome

(3) Tobias DK, Stuart JJ, Li S, Chavarro J, Rimm EB, Rich-Edwards J, et al. Association of History of Gestational Diabetes With Long-term Cardiovascular Disease Risk in a Large Prospective Cohort of US Women. JAMA Intern Med. 2017;177(12):1735-42. doi: 10.1001/ jamainternmed.2017.2790

(4) https://www.aerztezeitung.de/Wirtschaft/Deutlich-weniger-Klinikeinweisungen-durch-Telemedizin-406008.html

Heart Health in Women: Prevention and Innovation In The Digital Age - An Interview with Beatrix Jasper