Women with repeated chest pain represent the biggest disconnection between science and practice in all of American medicine and I have written about this topic several times in this space. Yesterday, I met with a group of nurse coaches who had been trained in optimal medical therapy and they told me about a woman they had engaged with repeated chest pain.
When a patient engages our health system, they have a problem—a complaint. When the system submits a bill for that visit, the complaint code is listed along with the claim for payment. This is called claims data. Our system can identify every female patient who has a chest pain complaint and then we submit the list to nurse coaches for them to contact.
When one of the nurses called one of these patients, she did indeed have repeated chest pain, but she had been told it was due to her esophagus. She had diabetes with a pregnancy and she remained prediabetic. The top number on her blood pressure was over 160 and she was over 50 years old. She probably has the heart artery disease that is typical for women and finding her is a big deal.
In the six years following diagnosis, eleven percent of these women without heart artery blockages die. About a third of them die suddenly of their heart artery disease without warning. Many of them die without ever being diagnosed. This is also a very expensive problem. These women have very high medical costs because their problem is not solved—it is frightening— and they return to the emergency room and hospital repeatedly for more expensive tests. Sixteen years ago they cost three quarters of a million dollars each. They are more expensive today.
There are thousands of these women out there without a proper diagnosis and we can find them pretty easily. Once we find them, we can protect them. The woman we just found had diabetes when she was pregnant and she is prediabetic now. She should be on metformin. She should be on 40mg of atorvastatin and she should be on additional blood pressure medication to bring the top number under 130. She should have nitroglycerin and other medications to help with the pain and she should be on an aspirin as a blood thinner. Once women like this are on optimal medical therapy (OMT), most of them no longer have chest pain after a year. They stop going to the emergency room and having expensive tests. Most importantly, they no longer have pain and their most dangerous health problem is solved. The specific research for women with chest pain has been done. We know what to do. You can protect the women in your life now. Let’s get started.
We can help!
Remember this? https://open.substack.com/pub/mcgdoc/p/how-mcg-helped-my-friend-bills-neighbor?r=q7iae&utm_medium=ios&utm_campaign=post