PCORI-Funded Studies Spotlight Heart Disease in Women

Heart disease is widespread and sadly, often deadly. According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death in the United States. While all people are affected, cardiovascular disease is particularly underdiagnosed and undertreated among women. Per the American Heart Association, heart disease kills more women than all types of cancer combined. Unfortunately, many women are unaware of their heart disease risk.

Funding for heart disease-related projects has been a longstanding priority at PCORI. As of December 2021, PCORI has awarded $397 million dollars to fund 83 comparative clinical effectiveness research studies related to cardiovascular disease. About 40% of these studies focus on women as the population of interest.

PCORI's Executive Director on Her Cardiology Journey

PCORI Executive Director Nakela L. Cook, MD, MPH, shares her inspiring journey and why she chose to pursue a career in medicine and the specialty of cardiology.

Improving Awareness About Women's Heart Health

In 2021, WomenHeart: The National Coalition for Women with Heart Disease partnered with the Society to Improve Diagnosis in Medicine (SIDM) and received funding, through the Eugene Washington PCORI Engagement Awards Program, to host a virtual convening about women’s heart health: A Convening to Address Missed and Delayed Diagnosis of Heart Disease in Women.

Approximately 50 participants, including patients, clinicians, advocates, and researchers, gathered to identify challenges that contribute to delays in the diagnosis of heart disease in women.

The participants generated ideas for interventions to address those challenges, which were then reframed as potential research questions, published in their 2021 report, A Report From a Convening on Missed and Delayed Diagnosis of Heart Disease in Women.

The goal is for this report to guide future, patient-centered research to help eliminate disparities in the accurate diagnosis and treatment of heart disease in women.

Maternal Heart Health

Unfortunately, cardiovascular complications of pregnancy and the postpartum period, including cardiomyopathy, heart failure, eclampsia, and stroke, are also the leading causes of maternal death. Moreover, maternal mortality among non-Hispanic Black and American Indian/Alaska Native women is 2-3 times that of white women, even when taking other sociodemographic factors into account.

In 2019, PCORI’s reauthorizing legislation identified maternal morbidity and mortality (MMM) as a priority topic for research. PCORI responded with an immediate call for applications to fund projects addressing MMM.

In 2021, PCORI also released a targeted funding announcement for studies designed to improve postpartum outcomes among underserved communities. 

In addition, PCORI is funding the Agency for Healthcare Research and Quality (AHRQ) to complete a systematic evidence review on the Peripartum and Postpartum Management of Women with Hypertensive Disorders of Pregnancy (HDP), a topic that was nominated by The American College of Obstetricians and Gynecologists (ACOG).

The review seeks to summarize the available evidence regarding strategies to monitor and treat hypertensive disorders of pregnancy, including gestational hypertension and chronic hypertension, as well as to compare the effectiveness and harms of different regimens to manage preeclampsia. This systematic review is currently ongoing.

A PCORI-funded study, The Path to Optimal Black Maternal Heart Health: Comparing Two CVD Risk Reduction Interventions, exploring the interplay between race and maternal heart health is also underway in Pennsylvania.

Sharon Herring, MD, MPH of Temple University and Saleemah NcNeil, MS, MFT of the Oshun Family Center in Philadelphia, PA designed the study to compare two approaches to address risk factors for heart disease among pregnant women who self-identify as Black or African American. Both approaches will address modifiable risk factors for heart disease, including hypertension, but only one intervention will provide added support from a multidisciplinary, maternal wellness team.

The Maternal Wellness Village approach, described by the investigators as, “for Black women by Black women” integrates community doula care, mental health services, and lactation counseling to support women during pregnancy and beyond. Study recruitment is expected to begin in Fall of 2022.

Through these and other ongoing projects, PCORI hopes to address sex-related disparities in the diagnosis and treatment of heart disease. PCORI will also continue to explore opportunities for our stakeholders to identify topics of interest and key research gaps concerning women’s heart health. We remain committed to funding actionable projects that improve patient outcomes overall and reduce the burden of cardiovascular disease among women, in particular.