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Summary
hub topic lead, retired psychotherapist, and current Chair of the Women and Heart Network at Global Heart Hub, Risa Mallory, and Karen Padilla, the staff lead of the Women and Heart Network at Global Heart Hub, discuss women’s heart health inequities from both an individual advocate’s and advocacy organisation’s perspective. They explain why the conversation must move beyond awareness alone into actions.
This blog is part of a series on noncommunicable diseases, in support of World Patient Safety Day 2026.
Content
For decades, heart disease has remained the leading cause of death among women, yet women continue to experience significant inequities in how heart disease is recognised, diagnosed, treated and managed. In addition to well-established risk factors, many women also face sex-specific and other under-recognised risk factors like premature menopause, gestational diabetes and hypertensive disorders of pregnancy, as well as psychosocial and environmental risk factors or socioeconomic deprivation. These inequities are often discussed as healthcare disparities, research gaps or issues of access. However, there is another lens through which we must view them: patient safety.
Patient safety is commonly associated with medication errors, hospital-acquired infections or surgical complications. However, patient safety also encompasses harm that results from delayed diagnosis, missed symptoms, inadequate communication, fragmented care and healthcare systems that fail to meet the needs of specific populations. Women living with heart disease encounter these risks every day.
Perspectives of an individual patient advocate
From the perspective of an individual patient advocate, the consequences of these inequities are deeply personal.
Many women describe years of unexplained symptoms before receiving an accurate diagnosis. Others recount being told their symptoms were caused by stress, anxiety, menopause or lifestyle factors when they were, in fact, experiencing serious cardiac conditions. Some women leave emergency departments without appropriate investigations. Others receive treatment only after their disease has progressed significantly.
These experiences are not isolated incidents. They are recurring patterns that expose women to preventable harm.
Women are more likely to experience unrecognised symptoms during a heart attack. Conditions such as spontaneous coronary artery dissection (SCAD), coronary microvascular dysfunction and myocardial infarction with non-obstructive coronary arteries (MINOCA) disproportionately affect women yet remain under-recognised in many clinical settings. When healthcare providers lack awareness of these conditions, the risk of missed or delayed diagnosis increases.
For patients, every delay matters.
A missed diagnosis is not simply an inconvenience. It can lead to worsening disease, avoidable hospitalisations, increased disability, psychological distress and, in some cases, death. When women are repeatedly required to advocate for themselves in order to be heard, believed or investigated appropriately, the burden of safety shifts from the healthcare system to the patient.
No patient should have to become an expert in their health in order to receive safe care.
Perspectives of a patient advocacy organisation
From the perspective of a patient advocacy organisation, these individual experiences reveal broader systemic failures.
Patient safety cannot be achieved when the evidence base itself has historically excluded women. For many years, cardiovascular research primarily focused on male participants, creating gaps in our understanding of how heart disease presents, progresses and responds to treatment in women. Women represented less than 39% of cardiovascular disease clinical trial participants between 2010-2017.[1] This underrepresentation limits the potential for developing sex-specific strategies and recommendations. Although progress has been made, these knowledge gaps continue to influence clinical practice today.
Healthcare systems also frequently rely on care pathways, educational materials and risk assessment tools that were not designed with women’s experiences in mind. The result is a mismatch between patient needs and the services available to support them.
Health inequalities are further compounded by social determinants of health.
Perspectives of the international community
From the perspective of the international community of heart patients, inequalities in healthcare place an enormous social, economic and psychological burden on patients, their families and their caregivers, jeopardising their quality of life and, ultimately, their safety. Women who are racialised, Indigenous, living with disabilities, living in rural communities or experiencing socioeconomic disadvantage often face multiple layers of inequity. They may encounter barriers to specialist care, longer wait times, transportation challenges, financial constraints or communication obstacles that further increase their risk of poor outcomes.
These factors do not merely influence health outcomes; they influence patient safety.
A healthcare system that does not account for these realities creates conditions in which preventable harm becomes more likely.
The transition from hospital to home provides a particularly important example. Many women report feeling unprepared following a cardiac event or hospitalisation. They may receive fragmented information, limited education about symptoms to monitor, unclear medication instructions or inadequate follow-up planning. For instance, registries show that the referral of women to cardiac rehabilitation is significantly lower, despite it being strongly recommended based on the highest quality evidence in the guidelines for the management of acute coronary syndromes. Without effective discharge processes and continuity of care, patients can experience avoidable complications, medication errors, emergency department visits and readmissions. Safe care extends beyond hospital walls.
Patient safety depends on ensuring that patients and caregivers have the information, resources and support necessary to manage their health after discharge. When those supports are absent, risk increases.
Addressing these inequities requires action at every level of the healthcare system.
Healthcare organisations must invest in education that improves awareness of sex- and gender-specific aspects of cardiovascular disease. Research funders must continue to prioritise studies that generate evidence relevant to women. Clinical guidelines must reflect emerging knowledge about conditions that disproportionately affect women. Health systems must strengthen transitions of care and ensure patients receive clear, accessible information throughout their healthcare journey.
Patients as partners
Equally important is the inclusion of patients as partners in designing solutions.
Women with lived experience bring critical expertise about where systems fail and where opportunities for improvement exist. Their insights can help identify safety risks that may otherwise remain invisible to healthcare professionals and decision makers. Meaningful patient engagement is not a courtesy; it is an essential component of safer care.
From both individual advocate’s and advocacy organisation’s perspective, we have witnessed the power of patient voices to drive change. We have also witnessed the consequences when those voices are ignored.
The conversation about women’s heart health must move beyond awareness alone. Awareness is important, but awareness without action does not prevent harm. We must recognise that health inequities in cardiovascular care are not only matters of fairness and access; they are patient safety issues that affect diagnosis, treatment, recovery and survival.
Every woman deserves to have her symptoms taken seriously. Every woman deserves timely diagnosis and evidence-based care. Every woman deserves a healthcare system designed to keep her safe.
References
Read our other World Patient Safety Day (WPSD 2026) blogs:
- What is a noncommunicable disease? Understanding this year’s World Patient Safety Day theme…
- The cost of a missed dose: how a new dashboard is transforming getting Parkinson’s medication on time
Download our WPSD 2026 poster to use in your organisation
About the author
Risa Mallory: a retired psychotherapist from Canada, became an advocate for patient healthcare following a serious cardiovascular event in 2018. Through her collaboration with local, national, and international healthcare organisations and institutions, she contributes the perspectives, priorities, and feedback of patients to healthcare decision-making at all levels, from individual care to organisational policymaking. She firmly believes that knowledge is power and that every individual can impact their health, and the health of their communities, through increased literacy, open dialogue, and advocacy.
Karen Padilla: Karen is the Networks Manager at Global Heart Hub, where she works with patient organisations worldwide to strengthen and unite the voice of people living with or affected by cardiovascular disease. She brings extensive expertise in stakeholder engagement and programme coordination and helps translate evidence into advocacy action, advancing patient-centred cardiovascular care and supporting the development of practical, impactful solutions. She holds an International Executive Master in Patient Advocacy Management from Università Cattolica del Sacro Cuore, Italy.
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