The heart attack gender gap
Edinburgh researchers have found that women receive poorer heart attack treatment than men, despite improvement in diagnosis. And they are now investigating why.
The Times newspaper recently reported that a mobile phone app that acts as a virtual GP was putting female patients’ health at risk. Tests found that entering identical heart attack symptoms for men and women resulted in different suggested diagnoses: men were told they could be having a heart attack and should visit A&E, while women were advised that they were likely having a panic attack.
Although justified by the app creators as based on probability, the report highlights a prevalent concern in heart health diagnoses, and one that has been underlined by new research conducted at the University.
Dr Ken Lee from the Centre for Cardiovascular Science found that while diagnoses for heart attacks or injury to the heart muscle in women was improved by refining the use of a highly sensitive test, women remained half as likely as men to receive recommended treatment for heart attacks.
His team sought to understand the impact of using the high sensitivity troponin blood test for heart attacks but with specific thresholds for men and women, as a lower amount of troponin is released in women during a heart attack.
The study included 48,282 people (47 per cent women, 53 per cent men) in 10 hospitals across Scotland, suspected to have had a heart attack. During the initial phase of the study, diagnosis was made using the same troponin threshold for men and women. A more sensitive troponin test with cut-off values specific for men and women was then implemented across these hospitals. The treatment they received, and whether they suffered from another heart attack or death one year later, was recorded. The results showed an increase in the number of women identified by 42 per cent – from 3,521 to 4,991 women out of a total of 22,562 women.
This increase meant a similar proportion of men and women were found to have a heart attack or injury to the heart muscle after going to A&E with chest pain (22 per cent of women and 21 per cent of men).
One piece of the puzzle
But the team also found that, despite the improvement in diagnosis, women were about half as likely as men to receive recommended heart attack treatments. This included coronary revascularisation in which a stent is fitted or a coronary bypass operation (15 per cent versus 34 per cent), dual antiplatelet therapy (26 per cent versus 43 per cent) and preventative treatments including statins (16 per cent versus 26 per cent).
These differences in treatment may explain why the improvement in diagnosis did not lead to a decrease in the number of women who experienced another heart attack, or died from cardiovascular disease within a year.
“Diagnosis of a heart attack is only one piece of the puzzle,” says Dr Lee. “The way test results and patient history are interpreted by healthcare professionals can be subjective, and unconscious biases may influence the diagnosis. This may partly explain why, even when rates of diagnosis are increased, women are still at a disadvantage when it comes to the treatments they receive following a heart attack.”
Indeed, the research follows a report from the British Heart Foundation that found a failure to treat women and men equally has led to more than 8,000 women in England and Wales dying needlessly from heart attacks over the past decade. A misperception that a heart attack is a man’s disease, and unconscious biases in the delivery of healthcare, are leading to delayed treatment and poorer survival chances for women who suffer heart attacks.
Dr Lee says: “By addressing a biological difference between men and women, we’ve successfully improved the test to detect more women who’ve had a heart attack. These women would otherwise be misdiagnosed.
“But it’s now important that this blood test, with its specific measures for men and women, is used to guide treatment and that we address these disparities in the care of men and women with heart attack. Women everywhere should benefit from improved heart attack diagnosis.”
The new research comes at a time when the issue of women and heart disease is being pushed to the fore. The BHF has found that women are less likely than men to recognise the symptoms of a heart attack, and may also be less likely to seek medical attention and treatment quickly, despite the warning signs. It is also known that coronary heart disease kills more than twice as many women in the UK as breast cancer every year, and is the single biggest killer of women worldwide – all while being perceived to be a ‘man’s disease’.
Dr Lee is adamant, therefore, that these new findings must find their way into routine healthcare practises:
“It’s essential that health care professionals are aware of the inequalities in heart care for women, and that everyone can spot the symptoms of a heart attack. With more research, and greater awareness, we can close this heart attack gender gap.”
The team's study was funded by the British Heart Foundation and published in the Journal of the American College of Cardiology.
The Times newspaper article (external)
BHF: Women and heart disease (external)
Centre for Cardiovascular Science