New research from the American Heart Association reveals that women who suffer heart attacks receive less care than men.
Explored through the journal Circulation: Heart Failure, the research found that women are 11 percent more likely to die in hospital after experiencing complications from heart attacks, and less likely to receive the same tests and treatment as their male counterparts.
23 percent of women died compared to 21.7 percent of men, indicating that gender predicted higher in-hospital death rates, even when adjusting for outside factors.
The startling research also found that compared with men, women were less likely to undergo coronary angiography to detect blockages in heart arteries, less likely to undergo an angiography on the day they were admitted to the hospital, less likely to receive stents or balloons to open blocked heart arteries and less likely to be put on a mechanical pump to maintain heart function.
The lead researcher of the study, Dr. Saraschandra Vallabhajosyula said that while “it’s very difficult to understand exactly what’s causing this,” he believes much of this issue has to do with “unconscious or conscious bias when it comes to women and acute cardiac conditions.”
“Much of the bias can be traced to doctors, the family or the health care system,” Vallabhajosyula said. “Women have atypical symptoms, such as belly pain, headaches, things that you don’t typically associate with having a heart attack.”
He further added that a woman suffering from a heart attack doesn’t always have the same symptoms as a man, which can result in misdiagnosis. Therefore, women are more likely to dismiss their symptoms and wait longer before going to the hospital, worsening their conditions and increasing their chances of contracting a deadly condition known as cardiogenic shock.
“It is very concerning that the young, productive women of our society face these health care disparities,” Vallabhajosyula said . “Our emphasis should be on providing high-quality and equitable care for every patient independent of their sex.”
Cardiogenic shock is a condition that occurs when the heart can no longer pump enough blood to keep the patient alive. In the US, cardiogenic shock remains a leading cause of death after heart attack, and claims the lives of roughly half of those who survive after admission to hospital.
Vallabhajosyula’s team also found that black women in America suffered more heart attacks with cardiogenic shock than men or white women. Women are also more likely than men to be from poorer, less educated families, and often suffering from other medical conditions or admitted to rural or smaller hospitals.
Vallabhajosyula and his team believe that fixing these gaps begins by recognising that they exist. Throughout history, doctors have based their understanding of diseases through research done primarily on middle-aged white men.
“We all know that is not true anymore. All subgroups are prone to different kinds of symptoms, so just recognition of the textbook description of symptoms is not true,” Vallabhajosyula said. “We as physicians or health care professionals have to lay aside any unconscious bias.”
Vallabhajosyula and his team at Emory University surveyed 90,648 patients aged between 18 to 55 who were admitted for cardiogenic shock between 2007 and 2012. They found that over time, men received interventions for these conditions at a persistently higher rates than women.
“There is evidence that women might actually derive greater benefit from more aggressive, timely, and appropriate cardiac interventions,” the team wrote in their published study. The team have subsequently called for further research into the causes of the disparities between women and men.
A second study from the American Heart Association found promising news about repeat heart attacks: the proportion of patients who experience a repeat heart attack within a year fell between 2008 and 2017. From the study of 1,000 people, they found that the recurrent heart attack rate declined from 89 to 72 in women, and from 94 to 81 in men, though the decline was not detected in women ages 21-54 or in men ages 55-79.
Dr. Sanne A. E. Peters, the lead author of the American Heart Association study and a research fellow in epidemiology at The George Institute for Global Health at the University of Oxford, said that the reason for the overall decline may be due to “improvements in the emergency treatment of heart attacks, and better treatment options for people who survive a heart attack.”
“We expected to see a decline in the rate of events,” Peters said. “However, we did not expect the rates to differ between the sexes. It may be that the improvements in men were achieved before our study period, leaving less room for improvement in the most recent decade.”
“It could also be that the attention paid to heart disease in women over recent years has resulted in the greater gains. However, regardless of the improvements, the rates of recurrent events in people who survived a heart attack are still very high in both sexes.”
Vallabhajosyula shares advice for women: Be your own advocate.“[Women] should never undermine their symptoms,” he stressed. “They should take their bodies’ signals very seriously and seek care when needed.”
Dr. Claudia Gidea of NYU Langone Health agrees. She says that women should be educated about risks for heart attack.
“By publicising this kind of study, we can increase recognition of risk factors for heart attack and atypical presentation,” Gidea said. “We need to do more educational programs so that when women come to the emergency room, they can collaborate with the physician and discuss their symptoms in such a way as to get an early diagnosis.”