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Women get half as many heart attack treatments as men

Diagnoses increase but gender gap in treatment persist

Adrian O'Dowd

Tuesday, 15 October 2019

Women appear to be half as likely to receive treatment for heart attacks as men, suggests research* published today in the Journal of the American College of Cardiology.

This gender imbalance is all the more surprising given that a new blood test is diagnosing more women with a heart attack.

The study, funded by the British Heart Foundation (BHF), was led by researchers from the University of Edinburgh who set out to understand the impact of using the high sensitivity troponin blood test for heart attacks but with specific thresholds for men and women.

It is widely accepted that there are currently large disparities between men and women in the diagnosis, management and outcome of acute coronary syndrome.

Women with suspected acute coronary syndrome are less likely to undergo evidence-based investigations and treatment, and outcomes following myocardial infarction are consistently poorer when compared to men.

The researchers used data from a previous trial – the High-Sensitivity Troponin in the Evaluation of patients with suspected Acute Coronary Syndrome or High-STEACS study – that evaluated implementation of the troponin test in consecutive patients presenting with suspected acute coronary syndrome across 10 secondary and tertiary hospitals in Scotland.

They wanted to examine whether or not implementation of the blood test with sex specific thresholds could address these gender differences in treatment.

The new analysis of the trial in 48,282 (47% women and 53% men) consecutive patients with suspected acute coronary syndrome, showed that implementation identified five times more additional women with myocardial injury than men.

Using the test increased the number of women identified by 42% – 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 the emergency department with chest pain (22% of women and 21% of men).

But the researchers found that, despite the improvement in diagnosis, women were about half as likely as men to receive recommended heart attack treatments.

The improvement in diagnosis also did not lead to a decrease in the number of women who experienced another heart attack, or died from cardiovascular disease within a year.

The research follows a BHF briefing released two weeks ago 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.

The charity said a misperception that a heart attack was a man’s disease, and unconscious biases in the delivery of healthcare, were leading to delayed treatment and poorer survival chances for women with heart attacks.

Dr Ken Lee, BHF clinical research fellow and study author at the University of Edinburgh, said: “Diagnosis of a heart attack is only one piece of the puzzle. 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.

“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.”

Dr Sonya Babu-Narayan, associate medical director at the BHF and cardiologist, said: “It’s extremely promising that bespoke blood tests for men and women could lead to better diagnosis of heart attacks.

“But this progress in diagnosis needs to translate in to better treatment and improved heart attack survival chances for women.”

*Lee KK, Ferry AV, Shah ASV, et al. Sex-Specific Thresholds of High-Sensitivity Troponin in Patients With Suspected Acute Coronary Syndrome. Journal of the American College of Cardiology. Volume 74, Issue 16, 2032-2043. DOI:10.1016/j.jacc.2019.07.082. 

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