Worse outcomes for women in heart attacks

A new study highlighting major differences in outcomes for women having heart attacks compared to men is prompting calls to change treatments.

Australian women who have heart attacks are less likely to receive the treatment they need and are at a greater risk of experiencing problems with care than men, according to the study.

The study published in the Medical Journal of Australia, looks at whether women with a STEMI (ST-elevation myocardial infarction) type of heart attack have the same outcomes as men

A STEMI is a common and often lethal type of heart attack.

"We chose this condition because it has a tell-tale signature on an ECG (or electrocardiogram, which measures the electrical activity of the heart), making it easy to identify," said the report authors, Dr Clara Chow, from the George Institute for Global Health and Professor David Brieger, Professor of Cardiology, University of Sydney

"We found that women with a STEMI heart attack were less likely to undergo coronary angiography – a special X-ray of the heart’s arteries – to see if they are narrowed or blocked than men," they wrote in The Conversation.

The study found women were less likely to get those blockages and when they did, treatment was more likely to be later than recommended by the hospital’s own performance goals.

These disparities lead to women being twice as likely to die than men six months after their heart attack.

The exact reasons for the disparity are unclear. But the type of heart attack and differences in other risk factors – such as the rate of diabetes, high blood pressure, high cholesterol – did not explain the differences.
Dr Clara Chow, Prof David Brieger

Bupa's head of Public Health Dr Zoe Wainer has a clinical background in cardiothoracic surgery and thoracic surgical oncology.

She says Australia trails other countries in looking at the differences between men and women in health.

"As seen in the MJA article significant clinical consequences can occur when you don’t understand the differences between men and women; we know there are differences and they’re not yet being fully implemented into clinical guidelines. This is a key step in precision medicine."

Dr Wainer says heart episodes can be very different in men and women.

Dr Zoe Wainer, Bupa Australia Head of Public Health
Women often present with different kind of chest pain when having a heart attack, it may not be the crushing kind of pain men most commonly present with. 
Dr Zoe Wainer, Bupa Australia Head of Public Health

Dr Wainer says understanding the differences between men and women is vital across health care.

"Not only do we see evidence of women having worse outcomes with heart disease, men have worse outcomes in a number of cancers. We are not systematically looking at the reasons these differences occur."

Differences starting to be acknowledged

There is progress being made in looking at gender specific care.

Dr Alyson McGregor has been researching sex- and gender-specific medicine and women’s health as they relate to emergency care.

She says the male model is the framework for medical research ... and women and men need to ask their doctors about getting the right care for their bodies.

In a TED Talk, Dr McGregor outlined how heart disease is a stark example of the differences in the treatments for men and women.

"If we look at the anatomy, the blood vessels that surround the heart are smaller in women compared to men, and the way that those blood vessels develop disease is different in women compared to men."

"The test that we use to determine if someone is at risk for a heart attack, well, they were initially designed and tested and perfected in men, and so aren't as good at determining that in women."

"And then if we think about the medications -- common medications that we use, like aspirin. We give aspirin to healthy men to help prevent them from having a heart attack, but do you know that if you give aspirin to a healthy woman, it's actually harmful?"

You can read the MJA study here.