Women receive poorer heart attack treatment than men, even when rates of diagnosis are the same, according to new research.
The clinical trial, led by researchers from the University of Edinburgh, UK, focused on the impact of the high sensitivity troponin blood test for heart attacks, looking at specific thresholds for men and women.
This increased the number of women identified by 42% – from 3,521 to 4,991 women out of a total of 22,562 women. It 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.
However, the researchers found that women were about half as likely as men to receive recommended heart attack treatments.
This included coronary revascularisation, which was used in 15% of women and 34% of men, dual antiplatelet therapy (26% compared with 43%, and preventative treatments, including statins, at 16% compared with 26%.
The research, which was funded by the British Heart Foundation (BHF), found that improvement in diagnosis did not decrease the number of women who experienced another heart attack, or died from cardiovascular disease within a year. The findings are reported in the latest edition of the Journal of the American College of Cardiology.
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.”
The research supports previous work by the Edinburgh team on improving heart attack diagnosis. Hospitals tend to use a uniform troponin blood test for men and women, but the scientists said the need for the test to be calibrated differently for men and women.
Dr Lee added: “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.
“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.”
Dr Sonya Babu-Narayan, associate medical director at the British Heart Foundation and Cardiologist, said while bespoke blood tests for men and women could lead to better diagnosis of heart attacks, progress in diagnosis needs to translate into better treatment and improved heart attack survival chances for women.
Lee KK, Ferry AV, Anand A et al. High-sensitivity troponin with sex-specific thresholds in suspected acute coronary syndrome. JACC. 14 October 2019.
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