Gender differences in heart attack treatment contribute to women’s higher death rates

17 Apr

The alarming results of a study undertaken in France highlighted serious gender differences in cardiac treatment of men and women.  These shocking differences contribute to a higher death rate among women suffering a heart attack.

The French study(1) investigated more than 3,000 patients, 32% women, who had been treated for heart attacks over a two-year period.

Lead author Dr. Francois Schiele, Cardiology Chief at the University Hospital in Besancon, France, presented the results of the research at the American College of Cardiology’s 59th Annual Scientific Session in Atlanta last month. Dr. Schiele’s team found that, on average, the women studied:

  • were nine years older than their male counterparts
  • were in poorer health
  • had been less effectively treated for heart attack
  • were almost twice as likely as men to die as a result, whether in the hospital or at home during the month following their heart attack. 

Researchers then compared the male and female patients to create matched pairs according to baseline characteristics.  When they followed the treatment of the man and woman in each pair, the researchers found clear differences in treatment despite highly similar clinical characteristics.

Analysis of the data showed that:

  • men were 72% more likely to receive clot-busting drugs than women
  • men were also 57% more likely to receive a diagnostic angiogram, a diagnostic procedure in which dye is injected into the arteries of the heart so that doctors can identify blockages through X-ray imaging
  • men were 24% more likely to have angioplasty to reopen a blocked artery once identified via angiography
  • the death rate among women was 48% higher during their hospital stay compared to their male counterparts

Of course, getting appropriate treatment happens only when appropriate diagnosis happens first.

But women (especially younger women) with heart disease are far more likely than men to be misdiagnosed.  Previous research(2) reported in the New England Journal of Medicine looked at more than 10,000 patients (48% women) who went to their hospital Emergency Departments with chest pain or other heart attack symptoms. Investigators found that one in every 50 people who had suffered a heart attack was misdiagnosed and sent home from hospital. But women younger than 55 were seven times more likely to be misdiagnosed than men of the same age.

The consequences of this were enormous: being sent away from the hospital during a cardiac event doubled the chances of dying.

IMPORTANT UPDATE:

January 31, 2016:   The American Heart Association released its first ever scientific statement on women’s heart attacks, confirming that “compared to men, women tend to be undertreated”, and including this finding: “While the most common heart attack symptom is chest pain or discomfort for both sexes, women are more likely to have atypical symptoms such as shortness of breath, nausea or vomiting, and back or jaw pain.”

See also:


.

(1)  American College of Cardiology’s 59th Annual Scientific Session, Atlanta, March 14-16, 2010. Francois Schiele, MD, chief cardiologist, University Hospital of Besancon, France.
(2)  Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342:1163-1170.

9 Responses to “Gender differences in heart attack treatment contribute to women’s higher death rates”

  1. Karen May 29, 2012 at 1:28 am #

    Thank you so much for this. Your site is a goldmine of useful heart info for women (and men, I’m sure). Keep up the good work -I’ve just subscribed to get your email updates.
    With thanks,
    Karen
    Yellowknife, NWT

    Like

  2. Ann's Son October 16, 2010 at 10:46 pm #

    “… men were also 57% more likely to receive an angiogram, a process in which dye is injected into the arteries of the heart so that doctors can identify blockages through X-ray imaging…”

    THANK YOU for this. I have been desperately searching for some explanation of why my 77-year old mother was sent home from the E.R. misdiagnosed with an “anxiety attack” last weekend. Next morning, she was back but this time correctly diagnosed with a “STEMI” (serious heart attack).

    This French research helps to explain it: she was older, with other serious health problems (diabetes, arthritis, dementia).

    I do suspect that if she was a MAN, they would have kept her overnight for observation and done that angiogram which would have revealed the extent of her coronary artery blockages, instead of just dismissing her as a confused old woman.

    ALL WOMEN should be outraged by this clear discrimination in medical diagnosis and treatment. Thank you for opening my eyes. I’ll be showing this article to my mother’s healthcare providers.

    Like

    • Richard W. September 14, 2012 at 3:37 am #

      @Ann’s Son:

      The reason that women are more likely to be misdiagnosed and not treated for heart attacks isn’t because they’re dismissed as a “confused old woman.” It has to do with the fact that the clinical symptoms that women have for a heart attack are more likely to be unorthodox or seemingly benign symptoms.

      Generally, when we think of heart attacks, we think of a crushing pressure-like pain on your chest. This pain often spreads down a person’s arm, along their back, to other parts of their chest, and maybe up their neck.

      However, women are less likely to have these “classic” symptoms. They tend to feel general malaise, headache, nausea & vomiting, or fatigue. Certain other patient groups, such as diabetics, are also less likely to display “classic” signs of a heart attack. In these situations, it’s easy for a physician to misdiagnose the situation as indigestion, the flu, or something that’s not an emergency.

      Here is an online link for your perusal.

      Surely, these differences are important to be aware of, but I don’t think this is a situation of society dismissing a patient due to her gender. Female heart attacks are misdiagnosed for the same reason that diabetics having a heart attack are misdiagnosed: Their symptoms are very easily confused for something else.

      Like

      • Carolyn Thomas September 14, 2012 at 6:54 am #

        Actually, Richard, there are a number of studies confirming that women heart patients are not only underdiagnosed compared to our male counterparts, but also undertreated even when appropriately diagnosed (as the French study cited above pointed out: “clear differences in treatment despite highly similar clinical characteristics“)

        If you read other posts about misdiagnoses on my site, you’ll find many other examples (e.g. here and here).

        I was one of these: crushing chest pain, nausea, pain radiating down my left arm – textbook “male” heart attack symptoms. The E.R. doc looked at me and said: “You’re in the right demographic for GERD (acid reflux)” and sent me home in mid-heart attack.

        Like

  3. Sandy April 17, 2010 at 5:51 am #

    My Cardiologist has always treated me aggressively. I had a heart attack in February with a stent put in place. This stent makes 6 for me.

    I am now in Cardiac Rehab. The interesting thing is I am in a class with 6 men. When I look around I see very few women in the center. Maybe I am the lucky woman who has a wonderful cardiologist, or maybe is it that women don’t take rehab as an important thing to do or are they just too busy with family and won’t take time to fit it in?

    I decided I have taken care of my family for 42 years, so now it is time to take care of me.

    Like

    • Carolyn Thomas April 17, 2010 at 6:11 am #

      Hi Sandy,
      You are fortunate to have a wonderful, pro-active cardiologist. My own experience with Cardiac Rehab was similar – I was vastly outnumbered by (old) men. You might be interested in reading Why Women Heart Attack Survivors Aren’t Showing Up For Cardiac Rehab”
      Cheers,
      C.

      Like

    • Connie January 25, 2012 at 6:25 am #

      Oddly enough when I started my cardiac rehab a year ago it was vastly more women than men in the class. 10 people…9 were WOMEN! Poor old guy never knew what hit him lol. The youngest women were myself and another woman both 47, the rest were mostly in their 60’s and 70’s.

      Like

Trackbacks/Pingbacks

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