Heart Attack and Gender Gap

A shocking fact brought to light by research funded by the BHF titled ‘Bias and Biology’, reveals that a woman is 50% more likely than a man to receive the wrong initial diagnosis for a heart attack. An even more horrifying fact that someone who has an incorrect initial diagnosis of heart attack has a 70% higher risk of death after 30 days compared to someone who receives the correct diagnosis initially – meaning gender inequalities in healthcare is causing preventable deaths caused by heart attack in women, as estimated by a BHF-funded study led by Dr Chris Gale and team from the University of Leeds in 2018 that 8000 lives of women in England Wales could have been potentially saved if they were offered the same standard of care as men, ‘a societal failure to provide fair care for women’ (stated by Dr Sonya Babu-Narayan, Associate Medical Director of BHF).

A societal misperception that coronary heart disease and heart attack is ‘a man’s disease’, perhaps because women are historically under-represented in clinical research for cardiovascular trials and therefore diagnostic tests and treatments are based on data gathered from men, an unrepresentative sample that leads to disparities in diagnosis and treatment delays in men and women. There is also a widespread misperception that men and women have different symptoms of cardiovascular diseases, and therefore a lack of awareness of heart attack symptoms in women, leading to women delaying seeking medical help. This is more apparent in a virtual GP app, the Babylon app, which utilises the use of AI to identify health problems through the inputs of the user. However, doctors have found that the algorithm advice a 60-year-old female smoker reporting on sudden onset chest pain and nausea that she is perhaps suffering from a panic attack or inflammation resulting in pain. Whereas same symptoms conferred by a 60-year-old male suggests a visit to the A&E whilst the woman is told to contact her GP if the symptoms continue in the next 6 hours – a concern raised by Paul Leeson, professor of cardiovascular medicine at Oxford University. All while, twice the number of women is killed by coronary heart diseases than breast cancers in the UK, and the biggest killer of women globally.

Another overlooked reason behind the chronical misdiagnosis of cardiovascular disease in women is due to an unbalanced gender team in the world of cardiology – for example in the US, only 4.5% of practising interventional cardiologists are women. Research conducted with 1.3 million Florida residents admitted to hospitals for a heart attack revealed that survival rates are two to three times higher for female patients treated by female physicians compared to being treated by male physicians. Hysteria, exaggerated, or uncontrollable emotion, is often associated with women, a negative connotation that can often portray women as irrational if they are ‘too expressive’ of their symptoms like chest pain and thus overlooked or downplayed by male physicians. Therefore, this may explain the evidence that female patients (men or women) were more than four times likely to return to the hospital with recurrent symptoms.

Studies have shown that women have worse after-effect for heart operations such as peripheral revascularisation (restoring blood flow in blocked arteries or veins through angioplasty or artery bypass graft) and valve replacement. Even when being treated, women are less likely to receive the best surgical treatment, beneficial medications such as aspirin and cholesterol- lowering medications and moreover, with haste. This is then proved by a lower survival rate amongst women – 47% of women who have experienced a first heart attack to die within the next five years, compared to 36% of men.

Though all these data perhaps point a bleak understanding of the female health, it is important to recognise that medical advancement is allowing an increasing accuracy of heart attack being detected amongst women by having a lower threshold of troponin level in female and using highly sensitive tests.

Written by Tasfiha

Moderated by Adelene

References:

The Times (2019) It’s hysteria, not a heart attack, GP app Babylon tells women. Available at: https://www.thetimes.com/uk/healthcare/article/its-hysteria-not-a-heart-attack-gp-app-tells-women-gm2vxbrqk (Accessed 31th October 2024)

British Heart Foundation (no date) Bias and Biology. Available at: https://www.bhf.org.uk/-/media/files/heart-matters/bias-and-biology-briefing.pdf?rev=cd26147a45f9444098aa2949551f3803&hash=7C4225981A8554B921502F609C42C7F9 (Accessed 1st November 2024)

The University of Edinburg (2023) The heart attack gender gap. Available at: https://edinburgh-friends.ed.ac.uk/supplements/the-heart-attack-gender-gap (Accessed: 1st November 2024)

Harvard Health Publishing (2016) Understanding the heart attack gender gap. Available at: https://www.health.harvard.edu/blog/understanding-heart-attack-gender-gap-201604159495 (Accessed 1st November 2024)

Harvard Health Publishing (2022) The heart disease gender gap. Available at: https://www.health.harvard.edu/heart-health/the-heart-disease-gender-gap (Accessed 1st November 2024)

The Guardian (2022) Why gender is at the heart if the matter for cardiac illness. Available at: https://www.theguardian.com/society/2022/sep/18/why-gender-is-at-the-heart-of-the-matter-for-cardiac-illness (Accessed 2nd November 2024)

British Heart Foundation (2019) No difference in key heart attack symptoms between men and women. Available at: https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2019/august/no-difference-in-key-heart-attack-symptoms-between-men-and-women (Accessed: 06th November 2024)