Women more at risk of dying after a heart attack

Health news

Women are at a greater risk of dying after a heart attack than men because their condition is being misdiagnosed, a leading researcher has told MPs.

Chris Gale, Professor of Cardiovascular Medicine at the University of Leeds, said women who have a heart attack have a 50 per cent higher chance of getting an initial wrong diagnosis, which can have potentially devastating consequences for their survival.

When people with heart attack receive the wrong initial diagnosis, there are potentially important clinical repercussions, including an increased risk of death.

Professor Chris Gale

He told the All-Party Parliamentary Group on Women’s Health that the initial diagnosis was vital because it determined the treatment the patient received in the vital minutes and hours after arriving at hospital.

Prior to the meeting, Professor Gale said: “Having a correct diagnosis is absolutely essential to ensure the patient gets the best possible treatment, be it the right drug therapy or invasive intervention such as putting in a stent to open up a blocked artery.

“The reality is if people don’t get the right treatment, they are at greater risk of adverse outcomes and possible death.”

Professor Gale was involved in a study, published in the European Heart Journal: Acute Cardiovascular Care in 2016, that analysed data from 564,412 patients treated for a heart attack in England and Wales over a nine year period to March 2013.

The analysis revealed that nearly one third (168,534) of patients were initially misdiagnosed. As a result, they faced a 70 per cent increased risk of death after 30 days, compared to those who received an accurate first diagnosis.

Women face increased risk of misdiagnosis

The two main types of heart attack are STEMI and NSTEMI. STEMI occurs when there’s a total blockage of the main artery that pumps oxygenated blood around the body. NSTEMI, which is more common, is a partial blockage of one or more arteries. Both result in serious damage to the heart muscle.

This research found that women who had a final diagnosis of STEMI had a 59% greater chance of a misdiagnosis compared with men. Women who had a final diagnosis of NSTEMI had a 41% greater chance of a misdiagnosis when compared with men.

Professor Gale said: “This nationwide research shows that women are at a higher risk of being misdiagnosed following a heart attack than men. When people with heart attack receive the wrong initial diagnosis, there are potentially important clinical repercussions, including an increased risk of death.”

“We need to work harder to shift the perception that heart attacks only affect a certain type of person.

“Typically, when we think of a person with a heart attack, we envisage a middle aged man who is overweight, has diabetes and smokes. This is not always the case: heart attacks affect the wider spectrum of the population – including women.”

“Heart disease among women is a major concern. According to the British Heart Foundation, heart attacks kill 28,000 women in the UK each year. That’s three people every hour.”

During a heart attack, a protein called troponin gets released into the bloodstream and its presence in the blood can help doctors with their diagnosis, but women sometimes have lower levels of troponin – even if they are experiencing a heart attack.

Professor Gale said universal implementation of a more sensitive troponin test may help improve the speed and accuracy of heart attack diagnosis.

Other research undertaken by Professor Gale, but using Swedish national data, found that women with heart attack had a higher excess mortality (the number of deaths above the number expected) compared with men, and this was associated with the less frequent use of evidence-based treatments for women.

Sweden has one of the lowest mortality rates from heart attack in the world – the researchers believe the situation in the UK is likely to be worse.

The British Heart Foundation has funded research into women and heart disease and is running a campaign to raise awareness of the risks women face. The charity estimates 3.5 million women in the UK are living with cardiovascular disease.

The All-Party Parliamentary Group on Women’s Health is launching an investigation into the treatment and inequalities in outcome for women suffering heart disease and stroke.

Further information

For more information on this story, please contact David Lewis, University of Leeds Media Relations, +44(0)113 343 8059 or by email, d.lewis@leeds.ac.uk