Gender differences in acute MI care costing women their lives, BHF study finds

Researchers call for more focus on delivering guideline-recommended treatments to women.

27 November 2018, by Siobhan Chan

Woman in a hospital bed

Over 8,000 women with acute myocardial infarction (MI) died because they didn’t receive the same quality of care as men, according to a study in England and Wales part-funded by the BHF.

Women who experienced an acute MI between 2003-13 were less likely than men to receive the level of care recommended by guidelines, research published in the journal Heart found.

The study did not look at all incidences of MI that occurred in the UK over the study period, so the true number of preventable deaths is likely to be higher than predicted here.

Researchers said that closing the mortality gap between genders was possible with greater attention to the delivery of recommended acute MI treatments.

Professor Sir Nilesh Samani, BHF Medical Director, said: “We need to tackle the false perception that heart attacks are a male issue. This leads to inadequate care for women – both at the time of and after heart attacks – with fatal consequences.”

Researchers from the University of Leeds used data from the UK’s national heart attack registry to analyse the treatment and outcomes of 691,290 people who were hospitalised for acute MI in England and Wales between 2003 and 2013.

They then assessed the treatment received against quality indicators taken from European Society of Cardiology guidelines. They found that care for women was less likely to meet guidelines in 13 out of 16 areas.

Guideline-recommended care

Their analysis showed that an estimated 8,243 deaths in women could have been prevented if they had received the same quality of care as men.

Women were nearly twice as likely as men to die on average in the month following their heart attack (5.2% versus 2.3%). The study also found that women were less likely than men to:

  • receive timely reperfusion therapy to restore blood flow to their arteries if they had a ST-elevation myocardial infarction (STEMI) (85% of women versus 87% of men)
  • receive coronary angiography within 72 hours of the onset of symptoms if they had a non-ST-elevation myocardial infarction (NSTEMI) (24% versus 37%)
  • be fitted with a stent in good time if they had a STEMI (77% versus 79%)
  • receive an inpatient evaluation of their left ventricular ejection fraction (47% versus 50%)
  • receive, or be referred to, cardiac rehabilitation (70% versus 77%)
  • be prescribed a statin (87% versus 90%)
  • be prescribed an ACE inhibitor (83% versus 86%).

Professor Chris Gale, Professor of Cardiovascular Medicine at the University of Leeds and Honorary Consultant Cardiologist, said: “In isolation the differences may appear small, but even in a high performing health system like the UK, small deficits in care across a population add up to reveal a much larger problem and a significant loss of life.”

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Addressing shortfalls

The findings follow BHF research that showed that women with MI are 50% more likely than men to receive the wrong initial diagnosis.

“We know women are dying due to unequal heart attack care – and now we’ve identified the shortfalls we need to target to save lives,” Professor Gale said.

“For example, women not receiving coronary angiography when they arrive to hospital puts them at a disadvantage right from the start, and has knock-on effects creating further shortfalls down the line.”



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