Behind the headlines

‘Heart attacks would kill fewer women if they had same treatments as men’

Woman clutching chest heart attack pain

Women are dying after heart attacks in ways that could be avoided if they were given the same treatments as men, a new study suggests. We look behind the headlines.

8 January 2018

Women are not being given the same treatments for heart attack, and are dying unnecessarily as a result, new research suggests. 

In the year after having a heart attack, the research found that women were dying at higher rates than would be expected. These women had an excess mortality of up to three times higher than men who’d had a heart attack. 

The excess mortality is the extra deaths in a particular group of people, above and beyond what you would expect in that group of people. It’s a more accurate way to study the death rate related to a specific issue, as it adjusts for the fact that women generally live longer than men.

The research

The study, led by researchers at Leeds University and part-funded by the BHF, looked at data from all the hospitals in Sweden that provide heart attack care, from 2003 to 2013. The researchers looked at the data of 60,712 patients with STEMI (a completely blocked coronary artery) and 119,656 with NSTEMI (a partially blocked coronary artery).

The researchers found that women with STEMI had an excess mortality which was twice as high as men six months after the heart attack. After one year it was nearly three times as high as men. After five years the excess mortality was nearly twice as high. The gender disparity was greatest in older women. For women with NSTEMI the gender difference was less noticeable. 

In the year after having a heart attack, the research found that women were dying at higher rates than would be expected

The researchers found that women were less likely than men to receive the recommended treatments after a heart attack, such as angioplasty and stent or heart bypass surgery where necessary, and less likely to be prescribed recommended medications (such as statins, aspirin and beta blockers) when they were sent home from hospital.

However, in women who received evidence-based treatments, the gap in excess mortality decreased or disappeared. This suggests that, if women were treated in line with the guidelines, the number of women who die could be decreased.

A strength of the research was the large amount of data that was used, over a long period. But a weakness (from a UK point of view) could be that it was Swedish data.

Sweden is a leader in healthcare and has a similar healthcare system to the UK, so it is likely that the gender gap would be the same or worse in the UK. However it is difficult to apply these findings to the UK without more research.

Lead researcher Chris Gale, Professor of Cardiovascular Medicine and Honorary Consultant Cardiologist at the University of Leeds, said: “Sweden has one of the lowest death rates from heart attacks, yet we still see this disparity between men and women.

“The situation in the UK may be worse. We need to work harder to shift the perception heart attacks only affect overweight, middle-aged men who smoke.”

The BHF view

Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said: “Heart attacks are often seen as a male health issue, but more women die from coronary heart disease than breast cancer in the UK. The findings from this research are concerning – women are dying because they are not receiving treatments that are proven to save lives after a heart attack.

“We urgently need to raise awareness of this issue as it’s something that can be easily changed. By simply ensuring more women receive the recommended treatments, we’ll be able to help more families avoid the heartbreak of losing a loved one to heart disease.”

How was the story reported?

The story received widespread media coverage. Much of this coverage did not explain that the gender difference was specifically about excess mortality, not total death rates.

The total death rates were in fact the same for men and women, but that is less relevant to this issue as women would usually live longer. The Daily Mail's headline wrongly said ‘Women 'three times more likely than men to die after a heart attack' because they do not receive treatments including bypass surgery’. 

Much of the news coverage did not explain that the gender difference was specifically about excess mortality, not total death rates

Sky News also reported that “Female patients were up to three times more likely to die in the first year after suffering the medical emergency than men, said the research.”

BBC News said that women were ‘three times more likely to die from their heart attack than men in the year after having one.’ This was later changed to “Women were two times more likely to die from the most serious type of heart attack than men in the year after having one” – which is closer to the study findings but still not completely accurate.

The Sun's headline, ‘HEART ATTACK Women are dying from heart conditions ‘because the NHS cares for men better’’. But the study doesn’t look at the NHS, it uses Swedish data. The article says that ‘The BHF-funded study, led by a team from Leeds University, looked at more than 180,000 Swedes — with similar, or worse, findings expected in the NHS.’ This is based on a quote from the lead researcher Chris Gale, although the source isn’t given in the article.

The Telegraph’s headline, ‘Women more likely to die after heart attack because doctors see it as a male problem, study finds’. Although the study does say the findings “may indicate inequalities in care”, it did not look at doctors’ attitudes.

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