Women are 50% more likely than men to be given incorrect diagnosis following a heart attack

Women have a 50 per cent higher chance than men of receiving the wrong initial diagnosis following a heart attack, according to a new study we part-funded.

The research, carried out at the University of Leeds, using the UK national heart attack register MINAP, found that overall, almost one third of patients had an initial diagnosis which differed from their final diagnosis.

When a patient is admitted to hospital they are given an initial diagnosis, which determines the types of treatments that they are first given.

In this study, researchers looked at the initial diagnoses  given to 564,412 patients who were ultimately diagnosed with heart attacks over the course of 9 years.

The team looked at patients who had two main types of heart attack are STEMI and NSTEMI. STEMI occurs when there's a total blockage of a coronary artery. NSTEMI, which is more common, is a partial blockage of one or more coronary arteries. Both result in serious damage to the heart muscle, which can lead to heart failure.

Overall, around a third of patients had a final diagnosis which differed from their initial diagnosis. Some patients were initially diagnosed with the wrong type of heart attack (2% of patients having a STEMI were initially diagnosed with an NSTEMI and 14% of patients having an NSTEMI were likewise diagnosed as having a STEMI).

Other patients were initially incorrectly diagnosed as having chest pain of an uncertain cause or other initial diagnoses, such as pancreatitis. This was most common for people with an NSTEMI, 18% were given another (non-heart related) initial diagnosis and 16% were initially diagnosed with chest pain of uncertain cause.

This research found that women who were finally diagnosed with the more serious type of heart attack, STEMI, had a 59 per cent greater chance of an initial misdiagnosis compared with men. Women who had a final diagnosis of NSTEMI had a 41 per cent greater chance of a misdiagnosis when compared with men.

Additional analysis by the researchers, which has not been published, showed that together this amounted to around women having a 50% higher chance of being initially misdiagnosed than men. 

Quick diagnosis is vital

Receiving a quick diagnosis and getting the correct treatment after a heart attack is vital to ensure the best possible recovery. A quick diagnosis shapes treatment in the short-term, and sometimes in the long-term. Women who were misdiagnosed had about a 70 per cent increased risk of death after 30 days compared with those who had received a consistent diagnosis. The same was the case for men.

Even being initially diagnosed with the wrong type of heart attack can be harmful, with patients missing out on specific treatments.

The findings are published today in the European Heart Journal Acute Cardiovascular Care. The study looked at 600,000 heart attack patients over the course of nine years.

We are urging both the public and health care professionals to be more aware of the signs and symptoms of a heart attack, to avoid mistakes being made in diagnosis. 

We also think more research is needed to further improve tests for diagnosing heart attacks in both men and women.

Watch our video about how our research is improving heart attack diagnosis in women.

Shifting perceptions of heart attacks

Dr Chris Gale, Associate Professor of Cardiovascular Health Sciences and Honorary Consultant Cardiologist at the University of Leeds, who worked on the study, said:

"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."

Dr Mike Knapton, our Associate Medical Director, said:

"The difference between men and women is alarmingly high, but recent BHF research in Edinburgh has shown one reason why this might be. 

"The research shows that when different limits are applied to the troponin test, a routine test for a heart attack, more women receive a correct diagnosis of heart attack. Thanks to this research there is now a better test for female heart attack diagnoses. 

"However more research is urgently needed into tests that will enable earlier and more accurate diagnosis of a heart attack, particularly in women."

Find out more about how women are affected by heart disease and how you can get support.