Fewer of the thousands of women who suffer a heart attack each year in the UK would die if they were given the same treatments as men, according to new research part funded by the British Heart Foundation (BHF) and published in the Journal of the American Heart Association.
An interventional cardiologist performing a procedure
Researchers at the University of Leeds and the Karolinska Institute in Sweden used data from Sweden’s extensive online cardiac registry, SWEDEHEART, to monitor the long-term health of 180,368 patients who suffered a heart attack between 1st January 2003 and 31st December 2013.
After accounting for the expected number of deaths seen in the average population, the researchers found that women had an excess mortality of up to three times higher than men’s in the year after having a heart attack. The excess mortality is the extra deaths in the people who have a disease, above and beyond what you might expect in the general population. It helps to separate the deaths are due to a specific disease (in this case heart attacks) from deaths due to other causes. This is important because it adjust for the fact that women generally live longer than men.
Women were more likely to suffer from other illnesses, such as diabetes and high blood pressure, but these did not fully account for the excess mortality.
However, women were on average less likely than men to receive the recommended treatments after a heart attack.
Women who had a STEMI, where the coronary artery is completely blocked by a blood clot, were 34 per cent less likely than men to receive procedures which clear blocked arteries and restore blood flow to the heart, including bypass surgery and stents. They were also 24 per cent less likely to be prescribed statins, which help to prevent a second heart attack, and 16 per cent less likely to be given aspirin, which helps to prevent blood clots.
Critically, when women received all of the treatments recommended for patients who have suffered a heart attack, the gap in excess mortality between the sexes decreased dramatically.
Previous BHF research has shown that women are 50 per cent more likely than men to receive the wrong initial diagnosis and are less likely to get a pre-hospital ECG, which is essential for swift diagnosis and treatment.
While the analysis uses Swedish data, treatment guidelines for patients who have suffered from a heart attack are comparable across Europe. Worryingly, the researchers believe that the situation for women in the UK is likely worse than in Sweden, which has one of the lowest mortality rates from heart attacks anywhere in the world.
Professor Chris Gale, Professor of Cardiovascular Medicine and Honorary Consultant Cardiologist at the University of Leeds who co-authored 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 heart attack patient, we see 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.”
“The findings from this study suggest that there are clear and simple ways to improve the outcomes of women who have a heart attack – we must ensure equal provision of evidence-based treatments for women.
“Sweden is a leader in healthcare, with one of the lowest mortality rates from heart attacks, yet we still see this disparity in treatment and outcomes between men and women. In all likelihood, the situation for women in the UK may be worse.”
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 proven treatments 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.”
Jules' story - panic attack or heart attack?
Jules Conjoice had her heart attack dismissed by paramedics as a panic attack. On New Year’s Eve in 2015, the now 47-year-old mother of four from Letterstone in Wales was stuck by the classic symptoms of a heart attack, pain in the jaw, clammy skin, sick and pins and needles down the arm. Like many women, Jules did not initially think it was a heart attack, but new something was wrong and called an ambulance.
“It didn’t cross my mind that I was having a heart attack. I thought it might be an allergic reaction to antibiotics I was taking.”
“The paramedic took an ECG, a method of diagnosing heart attacks, and Jules was given the all clear. They suggested she was having a panic attack. Her husband protested and she was taken into hospital, where a troponin test confirmed she was having a heart attack.
“I think my story shows that not only are women less likely to suspect a heart attack, but that the problem carries over to the perceptions of healthcare professionals too.”
“People need to be aware that this is happening, in particular women. We’re told our hormones protect us but obviously there are lots of us out there who are having heart attacks – and thinking it’s indigestion or a panic attack”
What is excess mortality
Death following a heart attack may be due to a number of causes, which aren't always caused by the heart attack, for example cancer or an accident. A statistical method called relative survival enables the correction for deaths due to other causes using background population mortality data. Excess mortality is the difference between the observed mortality (the deaths in the SWEDEHEART register) and the expected mortality in the population of Sweden (matched by age, sex, and year of hospitalisation). Excess mortality is calculated separately for men and women, and then compared. Evidence of excess mortality is observed when the excess mortality rate ratio (EMRR) is >1. So, an EMRR of 1.5 for women compared with men indicates that women experience 50% higher excess mortality than men).