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Women ‘get half the number of heart attack treatments as men’

Researchers say unconscious biases may influence diagnosis

Women receive poorer heart attack treatment than men even when rates of diagnosis are the same, research shows.

The clinical trial, led by researchers from the University of Edinburgh, sought to understand the impact of using the high sensitivity troponin blood test for heart attacks but with specific thresholds for men and women.

This increased the number of women identified by 42% – from 3,521 to 4,991 women out of a total of 22,562 women.

This increase meant a similar proportion of men and women were found to have a heart attack or injury to the heart muscle after going to the emergency department with chest pain (22% of women and 21% of men).

However, despite the improvement in diagnosis, women were about half as likely as men to receive recommended heart attack treatments. This included coronary revascularisation in which a stent is fitted (15% versus 34%), dual antiplatelet therapy (26% versus 43%) and preventative treatments including statins (16% versus 26%).

The improvement in diagnosis also did not lead to a decrease in the number of women who experienced another heart attack, or died from cardiovascular disease within a year.

Dr Ken Lee, study author at the University of Edinburgh, said the way test results and patient history are interpreted by healthcare professionals can be subjective, and unconscious biases may influence the diagnosis.

“This may partly explain why, even when rates of diagnosis are increased, women are still at a disadvantage when it comes to the treatments they receive following a heart attack,” he explained.

The research supports previous work by the team in Edinburgh on improving heart attack diagnosis. When people arrive at the emergency department and are suspected of having a heart attack, they are given a troponin blood test to diagnose the cause. Hospitals tend to use a uniform blood test for men and women, which works by measuring troponin in the blood – a protein released from the damaged heart following a heart attack.

However, the team found the test needs to be calibrated differently for men and women because a lower amount of troponin is released in women during a heart attack.

“By addressing a biological difference between men and women, we’ve successfully improved the test to detect more women who’ve had a heart attack. These women would otherwise be misdiagnosed,” said Lee. “It’s now important that this blood test, with its specific measures for men and women, is used to guide treatment and that we address these disparities in the care of men and women with heart attack. Women everywhere should benefit from improved heart attack diagnosis.”

Dr Sonya Babu-Narayan, the British Heart Foundation’s associate medical director and cardiologist, said progress in diagnosis needs to translate into better treatment and improved heart attack survival chances for women.