Investigators from the University of Alberta have found that although the gender gap is closing, women are still given fewer tests and medications following a heart attack and are less likely to see a specialist, resulting in an increased risk of death and heart failure.

During the 5 years following a heart attack, the study found that women have a 20% higher risk than men of dying or facing heart failure. The investigators noted, however, that women typically experience non-ST-elevation myocardial infarction (NSTEMI) heart attacks, which are less severe than STEMI heart attacks.

Lead author Justin Ezekowitz, MD, MBBCh, MSc, FRCPC, said the women in the study were on average a decade older than men at the time of their first heart attack. However, when they did experience a STEMI attack, women developed heart failure more often.

“We don’t know yet why there continue to be these differences in outcomes for men and women, but there is an international interest in looking at heart disease in women,” said co-author Padma Kaul, MSc, PhD, in a press release.

The investigators examined health records for more than 45,000 Canadians who were hospitalized for a first-time heart attack between 2002 and 2016, including data on their angiogram results, treatments, and clinical outcomes. Approximately 45% of the patients experienced STEMI heart attacks and 55% experienced NSTEMI attacks. Both types involve a blockage of the blood supply to the heart muscle and can lead to permanent damage.

According to a press release, the researchers found that the female patients were on average a decade older than the male patients, had more chronic conditions such as diabetes, high blood pressure, or atrial fibrillation, and were more likely to die in the hospital. The women were also less likely to receive a diagnostic angiogram or see a heart specialist and were prescribed fewer medications.

Ezekowitz said he gives the same advice to male and female patients, telling them to stop smoking, exercise more often, and control their blood pressure and stress levels, especially if they have already had a heart attack. Both researchers noted that some women delay going to the hospital because they do not realize they are having a heart attack. They added that more should be done to educate women on the symptoms, which can include chest or upper body pain, sweating, nausea, shortness of breath, or light-headedness.

All patients presenting with these symptoms should be diagnosed with both an electrocardiogram and a blood test looking for markers of heart damage, according to the press release. Although the recommended treatments for STEMI and NSTEMI heart attacks are similar, Ezekowitz said those experiencing more severe heart attacks need treatment faster.

The authors added that although previous studies have examined these gender gaps, their findings showed that the gap is narrowing over time.

“It’s not all bad news, as we do see the rates of diagnostic and intervention procedures coming together,” Kaul said in the press release. “It is improving, which shows there is a recognition on the part of clinicians that women are at risk and what kind of treatment they should get.”

Kaul said more research is needed in order to better understand and address the multiple factors behind the difference in outcomes between men and women.

“As we get better information to women and the system stops treating the 2 sexes differently, I think we’ll see it come together,” she concluded.

REFERENCE
Women face higher risk of death or heart failure following a heart attack: study [news release]. University of Alberta; December 15, 2020. https://www.ualberta.ca/folio/2020/12/women-face-higher-risk-of-death-or-heart-failure-following-a-heart-attack-study.html. Accessed December 16, 2020.