Heart Attacks Misdiagnosed More Often in Women Than Men

Chest pain is misdiagnosed more frequently in women than in men, according to research presented at ESC Acute CardioVascular Care 2021, a virtual conference of the European Society of Cardiology. The study also found that women with chest pain were more likely than men to wait more than 12 hours before seeking medical help.

A total of 41,828 patients with chest pain were included in the study, 42% of whom were women. Those women were significantly more likely to present late to the hospital, with 41% of women arriving 12 or more hours after the initial symptom onset compared to 37% of men. In women, 5% of acute coronary syndromes (ACS) were misdiagnosed, versus a 3% misdiagnosis rate in men (P < .001).

"This is worrying since chest pain is the main symptom of reduced blood flow to the heart (ischaemia) because an artery has narrowed," study author Dr. Gemma Martinez-Nadal of the Hospital Clinic of Barcelona, Spain, in a press release. "It can lead to a myocardial infarction which needs rapid treatment."

The study examined gender differences in the presentation, diagnosis, and management of patients admitted with chest pain to the chest pain unit of an emergency department between 2008 and 2019. Risk factors for a heart attack, like high blood pressure and obesity, were collected alongside the physician’s initial diagnosis of each patient.

Physicians were also more likely in their initial diagnosis to consider ACS the cause of chest pain in men compared to women. In 93% of patients, the electrocardiogram did not provide a definitive diagnosis and among those patients, probable ACS was noted in 39% of women and 44.5% of men (P < .001). This significantly lower probability to suspect ACS in women was maintained regardless of the patient’s number of risk factors, according to the study.

"Heart attack has traditionally been considered a male disease, and has been understudied, underdiagnosed, and undertreated in women, who may attribute symptoms to stress or anxiety,” Martinez-Nadal said in the release. “Both women and men with chest pain should seek medical help urgently."

REFERENCE

Heart attack diagnosis missed in women more often than in men [news release]. EurekAlert; March 12, 2021. Accessed March 17, 2021. https://www.eurekalert.org/pub_releases/2021-03/esoc-had031021.php