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Women face ‘sexual disadvantage’ in heart attack treatment

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Fewer of the thousands of women who experience a heart attack each year would die if they were given the same treatments as men, according to researchers in the UK and Sweden.

They found a “survival disadvantage” for women with ST‐segment-elevation myocardial infarction (STEMI) and non-ST‐segment-elevation myocardial infarction who were followed for 10 years.

“There are clear and simple ways to improve the outcomes of women who have a heart attack”

Chris Gale

If treatments were provided equally, then differences in deaths between men and women would be smaller and premature cardiovascular deaths among women would be reduced, they suggested.

The new study, by the University of Leeds and the Karolinska Institute, was part funded by the British Heart Foundation and has been published in the Journal of the American Heart Association.

Researchers at the looked at data from Sweden’s online cardiac registry, SWEDEHEART, to monitor the long-term health of 180,368 patients who had a heart attack between 2003 and 2013.

After accounting for the expected number of deaths seen in the average population, they found that women had an excess mortality of up to three times higher than men in the year after an infarction.

Women were more likely to have other conditions linked to cardiovascular health, such as diabetes and hypertension, but these did not fully account for the excess mortality, noted the researchers.

“We urgently need to raise awareness of this issue as it’s something that can be easily changed”

Jeremy Pearson

However, women were found, on average, to be less likely than men to receive the recommended treatments after an ST‐segment-elevation or non-ST‐segment-elevation myocardial infarction.

Women who had a STEMI – where the coronary artery is completely blocked by a blood clot – were 34% less likely than men to receive procedures such as bypass surgery and stents.

They were also 24% less likely to be prescribed statins for secondary prevention and 16% less likely to be given aspirin.

But, critically, when women received all of the recommended treatments, the gap in excess mortality between the sexes decreased dramatically, the researchers highlighted.

While the analysis uses Swedish data, the study authors noted that treatment guidelines for myocardial infarction patients were comparable across Europe.

They said they believed that the situation for women in the UK was actually likely to be worse than in Sweden, which has one of the lowest mortality rates from heart attacks anywhere in the world.

Study co-author Professor Chris Gale, an honorary consultant cardiologist at Leeds, said: “We need to work harder to shift the perception that heart attacks only affect a certain type of person.

“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,” he said.

University of Leeds

Chris Gale

Chris Gale

“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,” he said. “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,” said Professor Pearson.

“We urgently need to raise awareness of this issue as it’s something that can be easily changed,” he said. “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.”

Previous research funded by the charity has shown that women were 50% more likely than men to receive the wrong initial diagnosis and were less likely to get a pre-hospital electrocardiogram (ECG).

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