Mind the gender gap

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Originally published at bhf.org.uk, written by Molly Tresadern.

We’ve released a briefing, Bias & Biology, which brings together a breadth of research in order to paint a picture of how women in the UK are disadvantaged at every stage of having a heart attack, compared to men.

Question: if you are experiencing symptoms including central chest pain, pressure or restriction, sweating, pain in one or both arms, nausea and fatigue, should you:

a) Put the slow cooker on
b) Carry on going to work as normal
c) Go to an exercise class
d) Go to the pub
e) Make an appointment with your GP
f) Call 111
g) Call 999

Answer: g), call 999, because these are all symptoms of a heart attack — which is a medical emergency and can be life threatening.
Options a) to f) are just a snapshot of the many real examples of how women we’ve spoken to have reacted when having a heart attack, only seeking medical help when their symptoms became impossible to ignore, or others urged them to.

Underlying this is the common misconception that coronary heart disease and heart attack is a predominantly male disease, and women don’t have to worry about it in the same way. Yet 35,000 women are admitted to hospital following a heart attack in the UK each year — an average of 98 women a day, or four per hour.

“I never thought [my symptoms] were my heart, partly because I am a woman, I am relatively healthy and I don’t eat loads of fatty food. There was definitely a strange feeling in my arm. But I didn’t take it that seriously. When they told me I’d had a heart attack, I couldn’t believe it. I thought they’d got it wrong. My dad had died of a heart attack. So I thought if you had a heart attack you died straight away.” — Esther Stanhope, who had a heart attack when she was just 45.

Women are at risk

By not recognising the signs of a heart attack and delaying seeking help, together with gender inequalities in heart attack care, this is costing women’s lives.

Last year, a BHF-funded study reported that over 8,200 women died needlessly after a heart attack in England and Wales between the years 2003 and 2013, due to not receiving the same quality of treatment as men.

Examining this further, the BHF has released a new briefing, Bias & Biology, which brings together a breadth of research in order to paint a picture of how women in the UK are disadvantaged at every stage of having a heart attack, compared to their male counterparts.

The briefing shows that:

  • Misconceptions around heart attacks — most notably that they are a ‘man’s problem’ — have led to a culture where women do not recognise or act on their heart attack symptoms
  • Due to this misconception, women tend to arrive at hospital later than men when having a heart attack
  • Women are 50 per cent more likely than men to receive a wrong initial diagnosis
  • Women are less likely than men to receive a number of potentially life saving treatments in a timely way
  • Risk factors for heart disease, including smoking, diabetes and high blood pressure, put women at an ‘excess risk’ of a heart attack compared to men
  • Women are less likely than men to attend cardiac rehabilitation, and when they do attend, they don’t gain the same benefits
  • Women are less likely to receive preventative medicines for a second heart attack, including statins and beta blockers
  • Historically, two thirds of all clinical research has been carried out on men, and women are still under-represented in clinical trials

Two recent pieces of BHF-funded research might also contribute to understanding these inequalities.

Women’s symptoms are the same as men’s

Recent BHF-funded research showed that there is no key difference between men and women’s symptoms when having a heart attack, quashing one of the reasons given for women receiving unequal care. It was previously thought that women were more likely to experience ‘atypical’ symptoms, and this belief may have led to incorrect diagnosis and delayed treatment. This study underlines the importance of everyone knowing the most common symptoms of a heart attack — for men AND women.

The research was also notable for how it was conducted. As Amy Ferry, cardiology research nurse at the University of Edinburgh, and first author of the study, explains:

“It’s not unusual in hospital for patients’ symptoms to be recorded at the time doctors are reviewing the results of diagnostic tests, and when a diagnosis of a heart attack is being made. This means what the patient describes may be influenced by what they think a heart attack may feel like. Doctors may also be influenced in the same way: they may record the symptoms which are most relevant to the diagnosis they think is most likely.
To avoid this potential bias, we asked all patients coming to A&E with a possible heart attack to tell us their symptoms, and we recorded them, before they were given a diagnosis. We found that when people described their symptoms freely, women were as likely as men to report ‘typical’ symptoms like chest pain, tightness or pressure.”

Even with better diagnosis, women do not receive the same treatment

More BHF-funded research from the University of Edinburgh showed that even when diagnosis rates of men and women are the same, women do not receive the same levels of treatment.

The clinical trial looked at diagnosis using a high sensitivity troponin blood test with specific thresholds for men and women, which increased the number of women identified as having a heart attack by 42 per cent. The 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.

The researchers found that, despite the improvement in diagnosis, women were about half as likely as men to receive recommended heart attack treatments including stents, dual antiplatelet therapy and preventative treatments like statins.

While on the face of it these findings may not seem hopeful, they are still an important piece in the large puzzle of women’s unequal heart attack care.

What comes next?

We need to tackle the myth that only men have heart attacks. Both women and men can arm themselves with the knowledge of the most common heart attack symptoms, and can know that they need to dial 999 if these symptoms occur.

We can be aware that young women can have a heart attack too, and we can be aware of the risk factors that might make this more likely in ourselves. We can take women seriously when they describe a pain, pressure or squeezing feeling in their chest.

We need more work to get to the root causes of inequalities in diagnosing and treating heart attacks in women, but we want to work with the NHS and healthcare professionals to surmount the barriers that are currently preventing women receiving the same quality of care as men.

We also need increased support for research into heart and circulatory diseases in women — including by encouraging better representation of women in clinical trials.

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Mind the gender gap was originally published in British Heart Foundation on Medium, where people are continuing the conversation by highlighting and responding to this story.