There's A Serious Problem With How Heart Symptoms Are Treated In Women, Study Reveals

When it comes to misbehaving hearts, getting the best possible care and timely treatment can be a matter of life or death.

Unfortunately, it's been shown over and over again that women aren't as likely to get such care. A new study has reinforced that finding – although women and men have different proportions of types of heart conditions, new data reveal women with heart problems are less likely than men with similar conditions to receive treatment.

"In this study, we assessed differences in the evidence-based treatment received by men and women with non-ST-elevation acute coronary syndromes and in their outcomes (in-hospital and at 6- month follow-up)," the University of Sydney team writes in their new paper.

"We also separately assessed these differences in patients with documented coronary artery disease."

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ST-elevation refers to the abnormally high pattern seen in an electrocardiogram that indicates a heart artery is completely blocked – resulting in a large part of the heart muscle being unable to receive oxygen.

But some heart attacks do not display this way on an electrocardiogram. These non-ST segment elevation myocardial infarctions (NSTEMI) are often less severe, but can still cause damage to the heart.

The researchers looked at registry data for patients at 43 Australian hospitals between February 2009 and October 2018 – finding 7,783 patients who had a non-ST-elevation acute coronary syndrome, which they then analyzed during their hospital stay and at a six-month follow up.

Around 31 percent of the patients were women, showing already that more men are ending up in hospital for these symptoms. But once they get there, the treatment men and women receive is also slightly different.

"At discharge, fewer women were prescribed aspirin (85 v 91 percent), a second antiplatelet medication (59 v 68 percent), beta-blockers (71 v 75 percent), or statins (86 v 92 percent), or referred to cardiac rehabilitation (54 v 63 percent)," the team writes.

While NSTEMI don't show up on an ECG, they do cause an elevation in the blood of a protein released by damaged heart muscle, whereas another heart condition called an unstable angina (where the heart doesn't get enough blood flow and oxygen), does not show this elevation.

But the team also found differences in patients who had coronary artery disease more generally – a build-up of arterial plaque which could eventually cause a heart attack.

"A total of 4,676 patients had documented coronary artery disease, including 1,108 women. Smaller proportions of women with coronary artery disease than of men underwent coronary artery bypass grafting (10 v 16 percent) or were prescribed statins at discharge (94 v 96 percent)."

Now, there are some reasons for this which are not as nefarious as it might first seem.

Women more frequently have something called non-obstructive coronary artery disease – or NOCAD, which is (potentially not correctly) thought to be less likely to cause a heart attack, which might explain some of the differences in treatment.

"The women with non-ST-elevation acute coronary syndromes in our study received less evidence-based treatment, consistent with previous reports. The larger proportion of women with NOCAD may partly explain the difference," the team writes.

"However, NOCAD is not a benign condition, and patients can benefit from secondary prevention therapies. In Australia, adherence to guideline-based therapy for people with non-ST-elevation acute coronary syndromes could be improved, especially for women in hospital and for both sexes at discharge."

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