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Even With Same Diagnosis, Women Get Half the Heart Attack Treatments as Men

Mary Caffrey
The trial, led by a team from the University of Edinburgh, used the troponin blood test to detect heart attacks, but with separate thresholds for men and women.
New research from the United Kingdom amplifies the long-standing problem of women not receiving adequate treatment for heart disease, as results in the Journal of the American College of Cardiology show that women given a test that boosted their rates of diagnosis for a heart attack were still half as likely to receive recommended treatments.

The study, funded by the British Heart Foundation (BHF), comes as the American College of Cardiology and other organizations are asking how to get more women to specialize in the field—in part to address these disparities.

This new trial, led by a team from the University of Edinburgh, used the troponin blood test to detect heart attacks, but with separate thresholds for men and women.

The study followed 48,282 people (47% women, 53% men) in 10 hospitals in Scotland who were believed to have heart attack symptoms. An initial diagnosis was made using the same troponin threshold for men and women. Patients were given a second diagnosis using values specific for men and women: 16 ng/L troponin in women and 34 ng/L in men.

Researchers then followed up to see what treatment they received and whether they had a second heart attack within a year.

As a result, the number of women diagnosed rose by 42% (from 3521 to 4991 out of a total of 22,562) and meant that that roughly the same share of women as men were diagnosed with a heart attack after going to the emergency department with chest pain (21% of men, 22% of women).

Yet, treatments were still much more likely to be given to men:
  • Coronary revascularization, in which a stent is inserted, was performed for 15% of women and 34% of men
  • Dual platelet therapy, 26% of women versus 43% of men
  • Statins or other preventive therapy, 16% of women versus 26% of men
As a result, diagnosing more women correctly did not change the number of women who had a second heart attack or died of cardiovascular disease—which means women are dying for no reason, experts say.

“Diagnosis of a heart attack is only one piece of the puzzle. The way test results and patient history are interpreted by healthcare professionals can be subjective, and unconscious biases may influence the diagnosis,” said Ken Lee, MBBS, BHF Clinical Research Fellow and study author at the University of Edinburgh, in a statement. “This may partly explain why, even when rates of diagnosis are increased, women are still at a disadvantage when it comes to the treatments they receive following a heart attack.”

The results support earlier work by the team that show the blood test given to patients arriving at the hospital with a possible heart attack must be calibrated differently for men and women to ensure an accurate diagnosis. The test measures troponin levels in the blood.

“It’s now important that this blood test, with its specific measures for men and women, is used to guide treatment and that we address these disparities in the care of men and women with heart attack. Women everywhere should benefit from improved heart attack diagnosis,” Lee said.

Said Sonya Babu-Narayan, MBBS, associate medical director at the BHF and a cardiologist: “It’s extremely promising that bespoke blood tests for men and women could lead to better diagnosis of heart attacks. But this progress in diagnosis needs to translate in to better treatment and improved heart attack survival chances for women. We now need to dig deep into the complex reasons behind women having reduced access to investigations and treatment.”

Reference

Lee KK, Ferry AV, Anand A, et al. Sex-specific thresholds of high-sensitivity troponin in patients with suspected acute coronary syndrome. J Am Coll Cardiol. 2019;74(16). doi: 10.1016/j.jacc.2019.07.082.

 
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