Heart attacks in women not being picked up

Women are still less likely than men to be correctly identified as having had a heart attack, despite the publication of new guidance designed to lower the index of suspicion, reveals research in Heart.

Research has repeatedly shown that women get something of a raw deal when it comes to treatment after a heart attack, and they don't tend to survive as long as men who have been similarly affected.

But women with serious heart problems tend to be older than men, and it has therefore been suggested that age, rather than gender, might account for these disparities.

The researchers collected 6,172 samples of cardiac troponin T (cTnT), any rise in which is now usually considered indicative of a heart attack. The samples were collected from almost 5,000 patients, roughly half of whom were men whose average age was 66. The rest were from women, whose average age was 74.

The study was conducted over 2002 at one hospital trust in the north east of England.

Among the 561 heart attacks recorded during the year, over 90% had increased levels of cardiac troponin T.

Taken together, less than half (40%) of the total numbers of patients (1,304) with an increased cTnT were discharged from hospital with a diagnosis of heart attack. Women in this group were almost 40% less likely to be given this diagnosis than men.

New diagnostic criteria, published by the European Society of Cardiology and the American College of Cardiology in 2000, emphasise that slight increases in the troponins can indicate a heart attack.

And subsequent research has suggested that if strictly applied, the numbers of correct diagnoses would be given a major boost.

The authors point out that a full year had elapsed after the publication of the new guidance and before the start of their study, so the new criteria would have had time to filter through to clinicians.

They say that their study provides the first evidence showing that women are less likely to be diagnosed with a heart attack in the first place, let alone be given less effective treatment afterwards. And this is despite the evidence of increased cTnT levels.

The perception that women are less likely to have a heart attack than men must still be a factor in clinicians' decision making, they suggest.

Contact:
Dr Eric Kilpatrick, Department of Clinical Biochemistry, Hull Royal Infirmary, Hull, UK
Tel: +44 (0) 1482 607 708
Email: [email protected]