The gender imbalance in the identification and treatment of heart conditions

By Dr Richard Charles
World Heart Day on 29th of September provides an important opportunity to pause and reflect on the challenges we face in cardiology, and ways of addressing them. In particular, last year more than 1.3 million UK emergency department (ED) admissions were due to chest pain, but of these a significant proportion proved to have no serious cardiac-related condition. This resulted in blockages within over-stretched ED departments and delays in treatment for those that need it most urgently.
When a patient presents at an ED with chest pain, traditional ECGs often can’t conclusively rule out cardiac-related conditions, meaning that it can take a considerable amount of time and effort for clinical staff to identify the real cause. Despite recent published studies using new high sensitivity cardiac troponin algorithms to rule-in (or rule-out) acute coronary syndromes, in the real world it can still take between 3 to 24 hours to reach a conclusive diagnosis, and this current chest pain triage costs healthcare providers some £9 billion per year globally. There remains a very real need for a more efficient way to rule out patients with cardiac-related conditions in order to more efficiently triage those with life-threatening illnesses.
In addition to this, there have been a number  of studies recently highlighting a gender imbalance when it comes to the presentation of cardiac-related symptoms – building on what has long been known within cardiology.  There is an erroneous public perception that heart attacks mainly happen to men and as such, when they do happen to women, there is a tendency to believe that it’s a different problem they are experiencing. A recent study published in European Heart Journal: Acute Cardiovascular Care found that women wait longer than men to call an ambulance if they experience symptoms of a heart attack[1]. Additionally, another study recently found that men are more likely than women to receive cardiopulmonary resuscitation (CPR) from a bystander—and are therefore more likely to survive.
In addition to the inaccurate public belief that women are less likely to have a heart attack, an additional challenge is that women generally don’t suffer the same classic symptoms of angina or heart attack as men. Symptoms can often be much more subtle which is perhaps why they often aren’t treated with the same sense of urgency. It is imperative that more is done to highlight the specific symptoms of a heart attack in women – the European Society of Cardiology have already gone a long way in encouraging women to call an ambulance immediately if they suspect a heart attack.
The issue is that if women’s symptoms are not recognised quickly enough, this leads to a later presentation at EDs and subsequent delays to future treatment. In combination with the already stretched and overcrowded ED space, later presentation of women suffering a cardiac arrest puts them at a distinct disadvantage for positive outcomes.
I believe that innovative technologies such as magnetocardiography (MCG) must be explored so that emergency physicians can more quickly and accurately triage patients as they come through the ED door. It’s imperative that as physicians, we work together to find solutions to this issue as a priority, as well as raise awareness of the symptoms of heart attacking in both men and women so that chances of survival and successful treatment are maximised for everyone.
[1] Mirzaei S, Steffen A, Vuckovic K, et al. The association between symptom onset characteristics and prehospital delay in women and men with acute coronary syndrome. Eur J Cardiovasc Nurs. 2019. doi:10.1177/1474515119871734.
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