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Bias, biology and heart disease in women

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BHF, coronary heart disease, myth, women's symptoms, misdiagnosis, report‘Women who have heart attacks experience the same key symptoms as men’.

Stark inequalities in awareness, diagnosis and treatment of heart attacks are needlessly killing women every day in the UK.

Women are twice as likely to die of coronary heart disease, the main cause of heart attack, as breast cancer in the UK. Yet it is still not always seen as a woman’s problem.

The British Heart Foundation (BHF) wants to end the perception that heart attack is a male disease, and is encouraging women to understand their heart attack risk and the symptoms.

Over a ten-year period more than 8,200 women died needlessly following a heart attack. They could have been saved if they had received the same quality of care as men.

A new briefing, ‘Bias and Biology‘, sets out the scale of the problem.

By combining some of the latest evidence with first-hand patient stories, the briefing reveals a concerning picture of women faring worse than men at every stage of their heart attack experience:

Unaware: Women often delay seeking medical help, which can reduce their chance of survival. A global systematic review found that the average delay between the onset of symptoms and arrival at hospital for men ranges between 1 hour 24 minutes and 3 hours 30 minutes compared to between 1 hour 48 minutes and 7 hours 12 minutes for women.

Misdiagnosed: Research has shown that women are 50 per cent more likely to receive a wrong initial diagnosis when they are having a heart attack. Both men and women who are initially misdiagnosed have a 70 per cent higher risk of dying.

Substandard treatment: Over a ten-year period, it is estimated that more than 8,200 heart attack deaths in women in England and Wales could have been prevented if they had received the same standard of care as men. The study found women were less likely to receive standard treatments including bypass surgery and stents.

Increased risk: Risk factors for heart disease are often more deadly for women. Smoking increases women’s heart attack risk up to twice as much as men’s, high blood pressure increases women’s risk 80 per cent more, and type 2 diabetes increases women’s risk 50 per cent more.

Poorer aftercare: Women often receive poorer aftercare, following a heart attack. A BHF-funded study showed that women in England and Wales were 2.7 per cent less likely to be prescribed statins and 7.4 per cent less likely to be prescribed beta blockers when leaving hospital, despite their proven benefit of lowering the risk of a subsequent heart attack or stroke.

And according to BHF-funded research, women who have heart attacks experience the same key symptoms as men.

These findings question a medical myth that women tend to experience unusual or ‘atypical’ symptoms, quashing one of the reasons given for women receiving unequal care.

There are more than 800,000 women in the UK living with coronary heart disease, which is the main cause of heart attacks; and 35,000 women are admitted to hospital following a heart attack each year in the UK – an average of 98 women per day, or 4 per hour.

Considering these figures, it is worrying that some women do not think that heart disease could happen to them.

Chris Gale, Professor of Cardiovascular Medicine at the University of Leeds and lead author of some of the studies cited, said: “This problem is not unique to the UK – studies across the globe have also revealed gender gaps in treatment, suggesting this is a deeply entrenched and complex issue.

“On their own, the differences in care are very small, but when we look at this across the population of the UK, it adds up to a significant loss of life. We can do better.”

To read the full briefing, click here.

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