Over 8,000 women could have survived their heart attacks but for inequalities in care

More than 8,200 women in England and Wales could have survived their heart attacks had they simply been given the same quality of treatment as men, new research has found.

Researchers at the University of Leeds said the actual number of lives lost to unequal care is likely to be much higher, as they did not include all hospital admissions which occurred over the 10-year study period.

It saw them use anonymised data from the UK’s national heart attack registry, the Myocardial Ischaemia National Audit Project (MINAP), to analyse the treatment and outcomes of 691,290 people who were hospitalised for heart attacks in England and Wales between 2003 and 2013.

The registry includes detailed information about each patient’s demographics, medical history, and clinical characteristics such as heart rate when they entered hospital, and the investigations, treatments and procedures they received while in hospital.

In the study, women tended to be older when admitted to hospital, and were more likely to have other illnesses such as diabetes and high blood pressure.

But even after adjusting for their ages and greater risk factors, the team found that women had more than double the median rate of death in the 30 days following their heart attack than men (5.2% versus 2.3%).

Researchers suggested this may be, in part, explained by women being less likely to receive the guideline recommended care.

Women who had a non-ST-elevation myocardial infarction (NSTEMI), a type of heart attack where the coronary artery is partially blocked, were 34% less likely than men to receive timely coronary angiography (video images that reveal narrowings or blockages in the coronary arteries) within 72 hours of their first symptoms.

They also found women who suffered a ST-Elevation Myocardial Infarction (STEMI) heart attack – a very serious attack where the coronary artery is completely blocked – were 2.74% less likely to receive timely reperfusion – emergency procedures including drugs and stents which help to clear blocked arteries and restore blood flow to the heart.

Meanwhile, women were 2.7% less likely to be prescribed statins and 7.4% less likely to be prescribed beta blockers when leaving hospital, which help to lower the risk of having a second heart attack.

Researchers said that although the difference in proportions may seem small in isolation, even small deficits at each phase of a woman’s pathway of care can intensify into a considerable survival disadvantage.

They assessed the quality of care that men and women received following their heart attack based on “quality indicators” – a checklist for the optimal care based on the international guidelines and endorsed by the European Society of Cardiology.

Women’s care was less likely to meet 13 of the 16 heart attack quality indicators that were measured.

Altogether they estimated 8,243 deaths among women who were hospitalised with a heart attack in England and Wales could potentially have been prevented over the study period had they received care equal to that of men.

They said differences in heart attack symptoms, health-seeking behaviour, underlying biology, age and presence of underlying health problems, as well as response to drugs and treatments may have also played a role.

Each year in the UK around 70,000 women go to hospital due to a heart attack, and up to 25,000 women in the UK die each year from heart attacks – equivalent to three women every hour.

Senior author Chris Gale, professor of cardiovascular medicine at the University of Leeds, said: “We know women are dying due to unequal heart attack care – and now we’ve identified the shortfalls we need to target to save lives.

“For example, women not receiving coronary angiography when they arrive at hospital puts them at a disadvantage right from the start, and has knock on effects creating further shortfalls down the line.

“In isolation the differences may appear small, but even in a high performing health system like the UK, small deficits in care across a population add up to reveal a much larger problem and a significant loss of life.

“We also show that not all differences are down to bias – some are down to biology. Only with more research can we hope to better understand how to target biology and best treat heart attacks in women.”

Professor Sir Nilesh Samani (pictured), medical director of the British Heart Foundation – which part-funded the research, said: “We need to tackle the false perception that heart attacks are only a male health issue.

“This leads to inadequate care for women – both at the time of and after heart attacks – with fatal consequences.

“While further research is needed, this study has identified several areas where heart attacks are being treated differently between the sexes, which may contribute to the worse outcomes in women.

“If we start to address these now, it will make a huge difference and save lives.”

The study is published in the journal Heart.

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