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.
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