Every 40 seconds, someone in the United States has a heart attack, with 790,000 Americans having a heart attack every year. After a heart attack, heart damage can affect heart rhythm, pumping action, and blood circulation. Damage can increase the risk of another heart attack or other conditions such as stroke and kidney disorders. A recent study published in the Medical Journal of Australia showed a gender disparity in treatment after a heart attack, leading to increased death rates and adverse cardiovascular events in women compared to men.
Heart attack, also known as myocardial infarction, occurs when the blood flow to the heart is blocked, most often due to a buildup of fat and cholesterol known as a plaque. Plaques can break away from the blood vessel which leads to clot formation, and the clot can block blood flow leading to damage to the heart muscle that is no longer receiving blood. A particular type of heart attack, ST-elevation myocardial infarction (STEMI), accounts for about 20% of all heart attack presentations. STEMI is caused by prolonged periods of completely blocked blood supply affecting a large area of the heart, it has a high risk of death and disability if not treated and responded too quickly. STEMI diagnosis utilizes electrocardiogram (ECG) because STEMI heart attacks give a unique ECG signature. After treatment STEMI recovery involves medications, lifestyle changes such as quitting smoking, cardiac rehabilitation, and appropriate diet.
Previous studies have shown sex differences in the management and outcomes of patients with acute coronary syndromes, but these analyses did not account for confounding factors that may affect the accuracy of findings. A new study, by leading cardiac specialists and researchers across Australia, sought to examine gender disparities in characteristics, management and clinical outcomes of patients with STEMI. Researchers analyzed data obtained from CONCORDANCE (Cooperative National Registry of Acute Coronary care, Guideline Adherence, and Clinical Events) for 41 Australian hospitals, encompassing metropolitan and rural locations, for 2898 patients (2183 men, 715 women), from 2009 to 2016. The primary outcome measured was total revascularization, while secondary outcomes included adverse cardiac event rates, clinical outcomes and preventative treatments at discharge, as well as mortality in the hospital and six months after admission.
Of the patients analyzed the average age of women with STEMI was 66.6 and the average age of me 60.5 years. More women had hypertension, diabetes, prior stroke, kidney disease, heart failure, or dementia while fewer had the history or previous coronary artery disease or heart attack compared to men. Analysis of the CONCORDANCE data showed that women were twice as likely to die or have severe adverse cardiovascular events when presenting with STEMI in the past decade compared to men. Women with STEMI were less likely to receive invasive management, revascularization, or preventative medication at discharge. The reason for this under-treatment and management of women with STEMI is unclear; it may be due to the poor awareness that women are generally at higher risk with STEMI or lack of use of objective, reliable risk prediction tools.
The study will prompt more focus and attention on treating women with STEMI with evidence-based treatment. The study’s senior author, Dr. Clara Chow from the University of Sydney’s Westmead Hospital, said “Whatever the cause, these differences aren't justified. We need to do more research to discover why women suffering serious heart attacks are being under-investigated by health services and urgently identify ways to redress the disparity in treatment and health outcomes."
To read the study click here. To learn more about STEMI watch the video below!
Mayo Clinic, Center for Disease Control, American Heart Association