Overview: A Slow but Steady Improvement in Women’s Heart Attack Care
New findings from researchers at the University of Sydney, published in the Medical Journal of Australia, reveal that while outcomes for women experiencing a heart attack are improving, the gender gap in care and outcomes persists. Analyzing hospital records of nearly 30,000 NSW patients over nine years, the study highlights both progress and ongoing inequities in emergency cardiac treatment.
What the Study Found
The researchers looked at adults who had a ST-elevation myocardial infarction (STEMI), the most severe form of heart attack caused by a complete artery blockage. STEMI accounts for about a quarter of heart attacks and is the presentation most easily recognized on an electrocardiogram. The team tracked whether patients received timely care, including early angiography and percutaneous coronary intervention (PCI), and followed major adverse cardiovascular events and all-cause mortality for 12 months.
Women comprised about 30% of participants and tended to be older with higher rates of comorbidities such as heart failure, diabetes and dementia. Relative to men, women were:
- 13% less likely to receive an angiogram
- 16% less likely to receive a PCI/stent
Importantly, the study found that both men and women showed improving outcomes over time, with women experiencing faster declines in all-cause mortality and adverse cardiovascular events. However, the gap remained open, indicating that advances in treatment are not yet translating into parity for women.
Why Are Women Delayed in Diagnosis and Treatment?
Professor Clara Chow notes that women often present with different symptoms, such as breathlessness or chest tightness, rather than the classic “clutching of the chest” pain seen in men. These atypical presentations, along with residual unconscious biases in the health system, can delay recognition and treatment of a heart attack in women. As a result, delays in diagnosis may persist even when STEMI is the underlying issue.
Interpreting the Mortality and Event Trends
Despite higher baseline risk profiles, women’s mortality rates improved more quickly than men over the study period, suggesting that increased awareness and evolving practices may be making a difference. The researchers caution that attributing improved mortality solely to cardiac care is complex, as advances in other areas (for example, cancer treatments) can influence overall death rates.
Clinical and Policy Implications
Experts emphasize the need for continued, sex-specific research in cardiovascular care. Only 20–30% of cardiovascular clinical trial participants are women, limiting guidance on how best to treat heart attacks in female patients. More sex-specific data could inform guidelines, such as whether women require different blood pressure targets or other management strategies to reduce risk after a heart attack.
Education remains critical. Emergency physicians, general practitioners, and cardiologists alike should be trained to recognize female heart attack symptoms promptly and to apply equitable treatment strategies. Routine heart health checks, particularly for women with pregnancy-related risk factors (gestational diabetes, pre-eclampsia, early menopause), may help identify risk earlier and prevent events.
What This Means for Patients and Clinicians in Australia
The Australian health system already promotes free heart health checks for many at-risk groups. The study underscores that while progress is underway, more work is needed to close the gap between genders in access to diagnostic tests like angiograms and treatments such as PCI. Ongoing sex-specific research and guideline updates will be crucial to ensure women receive timely, appropriate care during a heart attack.
Conclusion
Heart attack care for women is improving in Australia, with faster gains in survival and fewer adverse events. Yet the evidence shows that the gender disparity in diagnosis and intervention remains, calling for sustained attention to sex-specific risk factors, symptom recognition, and equitable treatment pathways.
