What the study found
A large Australian study has found that care for women experiencing a heart attack is improving, but not quickly enough to close the gap with men. An analysis of hospital records from New South Wales (NSW) spanning 2011 to 2020 included 29,435 adults who suffered a STEMI (a severe, complete artery blockage). The study shows that while outcomes for both sexes are getting better, women still face a higher burden of adverse events in the year after a heart attack and are less likely to receive key life-saving procedures.
Key findings include that women were 13% less likely than men to receive an angiogram, which checks for blocked arteries, and 16% less likely to undergo a percutaneous coronary intervention (PCI), the procedure often used to place a stent and restore blood flow. The difference in mortality and major cardiovascular events over 12 months, while narrowing, remained clinically meaningful: women faced higher rates of major adverse events and a 6% greater likelihood of death within a year after a heart attack when existing conditions were accounted for.
Why the gaps persist
Researchers say women often present with different symptoms than men. Whereas the classic image of chest-clutching pain is common in men, women more frequently report breathlessness, fatigue, or upper body discomfort. Such atypical presentations can delay recognition by patients and health professionals alike, contributing to slower diagnosis and treatment. Professor Clara Chow, lead author and cardiologist at Westmead Hospital, emphasised that unconscious biases in how the health system treats men and women still influence care decisions.
“They’re less likely to get the classic clutching of the chest pain, and more likely to be breathless or have tightness,” Chow noted, explaining how misperceptions can delay timely intervention. While clinical teams have become more attuned to women’s symptoms, the gap in prompt care persists, underlining the need for greater awareness across all levels of emergency and primary care.
Trends over time
Despite these gaps, the study found encouraging signs. Both sexes showed improvements in outcomes over the studied period, with the rate of all-cause mortality dropping slightly faster in women than in men, suggesting the benefits of broader improvements in cardiac care may be reaching women more quickly. The use of angiography and PCI rose faster in women than in men, indicating a narrowing of treatment disparities as clinical practices evolve and guidelines emphasizing equitable care gain traction.
What can help move the needle
Experts advocate for several steps to accelerate progress and ensure equity. First, more sex-specific research is essential. Dr. Sonali Gnanenthiran argues that only 20–30% of cardiovascular clinical trials include women, and women are often not treated as a distinct subgroup in analyses. Better data can lead to sex-specific guidelines and tailored risk management. Second, education remains critical—not just for cardiologists, but for emergency physicians and general practitioners who are often first to assess a potential heart attack. Improved recognition of female-specific risk factors—such as gestational diabetes, pre-eclampsia, and early menopause—could prompt earlier screening and prevention efforts.
There is a call for re-evaluating thresholds for risk factors in women, too. High blood pressure is a major risk, but women sometimes experience events at lower pressures than men, raising questions about whether different targets are warranted. As Chow puts it, health guidelines should reflect these nuances, while Gnanenthiran stresses the need for more inclusive research so cardiovascular care can be customized for women.
The path forward
Australia’s heart health checks, available free to many, offer an opportunity to catch risk earlier. The study’s authors and independent experts concur that ongoing education and systematic changes are needed to shorten the time to diagnosis and treatment for women. By continuing to raise awareness of female-specific symptoms and risk factors and by expanding sex-disaggregated research, the health system can close the remaining gap more rapidly and save more lives.
