Overview: A Step Forward, Yet Not Fast Enough
New findings from the Medical Journal of Australia reveal that care for women experiencing a heart attack is improving in NSW, Australia, but the pace of that improvement leaves a persistent gender gap. An analysis of hospital records and outcomes for nearly 30,000 patients over nine years shows that while both men and women are benefiting from advances in treatment, women remain less likely to receive key interventions and are at higher risk of adverse events within 12 months of a heart attack.
The Study Details
Led by researchers at the University of Sydney and conducted with data from NSW hospitals, the study tracked adults who had a ST-elevation myocardial infarction (STEMI) from 2011 to 2020. STEMI is the most serious form of heart attack, caused by a complete blockage of a coronary artery. The researchers examined whether patients received timely care, including coronary angiograms and percutaneous coronary interventions (PCI, commonly involving stents), and looked at major adverse cardiovascular events and all-cause mortality over the following year.
Key Findings for Women
The analysis showed several important trends:
- Women were 13% less likely than men to receive an angiogram and 16% less likely to undergo PCI.
- Although overall outcomes improved for both sexes, women continued to experience higher rates of major adverse cardiovascular events and were 6% more likely to die within 12 months after a heart attack, even after controlling for pre-existing conditions.
- The gap narrowed over time: mortality declined faster in women, and the use of angiogram and PCI grew more rapidly among women than men.
Why the Gap Persists
Researchers point to several contributing factors. Women often present with atypical heart attack symptoms—breathlessness, chest tightness, or fatigue rather than the classic central chest pain—which can delay recognition by patients and health professionals. This may lead to slower triage, diagnosis, and treatment.
Clinical and Systemic Challenges
Professor Clara Chow, a cardiologist at Westmead Hospital and the study’s lead author, highlighted unconscious biases in healthcare settings that can delay care for women. “Symptoms differ, and that difference can lead to slower recognition,” she said. The study also notes that women tend to be older and have more comorbidities—such as heart failure, diabetes, and dementia—which can complicate management and influence decisions around invasive procedures.
Implications for Practice and Policy
Experts emphasize the need for sex-specific research and guidelines. Dr. Sonali Gnanenthiran of The George Institute argued that more women must be represented in cardiovascular trials to understand how best to tailor prevention and treatment. She also warned that gaps in care could persist if researchers focus only on aggregate data rather than sex-specific analyses.
There is also a call for broader education across all levels of healthcare—from emergency physicians to general practitioners—to ensure women presenting with atypical symptoms are promptly evaluated for heart disease and referred for preventive checks when appropriate.
Progress and Next Steps
There is positive news: the rate of use of diagnostic angiograms and PCI has risen faster in women than in men, suggesting that awareness efforts are making a difference. However, the overall pace is still insufficient to close the gender gap quickly. The authors argue for continued, targeted efforts to reduce delays, improve recognition of female-specific risk factors, and establish sex-specific cardiovascular guidelines.
Risk Factors and Early Detection
In addition to acute care, ongoing prevention matters. Women’s risk factors can include gestational diabetes, pre-eclampsia, and early menopause. The study underscores the importance of regular heart health checks, particularly for those with high blood pressure or a family history of cardiovascular disease. Australia already offers free heart health checks for eligible groups, and clinicians are encouraged to initiate earlier screening when risk factors are present.
Conclusion
Australian researchers are clear: progress has been made in narrowing the gender gap in heart attack care, but more work is needed to ensure that women receive timely, equitable treatment. By advancing sex-specific research, educating health professionals, and improving symptom recognition—especially for atypical presentations—the health system can move closer to equity in cardiovascular outcomes for all Australians.
