Closing the gender gap in heart disease care: a persistent challenge
Cardiovascular disease in women has long been under-recognised, under-diagnosed, and under-treated. Decades after Bernadine Healy highlighted sex bias in coronary artery disease management, disparities persist in Australia and internationally. Recent analyses, including a study from New South Wales, reveal that while progress is possible, sex-based differences in treatment and outcomes remain, underscoring the need for targeted actions in diagnosis, management, and policy.
What recent evidence shows about STEMI care
ST-elevation myocardial infarction (STEMI) is a critical emergency where timely revascularisation can save lives. A NSW study spanning 2011–2020 found that female patients presenting with first-episode STEMI were older, carried more comorbidities, and were more likely to live in socio-economically disadvantaged areas. They were also less likely to undergo timely angiography, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG). Consequently, 12-month adverse events and mortality were higher among women than men. However, the pace of improvement over the decade differed by sex, with both genders showing increases in revascularisation rates, and a slightly faster decline in mortality among female patients.
Interpreting the data: what drives the gaps?
The reasons for sex differences in STEMI care are multifactorial. Age and comorbidity at presentation are higher in women, which may influence treatment decisions and perceived risk. Other contributing factors include the higher prevalence of myocardial infarction with non-obstructive coronary arteries (MINOCA) and spontaneous coronary artery dissection (SCAD) in women, as well as potential delays in recognizing symptoms that diverge from traditional “men’s heart” presentations. While retrospective, the NSW analysis aligns with broader national and international findings that sex-based disparities persist despite overall improvements in care.
Are we closing the gap?
Encouragingly, the study noted a narrowing treatment gap over ten years and a relatively rapid rise in angiography and PCI rates for women. This concurrent progress likely reflects growing awareness of sex-specific cardiovascular risks, more inclusive clinical guidelines, and improved public and professional education about how heart disease can present in women. Notably, these gains occurred without artificial, sex-focused interventions in some settings, suggesting that broad-based improvements in cardiovascular care can benefit women as well. Still, the data also show a persistent gap in 12-month mortality, reminding us that progress must be accelerated to protect women equally in the long term.
What clinicians, policymakers, and patients can advocate for
To shorten the gender gap in heart disease care, a multi-pronged approach is needed. Clinicians should maintain a high index of suspicion for cardiovascular disease in women, apply guideline-recommended preventive therapies, and ensure timely testing and intervention regardless of age or socio-economic status. Healthcare systems can prioritize equitable access to diagnostic and interventional services, address social determinants of health, and monitor sex-disaggregated outcomes to identify where gaps persist. Public health campaigns must continue to raise awareness of female-specific presentations and risk factors, empowering women to seek care promptly and participate in shared decision-making.
The path forward
The evidence from Australia and beyond suggests incremental progress toward closing the gender gap in heart disease care. Yet, changing the trajectory will require sustained commitment, data-led policy, and culturally competent care that treats women as equal partners in cardiovascular health. By aligning clinical practice with an understanding of sex- and gender-related factors, the medical community can move faster toward a world where a woman’s heart disease is diagnosed and treated as promptly and effectively as a man’s.
