Women who suffer heart attacks are more likely than men to have their chest pain symptoms misdiagnosed by doctors as anxiety or stress, a study warned.
Researchers from Spain analyzed the treatment of 41,828 patients who were admitted to the hospital with chest pain and compared the treatment they received.
Women are almost twice as likely as men to have a case of acute coronary syndrome – including a heart attack – initially misdiagnosed.
But doctors were not the only ones to assess the circumstances, the team found, with women being more likely than men to wait more than 12 hours before seeking help.
A 2014 study, however, found that women with heart attacks are also more likely to have to wait longer to be examined in hospitals than men.
Women who suffer heart attacks are more likely than men to have their chest pain symptom misdiagnosed by doctors as anxiety or stress, a study warned (stock image)
“Our findings suggest a gender difference in the first assessment of chest pain, with the likelihood of heart attack being underestimated in women,” said the article’s author, Gemma Martinez-Nadal, of the Hospital Clinic of Barcelona, Spain.
“The low suspicion of heart attack occurs both in women and in doctors, leading to greater risks of late diagnosis and incorrect diagnosis.”
In their study, Dr. Martinez-Nadal and colleagues studied the experiences of a total of 41,828 patients who were admitted to an emergency department of a hospital with chest pain between the years 2008 and 2019.
Of the patients, 42 percent were women, and the average age was 65 for women and 59 for men.
For each subject, the researchers collected information about their risk factors for heart attack – including whether they were obese or had high blood pressure – and the initial diagnosis of the doctor responsible for the case.
“We had the doctor’s first impression of whether the chest pain had a coronary cause or another source, such as anxiety or a musculoskeletal complaint,” explained Dr. Martinez-Nadal.
These first impressions are recorded before exams such as blood tests and are instead provided based on the patient’s medical history, a physical exam and an electrocardiogram (ECG) measurement of cardiac activity.
The researchers found that women were significantly more likely to report to the hospital more than 12 hours after the onset of chest pain – this occurred in 41 percent of women compared to 37 percent of men.
“This is worrying, because chest pain is the main symptom of reduced blood flow to the heart – an ‘ischemia’ – because an artery has narrowed,” said Dr. Martinez-Nadal.
“It can lead to a myocardial infarction that needs rapid treatment,” she added, referring to the condition more commonly known as a heart attack.
“In the doctor’s first impression, women were more likely than men to be suspected of a non-ischemic problem,” said Dr. Martinez-Nadal. In the photo, a patient with chest pain (stock image)
The team found that doctors were significantly more likely to attribute chest pain to acute coronary syndrome – a generic term for diseases like heart attacks that involve a reduction in blood flow to the heart – if the patient were a man.
Specifically, in 93 percent of cases where the ECG was unable to provide a definitive diagnosis, doctors suspected acute coronary syndrome in 44.5 percent of men, but only in 39 percent of women.
In addition, this trend was maintained regardless of the number of heart attack risk factors that patients had or whether they exhibited typically indicative chest pains.
Acute coronary syndrome was initially misdiagnosed in 5 percent of women, but only in 8 percent of men.
“In the doctor’s first impression, women were more likely than men to be suspected of a non-ischemic problem,” said Dr. Martinez-Nadal.
‘Risk factors such as hypertension and smoking should instill a greater suspicion of possible ischemia in patients with chest pain.’
‘But we found that women with risk factors were still less likely than men to be classified as’ probable ischemia ‘.’
“Heart attack is traditionally considered a male disease and has been poorly studied, underdiagnosed and undertreated in women, who can attribute symptoms to stress or anxiety,” concluded Dr. Martinez-Nadal.
“Women and men with chest pain should urgently seek medical help.”
The full results of the study are being presented at the European Society of Cardiology’s Acute CardioVascular Care 2021 congress, which is being held virtually from 13 to 14 March 2021.