Women are receiving poorer quality treatment for heart attacks in hospitals and are dying at twice the rate of men in the six months after these visits, according to a new Australian study.
The research, published in the Medical Journal of Australia (MJA), looked at patient data from 28 hospitals across all states and territories from 2009–2016 for men and women who had been diagnosed with a specific type of heart attack known as an ST-elevation myocardial infarction (STEMI), where one of the heart's major arteries is blocked.
The researchers found that women were less likely to receive important intervention treatment in hospitals such as revascularisation (surgery to restore normal blood flow such as coronary artery bypass) and stents.
Six months after hospital treatment, women experience more major adverse cardiac events such as another STEMI or stroke and are twice as likely to die as men.
Professor Clara Chow from the University of Sydney is one of the study's co-authors. She told BuzzFeed News that she was shocked at the results and that "one would think that in modern day Australia, we shouldn't see these differences".
"I think that a lot of people in our society perceive that men are the ones who get heart disease and look after themselves ... but unfortunately that's not true," she said.
Ischaemic heart disease (where a narrowing of arteries restricts blood flow to the heart) is the leading cause of death in Australia, accounting for 12% of deaths in 2016.
The gender difference in heart attack experiences has been acknowledged in medical literature for some time, with one 2016 meta-analysis of studies from across the globe that spanned 41,000 patients finding that women are twice as likely to die in the 30-day bracket after a heart attack than men.
A study published earlier this year from Stony Brook University in New York state looked at data from the US National Registry of Myocardial Infarction (NRMI) and found that due to women's "atypical symptoms" heart attacks were less likely to be recognised and medical care was delayed compared to men.
Women tend to experience heart attacks differently to men, including less obvious chest pain, and instead exhibit other symptoms such as shortness of breath, nausea, and jaw pain.
Chow says that despite this evidence, the medical community isn't conscious of the gender differences, possibly because earlier studies have had too many confounding factors to be clear.
The MJA study focused on STEMI because it is a condition that is easily recognised in both genders in emergency rooms.
The researchers believed that once they had accounted for the potentially confounding factors such as types of heart attack and other risk factors such as diabetes, smoking, and age (women tend to have STEMIs later in life), they would not see a difference in outcome between men and women.
However the research proved the hypothesis wrong and women were less likely to receive appropriate medical investigation or treatment even when these factors were accounted for.
Chow says that the team can only speculate on why women are suffering from less treatment and more complications compared to men.
"We can't obviously be sure why these differences are occurring but certainly we wonder whether they've got to do with perceptions. We don't know whether health systems are perhaps less likely to think that this is a serious problem in a woman and less likely to treat them aggressively," she said.
Chow says that this is a worrying study that highlights the need for gender differences to be observed more in the medical literature.
"We have the same disease and differences in outcome so if we hadn't looked we wouldn't have found. I think we do need to be conscious that all sorts of biases occur in our healthcare and we probably need to look at them," she said.
Chow believes that the way forward is to now raise awareness of the problem in the Australian medical community to try and ensure that gender-biased treatment doesn't continue in our hospitals.
"Unfortunately heart disease doesn't differ by gender, it kills both of us equally."