Women who have a heart attack are more likely than men to have symptoms of chest pain misdiagnosed by doctors as anxiety or stress, a study has warned.
Researchers from Spain analyzed the treatment of 41,828 patients admitted to hospital with chest pain and compared the treatment they received.
Women were nearly twice as likely as men to have a case of acute coronary syndrome – including a heart attack – initially misdiagnosed.
But doctors weren’t the only ones to misjudge the circumstances, the team found, with women rather than men having to wait more than 12 hours before seeking help.
A 2014 study, meanwhile, found that women with a heart attack are also more likely to have to wait longer to be examined in hospitals than men.
Women who have a heart attack are more likely than men to have their symptom of chest pain misdiagnosed by doctors as anxiety or stress, a study has warned (stock image)
“Our findings suggest a gender gap in the initial assessment of chest pain, underestimating the risk of heart attack in women,” said paper author Gemma Martinez-Nadal of the Hospital Clinic of Barcelona, Spain.
‘The low suspicion of a heart attack occurs in both women and physicians, leading to a higher risk of late diagnosis and misdiagnosis.’
In their study, Dr. Martinez-Nadal and colleagues examined the experiences of a total of 41,828 patients admitted to a hospital emergency department with chest pain between 2008 and 2019.
42 percent of the patients were female and the mean age was 65 for the women and 59 for the men.
For each subject, the researchers gathered information about their heart attack risk factors – including whether or not they were obese or had high blood pressure – and the initial diagnosis from the doctor handling the case.
“We had the doctor’s first impression of whether the chest pain had a coronary cause or some other cause, such as anxiety or musculoskeletal complaints,” explains Dr. Martinez-Nadal.
Such first impressions are recorded prior to exams such as blood tests, and are instead given based on the patient’s clinical 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 concerning because chest pain is the main symptom of decreased blood flow to the heart – an ‘ischemia’ – because an artery is narrowed,” said Dr. Martinez-Nadal.
“It can lead to a heart attack that needs to be treated quickly,” she added – referring to the condition more commonly known as a heart attack.
“According to the doctor’s first impression, women were more likely than men to be suspected of having a non-ischemic problem,” said Dr. Martinez-Nadal. Pictured, a patient with chest pain (stock image)
The team found that the doctors were significantly more likely to attribute chest pain to acute coronary syndrome – an umbrella term for conditions such as heart attacks involving reduced blood flow to the heart – if the patient was male.
Specifically, in the 93 percent of the cases where the EKG was unable to make a definitive diagnosis, the doctors suspected acute coronary syndrome in 44.5 percent of the men, but only in 39 percent of the women.
In addition, this trend was maintained regardless of the number of heart attack risk factors the patients had or whether they typically exhibit indicative chest pain.
Acute coronary syndrome was initially misdiagnosed in 5 percent of women, but only 8 percent of men.
“According to the doctor’s first impression, women were more likely than men to be suspected of having a non-ischemic problem,” said Dr. Martinez-Nadal.
“Risk factors such as hypertension and smoking should raise suspicion of possible ischemia in patients with chest pain.”
“But we noted that women with risk factors were still less likely to be classified as” probable ischemia “than men.”
“Traditionally, a heart attack has been considered a male disease and is minor, underdiagnosed and under-treated in women, who can attribute symptoms to stress or anxiety,” concluded Dr. Martinez-Nadal.
“Both women and men with chest pain need to seek urgent medical attention.”
The full findings of the study will be presented at the European Society of Cardiology’s Acute CardioVascular Care 2021 conference, held virtually March 13-14, 2021.