In a new study, researchers found chest pain is misdiagnosed in women more frequently than in men.
They also found that women with chest pain were more likely than men to wait over 12 hours before seeking medical help.
The findings suggest a gender gap in the first evaluation of chest pain, with the likelihood of heart attack being underestimated in women.
The research was conducted by a team at the Hospital Clinic of Barcelona, Spain.
This study examined gender differences in the presentation, diagnosis, and management of patients admitted with chest pain to the chest pain unit of an emergency department between 2008 and 2019.
A total of 41,828 patients with chest pain were included, of which 42% were women. The median age was 65 years in women and 59 years in men.
The team found women were much more likely to present late to the hospital (defined as waiting 12 hours or longer after symptom onset): this occurred in 41% of women compared to 37% of men.
This is worrying since chest pain is the main symptom of reduced blood flow to the heart (ischemia) because an artery has narrowed. It can lead to a heart attack which needs rapid treatment.
In the doctor’s initial diagnosis, the acute coronary syndrome was more likely to be considered the cause of chest pain in men compared to women. Specifically, in 93% of patients, the ECG did not provide a definitive diagnosis.
In those patients, the doctor noted a probable acute coronary syndrome (ACS) in 42% of cases – when analyzed according to gender, probable ACS was noted in 39% of women and 44.5% of men.
The much lower suspicion of ACS in females was maintained regardless of the number of risk factors or the presence of typical chest pain.
The team says in the doctor’s first impression, women were more likely than men to be suspected of a non-ischaemic problem.
Risk factors like hypertension and smoking should instill a higher suspicion of possible ischemia in patients with chest pain.
But we observed that women with risk factors were still less likely than men to be classified as ‘probable ischemia’.
In women, 5% of ACS were initially misdiagnosed, whereas in men, 3% of ACS were initially misdiagnosed.
The team says heart attack has traditionally been considered a male disease, and has been understudied, underdiagnosed, and undertreated in women, who may attribute symptoms to stress or anxiety.
Both women and men with chest pain should seek medical help urgently.
The study was presented at ESC Acute CardioVascular Care 2021. One author of the study is Dr. Gemma Martinez-Nadal.
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