Women experiencing heart attacks are more likely than men to have the symptoms of chest pain misdiagnosed by doctors as anxiety or stress, a study warned.
Researchers in Spain analyzed the treatment of 41,828 patients who were hospitalized with chest pain and compared the treatment they received.
Women were 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 who misjudged the circumstances, the team found, with women more likely than men to wait more than 12 hours before seeking help.
Meanwhile, a 2014 study found that women with heart attacks are also more likely to wait longer to be examined in hospitals than men.
One study warned that women who suffer from heart attacks are more prone than men to the misdiagnosed chest pain symptom of anxiety or stress.
“Our findings suggest a gender gap in the first assessment of chest pain, with the likelihood of heart attack being underestimated in women,” said author Gemma Martinez-Nadal of the Hospital Clinic in Barcelona, Spain.
The low suspicion of heart attack occurs in both women themselves and doctors, which leads to higher risks of late diagnosis and misdiagnosis.
In their study, Dr. Martinez-Nadal and colleagues studied the experiences of a total of 41,828 patients who were hospitalized in the emergency department of a hospital with chest pain between 2008 and 2019.
Of the patients, 42% were women, and the median 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 or not they were obese or had high blood pressure – and the initial diagnosis of the doctor treating the case.
“I had the first impression of the doctor if the chest pain had a coronary cause or another origin, such as anxiety or a musculoskeletal complaint,” explained Dr. Martinez-Nadal.
Such first impressions are recorded before examinations, such as blood tests, and are instead given on the basis of the patient’s clinical history, a physical examination and an electrocardiographic (ECG) measurement of cardiac activity.
The researchers found that women were more likely to go to the hospital more than 12 hours after the onset of chest pain – this occurred in 41% of women, compared to 37% 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 requires prompt 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 having a non-ischemic problem,” said Dr. Martinez-Nadal. Pictured, a patient with chest pain (stock image)
The team found that 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 a man.
Specifically, in 93% of cases where the ECG failed to provide a definitive diagnosis, doctors suspected acute coronary syndrome in 44.5% of men, but only in 39% of women.
Moreover, this trend has been maintained regardless of the number of risk factors for heart attack that patients have had or if they have chest pain that is usually indicative.
Acute coronary syndrome was initially misdiagnosed in 5% of women, but only in 8% of men.
“In 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 instill a greater suspicion of possible ischemia in patients with chest pain.”
But we noticed that women with risk factors were still less likely than men to be classified as “probable ischemia.”
“Heart attack has traditionally been considered a male disease and has been underestimated, underdiagnosed and undertreated in women, who may attribute symptoms to stress or anxiety,” concluded Dr. Martinez-Nadal.
Both women and men with chest pain should seek emergency medical help.
The complete results of the study are presented at the congress of the European Society of Cardiology for Acute CardioVascular 2021, which takes place practically between March 13-14, 2021.