Doctor ‘bias’ behind women getting worse treatment for heart attacks, Australian study finds

·3-min read
<span>Photograph: Ivan Chiosea/Alamy</span>
Photograph: Ivan Chiosea/Alamy

Women receive worse medical treatment than men for common heart attacks, according to new research.

A study by Sydney researchers has found that women diagnosed with a common type of heart attack or the condition unstable angina received “less evidence-based treatment” than men, both immediately and in the long term.

The study analysed a registry of 7,783 patients from 43 Australian hospitals who had been diagnosed between 2009 and 2018 either with unstable angina or heart attacks known as non-ST elevation myocardial infarctions (non-STEMIs). Some 31% of these patients were female.

The lead researcher David Brieger, a physician and professor of cardiology at the University of Sydney, said the treatment for such conditions differed between men and women “every step of the way”.

Related: Women half as likely to get proper heart attack treatment in Australia

The study points to “physician biases” in medical care, he said. “Despite the way we think we’re practising, we are still innately conservative and under-treating women for whatever reason.

“I think we have to be aware of that and consciously address it.”

Non-STEMIs are serious but less damaging than another type of heart attack, STEMIs, for which Australian women are half as likely to receive proper hospital treatment, previous research has shown.

A recommended procedure for patients with non-STEMIs is an angiogram, an imaging technique that identifies blockages in the coronary arteries.

The study found a smaller proportion of women than men were given angiograms, and those who did tended to undergo them later.

“We’re not sure whether that reflects the fact that they presented to hospital later, or the decision to do the angiogram was delayed in some way,” Brieger said.

Women who have heart attacks can experience different symptoms to men – including nausea, sweating and generalised fatigue – and are far more likely to have their cardiac events misdiagnosed. But this study included only confirmed heart attacks, so misdiagnosis was not a likely factor for the differences in treatment.

There were also discrepancies in long-term medical care. “Once someone has come in with a coronary event they should all be discharged on evidence-based treatments,” Brieger said.

But the team found that women were less likely to be prescribed a number of standard therapies, including aspirin, anti-platelet drugs, statins and beta blockers.

Angiograms show that women tend to have less significant obstructions of their coronary arteries than men, Brieger said.

“That means that they’re less likely to require stents and require a bypass. But what we found is that that also drove a lower likelihood of receiving medical therapies.

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“To our surprise, even if they did have blockages, they still got less treatment.

“Even if we don’t identify tight blockages in the arteries, we still know that women that have these [heart attacks] are at an increased likelihood of having further events.

“Putting them on these medications will prevent these further events from happening.”

Women were also less likely to receive cardiac rehabilitation, “which is also very important in restoring them back to pre-event functional capacity and ensuring better longer-term outcomes”, Brieger said.

The study was published in the Medical Journal of Australia.

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