Heart disease is the leading cause of death among men and women. But studies have long shown that women are more likely than men to dismiss the warning signs of a heart attack, sometimes waiting hours or longer to call for emergency help or go to a hospital.

Now researchers are trying to figure out why. They have found that women often hesitate to get help because they tend to have more subtle heart attack symptoms than men — but even when they do go to the hospital, healthcare providers are more likely to downplay their symptoms or delay treating them. Health authorities say that heart disease in women remains widely underdiagnosed and undertreated, and that these factors contribute to heightened rates of death among women.

Most studies suggest that a major reason women delay seeking care — and are often misdiagnosed — is because of the symptoms they develop. While chest pain or discomfort is the most common sign of a heart attack in both sexes, women who have heart attacks are far less likely than men to have any chest pain. Instead, they often have symptoms that can be harder to associate with cardiac trouble such as shortness of breath, cold sweats, malaise, fatigue and jaw and back pain. A report by the American Heart Association found that heart attacks are deadlier in women who do not exhibit chest pain, in part because it means both patients and doctors take longer to identify the problem.

But when women suspect they are having a heart attack, they still have a harder time getting treated than men do. Studies show they are more likely to be told that their symptoms are not cardiovascular-related. Many women are told by doctors that their symptoms are all in their head. One study found that women complaining of symptoms consistent with heart disease — including chest pain — were twice as likely to be diagnosed with a mental illness compared to men with identical symptoms.

Women face longer waits

In a study published in the Journal of the American Heart Association, researchers analysed data on millions of emergency room visits before the pandemic and found that women — especially women of colour — who complained of chest pain had to wait an average of 11 minutes longer to see a doctor than men who complained of similar symptoms. Women were less likely to be admitted to the hospital, they received less thorough evaluations and they were less likely to be administered tests like an electrocardiogram, or EKG, which can detect cardiac problems.

Dr Alexandra Lansky, a cardiologist at Yale-New Haven Hospital, US, recalled one patient who had gone to multiple doctors complaining of jaw pain, only to be referred to a dentist, who extracted two molars. When the pain didn’t go away, the woman went to see Dr Lansky, who discovered the problem was heart-related. “She ended up having bypass surgery because the jaw pain was heart disease,” said Dr Lansky, who directs the Yale Cardiovascular Research Center.

A group of scientists delved into the factors that drive women to delay seeking care for cardiac troubles. They found that the absence of chest pain or discomfort was a major reason. The study, published in Therapeutics and Clinical Risk Management, looked at 218 men and women who were treated for heart attacks before the pandemic. It found that 62 per cent of the women did not have any chest pain or discomfort, compared with 36 per cent of the men. Many women reported shortness of breath as well as gastrointestinal symptoms like nausea and indigestion. About one-quarter of the men also reported having either shortness of breath or gastrointestinal distress.

Younger women affected

“There’s a lack of understanding in both women and men that a heart attack does not have to cause chest pain or these incredible movie-like symptoms,” said Dr Jacqueline Tamis-Holland, a cardiologist at Mount Sinai Morningside in New York, US. Dr Tamis-Holland said there were other reasons for the delays. One is that women don’t consider themselves to be as vulnerable to heart disease as men. Previous studies have shown that they are more likely to dismiss their symptoms as stress or anxiety. They also tend to develop heart disease at later ages than men. In Dr Tamis-Holland’s study, the women who had heart attacks were, on average, 69 years old, while the average age of the men was 61.

But younger women are not immune to heart disease. Recent studies have found that heart attacks have been rising among women between 35 and 54, in part because of an increase in cardiometabolic risk factors like high blood pressure and obesity.

Experts say that more outreach and education is needed to help women and men recognise the signs of heart disease. Dr Lansky said, “If you’re not feeling right and you think that in the realm of possibilities is an issue with your heart, then you should spell it out,” she said. “Say: ‘I am concerned I may be having a heart attack, and I want an EKG just to be sure.’ Nobody in the emergency department is going to say you can’t have it. But sometimes they’re just not thinking about it, so it’s good to flag it.”

NYTNS