Females who suffer from STEMI heart attacks more likely to miss out on specialist treatment, research shows

A STARK difference in treatment for women who suffer a serious type of heart attack revealed by Adelaide researchers has left experts “perplexed”.

A STARK difference in treatment for women who suffer a serious type of heart attack revealed by Adelaide researchers has left experts “perplexed”.

The bottom line is a “significantly higher” mortality rate for women six months after discharge.

The study of victims of ST-elevated myocardial infarction (STEMI) found women are less likely to receive invasive management, revascularisation or preventive medicine at discharge than men.

Research published today in the Medical Journal of Australia analysed data collected from 41 Australian hospitals between February 2009 and May 2016.

This covered 2898 patients admitted with STEMI — 2183 men, 715 women.

Researchers led by Dr Ehsan Khan from Flinders Medical Centre found significant differences in the way women were treated than men, leading to higher rates of death for women after discharge, even after using an internationally recognised formula which takes into account eight risk factors such as age and blood pressure.

Of the patients who survived, the study found a 2.2 per cent mortality rate for men six months after discharge compared 6.3 per cent for women.

“Despite broader awareness of STEMI protocols, revascularisation rates for women with STEMI are lower than for men,” Dr Khan and colleagues wrote.

“In hospital, rates of major adverse cardiovascular events and mortality were similar, but at six months after discharge they were significantly higher for women.

“Women were less frequently referred for cardiac rehabilitation or prescribed preventive medications on discharge.”

Reasons for the persisting differences in the investigation and management of men and women with STEMI in Australian hospitals was “perplexing”, the authors wrote.

“We found that women with STEMI … received less comprehensive assessment and treatment,” they wrote.

“Current guidelines support invasive management of patients at high risk, while acknowledging that this increases the risk of complications. Undertreatment of patients with a high-risk score has been a consistent feature of acute coronary syndrome management in studies.

“Undertreatment in the population we examined might be caused by poor awareness that women with STEMI are generally at higher risk, or by a preference for subjectively determining risk rather than applying more reliable, objective risk-prediction tools.

“Treatment protocols for patients with STEMI have improved in Australia, and we found that overall rates of total revascularisation have increased since 2010.

“Nevertheless, sex differences persist. More detailed qualitative evaluation of the reasons for these differences is needed to understand whether variances in management are justified.”