‘Like someone took a hot poker and stabbed it through my heart’: Women left behind by medical research

When 49-year old Suzanne Boatto suffered a heart attack, her symptoms were not typical. She recalls experiencing dizziness, overwhelming brain fog, tremors and heart pain.

“It felt like someone took a hot poker and stabbed it right through my heart,” she said.

Victorian woman Suzanne Boatto, who was turned away from the emergency department after suffering a heart attack.Credit: Suzanne Boatto

Boatto said she arrived at the emergency department and was made to wait a total of 14 hours before being misdiagnosed with reflux and sent home from the hospital with no doctors’ examination and no pain relief.

A few days later, her symptoms had not subsided. She decided to visit a different hospital in the hope that she might receive a proper assessment.

There, she was immediately sent for an angiogram that found an almost complete blockage of her right artery. Her doctor informed her that a flight of steps could have put her into cardiac arrest.

“They found my entire right artery 99 per cent blocked and I’d had a heart attack. If they had dismissed me again I would be dead now,” Boatto, from rural Victoria, said.

She was told by a doctor that “none of your symptoms line up with a heart attack”.

A new study from Monash University has found that medical research across almost all sectors still does not sufficiently account for the roles of sex and gender in recognising, diagnosing and treating disease.

The gap in the diagnosis and treatment of men and women is most pronounced in cardiovascular diseases and heart attacks, with women twice as likely to die than men in the first six months after a heart attack, the research found.

The scoping review, commissioned by the Assistant Minister for Health and Aged Care, Ged Kearney, found that cardiovascular disease has “disproportionately adverse effects” on women. Women experience more “non-biological, environmental and socioeconomic” risk factors for cardiovascular disease, take longer to seek medical treatment for these diseases and are less likely to be treated in emergency departments for heart attacks, the research revealed.

According to the Victor Chang Institute, 10 Australian women die every day from a heart attack – but only one in three women will experience “typical” heart attack symptoms.

Cardiologist Jason Kovacic is leading the research into two diseases which primarily affect women

This means that women are less likely to recognise their own symptoms as a heart attack, and medical professionals are less likely to diagnose heart attacks in women as they can present with less common symptoms.

Professor Jason Kovacic, cardiologist and chief executive officer of the Victor Chang Cardiac Research Institute, co-authored a 2021 study which found that there were marked differences in the gene networks operating in the artery walls of males and females. Understanding how these operate is critical to identifying different symptoms of heart attacks in men and women.

“It showed us for the first time that there are really intrinsic differences between males and females,” Kovacic said. “There are long-entrenched biases and misunderstandings that heart attack is a disease of middle-aged men. And that misunderstanding is pervasive, not just across healthcare professionals, but across our society.”

Kovacic is leading the research into two diseases which primarily affect women – fibromuscular dysplasia (FMD) and spontaneous coronary artery dissection (SCAD).

The Monash review also found the conflation of sex and gender to be a consistent problem in medical research. Sex refers to someone’s biological status as male or female, determined by chromosomes, sex hormones and reproductive organs, while gender refers to the socially constructed behaviours, expressions, roles and identities of girls, women, boys, men and gender diverse people.

Of the reviewed 80 Australian medical guidelines, the terms “sex” and “gender” were defined to some extent in only four; 34 guidelines employed “gender” to mean “sex”; 12 did not mention sex or gender whatsoever; and 15 made no reference to clinical practice concerning sex, including the National Heart Foundation’s guidelines.

This is at odds with the reality that sex disparities and gender bias can influence how women are treated within the healthcare system and how they present with symptoms of illness and disease.

Professor Bronwyn Graham, director for the Centre for Sex and Gender Equity in Health and Medicine, is leading the charge to implement sex and gender considerations into Australian medical research.

“When you look at the curriculum in medical schools … sex and gender are not being taught as factors that influence health outcomes. So medicine is taught in a gender-neutral way,” she said.

Professor Bronwyn Graham, director of the Centre for Sex and Gender Equity in Health and Medicine.

“The evidence base for medicine is predominantly male, and neither of those two facts are taught simultaneously. Medical students are not being made aware of the fact that the evidence base is mostly male, but simultaneously, they’re being taught that, implicitly, the way that you treat people, the way that diseases manifest, and their trajectory over the lifespan is the same for males and females.”

The review also made clear the need for an intersectional approach for minority groups in medical research. This is a key issue for the National Women’s Health Advisory Council, which is chaired by Kearney.

“Population groups that exist at the intersection of already vulnerable minorities – particularly Indigenous women, migrant women and transgender women – must overcome unique barriers to access the same quality of healthcare that others take for granted,” Kearney said.

“If you talk to a woman of colour, for example, she is often treated so differently in the healthcare system. So we are looking at that discrimination and the need to account for intersectionality as a barrier for women accessing proper healthcare.”

Indigenous women are up to twice as likely as non-Indigenous women to have cardiovascular disease and to die from coronary heart disease. Only 12 of the 80 clinical guidelines reviewed made any considerations of intersectionality in healthcare.

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