Scientists have announced a “revolution” in how women suffering heart attacks are treated after being ignored for decades. Heart attacks which mainly affect women have been upgraded in global rules to stop millions being missed by healthcare systems like the NHS.
“Primary” heart attacks given priority will now also include types often triggered by emotional stress, exercise and childbirth. The world’s biggest heart conference being held in Munich announced the biggest overhaul to how heart attacks are defined and diagnosed in more than 20 years. It heard how there has been an “unconscious bias” among medics who assume heart attacks are a man’s problem.
Deadly NHS delays for women
Tens of thousands of women face deadly NHS delays every year due to having their heart attack initially misdiagnosed. Research shows women are 50% more likely to receive an incorrect initial diagnosis.
Professor Nicholas Mills, a cardiologist from Edinburgh University who led the international taskforce of clinicians who devised the new guidelines, told the Mirror: “It is a revolution and it's going to make care better for patients.”
Coronary heart disease - the main cause of heart attacks - kills twice as many women as breast cancer in Britain and it is the single biggest killer of women worldwide. Some 33,000 women are admitted to hospital with a heart attack every year in the UK - one woman every 16 minutes.
What is the change?
Traditionally medics considered a more serious heart attack to be caused by a clot blocking blood flow to the organ. The types of heart attacks more likely to be experienced by women were considered “type 2” heart attacks. These were traditionally when the heart is not pumping enough blood for the body often due to another illness like anaemia or sepsis.
Prioritised heart attacks - previously categorised as type 1 - were typically caused by a sudden blood clot forming inside a coronary artery near or on the heart. The three newly upgraded primary heart attacks which are up to 10 times more common in women are:
- Coronary artery spasm – tightening of a heart artery which can deprive the heart muscle of blood and oxygen and cause a heart attack. It can be caused by emotional stress, exercise or extreme cold.
- Heart attack caused by a tear in the coronary artery - called a spontaneous coronary artery dissection (SCAD). Four out of five such heart attacks happen to women and often occur during or soon after pregnancy.
- Coronary embolism - where a blood clot or fatty deposit travels to a coronary artery and causes a blockage.
There are about 1,500 cases of SCAD per year, while the other two are not officially tracked. Professor Mills said: “Many would argue that these heart attacks, which mainly affect women, have been deprioritised in the past. We need to tell them with greater confidence that they have had a heart attack and what's caused it… right now, we don't do it well.”
Why it matters for patients
Experts said that until now women have been put on drugs for life that in many cases did not work and in some cases, made them worse. Currently women who have a heart attack caused by a coronary artery spasm may be prescribed beta blockers when they should really be getting vasodilator tablets. A coronary embolism may be treated with a statin when they should get a strong blood thinner while women who had a SCAD heart attack could get a statin or blood-thinner, when it would instead be better to manage their blood pressure.
Prof Mills added: “If you have a tear in the lining of your artery then you're not going to benefit from lifelong statin treatment. You're not going to benefit from being on two different blood thinners. In fact, it may be harmful and these treatments are recommended for life.”
Professor Bryan Williams, Chief Scientific Officer at the British Heart Foundation, said: “This is a landmark moment – a radical shift in how we define and diagnose heart attacks worldwide which will transform people’s care. For decades, women have missed out on accurate diagnoses and treatment.”
Professor Williams added: “This could be life changing for huge numbers of women in the UK and worldwide. The first worldwide definition of heart attacks was created almost 20 years ago. One person every five minutes in the UK is admitted to hospital following a heart attack, and it is vital for every one of those people that we get their care right.”
Dr Roy Jogiya, chief medical advisor at Heart Research UK, said: “For too long, heart disease has been thought of as a man’s problem. Women’s heart health should never be an afterthought.”
The change announced at the European Society of Cardiology Congress in Munich had to be agreed with the American College of Cardiology, the American Heart Association and the World Heart Federation. The guidance will mean women are more likely to see their heart attacks confirmed and treated straight away, rather than face weeks of delay. They should be fast tracked for an echocardiogram, an ultrasound scan of the heart, or an angiogram, which is an X-ray test that uses a special dye to provide a detailed picture of blood flow.
NHS England said the new international guidance was a “really welcome step and will help ensure we are spotting and treating heart attacks in women as quickly as possible.” Dr Rani Khatib, its National Specialty Advisor for Cardiovascular Disease Prevention, said: “Your sex should never be a barrier to accessing healthcare and it’s fantastic that research has been dedicated to ensuring tests and treatment reflect women’s specific needs. If you think you or a loved one might be having a heart attack, please call 999 immediately – the NHS is here for you 24 hours a day, seven days a week.”
The new global guidance is also published in the European Heart Journal.
