The omen is not worse than health care for men after a heart attack, causing unnecessary deaths, according to a new analysis of 180,368 Swedish patients followed up 10 years after a heart attack. When women get the best treatment (surgery or stents, aspirin and statins), they are as good as men. The British Heart Foundation said the situation may be even more pronounced in the UK.
Is this a clear gender difference because women ignore their symptoms? Get different symptoms – more easily confused with indigestion? General practitioners do not pay attention? Chest pain, the possibility of a heart attack is less? ECG is not likely to be carried out? In the hospital to accept different treatment? And is unlikely to provide implantable devices to prevent late death?
The likely answer to all these questions is yes. There’s a subconscious bias at work, which means I’m more likely to think of “heart disease” if I see a bitter or chest discomfort in an overweight middle-aged male smoker during my GP surgery. If She is a woman who thinks “acid reflux.” Historically, this may be statistically understandable, but it is an unreasonable bias that the general public now needs to be identified and countered by proper referral.
Even the most objective general practitioner will respond to what the patient is saying. So neither men nor women do anything because they neglect symptoms or implicate themselves in indigestion or muscle ache. In my experience, women are more likely to blame themselves than men, “I’ve made myself Christmas and I gain weight, so I may need to decompress, and the pressure on my chest will disappear.” A woman recently told me, but the electrocardiogram showed The heart is tense and triggers an emergency assessment in a fast-track chest pain clinic to prevent a heart attack.
I have always believed that although women are less likely to develop symptoms and are properly referred by general practitioners, she will be treated like a man once she arrives at the hospital. But the study shows that even if a heart attack is confirmed, the woman is less likely than men to get the recommended treatment. This is not in line with my clinical impression; the same medication was given to the female patient discharged after our female heart attack, and our male patient underwent the same surgery (stent or surgery) if needed.
Clinical guidelines are based on objective criteria and gender is not one of them. This requires further inquiries on the British database to verify that this equally clear and damaging discrimination has taken place elsewhere. It is also useful to hear what the Swedish cardiologists and their health departments are saying about what lies behind this horrible story.
On the other hand, as we continue to live longer than ever before, the prevalence of circulatory diseases (heart disease and stroke) continues to decline. In the United Kingdom, most of us die of cancer, circulatory diseases, or dementia. Declining smoking rates, lifestyle changes and medical advances all made heart attacks even worse than we imagined in the 1970s, when my dad died at the age of 48 at the third heart attack.
But the tragedy is that there are still 42,000 people in the UK who die prematurely from heart disease each year and can now be avoided. Both men and women need to recognize these signs, seek medical help, and demand timely and optimal care. And like in many places, women may need to shout aloud to hear it.