Cardiovascular diseases: women still less well taken care of

To carry out their work, the researchers started from a cohort of Danish patients who had had the same pathology. As Dr Sarah Holle, from Copenhagen University Hospital in Denmark, who led the work, explains: “The women and men in our study had similar clinical characteristics when they developed cardiogenic shock after a heart attack.“.

Cardiogenic shock, a complication of infarction

Cardiogenic shock is usually caused by a heart attack. It plunges the patient’s heart into a critical situation during which it can no longer pump blood to supply the body and organs with oxygen. Unfortunately, cardiogenic shock can affect 10% of people who have had a heart attack and only half will survive.

Making different medical decisions between men and women

The aim of this study was to be able to examine the differences in treatment and survival between women and men who suffered a heart attack and subsequent cardiogenic shock. For this, the researchers studied the data of 1,716 patients who suffered a heart attack and presented with cardiogenic shock between 2010 and 2017. Of these patients, 438 (26% of the total) were women, whose average age was 71, compared to 66 for men.

The findings of the study are surprising. Although the same constants are monitored in these patients (such as heart rate, blood pressure or ventricular ejection fraction, etc.), women were treated differently from men.

Fewer examinations performed on patients

For example, only 19% of women versus 26% of men received mechanical circulatory support. For minimally invasive or surgical procedures to restore blood flow in blocked arteries, there are 83% of women against 88% of men and for mechanical ventilation only 67% of women against 82% of men.

Women were significantly less likely than men to survive both short and long term. And 30 days after the cardiac event, only 38% of women were alive compared to 50% of men. And eight and a half years after this event, only 27% of women were still alive compared to 39% of men.

Greater patient awareness among healthcare professionals is needed

According to Dr. Holle, “this was a retrospective study, so it is unclear why clinicians made certain treatment decisions. But the results indicate that greater awareness among healthcare professionals that women have heart attacks and can develop cardiogenic shock could be a step towards equitable management and outcomes.”.

She also pleads for a “increased awareness among healthcare professionals that women have had heart attacks and can develop cardiogenic shock“.

Poorer knowledge of symptoms in women

According to Dr. Holle, there are also “growing evidence that women with acute heart problems are more likely than men to experience non-specific symptoms such as shortness of breath, nausea, vomiting, coughing, fatigue and back pain, jaw or neck“. This may be one of the reasons why more women than men were initially admitted to a local hospital, rather than to a specialized hospital, suggests the researcher.

“Better recognition that women may have symptoms other than chest pain could minimize delays in diagnosis and treatment and potentially improve prognosis.”. And to conclude:Treatment guidelines are based on studies that primarily recruited men. Further research is needed to determine whether women and men in cardiogenic shock might benefit from different interventions.”.