Similar numbers of men and women report to the emergency room with chest pains, yet according to researchers, women are less likely to be diagnosed with a heart attack. The authors of a new study suggest that using different criteria for men and women in a diagnostic blood test could improve diagnosis rates.
The study, funded by the British Heart Foundation (BHF) and published in The BMJ, suggests testing in this manner could double the number of heart attack diagnoses in women.
Around the same number of women and men die from heart disease in the US each year. However, the Heart Foundation report that only 435,000 American women report having heart attacks annually – less than half the estimated total of heart attacks for the country.
Study author Dr. Anoop Shah states that the team wanted to find out why women are less likely to be diagnosed with a heart attack. “At the moment 1 in 10 women with chest pains will be diagnosed with a heart attack compared to 1 in 5 men,” he states.
Improving rates of diagnosis can reduce the risk of dying or experiencing future heart attacks. The researchers decided to use a different form of blood testing to diagnose heart attacks, with gender-specific diagnostic thresholds, and evaluate its efficacy.
A total of 1,126 of people (46% women) were admitted to the Royal Infirmary of Edinburgh, Scotland, suffering from chest pain. In heart attack diagnosis, blood tests are used to measure levels of troponin, a protein that is released by the heart during an attack.
Previous research has identified that troponin levels can be twice as high in men than in women. The study authors hypothesized that using a single diagnostic threshold for both men and women could be the reason for under-diagnosis of heart attacks among women.
To test the theory, two cardiologists independently assessed each patient. One cardiologist would test for heart attacks using the standard blood test while the other would use a more sensitive test with gender-specific diagnostic thresholds. The Abbott ARCHITECTSTAT High Sensitive Troponin-I (hsTnI) test can detect much lower levels of troponin than the widely-used standard test.
When using the standard blood test with a single diagnostic threshold, heart attacks were diagnosed in 19% of men and 11% of women. However, while the high-sensitivity blood tests yielded a similar number of diagnoses in men (21%), the number of heart attack diagnoses in women doubled to 22%.
In addition, the researchers observed that participants whose heart attacks were only diagnosed by the high-sensitivity test with gender-specific diagnostic thresholds were also at a higher risk of dying or having another heart attack in the following 12 months.
Having identified that gender-specific diagnostic thresholds can improve heart attack diagnosis, the BHF will be funding a clinical trial of over 26,000 patients to investigate whether this form of testing leads to improved clinical outcomes.
“If these results are confirmed in the much larger clinical trial we’re funding, these results suggest that using a high sensitivity troponin test, with a threshold specific to each gender, could save many more women’s lives by identifying them earlier to take steps to prevent them dying or having another, bigger heart attack,” says Prof. Peter Weissberg, medical director of the BHF.
“Our findings suggest that differences in outcome between men and women are only in part due to sex differences in the clinical presentation of coronary artery disease,” conclude the study authors. “We show that myocardial infarction is under-diagnosed in women and that this contributes to inequalities in the management and treatment of myocardial infarction.”
Recently, Medical News Today reported on a study showing that more than 10% of patients in the US receiving low-dose daily aspirin to prevent a heart attack are likely to have been prescribed aspirin inappropriately.