Women are more likely to face delays in the diagnosis of heart disease and – as a result – are more likely to die, according to one of the largest reports of its kind.
Cardiovascular disease is the leading cause of death in women, accounting for around a third of deaths globally.
Yet it remains underdiagnosed, undertreated and under-researched in female patients, say experts.
A team of international scientists led by the European Society of Cardiology are now calling for dedicated women’s heart centres across Europe to address the inequality.
‘Heart disease kills more women than any other condition – three in ten women globally – yet it remains critically underdiagnosed and undertreated,’ said Dr Julia Grapsa, the report’s lead author.
‘Women’s symptoms are missed, they are less likely to receive guideline-recommended treatments and they are underrepresent in clinical trials that shape practice.
‘Women also face unique heart disease triggers that men do not, including pregnancy complications, early menopause and autoimmune disease, which are routinely overlooked in standard risk assessments,’ she added.
‘Closing these gaps is not just a matter of equity but a matter of appropriateness of care.’
Cardiovascular disease is the leading cause of death in women, accounting for around a third of deaths globally
The report – published in the European Heart Journal – highlights the positive impact existing centres across North America, Switzerland, Germany and the UK are already having.
A study of more than 1,300 high-risk women in the US found a six-month programme combining heart health advice with clinical guidelines set by the American Heart Association – on blood pressure, diet and exercise – helped reduce their risk of suffering a major heart event.
Another women’s heart centre in Canada has been able to pinpoint a diagnosis in more than 70 per cent of women with previously unexplained heart symptoms.
Just a year after assessment, patients being treated at the centre experienced reduced chest pain and improved quality of life, the report details.
Three years on, the same centre confirmed sustained health benefits for patients, including a better understanding of their condition, fewer hospital visits and better self-reported well-being.
The team said these women-centred hubs should act within existing cardiovascular care facilities, providing advanced diagnostics, expert consultation and education.
Most women will continue to receive support, treatment and monitoring from their GP and at general cardiology clinics, they said.
But women should be referred to women’s heart centres if, for example, they suffer with heart attacks, chest pain or reduced blood flow to the heart where traditional scans cannot identify a major cause.
These centres would also look after pregnant women with cardiovascular complications like preeclampsia – a condition that causes high blood pressure, the biggest single risk factor for stroke – as well as heart conditions linked to menopause.
Both pregnancy and menopause are unique risk factors for women’s cardiovascular health, research shows.
A major 2023 study found that women who suffer complications during pregnancy – including pre-eclampsia, premature birth and gestational diabetes – are more likely to develop heart disease up to five decades after giving birth.
And while younger women are less at risk of heart attacks than men, after menopause, women’s risk of heart attacks and heart disease rises five-fold.
Post-menopausal women under stress are also more likely to develop an irregular heartbeat, or atrial fibrillation (AF), increasing their risk of heart attacks and stroke, according to research in the Journal of the American Heart Association last year.
Symptoms include breathlessness and palpitations, but some have no signs at all.
The proposed heart health centres do not negate the need for a better understanding of women’s heart health among cardiologists, the study’s authors warned.
‘This clinical consensus statement by the European Society of Cardiology is an important step forward in women’s health,’ Dr Martha Gulati, director of the Davis Women’s Heart Center at Houston Methodist and study co-author said.
‘It provides a comprehensive, practical framework for how women’s heart centres can be created in different European healthcare systems, as well as detailing how patients should be referred for treatment and what training we need to provide for doctors in this area.
‘We still need much more research on the best ways to diagnose and treat cardiovascular disease in women, but these centres will ensure that this type of research can flourish.
Previous research has shown that women are more likely to downplay their symptoms and delay seeking treatment when experiencing a heart attack.
And a 2022 study found that they were also made to wait an average of 11 minutes longer to see a doctor or nurse than men with similar symptoms when attending A&E.
In the UK, a woman is admitted to hospital due to a heart attack every 16 minutes, according to the British Heart Foundation, highlighting the urgent need for better care.
