New approaches aim to reduce delays in diagnosing heart attacks in women

Women experiencing heart attacks can face potentially dangerous delays in diagnosis and treatment, prompting growing calls for healthcare systems to adopt diagnostic approaches that better account for differences between women and men.

For decades, much of cardiovascular research and many diagnostic standards were developed using evidence drawn predominantly from male patients. Researchers and clinicians are increasingly recognizing that this can affect how quickly cardiovascular disease is identified in women.

Heart & Stroke reports that approximately two-thirds of heart disease and stroke clinical research has focused on men, while half of women who experience a heart attack have their symptoms go unrecognized.

One important issue involves how women experience and describe symptoms.

Although chest pain or discomfort remains an important warning sign, women may also experience shortness of breath, unusual fatigue, nausea or indigestion, and pain in the back or neck. Women are also more likely to experience disease involving the heart’s smaller blood vessels, which can make some traditional diagnostic approaches less effective.

Canadian cardiovascular experts have identified disparities within emergency departments as a particular concern.

The Canadian Women’s Heart Health Alliance has reported that women experiencing ST-elevation myocardial infarction can encounter longer delays from arrival at hospital to receiving an electrocardiogram and subsequent treatment.

The Alliance recommends greater use of sex-specific diagnostic protocols, including sex-specific thresholds for high-sensitivity troponin testing in patients presenting with acute chest-pain symptoms. It also recommends incorporating differences in symptoms and female-specific cardiovascular risk factors into clinical assessment.

Troponin is released into the bloodstream when heart muscle is damaged and is commonly measured when clinicians suspect a heart attack. Using diagnostic thresholds that better account for biological differences between women and men may help identify cases that could otherwise be missed or recognized later.

The issue extends beyond laboratory testing.

Experts have called for greater education of healthcare professionals about cardiovascular disease in women, more representation of women in clinical trials and increased incorporation of sex and gender into cardiovascular guidelines and medical education.

Awareness among patients is also important. Symptoms such as fatigue, nausea, dizziness, sweating and shortness of breath can sometimes be attributed to other causes, potentially delaying emergency care.

Heart disease remains a major health burden in Canada. Statistics Canada reports that heart disease was the country’s second-leading cause of death in 2023, accounting for 57,890 deaths.

Efforts to close the cardiovascular gender gap increasingly focus on a combination of better research, clinician education, diagnostic protocols and greater public awareness.

For hospitals and emergency departments, the objective is straightforward: recognize cardiovascular disease in women sooner so appropriate treatment can begin sooner.

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