ACS misdiagnosed more often in women vs. men
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Women experienced more frequent misdiagnoses of chest pain compared with men, according to a presentation at the virtual European Society of Cardiology Acute Cardiovascular Care Congress.
“Heart attack has traditionally been considered a male disease and has been understudied, underdiagnosed and undertreated in women, who may attribute symptoms to stress or anxiety,” Gemma Martinez-Nadal, MD, urgent care physician at Hospital Clinic of Barcelona, Spain, said in a press release. “Both women and men with chest pain should seek medical help urgently.”
In a retrospective study, researchers analyzed 41,828 patients with chest pain (42% women; median age, 65 years for women, 59 years for men) to compare final diagnostics and management as well as CV risk factors and clinical ECG features between the sexes. At first patient evaluation, researchers classified patients as STEMI, non-STEMI or nondiagnostic ECG; the latter was the initial classification for 93%.
The researchers found that women were more likely to present later to the hospital ( 12 hours from symptom onset) compared with men (41% vs. 37%; P < .001) and that among nondiagnostic ECG, ACS was less likely to be considered the cause of chest pain in women than in men (39% vs. 44.5%; P < .001). Among patients with ACS, 5% of women were initially misdiagnosed compared with 3% of men (P < .001). Multivariable analysis yielded female sex as an independent risk factor for an initial misdiagnosis of non-ACS.
“Our findings suggest a gender gap in the first evaluation of chest pain, with the likelihood of heart attack being underestimated in women,” Martinez-Nadal said in the release. “The low suspicion of heart attack occurs in both women themselves and in physicians, leading to higher risks of late diagnosis and misdiagnosis.”
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Martinez-Nadal G, et al. Abstract 20071. Presented at: ESC Acute Cardiovascular Care Congress; March 13-14, 2021 (virtual meeting).
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