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After a heart attack, women are more likely to die than men and the main reason may be that they aren’t getting the same care.
The differing death stats have been known for a while. Researchers looking at survivors of a first heart attack determined that within a year, 47 percent of women had died, compared to 36 percent of men. That’s a pretty big difference.
It wasn’t clear why men did so much better. But a recent study may hold the key: Researchers found that when women received the same therapies as men, including cardiac rehab, their odds of survival were the same.
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That suggests there’s an underlying bias in the medical system — and society at large — that women need to confront and overcome, said Dr. Jennifer Haythe, an assistant professor of medicine and co-director of the Women’s Center for Cardiovascular Health at the Columbia University Medical Center.
Women minimize pain
As evidence, she points to a 2016 study of 50,000 older Americans: Compared with men, women were less likely to receive potentially beneficial medication such as aspirin and cholesterol-lowering medications, or to receive advice about quitting smoking.
“Women who’ve had heart attacks aren’t being treated the same way as men,” Haythe said. “They’re not getting the same interventions and they’re not being prescribed cardiac rehab or follow-up. So it’s not surprising that they’re dying more frequently.”
Perhaps this shouldn’t be a surprise, Haythe said. “It’s just like so many other aspects of life where women are not considered the same way as men,” she adds. “In this case, it’s the fault of society, but also the medical community.”
Part of the problem may lie in the way women communicate, said Dr. Katie Berlacher, director of the women’s heart program at the University of Pittsburgh Medical Center.
Typically, women downplay what they’re feeling, or come up with other things that might be less serious. Men have the reputation for being the more stoic ones, but women often minimize what they’re experiencing, Berlacher said. “I might ask if a patient has chest pain, and often if it’s a woman, she’ll say, ‘Oh no, it’s not pain, just a tightness.’"
If you think you're having a heart attack
Make sure you’re clear about your fear.
“You might say, ‘I’m worried about my heart,’ or ‘Can we check my heart?’" Berlacher said. “Make simple, brief statements.”
No one has yet studied why doctors aren’t giving women the same treatments as men. The fact that they’re not means women need to advocate for themselves, Haythe says. They need to ask the right questions and make sure they’re getting appropriate treatments.
Haythe suggests four important questions for women who think they might be having a heart attack:
1. Am I having a heart attack?
Check with your doctor to see if an EKG was done and if labs have been drawn to see if there are markers of a heart attack, Haythe suggests.
2. What medicines are you using to treat my heart attack?
"It's important to be informed," Haythe says. "Ask your doctor what medicines they are giving you and why. And if the therapy meets national guidelines."
3. Do I need a procedure or a stress test?
"If the doctors think you may be having a heart attack, ask if they plan to do a catheterization or an angiogram and if not, why not. There are times when an angiogram is not indicated," she said.
4. Should I be getting cardiac rehab?
"If you've been diagnosed with a heart attack and are getting ready to leave the hospital, ask if you will be prescribed cardiac rehab and if not, why not," Haythe said. "You should also ask what medicines you've been prescribed and why."
Haythe would like women to start talking to their friends about heart disease — before they have a heart attack. “I’d like women to at least start having the conversation,” she says.