New international recommendations look at how to best address heart attacks in premenopausal women.
The spotlight has been put on women’s heart attack care globally after a scientific statement from the American Heart Association (AHA) highlighted potential shortfalls in everyday practice.
Heart disease remains the second leading cause of death in Australia, with the AHA statement revealing that premenopausal women are slipping through the cracks of GP diagnosis.
According to the AHA, premenopausal woman face “significantly worse outcomes, including a higher likelihood of death or complications, compared to men of the same age”.
Often, women do not fit the traditional risk profile.
“Too many women are missing out on timely diagnosis and treatment for heart attacks because the system isn’t designed to properly recognise these patients,” director and CEO of the Victor Chang Cardiac Research Institute Professor Jason Kovacic said.
“We need urgent action to close these gaps.”
The AHA has outlined key priorities to address the gap including increased awareness of atypical presentation, higher representation of women in clinical trials, and more accurate diagnosis for premenopausal women.
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Current guidelines are reported to lack critical detail for women with particularly non‑atherosclerotic causes along with cases not driven by typical risk factors.
“When confronted with a woman having an acute coronary syndrome or heart attack, it’s really important that GPs or physicians are really actively thinking about what the other possibilities could be,” Professor Kovacic told The Medical Republic.
“These are not perhaps, conditions that a lot of GPs will be familiar with, certainly managing that a lot of these conditions do require specialist centres to work through them.
“There should be a low threshold for referring on to the appropriate specialist to manage these patients.”
Referral to specialists is the focus of Professor Kovacic’s contribution to the proposed guidance, with arguments for improvements in emergency pathways deemed critical to closing care gaps.
The AHA has also made calls for stronger follow-up care to address secondary risk factors in addition to issues linked to pregnancy.
Cardiac rehabilitation programs have been suggested to improve long-term health along with mental health support for those experience psychological issues after a heart attack.
“We need to be thinking about this, and these people that do suffer heart attacks need to be aware of that,” Professor Kovacic told TMR.
“It’s not just doctors and GPs, it’s all of our society, because the management of these patients actually starts in the community with the recognition.
“We’re part of the whole chain.
“But the whole chain isn’t actually working very well, because community recognition of these conditions and community appreciation that pre-menopausal women do get heart attacks isn’t very good, and that’s what we need to change.”
