Women are more likely than men to land back in the hospital after this

Women 55 and younger are more likely than men to end up back in the hospital in the year following a heart attack, according to a recent analysis. How women are medically evaluated and treated may be partially to blame, according to Hyannis cardiologist Peter Chiotellis, MD.

“Women are far less likely to get standard of care than men are,” he said. “I will definitely get more calls about men with chest pain for earlier follow-up than women.”

An article published in May 2023 in the Journal of the American College of Cardiology looked at the rate of rehospitalization in a year following a heart attack for women 18-55 in comparison to men in the same age group. Data was drawn from nearly 3,000 patients at 103 hospitals in the United States.

A heart attack, or myocardial infarction, occurs when blood flow is fully or partially blocked to part of the heart, causing muscle damage, according to the Centers for Disease Control and Prevention.

Researchers found almost twice as many women as men were hospitalized again after a heart attack for any reason, whether heart-related or not, according to the National Institutes of Health (NIH). The NIH’s National Health, Lung and Blood Institute funded the study. The leading reasons for rehospitalization for both men and women were complications related to blockages in the coronary arteries, which can cause heart attacks and angina (chest pain). Women suffered these complications 50 percent more often than men, and health issues, including diabetes and obesity, were cited as contributing factors.

Women were also more than twice as likely as men to be readmitted to a hospital for non-cardiac reasons. The article’s authors said they didn’t know the reasons for the difference. However, they noted more female than male patients in the study reported they were low-income and had experienced depression. The NIH said depression can follow a heart attack and undertreatment of the condition in women could have influenced their higher rate of rehospitalization.

More Awareness Needed

The NIH noted it was already known that women 55 and younger die in the hospital from heart attacks at approximately double the rate of men.

Coronary heart disease has been seen as “a middle-aged man’s disease,” Dr. Chiotellis said, adding that much prior research probably focused on men. Furthermore, women’s heart attack symptoms can differ from men’s, and are “atypical” – not fitting the male model, he said. While men may usually display the classic symptom of chest pain, women may complain of discomfort that’s not immediately apparent as resulting from the heart.

“A female is being treated for heartburn – then if you talk to her, the heartburn wasn’t food-related,” he said. “Women are often underdiagnosed.”

He urged more awareness of women’s heart attack symptoms. The American Heart Association says while chest pain or pressure forms the lead heart attack symptom for both sexes, women may instead display:

• Pain in jaw or back, stomach or arms.
• Nausea or vomiting.
• Shortness of breath.
• Lightheadedness.

Women Need to Advocate

Differences extend beyond symptoms. Women have smaller coronary arteries than men, Dr. Chiotellis said, and treadmill tests for heart function are less accurate in women.

“Women are more likely to die after a heart attack than men,” he said. “Maybe they’re less likely to get stented.”

They are also probably less likely to be referred to a cardiac rehab, he added.

Ironically, in many ways, women typically take better care of their health and are more willing to seek medical help than men, Dr. Chiotellis said. Men often put off care until they’re in crisis.

To improve matters, Dr. Chiotellis suggested that:

• Women need to advocate for their own healthcare.
• Doctors need to do a better job of evaluating women for heart attack symptoms and screening them for potential cardiac risk factors, including depression and anxiety.
• Researchers need to further probe the causes of disparity in outcomes between male and female heart attack patients.