Women Have Higher Rate of Heart Failure, Mortality After Heart Attacks Than Men

Women face a 20% increased risk of developing heart failure or dying within five years after their first severe heart attack compared with men, according to a new study.

Other studies have looked at gender differences among people who have had heart attacks, but this study zeroed in on whether women and men have different rates heart failure.

The researchers, Justin A. Ezekowitz and his colleagues at the University of Alberta, say their finding that women are more likely to develop heart failure after a heart attack mean patients, and especially women, should be monitored for signs and symptoms of heart failure after a heart attack. If possible, they say, people should get care that prevents heart failure or keeps mild cases from getting worse.

The study was publlshed in the journal Circulation,

Alberta, Canada

Ezekowitz and his colleagues had a large database to work with: some 45,000 patients, hospitalized for a first heart attack between 2002 and 2016 in Alberta, Canada. Just over 30% of them were women. One cut of their analysis separated patients into those who had severe, life-threatening ST-segment elevation myocardial infarction (STEMI) heart attacks and those who had less severe non-STEMI, or NSTEMI, heart attacks

Women had a higher unadjusted rate of in-hospital mortality than did men in both patients with STEMI (women, 9.4%, vs men, 4.5%) and patients with NSTEMI (women, 4.7%, vs men, 2.9%) heart attacks. But after various statistical adjustments, the gender mortality difference "disappeared" for NSTEMI heart attacks but not for the more severe STEMI ones.

After discharge, women more commonly developed heart failure after STEMI events (women, 22.5% vs men, 14.9%) as well as after NSTEMI heart attacks (women, 23.2% vs men, 15.7%).

Women were more likely to be an average of 10 years older than men at the time of their heart attack, at an average age of 72 years old versus 61 years old for men. They also had more complicated medical histories, including high blood pressure, diabetes, atrial fibrillation and chronic obstructive pulmonary disease—risk factors that may contribute to heart failure, according to a press release about the study.

Notably, women were seen less frequently in the hospital by a cardiovascular specialist (72.8% vs 84% for men). In addition, fewer women were prescribed medications such as beta-blockers or cholesterol-lowering drugs.

Women also had slightly lower rates of revascularization procedures to restore blood flow, such as surgical angioplasty, the researchers found.

Justin Ezekowitz

“Identifying when and how women may be at higher risk for heart failure after a heart attack can help providers develop more effective approaches for prevention,” Ezekowitz, a cardiologist and co-director of the Canadian VIGOUR Centre at the University of Alberta, said in the press release about the study. “Better adherence to reducing cholesterol, controlling high blood pressure, getting more exercise, eating a healthy diet and stopping smoking, combined with recognition of these problems earlier in life would save thousands of lives of women—and men.”

In addition to the elevated risk for heart failure among women, researchers found that 65.7% of men had NSTEMI heart attacks, while 34.3% of women experienced them.

More men (73.5%) also experienced the more severe STEMI heart attacks, while only 26.5% of women had them.

Padma Kaul

The next step is to further examine if all patients — particularly women — are receiving the best care and where interventions can address oversights, the study’s co-author, Padma Kaul, Ph.D., co-director of the Canadian VIGOUR Centre, said in the press release.

“There are gaps across diagnosis, access, quality of care and follow-up for all patients, so we need to be vigilant, pay attention to our own biases and to those most vulnerable to ensure that we have done everything possible in providing the best treatment,” Kaul said.