Studies show that women with heart disease are more likely to be misdiagnosed than men, and will have worse outcomes for surgery. What is behind this bias and how can how it be fixed?

Heart diseases are still chronically misdiagnosed or underdiagnosed in women. With depressing regularity, we see stories of women failed by the health system when they come to hospitals with the symptoms of a heart attack. As a professor of cardiac science with 40 years’ experience, for me it has been a frustrating journey to get to the real cause of this problem: a combination of professional, systemic and technical biases. The experiences of individual patients are complex to analyse and interpret, but now we can view these effects on a much bigger scale.

Women are 50% more likely to receive a wrong initial diagnosis; when they are having a heart attack, such mistakes can be fatal. People who are initially misdiagnosed have a 70% higher risk of dying. The latest studies have similarly shown that women have worse outcomes for heart operations such as valve replacements and peripheral revascularisation. As well as being misdiagnosed, women are less likely to be treated quickly, less likely to get the best surgical treatment and less likely to be discharged with the optimum set of drugs. None of this is excusable, but is it understandable?

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