A wide body of research shows that cardiovascular disease presents differently in women and men — so why are so many women still being misdiagnosed?
When Rhonda Munroe, then 36, called an ambulance with heart pain, sweats and numb, tingling arms, paramedics confirmed by electrocardiogram (EKG) that she was having a heart attack.
But she arrived in the emergency room to be told her heart wasn’t in fact failing at all — and was discharged.
Rhonda’s experience highlights a challenge reflected across Asia-Pacific and the world: cardiovascular disease (CVD) and heart failure (HF) present differently in men and women, but women are significantly underrepresented in the majority of cardiovascular research studies globally(1).
The participation to prevalence ratio for women in most CV trials is consistently under 0.8 — and the resulting lack of awareness of differing symptoms means CVD is consistently underrecognised and underdiagnosed in women(1).
Delayed or missed diagnoses can be fatal
CVD is the leading cause of death for both men and women in the Asia-Pacific region, causing over 10 million deaths (or approximately 35% of total deaths) in 2019(2). Almost all aspects of heart failure are, however, influenced by sex — from epidemiology and risk factors, to presenting symptoms, to treatment response and outcomes.
Of nine APAC economies examined by the Asia-Pacific Cardiovascular Disease Alliance, atrial fibrillation (AF), a heart condition, presents more commonly in women than men in seven of them. Deaths related to AF are higher in females in all nine economies(3).
After Rhonda returned home from the hospital, her symptoms persisted. She sought treatment again and again, at the hospital, and with a general practitioner too. Each time, her symptoms were dismissed.
Eventually — seven days after her ER admission — Rhonda was finally seen by a cardiologist. The doctor confirmed what she already knew: she had been having a heart attack for a week.
Emergency quadruple bypass surgery wasn’t successful, resulting in more surgery and repeated strokes.
She pulled through the surgery, but even after treatment, Rhonda wasn’t made aware that she was still at high risk of heart failure from the damage caused by her misdiagnosis.
Nine months later, her heart stopped pumping.(4)
Gold-standard cardiac biomarkers prevent premature deaths
How can we make sure that women across our region don’t have to experience Rhonda’s terrifying ordeal? Early detection is vital. Acute myocardial injury (MI) requires urgent hospitalisation and rapid access to specialised treatment. Delays to therapy are strongly associated with increased mortality.
And with new generations of cardiac biomarkers like hs-troponin, a protein released by damaged heart muscle, clinicians have the insight they need to make the right decision sooner at all stages of HF.
HF is often perceived as the end stage of cardiovascular care, but it encompasses a broad spectrum, including patients with mild or moderate symptoms.
The most sensitive cardiac biomarkers can play a crucial role in providing evidence to guide patient conversations, helping to motivate patients, encouraging engagement with their physicians and allowing the clinician to demonstrate the efficacy of medications and the associated risk reductions(5).
And in acute care settings, gold-standard cardiac biomarkers like hs-troponin can ensure women like Rhonda aren’t misdiagnosed. By broadening their application to include chronic or follow-up care stages, we can maximise their potential in clinical practice to improve patient outcomes and quality of care.
It’s time to standardise Asia-Pacific care pathways
This requires a standardised care pathway, leveraging next-generation cardiac biomarkers for early diagnosis alongside patient education and diverse patient representation in clinical research.
We therefore call on policymakers, health leaders and clinicians to work together to standardise care pathways for chest pain and CVD across the Asia-Pacific region, reducing the risk of misdiagnoses, improving management of disease and ultimately, reducing premature deaths.
Rhonda, meanwhile, miraculously made a full recovery. Now, she’s a passionate patient advocate and expert in CVD diagnostics, empowering women around the world to speak up when they know something is wrong. Her health has been stable for a decade.
If clinicians had followed a standardised, biomarker-led care pathway, though, perhaps she wouldn’t have been in and out of the ER at all.
If Rhonda’s story resonates with you, there’s a way you can help to make sure fewer women with CVD are misdiagnosed in future: spread the word. Please like, share or repost this article. Thank you.
