Women face a higher risk of heart failure, death after their first severe heart attack

Women are more likely to die or develop heart failure within five years after their first ST-segment elevation myocardial infarction (STEMI) than men, according to new findings published in Circulation.

The authors tracked data from more than 45,000 MI patients who received care in Alberta, Canada, from April 2002 to March 2016. More than 54% of those patients had a STEMI; the others had a non–ST-segment–elevation myocardial infarction (NSTEMI). Recurrent events were excluded from the team’s assessment.

More than 69% of patients included in the study were men. Women had a median age of 72 years old when experiencing their first STEMI or NSTEMI, and the median age for men was 61 years old. Women were also seen less regularly by a cardiovascular specialist (72.8% vs. 84%).

The unadjusted in-hospital mortality rates for women were 9.4% after a STEMI and 4.7% after a NSTEMI. For men, those rates were 4.5% after a STEMI and 2.9% after a NSTEMI. After making adjustments, the authors noted, the difference was still statistically significant for STEMI patients, but not for NSTEMI patients.

After a STEMI, women also had a higher risk of death both one year after hospital admission and after five years after admission. After a NSTEMI, the risk was similar between the two groups after one year and five years.

After adjustments, women also had a greater chance of developing in-hospital heart failure after a STEMI. After a NSTEMI, the risk was similar between the two groups. When it came to developing heart failure after discharge, however, women had a greater chance after both a STEMI and a NSTEMI. This was true after one year and five years.

“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,” lead author Justin A. Ezekowitz, MBBCh, MSc, a cardiologist at the University of Alberta in Edmonton, Alberta, Canada, said in a prepared statement. “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 the same statement, co-author Padma Kaul, PhD, chair of sex and gender science at the Canadian Institutes of Health Research, spoke about the importance of learning from these findings and working to improve care for women through interventions.

“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.”

The full analysis can be read here.