Women likelier than men to die of heart failure
Doctors, women need to be more aware of differences found in five-year study
Women with heart failure in Ontario are more likely to be hospitalized and die than men, according to a five-year study pointing to the need for more research. “There’s something that we’re doing right in men that we’re not doing right in women, so that’s why we really need to raise awareness of this,” said Dr. Louise Sun, one of the principal investigators of the study published in the Canadian Medical Association Journal. Sun, a cardiac anesthesiologist and a clinical epidemiologist, and cardiologist Dr. Lisa Mielniczuk at the University of Ottawa Heart Institute, studied records of more than 90,000 patients diagnosed with heart failure in Ontario, including patients from Windsor. The study followed people who were newly diagnosed with heart failure over five years from 2009 to 2013. Within one year of followup after diagnosis, 16.8 per cent (7,156) of women died compared with 14.9 per cent (7,138) of men. Overall, the death rates decreased in both sexes but stayed higher in women, Dr. Mielniczuk said. “The mortality for heart failure for women is not improving, the survival is not improving to the same extent as with men,” she said. “We didn’t expect to see such a marked gender difference.” The study also found 98 women per 1,000 were hospitalized in 2013 while the number was lower in men at 91 per 1,000 men. Heart failure is a chronic condition and is different than a heart attack. The heart is not pumping to meet the needs of the body in heart failure, and common signs include fatigue, shortness of breath and swelling in the legs. The patient may have had a heart attack but not always to be diagnosed with heart failure, which is the most common reason for patients to be in hospital after age 65, Dr. Mielniczuk said.
It’s one of the first studies to take a detailed look at the differences between men and women with heart failure in Ontario and is also different because it looked at patients who had not been initially hospitalized, Dr. Sun said. “Women have a different type of heart failure,” Dr. Sun said. “The type of heart failure in women is harder to diagnose and harder to treat.”
Sometimes in both men and women the heart function in an ultrasound looks fine but they have heart failure. Sun said men often come in with heart failure after a heart attack and the ultrasound shows the pumping of the heart is not normal. In women, they often have not had a heart attack and the heart function may appear OK in an ultrasound even though they have heart failure, she said. The higher death rate and hospitalization may be because women aren’t being diagnosed early. For example, women could be mislabelled as having lung disease because they’re short of breath, Dr. Sun said.
Doctors and women need to be more aware of the differences the study found and consider the possibility of heart failure when symptoms emerge, she said.
The study is the first in a series of studies. Next, the researchers will look at the differences between men and women in healthseeking behaviour, access to care and if they respond differently to medication. Cardiologist Dr. Kushal Dighe, director of Windsor Regional Hospital’s Cardiac Cath Lab, said he wasn’t surprised by the results. He said research hasn’t been able to pin down a reason for the higher mortality rates for women that also emerge in studies on heart attacks. “Probably as a society we don’t understand that women could have a heart attack as well or heart failure,” he said. “We attribute this to be a men’s disease but that’s not true.”
Dr. Dighe said another factor is that women have a lot of things on their plate and may downplay some symptoms because they are so busy. Studies show women in their 40s and 50s don’t seek help because they think it’s something else, he said. If you have shortness of breath or chest pain while doing physical work or walking, see a doctor, he said.
There’s something that we’re doing right in men that we’re not doing right in women, so that’s why we really need to raise awareness of this.