New universal heart attack definition could transform care for women

Four leading cardiovascular health groups have agreed new guidance for healthcare professionals assessing patients with suspected heart attacks.

Historically, some less common forms of heart attack, which evidence shows affect women far more than men, have been classified as less important, with treatment and care often worse as a result.

Experts said women had been receiving less effective treatments that did not always target the specific cause of their heart attack and could even make them more unwell.

The changes were announced in Munich on the opening day of the annual congress of the European Society of Cardiology (ESC).

Professor Bryan Williams, chief scientific and medical officer of the British Heart Foundation, said: “This is a landmark moment, a radical shift in how we define and diagnose heart attacks worldwide which will transform people’s care.

“For decades, women have missed out on accurate diagnoses and treatment.

“This focus on finding less common causes of heart attacks, which predominantly affect women, should help to change that. It could be life-changing for huge numbers of women in the UK and worldwide.”

The new guidance upgrades three types of heart attack that can be up to 10 times more common in women and are often caused by childbirth, exercise and emotional stress.

The most serious cases, previously known as “type 1” and now classed as “primary” heart attacks, had previously prioritised those caused by a clot blocking blood flow to the heart.

Other forms can involve reduced blood flow for different reasons, including the tightening or tearing of coronary arteries. These can be more likely to be missed or treated less urgently.

The guidance also introduces a lower diagnostic threshold for women based on levels of troponin, a protein released into the blood when the heart is injured and damaged.

Previously, women were expected to meet the same troponin threshold as men to receive a diagnosis.

Williams said the streamlined heart attack categories would also help patients understand the cause of their heart attack and what comes next.

The three upgraded types are coronary artery spasm, coronary embolism and spontaneous coronary artery dissection (SCAD).

Coronary artery spasm involves the tightening of an artery, which can deprive the heart muscle of blood and oxygen. It can be caused by emotional stress, exercise or extreme cold.

Coronary embolism occurs when a blood clot or fatty deposit travels to a coronary artery and causes a blockage.

SCAD is caused by a tear in a coronary artery. Around 80 per cent of cases occur in women, and it often happens during or soon after pregnancy.

Professor Nicholas Mills, a cardiologist at the University of Edinburgh who led the international taskforce behind the guidance, said it was “the first time that we’ve had a truly global approach to aligning how we diagnose what is probably the most important diagnosis there is”.

He said: “It kills so many people, and we’ve never got everyone together around the world to agree how we’re going to describe it, classify it, explain it to our patients.

“Our job now is to implement this as widely as possible. It’s just as relevant for the UK as it is for any other country around the world. It is a revolution. It’s going to make care better for patients.”

Mills said there had been “unintended systematic bias against women”, including through the use of the key blood test for diagnosing heart attacks at an average level, which picks up all men but misses some women.

He said: “This is used for all types of heart attack in every emergency department in the world, and we want to make sure that it’s used correctly.”

The guidance was drawn up by the ESC, the American College of Cardiology, the American Heart Association and the World Heart Federation.