World-first heart attack consensus set to transform care for women

A world-first universal definition of myocardial infarction has been jointly developed by four major cardiac societies, in a landmark overhaul of heart attack diagnosis that will help women receive faster, more appropriate care.

The new consensus statement was unveiled at the European Society of Cardiology (ESC) Congress, currently taking place in Munich. It has been jointly published by the European Society of Cardiology (ESC), the American College of Cardiology (ACC), the American Heart Association (AHA) and the World Heart Federation (WHF) led by Chair, Associate Professor Sarah Zaman from the University of Sydney.

Australian women are more than twice as likely to die after a heart attack than men. The world’s top cardiologists have described the changes as a potential “revolution” in care, with the overhaul designed to address often deadly delays affecting women.

The consensus statement will upgrade three types of heart attack, including coronary artery spasm, coronary embolism and spontaneous coronary artery dissection (SCAD), that are up to 10 times more common in women.

Previously, the most serious cases, known as “type 1” and now classed as “primary” heart attacks, largely focused on those caused by a clot blocking blood flow to the heart. However, heart attacks more common in women can result from other causes, including a tear or tightening of the arteries. These cases are more likely to be missed or not treated as urgently, contributing to dangerous delays in care.

The consequences of those gaps were highlighted at the Women’s Health MedTech Summit, hosted by the Medical Technology Association of Australia (MTAA), where keynote speaker Jen O’Neill shared a deeply confronting story.

O’Neill was just 36 years old and a mum of two beautiful boys when she experienced a SCAD heart attack, where 90% of those affected are women. But instead of urgent care, she was dismissed and not considered an emergency department priority. Her diagnosis was delayed.

She waited days in a public hospital for an angiogram that never came. Eventually, out of fear for her life, she asked to be transferred to a private hospital to get the procedure she desperately needed.

Then came the words no patient should ever hear, “You’ve had a SCAD heart attack… here it is on a Post-it note, you can Google it.”

Her experience highlights a reality too many women face in healthcare. Being unheard, overlooked, and misdiagnosed because their symptoms don’t fit the “typical” picture.

“Speak up if you don’t feel heard,” emphasised O’Neill. “My goal is to change the perception of what a normal heart attack looks like.”

Importantly, the new consensus statement also call for sex-specific thresholds for troponin, the protein measured in blood to help diagnose a heart attack.

The next challenge is implementation, ensuring the new definition and diagnostic approach translate rapidly and consistently into clinical practice around the world.

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