Missed opportunities in women’s stroke diagnosis: Study

As National Stroke Week takes place, new Australian-led research shows improving timing and accuracy of stroke identification in women to match that of men can lead to improved health outcomes and cost savings.
 
Published in the Medical Journal of Australia (MJA), the study aimed to estimate the long-term gains in life years and quality-adjusted life years (QALYs) that could be achieved if stroke was identified in women with the same level of accuracy as men.
 
It found women are 11% less likely than men to be correctly identified as having a stroke by emergency medical staff, indicating that if both sexes received equal pre-hospital stroke diagnosis, not only did they gain life years and QALYs, but benefited from cost savings, ‘compared with the status quo’.
 
The study’s co-lead, Associate Professor Lei Si, said the benefits of timely and accurate identification of ischaemic stroke among women in the pre-hospital setting are two-fold.
 
‘Our study shows that if we could match the accuracy with which men’s strokes are identified, women would gain an average of 51 extra days of life and nearly a month of life in perfect health – all while saving nearly $3000 in healthcare costs per patient,’ he said.
 
‘At the national level, this could translate to over 250 additional life years, 144 extra QALYs and $5.4 million in healthcare savings each year.’
 
Around 85% of stroke cases in Australia are acute ischaemic stroke, for which intravenous thrombolysis (IVT) is the current standard treatment.
 
Associate Professor Si said timely pre-hospital stroke identification increases the chance of receiving IVT within the ‘critical’ 60-minute treatment window.
 
‘This significantly improves patient health outcomes and saves medical costs,’ he said.
 
The research comes following the Stroke Foundation’s 2024 national report detailing a lifetime cost to the economy of $350,000 for each person who had a stroke in the previous year.
 
According to the MJA study, stroke is less likely to be identified by emergency medical staff in women compared with men, among people aged under 70 years.
 
University of Tasmania Professor Seana Gall is an epidemiologist who studies the risk factors and outcomes for stroke and heart disease. She told newsGP the ‘important study’ shows the impact of the misdiagnosis of stroke in women compared to men during the pre-hospital phase.
 
‘It is known that women are more likely to present with “non-typical” symptoms of stroke compared to men, which results in women with stroke not having access to timely care,’ she said.
 
‘We need to ensure that emergency medical staff are properly trained to use validated tools to identify stroke in women and men. We also need to ensure the tools we have to identify strokes are equally accurate in men and women, potentially considering the possibility of non-typical symptoms and signs.’
 
Kelly Ryan is one of those women. Five years ago, she was 32 years old when she had a stroke but was incorrectly diagnosed with vertigo and a migraine. Her symptoms included loss of balance, blurred double vision, vomiting, and a severe, sharp headache.
 
‘Initially I was shrugged off as I was not FAST positive, it took six hours to get a CT scan, and I was sent home with an outpatient appointment for an MRI a week later,’ she said.
 
‘It took a total of two weeks to be diagnosed as having a stroke.’
 
With women more likely to present with additional symptoms such as headache, confusion, nausea or fatigue outside the classic FAST warning signs, Professor Gall says it is important healthcare providers are aware.
 
‘Women with stroke presenting with these other signs may be missed, leading to delayed diagnosis,’ she said.
 
‘The risk is not static – women are at a relatively higher risk of stroke at certain points in their life particularly around pregnancy and post-partum and through the menopause transition.
 
‘Increasing awareness of the broader signs and symptoms, as well as the potential sex or gender differences among the community, but also health professionals, is therefore important.’
 
Professor Gall lists hypertensive disorders of pregnancy, gestational diabetes and a history of migraine as female-specific risks, and says that women with these risk factors may benefit from interventions to address other stroke risk factors like high blood pressure to lower their risk of stroke.
 
‘Recognising the potential for stroke in women of all ages, but particularly younger women, is very important,’ she said.
 
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