News
Women a key focus in new global heart attack definition
The simpler, clinically focused approach aims to help doctors accurately diagnose a heart attack, particularly in women.
‘This new definition will help us recognise some of these female dominant causes, and in this way, we can improve the diagnosis and treatment of these conditions for women’: World Heart Federation.
A revised global definition of a heart attack has been launched, delivering a ‘simpler, clinically focused approach’ to guide accurate diagnosis, with hopes it will ensure causes in women become more visible.
The Fifth Universal Definition of Myocardial Infarction (UDMI) and accompanying joint statement recognises the different causes of heart attack and introduces clearer, sex-specific diagnostic criteria.
It was jointly developed by leading international cardiovascular organisations, including the World Heart Federation (WHF) and European Society of Cardiology.
Until now, heart attacks were classified using a numerical system of five types. The new definition replaces this with three clinical categories based on the circumstances and underlying cause of the heart attack:
- Primary myocardial infarction
- Secondary myocardial infarction
- Procedure-related myocardial infarction
Chair of the WHF UDMI Taskforce and Australian academic interventional cardiologist, Associate Professor Sarah Zaman, told
newsGP this new definition is important for GPs and clinicians globally.
It means some heart attack causes that are more common in women, including spontaneous coronary artery dissection (SCAD), coronary artery spasm and coronary embolism, are now recognised as forms of ‘primary myocardial infarction’ alongside heart attacks caused by atherosclerotic plaque rupture and blood clots.
‘Importantly, all acute coronary causes of myocardial infarction [MI] are classified into primary MI – so it is not just atherothrombosis (although this is the most common cause); but to improve awareness of other types of primary MI, such as SCAD, vasospasm, embolism,’ Associate Professor Zaman said.
‘In addition, [there are] new changes that affect the diagnosis of MI in women: notably, the inclusion of high-sensitivity, sex-specific cardiac troponins in the diagnosis.
‘This means using these high sensitivity assays and the sex-specific references, as women have lower normal cardiac troponins than men.’
Associate Professor Zaman added that a woman who presents with a heart attack is more likely to have a cause that is not related to cholesterol plaque buildup, particularly if they are younger or if their heart attack occurs during or after pregnancy.
‘This new definition will help us recognise some of these female dominant causes, and in this way, we can improve the diagnosis and treatment of these conditions for women,’ she said.
Melbourne GP Associate Professor Ralph Audehm told
newsGP it is positive to see women’s heart health elevated in the global definition.
‘The focus on the difference between men and women in heart disease over the last few years has been really a positive change because women aren’t men shaped a little bit differently. They are different, and I’m glad that this research in women is actually happening,’ he said.
Associate Professor Audehm also believes the way heart attacks have been categorised in the new definition seem to align with how GPs see cases occurring. However, he hopes this comes with clear information on patient discharge to GPs.
‘I don’t think the classification itself is going to impact on us GPs much but when we get discharge summaries or letters … we do need to know the underlying cause, so they will have to go further than “primary myocardial infarction” and describe whether it is atherosclerosis or SCAD, or stent-related, or something of that nature, so that we understand the process behind it,’ he said.
‘We need to know what the underlying cause is because the way we treat it can vary.’
Associate Professor Audehm added that while a patient presenting to a GP with heart attack symptoms would be sent to hospital, the new thresholds for cardiac troponin may be more of an issue in country areas, or in cases where patients were being assessed in general practice settings.
‘It’s those situations that I think the troponin levels are important to be aware of, and the key message is certainly that women experience infarcts a bit differently. They can have more predominance of the atypical symptoms, and we’ve just got to be aware of that when we’re assessing women who are presenting with an acute issue.
‘The troponins may be more relevant to some of our isolated rural and remote colleagues, because if they’re talking about sending someone one- or two-hours [away], that distinction between the female cut-offs, and whether their machines actually are sufficient to actually record that, [is important].’
The updated sex-specific thresholds for cardiac troponin have been welcomed by the Heart Foundation to address ‘longstanding gaps in recognition of women’s heart disease’.
The advice also aligns with the Foundation’s
Australian clinical guideline for diagnosing and managing acute coronary syndromes published last year, which recommends sex-specific troponin thresholds to improve the diagnosis of heart attacks in women and support faster treatment in emergency departments.
Log in below to join the conversation.
cardiovascular event heart attack heart disease spontaneous coronary artery dissection women’s health
newsGP weekly poll
Have you ever found out that a patient has previously failed to disclose their use of GLP-1 medicines to you as their usual GP?