Heart disease continues to be the No. 1 killer of women in the United States — and gender is one of the biggest reasons why.

If you’re a woman who has a heart attack, your gender — and the gender of your doctor — may be factors in whether or not you survive.

Recent research shows women having heart attacks will wait more than 30 percent longer than men, from the moment they begin experiencing symptoms to the time they arrive at a hospital.

Once there, women also experience a 20 percent longer wait time than men, from arrival to the moment they begin receiving care.

Even after medical attention has begun, women having heart attacks are also less likely to receive many of the same treatments as their male counterparts.

And if that care is coming from a doctor who is a male — which is highly probable given current statistics — women experiencing cardiac arrest are less likely to survive than they would be if the doctor treating them was a female.

With each gap in care, health outcomes worsen.

For many years, heart disease was thought to be a prototypical male disease, but today it’s the No. 1 killer of women in the United States. In fact, 1 in 3 deaths are attributable to it, and since 1984, more women die from heart disease each year than men.

A new study published in the journal Proceedings of the National Academy of Sciences of the United States of America is bringing gender-based disparities in medical care for heart attacks to the mainstream.

It highlights “patient-physician gender concordance” — how a physician’s gender impacts the outcomes of their patient.

In the study, researchers examined survival rates of heart attack patients at Florida hospitals between 1991 and 2010 based on the gender of the treating physician and found that female patients treated by male physicians were less likely to survive.

Furthermore, they found that female patients treated by female physicians were 2 to 3 times higher compared with those treated by male physicians.

While there’s not a clear answer for why this disparity exists, the authors do offer some ideas.

“Gender concordance often facilitates communication between the patient and the physician, which means that men might not be getting the signals that they need from female patients to diagnose the [heart attack],” said Brad Greenwood, study co-author and associate professor of information and decision sciences at the University of Minnesota Carlson School of Management. “It could be that women are more comfortable advocating for themselves with a female physician.”

They also suggest that because women present differently for heart attacks than men at the hospital, male doctors may not recognize and treat it with the same urgency.

“We’ve always thought about this concept of the ‘Hollywood heart attack,’ this idea of a heart attack looking like crushing chest pain,” said Dr. Suzanne Steinbaum, a spokesperson for the American Heart Association’s Go Red for Women movement, and the director of Women’s Cardiovascular Prevention, Health and Wellness at Mt. Sinai Heart in New York City. “Women’s heart disease tends to be more subtle.”

Female heart attack symptoms can vary, but often include:

  • fatigue
  • flu-like symptoms
  • shortness of breath
  • nausea
  • jaw or neck pain

Steinbaum encourages women who feel these symptoms to speak out and speak loudly if they go to the hospital.

“I want to make sure every woman goes into the emergency room and says, ‘I am afraid it might be my heart.’ By saying that it starts a chain of events, making the diagnosis sooner and getting her to life-saving treatment as soon as possible,” she said.

The study also offers some positive indication that male physicians are also learning to be more attentive to female patients. The authors point out that the number of female patients a male physician has treated has a direct result on improving outcomes for the patients.

In other words, the more female patients a male physician treats, the better the survival rates will be for female patients seen by that male doctor in the future.

The presence of female physicians also matters. Researchers saw that when there was a higher ratio of female physicians, male physicians had better survival rates with female patients.

“Much like the overall effect, why that might happen is kind of speculative,” said Greenwood. “It could be that the female physician taps the male physician on the shoulder and says ‘Hey, this could be a heart attack.’ It might be that the male physician observes the female physicians’ practice behavior and there is passive learning that happens there.”

Beyond issues of gender concordance, a review published in the journal Current Cardiology Reports reveals further disparities in care between men and women for heart attacks.

Perhaps most egregious is the fact that women experience more than 30 percent increased wait time from initial onset of symptoms to arriving at a hospital than men, and an additional 20 percent increased wait time from hospital arrival to medical intervention.

Those statistics, “Bother me beyond belief,” said Steinbaum.

There are different factors at play that can help explain these time discrepancies.

The first is women being unaware that their symptoms for a heart attack are usually different than those experienced by men.

“If a woman doesn’t know she’s having a heart attack, she’s not going to go to the emergency room. If she doesn’t understand that her symptoms are different, she’s not going to go,” said Steinbaum.

Steinbaum says for many female patients, the first line of defense is awareness, and more information is becoming available to more women every day.

However, it’s the delay between arriving at the hospital and receiving care that Steinbaum finds the most troubling, because when a woman does seek help for a heart attack “the people who are helping her are delaying her treatment.”

So-called “door-to-balloon times” — how long it takes to get a heart attack patient in to receive a life-saving angioplasty — are an important predictor of heart attack survivability. A door-to-balloon time of under 90 minutes is considered a benchmark of heart attack care.

Yet, even when women do receive care for a heart attack, they may not receive the same treatment as men.

The review found that women were less likely to receive ACE inhibitors, statins, and even aspirin.

“Women are more likely than men to suffer another heart attack in the following year and more likely to suffer from heart failure. So, their outcomes are really mirroring the treatment,” said Steinbaum.

Women have become significantly more aware of their heart health in the past twenty years.

According to a landmark 2012 study from the American Heart Association: Women in 1997 were more likely to cite cancer than cardiovascular disease as the leading killer (35 percent versus 30 percent), but by 2012, that trend reversed (24 percent versus 56 percent).

However, certain groups of women remain at greater risk. Awareness of cardiovascular health and heart attack risk is still significantly lower among African American or Hispanic women compared with white women.

Referring to his own study, Greenwood said, “If there is anything that this paper emphasizes, at least in my reading, it’s the importance of diversity. When there is a diversity of perspectives among the physician population, when it more closely mimics the patient pool, there are superior outcomes.”

Nevertheless, until gender-based disparities disappear completely, Steinbaum encourages women to take their own health into their own hands.

“Women patients need to understand how important it is for them to advocate for themselves,” said Steinbaum. “As women, we have to take care of ourselves as early on as possible, because 80 percent of the time this horrible disease that kills more women than men can be prevented.”