Women facing significant inequalities in diagnosis, treatment of heart disease in NZ

A researcher says women are facing significant inequalities in the diagnosis and treatment of heart disease in New Zealand.

Around 3000 women in New Zealand die from cardiovascular disease - such as heart attacks, strokes and blood clots - each year, while more than 65,000 are living with it.

Kylie Short, from the University of Canterbury, said despite the disease being a leading cause of death and a significant health issue for women, it had traditionally been seen as a men's illness.

The symptoms could present differently in women, Short said, which had led to the disease being diagnosed later, misunderstood or minimised.

Short, along with Carol Bussey, Susan Crabtree and Julia Shanks, had reviewed 61 New Zealand studies published between 2000 and 2024 to establish what was known about women living with heart disease.

They found that women were underrepresented in the research, with only around a quarter having looked at the difference between men and women.

"They often report the [number] of women in the study, but they don't tend to report the actual specific findings for men and for women," Short said.

The review found that the inequalities occurred at every stage, from recognising and diagnosing through to treatment and recovery.

Women faced delayed diagnoses and were less likely to receive some recommended treatments and interventions.

One study found that women were 28 percent less likely to be referred to cardiac rehabilitation, even after factors such as age, ethnicity and deprivation were taken into account.

The review also found that women under 50 were nearly 20 percent less likely than men to be maintained on recommended triple therapy for cardiovascular disease.

Short said more gender-specific research was needed.

"We really need to be seeing that men and women are separate populations, and that we have a focus of any research that we're doing in heart disease, that we're very specifically looking at outcomes for men and women separately, that we're actually extrapolating the data to see what the differences are, so that we can see what is really happening for women in this space, and particularly for our Māori and Pacific populations."

Some of the greatest inequalities were experienced by Māori and Pacific women, Short added.

Māori women developed coronary heart disease at a median age of 59, compared with 75 for non-Māori women.

Māori and Pacific women also faced around twice the one-year mortality risk following acute coronary syndrome compared with European and other women, while the rate of heart failure hospitalisation was two to four times higher.

One study found revascularisation rates of 58 percent for Māori women and 53 percent for Pacific women, with Pacific women remaining less likely to receive the treatment even after other factors were taken into account.

Short said researchers needed to look specifically at outcomes for Māori and Pacific women, rather than treating women as a single group. She said women themselves also needed to have a greater role in the research.

"We need to also have women in this research space, so helping us co-design this research as well, and having a real collaborative approach to this between researchers, between clinicians and women."

The review had identified wider barriers to women's heart care, including family responsibilities, financial pressures, limited time, transport and a lack of culturally appropriate services.

It also found that psychological and emotional needs could be overlooked during recovery.

One study found women with cardiovascular disease were five times more likely than men with the disease to meet the criteria for major depressive disorder.

Short said addressing the disparities would require better sex-specific data, earlier diagnosis and treatment, improved access to cardiac rehabilitation and more person-centred support.

For Māori and Pacific women, she said services also needed to be culturally grounded and designed with Māori and Pacific leadership.

"When we look after women, when we have good outcomes for women, we have good outcomes for families, we have good outcomes for community, and we'll have a good outcome for our health service as a whole."