Gender Disparities in Acute MI Care Linked to Higher Mortality Among Indian Women, suggests study
A nationwide study has revealed that women in India experience significant gender bias in the management and outcomes of acute myocardial infarction (AMI). Representing only 21.6% of the 41,832 patients studied, women were found to be older at presentation, less likely to receive life-saving revascularization, and faced a nearly double in-hospital mortality rate compared to men.
These findings were published in the Indian Heart Journal in January 2025.
The Clinical Burden of Gender-Based Healthcare Inequity
Coronary artery disease remains a primary cause of global mortality, yet a persistent assumption remains that it predominantly affects men. This misconception has historically led to more conservative treatment and poorer outcomes for female patients, a phenomenon sometimes referred to as "Yentl syndrome." Prior to this research, nationwide data on gender bias within the Indian context was scarce and often conflicting. The study highlights that these disparities cannot be fully explained by age or comorbidities alone, pointing toward systemic deficiencies in healthcare delivery for women.
Study Overview
This nationwide retrospective, multicenter, cross-sectional study was conducted by the Cardiological Society of India (CSI). The analysis utilized data from 41,832 patients admitted across 187 hospitals, covering 24 states and 2 union territories. Researchers compared AMI cases from the Coronavirus Disease 2019 (COVID-19) lockdown period in 2020 against historical controls from 2019. The inclusion criteria involved adult patients diagnosed with either ST Elevation Myocardial Infarction (STEMI) or Non-ST Elevation Myocardial Infarction (NSTEMI).
The key findings from the study include
• Women presented at a significantly older average age (61.2 years) compared to men (57.3 years).
• A higher proportion of women presented with NSTEMI (41.6%) rather than STEMI, and they often arrived with more severe Left Ventricular Ejection Fraction (LVEF) dysfunction of 30% or less.
• Revascularization therapy was less frequent for women; only 29.5% underwent Primary Percutaneous Coronary Intervention (PCI) and 32.9% received thrombolysis, compared to higher rates in men.
• Women faced significantly higher rates of major complications, including cardiogenic shock (8.6%), heart failure (13.9%), and malignant arrhythmias (3.4%).
• The in-hospital mortality rate for women was 7.07%, starkly higher than the 4.07% observed in men.
Clinical Relevance and Targeted Action
For medical practitioners and policymakers, this study underscores a critical need for long-term vigilance and systemic reform to address the gender gap in cardiac care. The data suggests that social structures in India may prioritize male "breadwinners" for early treatment, leading to delayed hospital presentation for women. Addressing these disparities requires a multipronged strategy, including government policy initiatives, increased caregiver awareness, and public education to ensure equitable access to high-quality care for all AMI patients, regardless of gender.
Reference
Das MK, Malviya A, Zachariah G, et al. Gender bias in acute myocardial infarction care in India: Nationwide retrospective study of 41832 patients. Indian Heart J. 2025;77(1):22-27
