Her heart matters: Disparities in women's heart health

Heart disease is the leading cause of death for Kiwi women. But in the event of a cardiac arrest, women are less likely to receive bystander CPR. Hato Hone St John’s Dr Sarah Maessen highlights the disparities in women’s heart health and the importance of taking action to save a life. 

We’ve all seen the classic portrayal of a person having a heart attack in a movie. It’s typically a man, suddenly clutching his chest or arm before dramatically collapsing to the ground. 

Seldom do we see the heart attack scenario happening to a woman on screen. While rates of heart attack and cardiac arrest are lower for women than men, they are still a significant health concern for women, and the warning signs are often not the ones we’ve been conditioned to expect. 

Different signs and symptoms 

“Women tend to have more atypical symptoms,” explains Dr Sarah Maessen, a Clinical Evaluation, Research and Insights Manager for Hato Hone St John. “They can feel exhausted or nauseous or have a sense of impending doom – feeling that something is really wrong but they don’t know what.” 

Confusingly, these symptoms could just as easily be perceived as signs of something else less urgent. Depending on the woman’s age, they may attribute them to menopause and not seek medical advice at all. Even if they do, because these symptoms are vague, their doctor may begin with a blood test rather than respond immediately with an ECG. 

What’s the difference between a heart attack and cardiac arrest? 

A heart attack occurs when one of the blood vessels supplying the heart muscle with blood is blocked. The heart loses its own blood supply, and the heart muscle is injured. If left for too long, the heart muscle will die. A heart attack is a serious condition and can sometimes lead to a cardiac arrest. If someone has chest pain that does not ease after 10 minutes, or is very unwell, call 111 for an Ambulance.   

A cardiac arrest is where someone’s heart suddenly stops beating, they are unresponsive and not breathing normally. If someone is in cardiac arrest, start CPR, call 111 for an ambulance, and send someone to get a defibrillator. 

For more information about the differences and how to respond to each, visit the Hato Hone St John website. 

Delayed bystander CPR reduces survival rates  

The situation becomes even more precarious if a woman’s heart issues do then lead to an out-of-hospital cardiac arrest. “When people see women collapse in the media, it’s often for something like fainting, so when it does happen in real life, bystanders might not immediately assume it’s a heart issue or cardiac arrest,” says Sarah. “The problem in that scenario is that any delay in responding can be the difference between surviving and not surviving.” 

When anyone goes into cardiac arrest – man or woman – taking action as quickly as possible is critical. “Someone who gets CPR before the ambulance arrives is nearly 3 times more likely to survive a cardiac arrest than someone who doesn’t,” says Sarah. “And getting a shock from a defibrillator before the ambulance arrives more than doubles someone’s chance of survival.” 

The dilemma of public defibrillation  

This is where the statistical differences between men and women become particularly stark. “Women are less than half as likely as men to get a shock from an AED (automated external defibrillator) before the ambulance arrives,” says Sarah. “And this is not a trend that’s unique to Aotearoa New Zealand – we see this all around the world.” 

The reason for this is that while people are naturally hesitant about touching a stranger in a medical emergency, when that stranger is a woman, this hesitation seems to be even stronger. And when it comes to using an AED, there’s an added complication.  

“The pads of the defibrillator need to be placed in the right place, directly on the person’s skin. In order to do that, the first thing you need to do is take someone’s clothes off,” Sarah explains. “At Hato Hone St John, we recommend cutting off the clothes and the bra of the woman in cardiac arrest so they’re all out of the way, because it is so important that the pads are in the right place and sticking to the skin.” 

Once that’s done, however, Sarah says their modesty can still be protected. “You can always put a covering back over the top once you’ve removed the clothing and got the pads in the right place. They don’t have to stay exposed while CPR is happening or they’re being defibrillated.” 

Being in the presence of a person in cardiac arrest is obviously a stressful moment for anyone. This is why learning the right skills through Hato Hone St John’s 1-hour 3 Steps for Life training course is so valuable. It’s a programme MAS is very proud to be sponsoring, because when people have more confidence about the process they are in a much better position to save a life. 

Lack of diversity in training manikins 

Even for those who have undergone training however, including paramedics, there’s a twist that means they’re more practised at treating men. “A research group found that of all the manikins on the market globally, only 5% are female. That means 95% of CPR training that’s done, worldwide, is with male manikins,” says Sarah. 

“Even the female manikins out there are pretty unrealistic,” adds Sarah. “They have very solid, perky breasts that sit directly on top of their chest. That’s not the case for most women who are having a cardiac arrest, particularly older women who are more likely to be having one.  

“Often people may have to move a woman’s breast out of the way to stick the AED pad on, but that can be the case for a lot of men too, who may have extra flesh in that area. So it’s not just female manikins that are inaccurate.” 

Despite the challenges, Sarah’s parting message is simple, “We want people to understand and recognise that in a cardiac arrest, the effect of a bystander can be huge. It can mean a life saved. We don’t want fear and uncertainty to stop women from having the same chance of survival as men. Seconds count and you really can’t make things worse. This person is basically in the worst situation they can be in and they need help fast.” 

MAS on a mission 

MAS is the major sponsor of Hato Hone St John’s 3 Steps for Life programme, helping to significantly expand its reach and impact, and enabling more people across Aotearoa New Zealand to gain the confidence and knowledge to act in a cardiac arrest.   

Of the partnership, Matt Harvey, MAS Chief Distribution and Marketing Officer, says, “We’re honoured to be supporting this vital initiative that equips New Zealanders with essential life-saving skills. As a mutual, dedicated to protecting and growing the financial wellbeing of New Zealanders, this partnership reflects our broader commitment to the health and resilience of our communities.”