Medical Forum
Updated definition of heart attack better represents women
A new global definition of heart attack is expected improve the diagnosis of women and address longstanding gaps in care.
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Medical Forum
The updated definition, published in the European Heart Journal, introduces female-specific troponin blood test thresholds which aim to address the underdiagnosis of heart attacks in women.
Currently, the underdiagnosis of heart attacks in women contributes to delays in treatment and worse cardiovascular outcomes.
The Heart Foundation said the new definition aligns with the existing Australian clinical guideline for diagnosing and managing acute coronary syndromes, published in 2025, which recommends sex-specific troponin thresholds to improve the diagnosis of heart attacks in women and support faster treatment in emergency departments.
Cardiovascular disease remains one of the leading causes of death for women in Australia, accounting for around one in four female deaths per year.
Clinician Scientist and Rural Generalist Registrar Dr Revathy Carnagarin, who leads the HOPE (Heart Failure Optimisation through Patient and Practitioner Education) project across the Midwest GP network, said this was a positive development in cardiovascular medicine.
"The significance of this change is not simply about adjusting a laboratory number, it is about improving our ability to recognise and diagnose myocardial infarction in women who may previously have been under-diagnosed or diagnosed later than ideal," she told Medical Forum.
"Historically, diagnostic thresholds for cardiac biomarkers were often derived from mixed populations and may not have adequately accounted for important biological differences between men and women.
"We now recognise that women can experience myocardial injury at lower troponin concentrations than men and that the use of sex-specific thresholds may improve diagnostic accuracy.
"Australian clinicians are already accustomed to contemporary acute coronary syndrome guidelines that acknowledge sex-specific considerations, so this is perhaps better viewed as an evolution rather than a complete change in practice.
"However, it further reinforces the importance of considering sex-specific biology when interpreting investigations and making clinical decisions."
Dr Carnagarin added that, more broadly, the updated definition reflects a growing recognition that cardiovascular care should be personalised and that improving outcomes requires an understanding of important differences between patient groups.
"One of the key messages for both clinicians and the community is that heart disease is not solely a men's health issue. Women experience heart attacks, heart failure and cardiovascular disease at significant rates, and improving awareness and recognition remains critically important," she said.
Natalie Raffoul, head of clinical strategy at the Heart Foundation, said the new definition would empower healthcare professionals to tailor heart attack diagnosis for women.
“A sex-specific cut off means we are tailoring diagnosis thresholds for a heart attack to women rather than using the standard cut off derived from largely male study participants,” Ms Raffoul said.
“The new female-specific blood test cut off is good news for women worldwide. It will mean that healthcare workers across the world can now better diagnose women who are experiencing a heart attack when they present to emergency departments.”
Ms Raffoul said women’s symptoms may not fit the ‘Hollywood heart attack’ of a man clutching his chest.
“Because women’s symptoms are more likely to be misinterpreted, dismissed or attributed to other causes, it can often contribute to delays in seeking care and receiving treatment for heart attack which, for many women in Australia, can unfortunately result in poorer outcomes including death.”
The Fifth Universal Definition of Myocardial Infarction (UDMI) also outlines three clinical types of myocardial infarction - primary, secondary, or procedure-related.
These classifications better reflect underlying pathophysiology, align with clinical evaluation of patients, and incorporate objective diagnostic criteria.
The definition is a joint statement between the European Society of Cardiology, the American College of Cardiology, the American Heart Association (AHA), and the World Heart Federation (WHF).