The Doctors Company (the largest physician-owned medical malpractice insurer in the United States) conducted a study of closed medical malpractice claims involving undiagnosed heart disease in women and found that in 61% of the medical malpractice claims, the patient died when her heart condition was not correctly diagnosed and 33% sustained heart muscle damage from myocardial infarction.
The study found that it was a primary care physician (“PCP”) who failed to diagnose a woman’s heart disease in 50% of the closed medical malpractice cases. Cardiologists were named as a medical malpractice defendant in 22% of the closed medical malpractice claims involving women with heart disease, and emergency room physicians were named as medical malpractice defendants in 17% of the claims.
Cardiovascular disease develops 7 to 10 years later in women than in men and is the major cause of death in women over the age of 65 years. Over the past two decades, the prevalence of myocardial infarctions has increased in women between the ages of 35 to 54, while declining in similarly aged men. The under-recognition of heart disease and differences in clinical presentation in women lead to less aggressive treatment strategies and a lower representation of women in clinical trials.
It is well established that there are differences in the early signs and symptoms of an impending heart attack between men and women that makes the diagnosis more difficult in women. Chest pain syndromes are more common in women than in men. Women who are diagnosed with noncardiac chest pain have a twofold increased risk to develop a coronary heart disease event in the next 5 to 7 years and have a four times higher risk for re-hospitalizations and recurrent angiograms in the next 180 days. At younger ages, women more often have acute coronary syndromes with angiographically ‘normal’ coronary arteries than men.
For women under 50, smoking is more harmful than in men (smoking increases the risk of a first acute myocardial infarction relatively more in females than in men). Women with diabetes are at greater risk for cardiovascular complications than men (the risk of fatal coronary heart disease is 50% higher in women with diabetes than for men with diabetes).
The Doctors Company recommends the following for physicians to reduce the risk of being named as a defendant in a medical malpractice claim involving undiagnosed heart disease in women:
• Rule out myocardial infarction before arriving at a GI-related diagnosis such as gastric reflux as the cause of chest pain or discomfort.
• Consider cardiac risk factors such as obesity, smoking, hypertension, and hyperlipidemia.
• Offer patients same-day appointments when they complain of continued symptoms for which they were recently seen. If this is not possible, send them to the ED and document this in the medical record.
• Develop a written chest pain protocol.
If you or a loved one were undiagnosed or misdiagnosed with heart disease and you suffered harm as a result, you may be the victim of medical negligence and may have a medical malpractice claim for compensation for your injuries.
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