Heart health and women employees: Misdiagnosis crisis

This article is authored by Dr Vikram Vora, medical director, Indian Subcontinent and Middle East, International SOS.

The hectic pace of today’s lifestyles reflects the growing strain on our health and India’s rising burden of cardiovascular disease is its most worrying consequences. Let’s consider a scenario that unfortunately is no longer a rare occurrence--a female colleague in her late 30s starts feeling an acute discomfort in her chest during an office meeting. She also feels nauseated, notices an increasing feeling of tightening and is suddenly unusually tired. She struggles but finishes the presentation, blames the feeling on her train commute and promises herself that she will see a doctor after work. She does not – she needs to pick up groceries for dinner. Her colleagues see her as a beacon of resilience for soldering on. No one realises that she may be having a heart attack.

Heart attack

That gap between what we know and what is really happening in the heart musculature and the cardiovascular system has led to the current misdiagnosis crisis. It begins much before a visit to a doctor – for women, it is tied to different stages of life, pregnancy-related high blood pressure or gestational diabetes creates a greater cardiovascular risk in later life, menopause and related hormonal changes predispose women to increased risk.

More often than not, symptoms get dismissed and labelled as just stress, and even a physician could end up ruling out a possible cardiac cause if due investigations are not done.

On World Heart Day, September 29, 2026, organisations, business leaders, managers and employees in workplaces across the country, regardless of industry or location, need to ask themselves a difficult question--would I recognise a heart emergency in the team that keeps this workplace running?

Scientific evidence gives us reason to ask this question. In a nationwide Indian study of 41,832 heart attack patients, women participants had a longer delas before treatment was initiated to restore coronary blood flow and a higher in-hospital mortality rate than men. This does not mean every delay was a misdiagnosis. But it shows that the journey from symptom to definitive treatment is disproportionately longer for women.

Western health data reveals a similar problem. In the UK, a large British Heart Foundation study found that women were about 50% more likely than men to receive an incorrect initial heart attack diagnosis. In the US, the American Heart Association guidance explicitly warns that women with chest pain are at risk of underdiagnosis.

There is a dangerous misunderstanding in certain circles--that women’s heart attacks do not cause chest pain. Chest discomfort and pain are the most common symptoms in both women and men. Women may have additional breathlessness, nausea, unusual fatigue, or discomfort in the back, jaw or upper abdomen. It is easy for a busy employee to explain away each symptom and for a hurried observer to do the same. Whereas the correct response to such possible heart attack symptoms is to seek immediate medical assessment, regardless of gender or job title.

The availability of the right diagnostic methods is important too. Western research has found that using a high-sensitivity blood test (known as a troponin test) is able to identify more cases of heart injury, if the appropriate thresholds for women are considered and known. However, finding more positive cases does not, by itself, guarantee better outcomes. Accurate diagnosis must be followed by timely decisions and quick initiation of definitive treatment.

What role can employers play in making the workplace ready to respond? The first step is to foster a culture of health and wellbeing--one in which leaving a meeting for a medical reason is never looked upon as a failure of commitment, but rather a decision based on sound judgment. Second is to educate all employees and managers about the warning signs, leaving out the myth that women having a heart attack present differently. Thirdly, ensure the availability of a structured emergency response plan and medical transport. Ensure that your emergency response accounts for women’s cardiovascular risks, including a history of pregnancy complications where relevant. And lastly, but most importantly, encourage employees to undergo annual preventive health checks that measure blood pressure, diabetes and cholesterol risks, ensuring that there is access to follow-up care (rather than conducting a one-day screening camp, leading to a forgotten report somewhere in the employees’ drawer).

One of the most dangerous missed signals in our society is a woman who appears to be managing everything. Men in society have an important part to play--whether as colleagues, managers, leaders, family members or clinicians in the community. They need to start taking symptoms seriously, support those who need help and resist the familiar impulse to praise a woman for working through illness.

On World Heart Day 2026, our collective ambition must be larger than a single day’s awareness. It should be to build a workplace where no employee has to prove how sick she is before someone believes her and is backed by a health care system that stands ready to act when she arrives at a hospital.

(The views expressed are personal)

This article is authored by Dr Vikram Vora, medical director, Indian Subcontinent and Middle East, International SOS.