When heart attack symptoms begin, women wait longer than do men to call for help, and it takes longer for them to arrive at a hospital that can care for them appropriately.
Further, statistical analysis suggests that this prehospital delay is a chief contributor to the higher in-hospital mortality rate for women who have sustained myocardial infarctions. Dr. Raffaele Bugiardini of the University of Bologna and his associates in the ISACS-TC study group examined data from a large international study to clarify gender disparities in heart attacks, and to identify more precisely where time is lost in caring for women.
Dr. Raffaele Bugiardini
They examined data from 2,282 women and 5,175 men who experienced ST-segment–elevation myocardial infarction (STEMI). Overall, female participants were older than males and were more likely to have diabetes, to be treated for hypertension, and to have experienced atypical chest pain – or no chest pain at all – during their heart attacks. The men were more likely to be smokers, to have chronic renal failure, and to have a prior history of angina.
The results were released in advance of the researchers’ presentation on March 14 at the annual meeting of the American College of Cardiology in San Diego.
Once symptoms began, women tended to wait significantly longer to call for help, a median 60.0 minutes, compared with 45.5 for men. Time to hospital admission was just a bit longer for women (60 minutes) compared to men (55 minutes). On admission, time to angioplasty or fibrinolysis did not vary significantly between the sexes. The likelihood of receiving appropriate medical treatment (aspirin, clopidogrel, heparin use) was also similar.
In outcome measures, 30% of women achieved hospital admission in 60 minutes or less from leaving home, compared with 70% of men. Dr. Bugiardini explained that the 60-minute admission marker is an important quality standard in the European framework. The odds ratio (OR) for a greater-than 60-minute time from home to hospital admission for women was 2.90 (95% CI, 1.52-5.82).
In-hospital mortality for women was nearly double that for men, at 11.8% compared to 6.3% for men (OR 1.34, 95% CI 1.01-1.77). However, after logistic regression analysis adjusted for the differences in time from home to hospital admission, the disparity in mortality disappeared (OR 0.90, 95% CI 0.31-2.56). Dr. Bugiardini emphasized that his analysis makes clear that delay in treatment is an important contributor to greater in-hospital mortality for women suffering heart attacks.
Though these finding were drawn from a large international study, American College of Cardiology Vice President Richard Chazal affirmed during a media briefing that the results are definitely applicable to the United States and other developed nations. “They are confirmatory,” said Dr. Chazal, “of other studies that have suggested this but have not shown this in such a complete and comprehensive way. This is very important information in this population.”
Heart disease kills more women than do all forms of cancer combined, but the varied presentation of heart attack symptoms in women is still underrecognized, noted Dr. Chazal of Lee Memorial Health System, Fort Myers, Fla. Raising awareness about heart disease risk and heart attack symptoms is critical to addressing the disparities identified in this study. “The delays in getting the patient to the hospital are really crucial in determining what the outcomes are,” he said.
“Time is still lost between contact with the system and arrival to the hospital” for women, he added. “There is less awareness not just by women, but in doctors in underestimating what’s going on with women. We are confused, so we stop and do one more EKG. We are losing time.”
Dr. Marija Vavlukis is on the speakers bureau for KRKA Macedonia. The other authors have no disclosures.