Women suffering a heart attack wait much longer than men to call emergency medical services and face significantly longer delays getting to a hospital equipped to care for them, putting women at greater risk for adverse outcomes, according to research to be presented at the American College of Cardiology’s 64th Annual Scientific Session in San Diego.
The study found that delays in getting hospital treatment—either because women waited longer to call for help or were not taken to the right hospital as quickly as men—were associated with a higher risk of dying. Overall, women were nearly twice as likely to die in the hospital compared with men, with in-hospital deaths reported for 12 percent of women and 6 percent of men in the study.
The risk of dying remained higher in women even after adjusting for other clinical variables including age, treatments received and cardiovascular risk factors. Women were also less likely to undergo treatment to open clogged arteries compared with men (76 versus 80.4 percent), which tend to work best within the first hour after a heart attack starts.
“Pre-hospital delays remain unacceptably long in women, and time matters,” said Raffaele Bugiardini, M.D., professor of cardiology, University of Bologna, Italy, and lead author of the study, which examined records of 7,457 European patients enrolled from 2010 to 2014 in an international registry to study heart disease and treatments.
Many delays occurred because women simply waited longer than men to call emergency medical services, with women waiting an average of one hour compared to 45 minutes for men. Even after calling for help, Bugiardini said women “seem to disappear somewhere in the health care system.”
More than 70 percent of women in the study took longer than an hour to get to a hospital that could treat them, while less than 30 percent of men took that long. Overall delays—the time to call for help and then be taken to the right hospital—ranged from five minutes to three days.
Interestingly, once patients were admitted, there were no significant differences between men and women in time to treatment with a medication to breakdown blood clots, which took 26 minutes on average for men and 28 minutes for women, or with balloon angioplasty to open clogged arteries, which took 45 minutes on average for both men and women.
Men and women who got to the hospital within 60 minutes and, therefore, received treatment relatively quickly, had similar in-hospital mortality rates. Bugiardini said the most important factor for worse outcomes for women in his study was the pre-hospital delay, and he called for broad efforts to improve recognition of heart attack symptoms, especially among women.
“Our findings should set off an alarm for women, who may not understand their personal risk of heart disease and may take more time to realize they are having a heart attack and need urgent medical help,” Bugiardini said.
One challenge is that women typically don’t have the “classic” signs of a heart attack. For example, instead of crushing chest pain, they may have shortness of breath, nausea or vomiting, or pain in the back, neck or jaw. These symptoms may develop slowly over hours or days and even come and go. Women and medical personnel may also attribute symptoms to other health conditions such as indigestion, which may lead to misdiagnoses.
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