Gender Affects Treatment Delays for Heart Disease




Many studies, as well as common medical sense, indicate that any delay in treatment for acute cardiac symptoms can lead to significant morbidity and mortality. Complications of delaying treatment may cause cardiac dysrhythmias, congestive heart failure, infections in the lining of the heart, rupture of the heart structures, or death. Any delay in the recognition of symptoms, diagnosis of condition, or receipt of treatment increases the risk of these complications. Socioeconomic status, cultural beliefs, and psychological factors all influence the timing of treatment, but a new study indicates that gender may be a leading factor in treatment delays for acute cardiac symptoms.

A study published in Circulation: Cardiovascular Quality and Outcomes reports that women are 52% more likely than men to experience delays in treatment for cardiac complaints after calling emergency medical services (EMS.) The authors conducted a retrospective cohort study of nearly 6,000 patients with suspected cardiac-related symptoms who called EMS in Dallas County, Texas during 2004. Half of the patients were women, and half of the patients were white.

The total median time that patients spent in EMS care, accounting for response time, EMS’s on-scene time, and transport time to the hospital, was 34 minutes. A “delay” in treatment was considered 15 minutes or more above the median time spent in the care of EMS, or 49 minutes. Overall, 11% of the patients were delayed and women were 52% more likely to be in the “delayed” group than their male counterparts. Additionally, each additional mile traveled accounted for a 9% delay in treatment times. Other factors influencing treatment delays included traveling during rush hour and passing by a nearer hospital to get to a patient’s hospital of choice. No significant delays were discovered in EMS response time based on personal or neighborhood factors; delays in treatment began after EMS arrived on scene.

The study was unable to deduce why a disparity existed between women and men, but treatment delays could result from women not recognizing their own symptoms, accepting care, or choosing a hospital. Further, some findings point to medical professionals — EMS workers as well as physicians — failing to recognize cardiac symptoms in women. Several previous studies have pointed to women delaying their own treatment by waiting several hours longer than men before seeking treatment for cardiac symptoms. Their emotional state, the presence of other illnesses, and the false sense of low cardiac risk factors influence women’s decisions about obtaining health care.

Equally, many women do not know the typical clinical presentation of cardiac symptoms in females versus males. Rather than the characteristic chest tightening and pain, women may experience a burning sensation in their chest, or tenderness in their arms, shoulders, back, and jaw when experiencing angina. During a heart attack, women frequently experience nausea, vomiting, indigestion, shortness of breath, and extreme fatigue, but, again, may not suffer chest pain.

During this February’s American Heart Month, women must remember to be their own health advocates. This latest study did not reveal why women receive delayed treatment for cardiac conditions, but it follows a long line of research that supports similar findings. Health professionals should pay more attention to atypical presentation of cardiac symptoms in women, and should educate women about the risks of heart disease. But, first and foremost, women must advocate for themselves and obtain treatment immediately for any suspected cardiac symptoms.

References

Bird MW, Woods AG, Warren NA. Factors influencing treatment delays for acute myocardial infarction. Crit Care Nurs Q. Jan-Mar 2009;32(1):19-23.

T. W. Concannon, J. L. Griffith, D. M. Kent, S.-L. Normand, J. P. Newhouse, J. Atkins, J. R. Beshansky, H. P. Selker (2009). Elapsed Time in Emergency Medical Services for Patients With Cardiac Complaints: Are Some Patients at Greater Risk for Delay? Circulation: Cardiovascular Quality and Outcomes, 2 (1), 9-15 DOI: 10.1161/CIRCOUTCOMES.108.813741

Lefler LL, Bondy KN. Women’s delay in seeking treatment with myocardial infarction: a meta-synthesis. J Cardiovasc Nurs. Jul-Aug 2004;19(4):251-268.

J. P. Ornato (2009). Gender Delay in Emergency Medical Services: Does it Really Exist? Circulation: Cardiovascular Quality and Outcomes, 2 (1), 4-5 DOI: 10.1161/CIRCOUTCOMES.108.841916

Linda Perkins-Porras, Daisy L. Whitehead, Philip C. Strike, Andrew Steptoe (2008). Causal beliefs, cardiac denial and pre-hospital delays following the onset of acute coronary syndromes Journal of Behavioral Medicine, 31 (6), 498-505 DOI: 10.1007/s10865-008-9174-3

Anne G. Rosenfeld (2004). Treatment-Seeking Delay Among Women With Acute Myocardial Infarction Nursing Research, 53 (4), 225-236 DOI: 10.1097/00006199-200407000-00005

  • Excellent blog! There is a lot to be said about the treatment seeking behavior and treatment adherence in female heart patients. As you noted, the reasons for delayed treatment seeking can only be specualted at this time. However, the behavior patterns of female patients are liekly to be a result of psychosocial factors such as women not considering themselves to be at risk for heart disease. There is still little public awareness about the prevalence and severatity of heart disease in women.
    Another aspects are psychological variables. Women are quite liely to experience multiple psychological risk factors and stressors in addition to heart disease and those can influence health behaviors and coping. If a woman with cardiovascular disease experiences symptoms of depression or anxiety or both, her coping responses will likely be affected. Psychological distress complicates adaptive coping as it requires coping with the physical and psychological challenges.
    Heart disease comes with big changes in one’s life, habits and family dynamics. This change can be very unsettling and stressful. At times of severe distress, women often cope in ways that are comfortable and familiar rather than adaptive. Some of those coping strategies can include increased self-silencing to maintain equilibrium rather than seeking new and adaptive behaviors.

Jennifer Gibson, PharmD

Jennifer Gibson, PharmD, is a practicing clinical pharmacist and medical writer/editor with experience in researching and preparing scientific publications, developing public relations materials, creating educational resources and presentations, and editing technical manuscripts. She is the owner of Excalibur Scientific, LLC.
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