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. This places them at greater risk of adverse outcomes, according to research to be presented at the American College of Cardiology’s 64th Annual Scientific Session in San Diego.
According to the study, compared to men, women don’t call for help as quickly and aren’t taken to the right hospital as fast as men which results in more women dying of heart attacks.
In fact, in this study, women were nearly twice as likely to die in the hospital compared with men. 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.
"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.
The total pre-hospital delay period includes: the time spent to recognize the symptoms were serious enough to call for help and the time between when emergency care arrived and hospital admission. Although the reasons for the lag in getting women to a center where they could be treated with balloon angioplasty and stenting is unknown, Bugiardini said it might be due to misdiagnosis or unnecessary stop-overs in hospitals not equipped to insert stents. He said these findings reflect similar trends seen in the United States where more than 400,000 women have heart attacks each year and demonstrate a need for broader quality indicators.
"It is time to look beyond using in-hospital quality initiatives that focus on door-to-balloon or needle time as the only performance measures, especially in women," he said. "In the last decade, hospitals in the U.S. and other countries have spent a lot of money improving in-hospital time to treatment for heart attack, but nobody considered what happens before they actually get to the hospital. We must take a step back and look at the overall 'time to reperfusion' and find strategies that can favorably impact outcomes in women."