Sunday, December 21, 2014

Women wait longer: Study shows gender differences in time to coronary care

TORONTO — Younger women experiencing a heart attack or other cardiac event wait longer for essential care in emergency rooms than men of a similar age, a new study suggests.
The research also found that both women and men who score as having more feminine traits on a standardized test wait longer for care as well.

The lead author of the study, Roxanne Pelletier, said the findings suggest younger people of both genders who go to hospital with suspected heart attacks need to be clear about their symptoms.
“Both men and women need to know that the way they present themselves and the way they report their symptoms may have an important influence on their access to care,” said Pelletier, a clinical psychologist and post-doctoral fellow at McGill University Health Centre in Montreal.
“And so they need to know that they should be assertive when expressing their needs and reporting their symptoms. And they need to be concise and precise when reporting their symptoms.”
If they are suffering from chest pain, that should be the first symptom they report, and the symptom they stress, Pelletier said.
The study was published Monday in the Canadian Medical Association Journal.
It’s well known that diagnosing heart attacks in older women can be more difficult than in older men, and that those women sometimes do not get the same level of care or the same speed of care that men do.
But less is known about younger adults who have cardiac events and whether sex or gender influences the speed of care they receive.
So Pelletier and colleagues set out to look at the question, enrolling 1,153 cardiac patients aged 18 to 55 between January 2009 and April 2013. A total of 24 Canadian hospitals, one Swiss hospital and one American hospital took part in the study.
Participants were people who were hospitalized after a cardiac event, with nurses gathering health information and conducting interviews to score them for feminine versus masculine traits and roles within 24 hours of the patient’s admission to hospital.
The researchers wanted to see whether sex alone — male or female — appeared to be predictive of time to care or whether gender-related characteristics also might be influencing care. So they used a standard questionnaire to score patients on traits like shyness, gullibility, sensitivity to others and compassion.
They saw that regardless of sex, patients who presented with more typically feminine traits experienced longer delays and were less likely to receive some of the invasive procedures than patients who scored higher on the masculine traits side did.
“At the triage, maybe these patients are just less assertive,” Pelletier said.
It should be noted that most of the patients did not receive standard treatments within the time frames recommended by the American Heart Association and the American College of Cardiology.
Those organizations recommend that incoming cardiac patients receive electrocardiograms within 10 minutes of arrival, receive clot-busting drugs within 30 minutes and undergo angioplasty — opening clogged arteries with balloons — within 90 minutes.
Nearly 60 per cent of men in the study received clot-busting drugs within the recommended time frame. For women, that rate was less than 40 per cent. About 38 per cent of men got an ECG within 10 minutes, compared to about 30 per cent of women. There was no statistically significant difference between the time to angioplasty for men and women, but only around 50 per cent underwent the procedure within the recommended time.
Dr. Paul Armstrong, a cardiologist at the University of Alberta, said there are details missing from the study that make it difficult to assess the findings.
For one thing, Armstrong said, the researchers don’t indicate whether the patients arrived in the emergency department by ambulance or under their own steam. That typically plays a role in how quickly patients are triaged, he said, and if more male patients arrived by ambulance that could have had an impact on the findings.
As well, Armstrong noted that only people who survived the cardiac event were included in the study. Nothing is known about whether some patients died in the emergency room or before they could be interviewed by the study nurse. If there were differences there between the breakdown of male and female patients, that could also have an impact on the outcome, he said.
Another finding of the study related to patients showing signs of anxiety. Women with this symptom were less likely than other women to have an ECG within the recommended 10-minute window; the same was not true for men.
Pelletier suggested this may mean emergency room staff were mistaking cardiac events in younger women for panic attacks.
“It’s well known today that people presenting to the ER with non-cardiac chest pain and when they are anxious, sometimes they are having a panic attack,” she said. “These patients are more often women compared to men.”
The combined findings suggest emergency department staff need to consider the possibility that younger patients are undergoing cardiac events, she said.

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