Heart disease is the leading cause of death
among men and women in the
United States, killing nearly 700,000 people a year.
But studies have long shown that women are more likely than men to dismiss the
warning signs of a heart attack, sometimes waiting hours or longer to call 911
or go to a hospital.
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Now researchers are trying to figure out why.
They have found that women often hesitate to get help because they tend to have
more subtle heart attack symptoms than men — but even when they do go to the
hospital, health care providers are more likely to downplay their symptoms or
delay treating them. Health authorities say that heart disease in women remains
widely underdiagnosed and undertreated, and that these factors contribute to
worse outcomes among women and heightened rates of death from the disease.
Most studies suggest that a major reason women
delay seeking care — and are often misdiagnosed — is because of the symptoms
they develop. While chest pain or discomfort is the most common sign of a heart
attack in both sexes, women who have heart attacks are far less likely than men
to have any chest pain at all. Instead, they often have symptoms that can be
harder to associate with cardiac trouble, like shortness of breath, cold
sweats, malaise, fatigue, and jaw and back pain. A report by the American Heart
Association found that heart attacks are deadlier in women who do not exhibit
chest pain, in part because it means both patients and doctors take longer to
identify the problem.
But when women suspect they are having a heart
attack, they still have a harder time getting treated than men do. Studies show
they are more likely to be told that their symptoms are not cardiovascular-related.
Many women are told by doctors that their symptoms are all in their head. One
study found that women complaining of symptoms consistent with heart disease —
including chest pain — were twice as likely to be diagnosed with a mental
illness compared to men who complained of identical symptoms.
Women face longer waits and slower diagnoses.
In a study published this month in the Journal
of the American Heart Association, researchers analyzed data on millions of
emergency room visits before the pandemic and found that women — and especially
women of color — who complained of chest pain had to wait an average of 11
minutes longer to see a doctor or nurse than men who complained of similar
symptoms. Women were less likely to be admitted to the hospital, they received
less thorough evaluations and they were less likely to be administered tests
like an electrocardiogram, or EKG, which can detect cardiac problems.
Dr. Alexandra Lansky, a cardiologist at
Yale-New Haven Hospital, recalled one patient who had gone to multiple doctors
complaining of jaw pain, only to be referred to a dentist, who extracted two
molars. When the jaw pain didn’t go away, the woman went to see Lansky, who
discovered the problem was heart-related. “She ended up having bypass surgery
because the jaw pain was heart disease,” said Lansky, who directs the Yale
Cardiovascular Research Center.
Over the years, health authorities have tried
to address the gender gap in cardiovascular care through a variety of public
service campaigns. The federal government and the American Heart Association
launched campaigns to increase awareness of heart disease and its symptoms
among women, as did the Women’s Heart Alliance, which started placing ads last
year on Facebook, Instagram, and thousands of radio and television stations.
Set to music from Lady Gaga, the group’s ads urge women to “know the signs” of
a heart attack, which it cautions can be as vague as sweating, dizziness or
unusual fatigue.
In January, a group of scientists published a
study that delved into the factors that drive women to delay seeking care for
their cardiac troubles. They found that the absence of chest pain or discomfort
was a major reason. The study, published in the journal Therapeutics and
Clinical Risk Management, looked at 218 men and women who were treated for
heart attacks at four different hospitals in New York before the pandemic. It
found that 62% of the women did not have any chest pain or discomfort, compared
with just 36% of the men. Many women reported shortness of breath as well as
gastrointestinal symptoms like nausea and indigestion. About one-quarter of the
men also reported having either shortness of breath or gastrointestinal
distress.
Ultimately, 72% of women who had a heart
attack waited more than 90 minutes to go to a hospital or call 911, compared
with 54% of men. Slightly more than half of the women called a relative or a
friend before dialing 911 or going to a hospital, compared with 36% of the men.
Heart disease is rising in younger women.
“There’s a lack of understanding in both women
and men that a heart attack does not have to cause chest pain or these
incredible movie-like symptoms,” said Dr. Jacqueline Tamis-Holland, an author
of the January study and a cardiologist at Mount Sinai Morningside in New York.
Tamis-Holland said there were other reasons
for the delays. One is that women don’t consider themselves to be as vulnerable
to heart disease as men. Previous studies have shown that they are more likely
to dismiss their symptoms as stress or anxiety. They also tend to develop heart
disease at later ages than men. In Tamis-Holland’s study, the women who had
heart attacks were, on average, 69 years old, while the average age of the men
was 61.
But younger women are not immune to heart disease.
In fact, recent studies have found that heart attacks and deaths from heart
disease have been rising among women between ages 35 and 54, in part because of
an increase in cardiometabolic risk factors like high blood pressure and
obesity.
Experts say that more outreach and education
is needed to help women and men recognize the signs and risk factors for heart
disease. But Lansky said she also wants to empower people to become advocates
for themselves. If you suspect something is wrong with your health then do not
let a health care provider turn you away until you have answers, she said.
“If you’re not feeling right and you think
that in the realm of possibilities is an issue with your heart, then you should
spell it out,” she said. “Say: ‘I am concerned I may be having a heart attack,
and I want an EKG just to be sure.’ Nobody in the emergency department is going
to say you can’t have it. But sometimes they’re just not thinking about it, so
it’s good to flag it.”
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