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Female Heart Patients Experience More Emergency Room Delays

Cara

As sad as it is that there has to be an addition to our discussion from last week regarding the gender disparities in kidney transplants, this article about disparities in emergency room care for those experiencing heart trouble does make a nice one, as far as things go.

Researchers at Tufts Medical Center in Boston examined 5,887 emergency calls about suspected cardiac symptoms in Dallas County, Tex. About half of the calls were made by women.

Ambulances arrived just as quickly for women as for men, the researchers found. Patients of both sexes spent an average of 34 minutes in the care of emergency medical workers, including about 19.9 minutes of care on the scene and 10.3 minutes spent traveling to the hospital.

But 647 patients, about 11 percent, were delayed, spending 45 minutes or longer in the care of emergency workers.

Women were 52 percent more likely than men to be among the delayed, said Thomas W. Concannon, an assistant professor of medicine at Tufts University who was lead author of the study, published this month in Circulation: Cardiovascular Quality and Outcomes.

It’s suggested that the delays could be due to a lower rate of professionals recognizing the signs of heart trouble in female patients.  This seems plausible to me, as the symptoms commonly described for heart attacks largely don’t apply to women.  Further, I think that heart disease is typically framed as a men’s health issue.  Just look at which heart attack survivors typically make it on talk shows, are portrayed on scripted film and television, featured in commercials for cardiovascular treatment/drugs, etc.  This is the case even though women have heart attacks at the same rate as men and are in fact more likely to die from them.

Of course, as is always the case, other factors could very, very easily be at play both instead of or in addition to the ones above.  Some of them ascribe more sinister motives to the problem, and some of them more institutional.  But just like with the kidney transplant issue, we’ve got reason to worry and demand both solutions and answers, regardless.

16 thoughts on Female Heart Patients Experience More Emergency Room Delays

  1. It’s very hard to interpret these statistics. They appear to say that on average, men and women had 20 minutes of on-scene care before being put in the ambulance and taken to the hospital for a ten-minute ride.

    But 647 (11 percent) of the patients had 31 minutes or more of on-scene care before being loaded into the ambulance. Of these, 388 were women and 259 were men.

    So, roughly 13% of the women patients had 11 extra minutes or more of on-scene care, while roughly 9% of the men had 11 extra minutes or more of on-scene care.

    In order to have equal treatment times for men and women – in order to bring the woman’s figure down to the level of the men’s figure –on scene treatment time of roughly 4% of the women – that is, 117 women – would have to be reduced by 11 or more minutes.

    Given that women’s heart attacks are harder to diagnose than men’s because the symptoms are more diffuse and variable, there may be nothing inappropriate in the fact that emergency workers needed 11 extra minutes in 4% of the cases to diagnose a heart attack among women.

    Or maybe there is something inappropriate. But you can’t tell that from these figures.

  2. Could you provide a reference to the actual journal article (ie. authors, title, journal)? Newspapers and magazines are notoriously bad about accurately representing research results.

    Until reading the actual article and perhaps some background research that led to the study I would say any conclusions would be premature.

    I’d say the whole study is probably less relevant than the need to expand research to further understand how heart disease specifically develops and affects women.

    Maybe not, who knows?

  3. From the NY Times article, lead author is Thomas W. Concannon, and it’s in this month’s Circulation: Cardiovascular Quality and Outcomes.

  4. So basically at least from my reading of this article is that it’s not the health care providers that are sexist but those who prepare the manuels, textbooks, and training packages that do not include women’s symptoms? I think it was one of our textbooks at our college actually mentioned that there are few trials and studies even done on women and heart disease, that is with drug trials included.

  5. I agree with Bloix; it’s really hard to interpret what exactly this means. But I’m still very very concerned, and also agree with Cara’s assertion that we should be demanding more answers.

    BTW, I’d never really noticed the disparities on heart attack survivor shows/movies/etc, but I’ll watch for that. Thanks for the heads-up.

  6. I do agree that the heart attack is a stereotypical medical emergency – the sufferer is the hard-charging, powerful mid-life male. Heart attacks are either ironic- the body betrays the personality – or tragic – the personality’s flaw (over-aggressiveness) causes the body’s failure. The dramatic function of the heart attack works in stereotypical narratives of a certain type of man but not for in any kind of woman.

  7. I have to tell you, back when I was an EMT, we were taught only one set of symptoms for heart attack, and those were ones primarily occuring in men. When I took CPR and First Aid last year, I got the same series of symptoms. Nothing was mentioned about the fact that men and women tend to have differing symptoms in a heart attack, so I doubt much has changed in the education of emergency personnel in the last 20 years.

    And, yes, that needs to change.

  8. I recall back in ye olde college days trying to have a discussion with my (mostly male) friends about gendered health disparities, and about how health care education teaches that the male body is the norm, and to treat the female body you have to learn extra.

    They responded with absolute disbelief, and a complete unwillingness to even explore the possibility that this was true. I think that attitude is common. Medicine is SCIENCE, there’s no way there could be any BIAS! Science is 100% objective!

    This stony refusal to even consider that the effects of a centuries-long history of medical and scientific bias against women (and others) may have any bearing on the practice of medicine or science today.

    It makes me so angry! The refusal to consider even hypothetically the existence of bias is just another form of perpetuating it. We are afraid that if we consider it, it will turn out to be true, and then we’d have to do something about it.

  9. This study is only part of a much larger problem. As Maritzia and idyllicmollusk point out, there’s a huge problem with how EMT’s and other medical personnel are trained concerning heart disease. Why? Virtually all research into heart disease prior to the 1990’s was done on men exclusively. The American Heart Association didn’t have guidelines for women with heart disease until 2003.

    In that environment, this study is only one small part of a larger trend towards women getting substandard care when it comes to heart disease. Extensive studies of the issues have revealed that women are less likely to be accurately diagnosed promptly if they’re diagnosed correctly at all, more likely to be erroneously discharged after displaying cardiac symptoms, less likely to receive aggressive treatment, etc. No wonder that, despite equal rates of heart disease, women have a greater chance of dying of it.

  10. Melinda,
    Most work done in the ’90s suffered from a couple of biases.One;premenopausal women don’t have MI’s(they do-but at a lower rate0 and two-drug companiews hesitate to do studies on woman of child bearing age-even retrospective.I’d like more data on this.mainly to know how many of these women were missed heart attacks.when I was a young man(dee-dee diddle diddle do) ,I’d automatically think MI:then I learned about peripheral neuropathy,panic attacks(disproportionately female), thoracic outlet,Tietsche’s syndrome,GERD,and other things.So,if a disproportionate number of female MI’s were missed,it’s one thing.If a disproportionate number of hyperventilating ER presenters were female and correctly not worked up as R/O Mi it’s something else.Frankly,this is a pretty skimpy post.
    (But then,what do I know.It’s not as if I had ever taken care of an MI patient)

  12. This is awful. My wife told me that women have different symptoms and if she has them to call 911. Now, if SHE knows, and she’s NOT a medical employee, why don’t the EMT’s and the DOCTORS know? How do they graduate med school and EMT school without knowing these basics? Maybe the USA is falling down in this area like all areas now. This whole thing disgusts me.

  13. @Jose, maybe? The US has the highest rate of medical mistakes among developed countries, as well as some other really poor measures. The idea that the US is superior in this area is a myth. And this is not new.

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