Women take longer to notice symptoms of heart disease

Heart disease is the leading cause of death for both men and women in the United States, killing nearly 700,000 people each year. But studies have indicated for years that women are more likely than men to dismiss the warning signs of a heart attack, sometimes waiting hours or longer before calling the emergency number or going to the hospital.

Researchers are now trying to understand why. They found that women are often hesitant to seek medical care because they tend to have more subtle heart attack symptoms than men — but even when they do go to the hospital, doctors are more likely to downplay the urgency of their symptoms or delay. the treatment.

Health officials say that heart disease in women remains largely underdiagnosed and undertreated, and that these factors contribute to worse outcomes and higher death rates among women.

Most studies suggest that the main reason why women are slow to seek medical help and why they are often misdiagnosed is the symptoms they experience.

While chest pain or discomfort is the most common sign of a heart attack in both men and women, women who experience a heart attack are much less likely than men to experience any chest pain. Instead, they often have symptoms that can be difficult to link to heart problems: shortness of breath, cold sweats, malaise, fatigue, jaw and back pain.

An American Heart Association article found that heart attacks are more lethal in women who don’t have chest pain, in part because it means it takes patients and doctors longer to identify the problem.

But even when women suspect they are having a heart attack, they find it more difficult than men to receive treatment.

Studies show that they are more likely to be told that their symptoms do not have a cardiovascular origin. Many women hear from their doctors that the symptoms are all in their head.

One study found that women who complain of symptoms consistent with heart disease, including chest pain, are two times more likely to be diagnosed with a mental illness, compared with men who complained of identical symptoms.

Women face longer waits

In a study published this month in the Journal of the American Heart Association, researchers analyzed data from millions of emergency room visits before the pandemic and found that women who complained of chest pain, especially women of color, had to wait in average 11 minutes longer to be seen by a doctor or nurse than men who complained of similar symptoms.

Women were less likely to be admitted to hospital, received less thorough medical evaluation and were less likely to have tests such as an electrocardiogram, which can detect heart problems.

Cardiologist Alexandra Lansky, from Yale-New Haven Hospital, in the United States, mentioned a patient who went to several doctors to complain of jaw pain, but was referred to a dentist, who extracted two molars. When the jaw pain didn’t go away, the woman went to Lansky, who discovered the cardiac origin of the problem.

“She ended up having heart bypass surgery because her jaw pain was caused by heart disease,” said Lansky, who directs the Yale Center for Cardiovascular Research.

Over the years, health authorities have launched several public campaigns to try to close the gender gap in cardiovascular care. The federal government and the American Heart Association have launched awareness campaigns for heart disease and its symptoms in women.

The Women’s Heart Alliance has followed suit, having last year started running ads on Facebook, Instagram and thousands of radio and television stations. Set to music by Lady Gaga, the ads urge women to “recognise the signs” of a heart attack, warning that they can be as pervasive as sweating, dizziness or unusual fatigue.

In January, a group of scientists published a study that investigated the factors that make women delay seeking medical care for their heart problems. The study concluded that the absence of chest pain or discomfort is one of the major reasons.

Published in the specialist journal Therapeutics and Clinical Risk Management, the study looked at 218 men and women who received care for a heart attack at four separate New York hospitals before the pandemic. It found that 62% of women felt no pain or discomfort in their chest, compared with just 36% of men. Many women have reported shortness of breath and gastrointestinal symptoms like nausea and indigestion. About a quarter of men also reported feeling short of breath or having gastrointestinal discomfort.

In the end, 72% of women who had a heart attack waited longer than 90 minutes to go to a hospital or call the 911 emergency number, versus 54% of men. Just over half of the women called a family member or friend before calling 911 or going to the hospital, which was done by only 36% of men.

Heart disease is on the rise among younger women

“Neither women nor men understand that a heart attack doesn’t necessarily have to cause chest pain or dramatic symptoms like you see in movies,” commented Dr. Jacqueline Tamis-Holland, author of the January study and a cardiologist at Mount Sinai Morningside in New York.

According to her, there are other factors that motivate the delay. One is that women do not consider themselves as vulnerable to heart disease as men.

Previous studies have also shown that they are more likely to dismiss their symptoms, attributing them to stress or anxiety. They also tend to develop heart disease at an older age than men.

In the Tamis-Holland study, women who had a heart attack were on average 69 years old, while the average age of 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 are on the rise among women aged 35 to 54, in part due to an increase in cardiometabolic risk factors such as hypertension and obesity.

Experts say more information and education is needed to help women and men recognize the signs and risk factors of heart disease.

But Lansky said he also wants to empower people to champion their own cause. If you suspect something is wrong with your health, don’t let the doctor or hospital turn you down until they get answers.

“If you’re not feeling normal and you think a heart problem is one of the possible causes, make that explicit,” she recommended. “Say, ‘I think I might be having a heart attack and I want to get an EKG just to be sure.’ . So it’s good to mention it.”

Translation by Clara Allain