From Our 2009 Archives

Gender Gap in Heart Care Extends to 911

Women More Likely Than Men to Experience Delays Getting to the Hospital

By Salynn Boyles
WebMD Health News

Reviewed By Elizabeth Klodas, MD, FACC

Jan. 13, 2009 -- Women who call 911 with cardiac complaints are about 50% more likely than men to experience delays getting to the hospital after an ambulance arrives, new research shows.

No difference was seen in the time it took emergency medical services (EMS) to respond to calls from men and women. But once help arrived, women were much more likely than men to experience significant delays during their time in EMS care.

Researchers tracked nearly 6,000 911 calls made on behalf of patients with suspected cardiac symptoms across 10 municipalities in Dallas County, Texas, during 2004. About half the patients were women and half were white.

They found that the average time in EMS care was about 34 minutes, with about 20 minutes spent at the scene of the call and 10 minutes spent en route to the hospital.

A total of 11% of patients spent an extra 15 minutes or more in EMS care, and women were 52% more likely than men to be in this group.

"We don't have enough information about these patients to fully understand why women were more likely to experience delays, but the findings are similar to what has been seen elsewhere in cardiac care," lead researcher Thomas W. Concannon, PhD, of Boston's Tufts Medical Center tells WebMD.

Cardiac Care Gender Gap

The report comes less than a month after a separate investigation found that women are more than twice as likely as men to die when hospitalized with the most serious type of heart attack.

And numerous studies suggest that women with heart disease and those who have heart attacks and other cardiac events often receive less aggressive treatment than men.

"We know that diagnosis of coronary heart disease in women is often delayed, especially when compared with their male counterparts," New York University cardiologist Jennifer H. Mieres, MD, says in a news release.

Mieres, a spokeswoman for the American Heart Association, says that when classic heart attack symptoms like shortness of breath and chest tightness occur in women, the symptoms are more likely to be attributed to non-cardiac causes.

Women having heart attacks are more likely to experience non-classic symptoms, including extreme fatigue, dizziness, and nausea.

Concannon and colleagues write that this might explain the gender differences they saw in the study.

"Inappropriate delays may occur because there is less certainty of cardiac involvement, because more time is spent diagnosing the condition, because the patient's condition may not be seen as emergent, or as a result of a combination of these factors," they note in the latest issue of the American Heart Association journal Circulation.

EKGs May Contribute to Delay

In an accompanying editorial, emergency medicine specialist Joseph P. Ornato, MD, suggests that other factors may be involved, including attempts to preserve the modesty of female patients.

Ornato leads the department of emergency medicine at Virginia Commonwealth University in Richmond.

EMS medics often perform electrocardiograms (EKGs) on patients with cardiac complaints before transporting them to a hospital -- a practice that involves placing electrodes around the chest area.

Ornato confirmed that this was the practice in Dallas County at the time the study was conducted.

He tells WebMD that the extra minute or two devoted to preserving a woman's modesty while performing an EKG may contribute to delays.

And because the study did not include cardiac outcomes, there is no way to know if women had the same number of heart attacks and other serious cardiac events as men. If they did not, and had more normal pre-transportation EKGs as a result, this could explain the gender gap.

"This study is an important first step, but like all good studies it raises more questions than it answers," he says. "The next logical step is to focus only on patients (with cardiac complaints) who have abnormal EKGs. If there is still a gender difference in these patients, then it is clear we have a problem."

SOURCES: Concannon, T.W., Circulation, published online. Thomas W. Concannon, PhD, assistant professor of medicine, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston. Joseph P. Ornato, MD, FACP, professor and chairman, department of emergency medicine, Virginia Commonwealth University, Richmond, Va. Jennifer Mieres, MD, director of nuclear cardiology, New York University School of Medicine; spokeswoman, American Heart Association. WebMD Medical News: "Deadliest Heart Attack Takes Toll on Women."

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