11 May Young Women With Chest Pain Evaluated Differently Than Men
MedicalResearch.com Interview with:
Darcy Banco, MD, MPH
Internal Medicine Resident
NYU Langone Health
MedicalResearch.com: What is the background for this study?
Response: We became interested in this question because of recent epidemiological data showing that despite improvements in the number of heart attacks in overall population, that number is rising among young adults (<= 55 years old) and in particular, young women. Compared to young men, young women with heart attack experience more delays in care and have higher mortality and poorer quality of life after heart attack.
Despite these findings, there was also a study that asked young adults who had experienced heart attack: “When you first went for help, did the health care providers think that you were having a problem with your heart?” Women were more likely to answer no to this question.
Therefore, our study asked: Are young women evaluated and treated differently than men when presenting to the emergency room with symptoms of chest pain?
MedicalResearch.com: What are the main findings?
Response: Our study found that young women were less likely to be triaged as urgent or emergent, waited longer for evaluation by a provider and were less likely to undergo ECG testing, to be seen by a consultant in the ED, or to be admitted to the hospital or to observation. After adjustment for differences in baseline characteristics, women with chest pain were 40% less likely to be admitted to the hospital or to an observation unit and waited an average of 10 minutes longer compared to young men.
MedicalResearch.com: What should readers take away from your report?
Response: If seeking medical attention for symptoms of chest pain or discomfort, women should consider asking their doctor, “Am I having a heart attack? How can you be sure?”
The most common symptom of a heart attack is chest discomfort, even in women, but it’s important for women to know that the discomfort may not feel like something they would call pain. It could be pressure, tightness or another uncomfortable feeling. Also, research shows that women have a broader range of accompanying symptoms which may not initially be recognized as a sign of a heart attack. Women should seek care right away if they experience new chest discomfort, difficulty breathing, nausea, vomiting, fatigue, sweating or back pain, as these could all be signs of a heart attack. Women should trust their instincts. The most important thing a woman can do is to get medical care right away if she is worried, and to ask specific questions of her doctor.
At the same time, clinicians should always consider heart attack as a potential explanation for a patient’s chest pain. It can challenging to diagnose young adults with heart attack because it is not an exceedingly common diagnosis, but it can have serious consequences for patients. Young women are at risk for heart attack and, when they do experience heart attack, have poorer outcomes than young men. When encountering patients with chest pain, providers should keep in mind the changing demographics of heart attack toward more young patients.
As health care providers, we should continue to learn about how best to triage and diagnose patients with heart attacks, particularly among those who have historically been under-diagnosed or under-treated such as women.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The next studies should link these potential delays in care and diagnosis to clinical outcomes. For example, of the people that were discharged from the emergency room, did they come back with recurrent symptoms? Due to limitations in our data, we were unable to do this analysis.
There should also be increased attention on the role of non-traditional risk factors, which we know are more common in women, like hypertensive disorders of pregnancy, mental health disorders and autoimmune disorders. These risk factors are not currently part of common risk stratification tools used by physicians, but can increase a woman’s risk of having a heart attack.
Historically, there has been a dearth of research on how to diagnose and treat heart attacks in women, which can have some unique features compared to those seen in men. There has been an emphasis on this in recent years, but there are still questions about how to best risk stratify, diagnose, and treat certain types of heart attack that are seen more frequently in women.
Sex Differences in Evaluation and Management of Young Adults Presenting to the Emergency Department with Chest Pain.
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