Medical Research: What is the background for this study? What are the main findings?
Dr. Lichtman: Heart disease in younger women (18-55 years of age) is relatively rare, and represents less than 5% of all heart disease in women; however, young women who present with a heart attack are twice as likely to die in the hospital as compared with a similarly aged man, and this excess mortality risk continues beyond the index event. Delays in seeking prompt care has been suggested as one potential cause for the excess mortality in young women. We were interested in learning about the recognition of symptoms, perceived risk of heart disease, decision-making process to seek medical care, and interactions with the healthcare system among young women who recently had a heart attack. We found that even though the majority of young women presented with chest pain, they also experienced many other symptoms such as fatigue, nausea, muscle pain, and weakness. They commonly attributed symptoms to non-cardiac conditions because they felt they did not experience the “Hollywood Heart Attack” that is commonly portrayed in the media. Interestingly, despite reporting a strong family history of cardiac disease, and having multiple risk factors, many of the women we spoke with did not perceive they were at risk for heart disease, and many were not working with their physicians to manage their risk factors. They were also concerned about being seen as a hypochondriac if they reported their symptoms. Finally, women reported that the healthcare system was not consistently responsive when they reported their symptoms.
Medical Research: What should clinicians and patients take away from your report?
Dr. Lichtman: Clinicians can have an important impact by discussing potential heart disease risk with young women, particularly those with a strong family history of heart disease and traditional risk factors for heart disease (high blood pressure, high cholesterol, obesity, smoking status, diabetes). Clinicians and care providers should also help empower women to discuss their symptoms without stigma or perceived judgment, and care providers should listen carefully for symptoms that may be associated with a heart attack, regardless of patient age. Patients should recognize that although chest pain is the most common symptom of heart disease, other symptoms women report include jaw or chest pain, weakness, and nausea. A young women with a strong family history of heart disease and traditional risk factors for heart disease should work with their care providers to prevent their risk of heart disease, but should also realize that they are not immune from heart disease due to age.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Lichtman: Future research is needed to identify effective strategies to promote better cardiovascular knowledge, improve preventive health practices, and promote prompt care-seeking behaviors for younger women at increased risk for heart disease.
MedicalResearch.com Interview with:Judith Lichtman, PhD, MPH (2015). Young Women With Heart Attack May Have Confusing Symptoms