The study looked at 1,123 men and women aged 18 to 55 years who were admitted for acute coronary syndromes (heart attacks or myocardial infarctions and their precursors, such as angina), from 24 centres across Canada, one in the United States and one in Switzerland.
Heart attacks or acute coronary syndromes (ACS) are caused by blockages of the blood supply to the heart muscle, and treatment is usually aimed at getting rid of the block.
Researchers looked at time-intervals from presentation to various treatments, including:
- Time to balloon catheter (which stretches the block open).
- Time to removal of the blockage, either by putting in a stent or through medications that break down clots called fibrinolytics.
Men received faster access to ECGs than women with average times of 15 and 21 minutes respectively, as well as faster access to fibrinolytics than women, with average times of 28 and 36 minutes, respectively. Men were also more likely to undergo invasive procedures than women overall (66 per cent versus 48 per cent).
To explain this delay, differences in clinical presentation as well as gender traits were assessed. Traditionally, men who have ACS, present with chest pain more commonly than women, making diagnosis easier and and treatment quicker. Women, on the other hand, are known for their atypical presentations and do not always get chest pain, presenting with '‘silent" heart attacks that delay their treatment.
As expected, clinical differences between sexes were present. Women presented with more silent ACS as well as more risk factors like high blood pressure, diabetes, and a family history of heart disease. Anxiety levels were similar across the sexes, but interestingly, women who presented with increased anxiety were more likely to get delayed care than men.
"Patients with anxiety who present to the emergency department with non-cardiac chest pain tend to be women, and the prevalence of acute coronary syndrome is lower among young women than among young men," writes Dr. Louise Pilote, clinician-researcher, Division of Clinical Epidemiology at the Research Institute of McGill University Health Centre in Montréal, and professor of medicine at McGill University with coauthors.
"These findings suggest that triage personnel might initially dismiss a cardiac event among young women with anxiety, which would result in a longer door-to-ECG interval."
But while these clinical differences were present, the authors were surprised to find they were less significant than differences in gender-related traits. Patients were asked to complete a validated survey that asked about gender-related issues such as "traditional" masculine and feminine traits of personality, responsibility for housework, education level and health status before the event.
"We expected there would be differences but thought they would be more biological than gender related," Roxanne Pelletier, one of the lead investigators of the study, tells CBC News. "We’re not sure why this is the case. Individuals in the study with feminine traits tended to be more vague and not assertive enough when talking about the pain, and were not able to describe their symptoms well to the health care workers."
While there is definitely more work to be done in the area of gender-related differences in access to care, Pelletier suggests that the take-home message is that how people present to the emergency department will have a big impact on their treatment.
"It is important for people to be assertive and clear about their symptoms when they get to the hospital."
Dr. Meera Dalal is a journalism fellow at the Munk School of Global Affairs at the University of Toronto.