TORONTO - Younger women experiencing a heart attack or other cardiac event wait longer for essential care in emergency rooms than men of a similar age, a new study suggests.
The research also found that both women and men who score as having more feminine traits on a standardized test wait longer for care as well.
The lead author of the study, Roxanne Pelletier, said the findings suggest younger people of both genders who go to hospital with suspected heart attacks need to be clear about their symptoms.
"Both men and women need to know that the way they present themselves and the way they report their symptoms may have an important influence on their access to care," said Pelletier, a clinical psychologist and post-doctoral fellow at McGill University Health Centre in Montreal.
"And so they need to know that they should be assertive when expressing their needs and reporting their symptoms. And they need to be concise and precise when reporting their symptoms."
If they are suffering from chest pain, that should be the first symptom they report, and the symptom they stress, Pelletier said.
The study was published Monday in the Canadian Medical Association Journal.
It's well known that diagnosing heart attacks in older women can be more difficult than in older men, and that those women sometimes do not get the same level of care or the same speed of care that men do.
But less is known about younger adults who have cardiac events and whether sex or gender influences the speed of care they receive.
So Pelletier and colleagues set out to look at the question, enrolling 1,153 cardiac patients aged 18 to 55 between January 2009 and April 2013. A total of 24 Canadian hospitals, one Swiss hospital and one American hospital took part in the study.
Participants were people who were hospitalized after a cardiac event, with nurses gathering health information and conducting interviews to score them for feminine versus masculine traits and roles within 24 hours of the patient's admission to hospital.
The researchers wanted to see whether sex alone — male or female — appeared to be predictive of time to care or whether gender-related characteristics also might be influencing care. So they used a standard questionnaire to score patients on traits like shyness, gullibility, sensitivity to others and compassion.
They saw that regardless of sex, patients who presented with more typically feminine traits experienced longer delays and were less likely to receive some of the invasive procedures than patients who scored higher on the masculine traits side did.
"At the triage, maybe these patients are just less assertive," Pelletier said.
It should be noted that most of the patients did not receive standard treatments within the time frames recommended by the American Heart Association and the American College of Cardiology.
Those organizations recommend that incoming cardiac patients receive electrocardiograms within 10 minutes of arrival, receive clot-busting drugs within 30 minutes and undergo angioplasty — opening clogged arteries with balloons — within 90 minutes.
Nearly 60 per cent of men in the study received clot-busting drugs within the recommended time frame. For women, that rate was less than 40 per cent. About 38 per cent of men got an ECG within 10 minutes, compared to about 30 per cent of women. There was no statistically significant difference between the time to angioplasty for men and women, but only around 50 per cent underwent the procedure within the recommended time.
Dr. Paul Armstrong, a cardiologist at the University of Alberta, said there are details missing from the study that make it difficult to assess the findings.
For one thing, Armstrong said, the researchers don't indicate whether the patients arrived in the emergency department by ambulance or under their own steam. That typically plays a role in how quickly patients are triaged, he said, and if more male patients arrived by ambulance that could have had an impact on the findings.
As well, Armstrong noted that only people who survived the cardiac event were included in the study. Nothing is known about whether some patients died in the emergency room or before they could be interviewed by the study nurse. If there were differences there between the breakdown of male and female patients, that could also have an impact on the outcome, he said.
Another finding of the study related to patients showing signs of anxiety. Women with this symptom were less likely than other women to have an ECG within the recommended 10-minute window; the same was not true for men.
Pelletier suggested this may mean emergency room staff were mistaking cardiac events in younger women for panic attacks.
"It's well known today that people presenting to the ER with non-cardiac chest pain and when they are anxious, sometimes they are having a panic attack," she said. "These patients are more often women compared to men."
The combined findings suggest emergency department staff need to consider the possibility that younger patients are undergoing cardiac events, she said.
Related on HuffPost:
1. Not Smoking
While not entirely surprising, it doesn't make the message any less important: <a href="http://www.nhlbi.nih.gov/health/health-topics/topics/smo/" target="_hplink">Smoking kills</a>. The habit is considered the No. 1 cause of preventable death and sickness in the U.S. Specifically, <a href="http://www.nhlbi.nih.gov/health/health-topics/topics/smo/" target="_hplink">smoking cigarettes harms the heart</a> in that it damages heart and blood vessel function, thereby upping the risk of atherosclerosis (where your arteries harden), according to the National Institutes of Health.
2. Being Physically Active
Aerobic exercise is good for the heart in that it makes you take in more oxygen, helps you <a href="http://www.mayoclinic.com/health/aerobic-exercise/EP00002/NSECTIONGROUP=2" target="_hplink">keep to a healthy weight</a>, reduces plaque buildup in the arteries and helps to lower blood pressure, according to the Mayo Clinic. According to the Centers for Disease Control and Prevention, adults are recommended to get at least <a href="http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html" target="_hplink">150 minutes of aerobic exercise</a> a week (moderate to intense level), and also do muscle-strengthening at least twice a week.
3. Maintaining Normal Blood Pressure Levels
<a href="http://www.nhlbi.nih.gov/hbp/bp/bp.htm" target="_hplink">Blood pressure measurements</a> are written in terms of systolic over diastolic. Systolic pressure is "as the heart beats," according to the National Institutes of Health, while diastolic pressure is the relaxation of the heart between heartbeats. A person with a normal blood pressure level has a systolic blood pressure reading of 120 millimeters of mercury or less, and a diastolic blood pressure reading of 80 millimeters of mercury or less. A person is <a href="http://www.nhlbi.nih.gov/hbp/detect/categ.htm" target="_hplink">considered hypertensive</a> (has high blood pressure) when the systolic blood pressure is between 140 and 159, and the diastolic blood pressure is between 90 and 99.
4. Maintaining Normal Blood Glucose Levels
Having chronically <a href="http://diabetes.webmd.com/blood-glucose" target="_hplink">high levels of glucose</a>, a kind of sugar, in the blood can lead kidney and blood vessel damage, according to WebMD. Insulin, a hormone in the body, is responsible for helping the body's cells to <a href="http://www.medicinenet.com/insulin/article.htm" target="_hplink">use glucose in the blood</a>. However, if the body doesn't have enough insulin or isn't able to use it properly, then <a href="http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hyperglycemia.html" target="_hplink">blood sugar levels may rise</a>, according to the American Diabetes Association. High blood sugar is considered a diabetes complication. Tests to check for high blood glucose can help show whether a person has diabetes, and are used to <a href="http://diabetes.webmd.com/blood-glucose" target="_hplink">monitor someone with diabetes</a> over time, WebMD reported.
5. Maintaining Normal Total Cholesterol Levels
<a href="http://www.nhlbi.nih.gov/health/public/heart/chol/wyntk.htm" target="_hplink">High cholesterol</a> is a known risk factor for heart disease, because it causes hardening of arteries going to the heart, according to the National Institutes of Health. When part of the heart is deprived of blood, it could trigger a heart attack. The <a href="http://www.nhlbi.nih.gov/health/public/heart/chol/wyntk.htm" target="_hplink">optimum total cholesterol level</a> is 200 or fewer milligrams of cholesterol per deciliter of blood, while having a total cholesterol level of 200 to 239 milligrams per deciliter is considered borderline high. High total cholesterol is having 240 milligrams of cholesterol per deciliter of blood, or more, according to the National Institutes of Health.
6. Having A Healthy Weight
Calculating your body mass index (BMI, a ratio of weight to height) is a good starting point for knowing if you're at a <a href="http://www.cdc.gov/healthyweight/assessing/index.html" target="_hplink">healthy weight</a>, according to the Centers for Disease Control and Prevention. According to the BMI chart, having a BMI of 18.5 or below is considered "underweight" and a BMI of 18.5 to 24.9 is considered "normal" or healthy weight. A BMI of 25 to 29.9 is considered overweight, and a BMI of 30 and above is considered obese. <a href="http://www.nhlbisupport.com/bmi/" target="_hplink">Click here to calculate your BMI</a>. <a href="http://www.cdc.gov/healthyweight/assessing/index.html" target="_hplink">Waist circumference</a> can also give clues to your weight; a man may be at risk for health problems from obesity if his waist circumference is more than 40 inches, the CDC reported. For a non-pregnant woman, it's more than 35 inches.
7. Eating A Healthy Diet
While there are obviously differences in opinion depending on who you ask as to what you should or shouldn't eat for optimal health, there are some <a href="http://www.mayoclinic.com/health/heart-healthy-diet/NU00196" target="_hplink">heart-healthy nutrition rules</a> that remain true across the board. The Mayo Clinic reports that eating a diet low in cholesterol and "bad" fats (saturated and trans fats), with low-fat proteins (like lean meats, fish and beans), whole grains (with lots of fiber), and little sodium is good for your heart. For more nutrition advice, <a href="http://www.mayoclinic.com/health/healthy-diet/NU00200" target="_hplink">click over to the Mayo Clinic</a>.
Follow a heart healthy diet to reduce your risk of coronary disease.