Researchers found that women waited longer to receive a life-saving cardiac treatment and experienced worse outcomes than men.
Once thought of as a disease that mainly affected men, research has shed light on the fact that heart disease and stroke are the primary cause of premature death among Canadian women. Despite increased awareness and understanding of these risks, women with a form of heart attack called ST-elevation myocardial infarction (STEMI) waited longer for the recommended treatment and experienced worse outcomes than their male counterparts, according to research led by Vancouver Coastal Health Research Institute researcher Dr. Christopher Fordyce.
“These results point to a need for further investigations on how health care protocols can be introduced or adjusted to shorten the treatment interval and improve health outcomes for women presenting with STEMI and other heart conditions,” says Fordyce.
STEMI occurs when a block in a coronary artery stops the flow of oxygen- and nutrient-rich blood to the heart. Acute STEMI requires urgent care, as patients are at risk of sudden cardiac arrest. Delaying treatment can lead to heart muscle atrophy and cell destruction due to a lack of blood flow to the area.
“The saying among clinicians goes that ‘time is muscle’,” says study co-investigator, Dr. Erin Rayner-Hartley. “The longer that an artery is blocked and a heart attack is ongoing without the artery being reopened, the more likely that the cardiac muscle could be damaged.”
More sex-specific protocols are needed to prevent care disparities
Fordyce and Rayner-Hartley’s study, published in the Clinical Cardiology, examined 1,928 STEMI patients who received a primary percutaneous coronary intervention (PCI) procedure. The non-surgical procedure involves threading a flexible hollow tube, called a catheter, up to the heart and expanding a small balloon to part fatty tissue that is blocking blood flow. The reopened coronary artery is then shored up with a stainless steel mesh stent.
Fordyce and his team found that the average time between first contact with a family doctor, paramedic or other health care provider and when a patient arrived in the emergency room was longer for women than men—26 minutes versus 22 minutes. So, too, was the time between first medical contact and when a female patient received heart treatment—109 minutes for women compared with 101 minutes for men.
The 21.4 per cent of the study cohort who were women also tended to have worse outcomes. This, Rayner-Hartley says, is likely because women had more comorbidities than men when they arrived in hospital with STEMI, it took longer to reestablish their blood flow and they also tended to be older on average than men.
“These findings were unexpected,” she notes. “Although many factors likely contributed to the differences in wait times, it is important that we highlight what we discovered so that researchers and practitioners pay more attention to how to enhance women’s heart care moving forward.”
While the disparity between wait times and outcomes was significant, the study team found that this did not result in more deaths among women than men.
“We know that when PCI is administered in a timely fashion, the rate of survival is greater, which is really one of the most important outcomes that we are striving for, as well as that patients live long and healthy lives after treatment,” says Rayner-Hartley.
Still, Rayner-Hartley believes that more action will be needed in the next while to raise awareness and change protocols to close the gap between the sexes.
“Heart conditions have not traditionally been considered a women’s disease; however, we know by the data that women seem to be at higher risk of heart disease and heart attack than men.”
“Despite there being quite a lot of awareness about the fact that men and women experience health conditions, including heart disease, in unique ways, we are still seeing statistical differences in treatment times,” she says. “This means that we need to recognize that women have separate heart health needs and have the potential to be higher risk patients.”