A new study led by the Research Institute of the McGill University Health Centre (RI-MUHC) in Montreal indicates that in younger adults experiencing heart attacks and angina, men are more likely to receive faster care compared with women. The study, published in the Canadian Medical Association Journal (CMAJ) also found that gender-related factors affected access to care for both men and women.
To understand why sex differences in mortality exist in younger men and women with acute coronary syndrome, researchers studied 1123 patients aged 18 to 55 years, recruited from 24 centres across Canada, one in the United States and one in Switzerland.
Within 24 hours after admission to hospital, patients completed a 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.
Women came from lower income brackets, were more likely to have diabetes, high blood pressure and a family history of heart disease, and had substantially higher levels of anxiety and depression than men.
Men received faster access to electrocardiograms (ECGs) and fibrinolysis than women, with door-to-ECG and door-to-needle times of 15 and 21 minutes and 28 and 36 minutes, respectively.
“Anxiety was associated with failure to meet the 10-minute benchmark for electrocardiograms in women but not in men,” says study principal investigator Dr. Louise Pilote, a clinician-researcher from the Division of Clinical Epidemiology at the RI-MUHC and a professor of medicine at McGill University. “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. 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.”
Patients visiting the emergency department with atypical symptoms or multiple risk factors also had longer treatment delays. The researchers found, interestingly, that both men and women with feminine character traits were less likely to receive timely care than patients with masculine traits.
“A novel finding of our study was the identification of gender-related determinants of access to care,” adds lead author Roxanne Pelletier, Postdoctoral Fellow in the Division of Clinical Epidemiology at the RI-MUHC and a Clinical Psychologist.
“Men and women who reported higher levels of feminine personality traits, as well as those who reported being the person at home mainly responsible for housework, were less likely to undergo invasive procedures.”
According to the authors, more specific management may be required for patients presenting to the emergency department with no chest pain, several risk factors or a feminine gender identity and role.