NEW YORK (Reuters Health) - Women in their 30s, 40s and 50s don't seek preventive care for heart disease, aren't very good at gauging their risk for heart attack and often delay seeking treatment for symptoms of acute myocardial infarction (MI), a new study shows.
Women are known to be at higher risk of dying after acute MI and these new findings suggest that both prevention and acute care may be contributing factors, say Dr. Judith H. Lichtman of the Yale School of Public Health in New Haven, Connecticut, and colleagues.
They did in-depth interviews with 30 women aged 30 to 55 years who were hospitalized with acute MI to explore their experiences with prodromal symptoms and their decision-making process to seek medical care. Most were white (60%) and nearly half were married and worked outside the home; 53% had health insurance and 37% reported trouble accessing health care.
In an interview with Reuters Health, Dr. Lichtman said this study is "interesting on multiple levels. We used qualitative methods that were more story-telling in nature. We really wanted to try to understand from a young women's perspective who had recently had a heart attack what they were thinking when they noticed their symptoms, how they would describe their symptoms, what they perceived them to be and what triggered them to act on them."
Dr. Lichtman said five themes emerged:
1) Prodromal symptoms varied substantially in both nature and duration. The vast majority of the women reported chest pain, but they also reported discomfort or pain in the neck or jaw and more general symptoms such as sweating, anxiety, fatigue, and dizziness. Some women experienced a rapid onset of severe pain that appeared "out of the blue." Other women reported more subtle symptoms, feeling like "something was off." These symptoms would pass or recur and build over days, weeks or months prior to the heart attack, the researchers say.
2) Women often failed to accurately assess their risk of heart disease and commonly attributed symptoms to non-cardiac causes. "A lot of the women reported having a relative or a bunch of relatives with heart disease and they talked about their own risk factors, but they really didn't connect this to their own risk of having a heart attack," Dr. Lichtman told Reuters Health. "Because of their young age, many women felt they couldn't be having a heart attack even though they had a strong family history and multiple risk factors."
3) Competing and conflicting priorities often influenced the decision to seek care promptly. "Even women who thought they could be having a heart attack were embarrassed or concerned about being perceived as wrong or being a hypochondriac. We need to empower women so they don't feel stigma," Dr. Lichtman said.
4) The healthcare system was not consistently responsive to these younger women with acute MI, leading to delays in workup and diagnosis. "The healthcare system needs to step up; some women called their normal care provider to report their symptoms and were given an appointment days later or when they did show up in the emergency department and they were triaged," Dr. Lichtman said.
5) Women did not routinely access primary care, including preventive care for heart disease.
Dr. Lichtman and colleagues reported their findings online February 24 in Circulation: Cardiovascular Quality and Outcomes. The study will appear in print in the March issue of the journal, a portion of which is dedicated to research in women.
In a perspective article, American Heart Association CEO Nancy Brown says the AHA's Go Red For Women campaign has helped increase awareness among women, but more work is ahead.
"We've come a long way from an American Heart Association study in 1997 that showed only 8% of women understood that heart disease was their greatest health threat, to the association's most recent statistics, which indicate 54% of women are aware that heart disease is the number one killer of women," Brown said in a statement.
"Despite these wins, women are still dying prematurely, and more women than men continue to die from cardiovascular disease. Significantly increasing women's representation in clinical trials and studies, so they receive the right cardiovascular diagnoses and appropriate treatment is critical," she added.
"Women have been generally underrepresented in studies, leading to a lack of key information about whether women react differently to heart disease, if our diagnostic methods work as well in women as in men, and if women respond differently to treatment," Dr. Harlan Krumholz, editor of Circulation: Cardiovascular Quality and Outcomes, said in the statement. "Dedicating a women's themed section in this research journal offers the latest in quality studies on women and reminds us about the importance of this area of investigation."
"In the future, if we really want to answer all the questions we have about gender differences, then we need studies that are large enough, focused enough and with the intent from the start to illuminate the issues around sex differences," added Dr. Krumholz, who is director of the Center of Outcomes Research and Evaluation at Yale-New Haven Hospital in Connecticut.
The study was funded by the Fannie E. Rippel Foundation and the National Heart, Lung and Blood Institute. The authors have no disclosures.
SOURCE: http://bit.ly/1akfEzO and http://bit.ly/1BcHXKP
