Women receive slower, less effective STEMI care than men

Women are more likely to call ambulances for male relatives like brothers, sons and husbands with suspected MIs than they are to call an ambulance for themselves, according to research presented March 3 at the European Society of Cardiology’s Acute Cardiovascular Care 2019 congress in Malaga, Spain.

Two studies from the Polish Registry of Acute Coronary Syndromes (PL-ACS) comprising 7,582 patients found women were treated more slowly and without the same urgency as their male counterparts when it came to ST-segment elevation myocardial infarction, or STEMI.

“Very often women run the house, send children to school and prepare for family celebrations,” Mariusz Gasior, principal author of the studies, said in a release. “We hear over and over again that these responsibilities delay women from calling an ambulance if they experience symptoms of a heart attack.”

Gasior et al.’s analyses found just 45 percent of their study group were treated for STEMI within the guideline-recommended timeframe of 90 minutes, and the patients who were treated promptly were less often women. Professional organizations recommend a patient’s artery is stented within an hour and a half of diagnosis in the ambulance with an electrocardiogram.

ECG results were transmitted from the ambulance to a heart attack center in 40 percent of patients. For women, the likelihood of an ECG transfer rose with age, from 34 percent in women 54 years old and younger to 45 percent in those aged 75 and up, while it stayed stagnant at 40 percent for men.

“One of the reasons women are less likely than men to be treated within the recommended time period is because they take longer to call an ambulance when they have symptoms—this is especially true for younger women,” Gasior said. “In addition, ECG results for younger women are less often sent to the heart attack center, which is recommended to speed up treatment.”

The team found in-hospital STEMI mortality rates were similar for both men and women within and outside the advised treatment window, but those treated within the window were less likely to have a left ventricular ejection fraction below 40 percent.

Marek Gierlotka, coordinator of the PL-ACS registry, said women tend to make sure their male relatives receive urgent care when it’s needed, but acknowledged “it is time for women to take care of themselves, too.”

“More efforts are needed to improve the logistics of pre-hospital heart attack care in young women,” Gierlotka said. “Greater awareness should be promoted among medical staff and the general public that women, even young women, also have heart attacks. Women are more likely to have atypical signs and symptoms, which may contribute to a delay in calling for medical assistance.”