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Women With Heart Ills Face Delays en Route to Hospitals

In a study that's ultimately more tantalizing than conclusive, researchers have found that women with heart-attack symptoms who call emergency medical services (EMS) are more likely than men to experience delays in delivery to the hospital.

Reporting in the journal Circulation: Cardiovascular Quality and Outcomes (published by the American Heart Association), Thomas W. Concannon, Ph.D., the study's lead author and assistant professor of medicine at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center in Boston, and his team examined EMS delivery times in the Dallas area. Looking at EMS logs from 2004, the researchers tracked response time (from receipt of call to arrival on the scene), on-scene time (between arrival on the scene and departure for the hospital) and transport time (from departure from the scene to arrival at the hospital).

Overall times were similar for men and women and, for the most part, among the various ethnic and socioeconomic groups studied. But one anomaly stood out: Among cases where total delivery time was delayed by 15 minutes or longer than the median, women were 52 percent more likely to experience such delays than were men.

It's not that EMS providers took their time responding to females' calls for help: The initial response time was similar for men and women alike. Rather, the delays typically occurred in the second and third phases of the journey. Whereas average response time for all groups was 5.7 minutes, the average time spent on the scene was 28.3 minutes for women versus 19.9 for all subjects, and women's average transport time was 27.7 minutes compared to 10.3 minutes across the whole group.

Unfortunately, the study didn't identify the reasons those delays occurred. It's possible, the authors suggest, that because women's heart attack symptoms (such as shortness of breath) can easily be attributed to other causes, it takes emergency responders longer to assess female patients' conditions. And perhaps drivers feel less urgency when transporting women to the hospital when their subtle symptoms lack the drama of the stereotypical TV-show heart attack.

In any case, the study raises important matters for further investigation. It's well known that time is of the essence when treating heart attacks, both in terms of saving lives and limiting damage to the cardiovascular system. That's why so many hospitals have focused on fine-tuning their heart-attack responses, aiming to get patients from the front door to the catheterization lab for insertion of an artery-opening "balloon" within 90 minutes. The new study suggests that it's now time to focus on the time it takes to get patients, both male and female, to the front door in the first place.

By Jennifer LaRue Huget  |  January 21, 2009; 7:00 AM ET
Categories:  Women's Health  
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I had a heart attack this month and Fairfax County first responders were in my office in a few minutes after the call to 911. I was given chewable aspirin immediately. In the ambulance I was readied for transport - hooked up to a monitor and given an EKG, IV established, pain medicine (nitro spray). My pain started about 1230 and I was in the ER about 115.
I had classic symptoms - chest pain, radiating to arm and jaw. But my EKG and blood work were all normal initially; no heart attack diagnosis until 11 PM. Might I have gotten different treatment if I had other symptoms, more pain or a family history? I didn't go to the cath lab until 1015 the next morning.
One thing to consider is the pain measure system - if 10 is the worst pain I ever had, doesn't the person asking need to know what that was? When I saw a chart last week with emoticons for pain measure, I realize I should have picked a a higher number! Childbirth pain does not show on the chart. I labored for 3 days and nights, was physically and mentally exhausted and still had to push a 9 lb human out of my body. My heart attack was *very* serious but did not hurt nearly as much.

Posted by: NoVaMusicMom | January 23, 2009 3:02 PM | Report abuse

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