Ischaemic heart disease

Huge gender gap in MI care

Women who have a heart attack take longer to get an ECG, are less likely to be triaged appropriately and admitted to a cardiac care unit and are more likely to die from STEMI than men, new research has found.

Speaking at the conference last week Dr Lisa Kuhn from Monash University, an emergency nurse and previously a member of the Centre for Quality and Patient Safety Research in Deakin’s School of Nursing and Midwifery, said the inequality of care for women with heart conditions has been her main research focus over the past decade.

“Coronary heart disease in Australia kills about one in four women – that’s about 25 women a day,” she told the audience.

“It accounts for more than all of the cancer deaths added up together.”

The Melbourne researcher said she found several gender practice gaps while scouring the case notes of nearly 500 Victorian cardiac patients who attended a major emergency department with early acute coronary syndrome as part of a pilot study to work out why women are falling through the cracks.

Dr Kuhn found that, compared to men, women waited on average six minutes more than the recommended 10 minutes from arrival to having their first ECG after being admitted to the emergency department, which blows out further when time for interpretation is added, she said.

When it came to triage Dr Kuhn found that women were much less likely to be given an appropriate score.

“We couldn’t find any good reason to explain it – for some reason we nurses seem to be much tougher on women than men and we triage them lower.”

And while equal numbers of men and women got pain scores and troponins as soon as they arrived to emergency Dr Kuhn said that ‘for no discernable reason’ more men were admitted to specialist cardiac care units than women, who tended to be admitted to general medical wards.

Dr Kuhn also found that fewer women had STEMI but those who did were more likely to die from the condition in hospital than their male counterparts.

“That’s a big issue because it’s very easy to measure what should be done in STEMI but it’s harder in non-STEMI and unstable angina,” she noted.

On another measure, time spent in the ED was the same between genders but women did end up staying in hospital longer than men – an interesting revelation given that 20% more hospital expenditure is allocated to men’s admissions than women’s she added.

While women typically didn’t report having the same symptoms as men after heart attack, the study found that chest pain was the main symptom for both genders.

“I’ve done triage for many years and one of the problems with women presenting with chest pain is that they will downplay it. They’re expecting the Hollywood heart attack where they have chest pain of eight or nine out of 10.

“The reality is women have chest pain that’s one, two or three out of 10 and often they will have angina first so they present differently – their description of chest pain doesn’t sound like the normal chest pain we’ve come to expect in MI.”

It’s sobering information but Dr Kuhn said there is a need to raise awareness of possible gender-related bias in management of heart attack patients.

“One of the issues is that most of the research on heart attacks is done on men. Even the diagnostic tools we use are based on research done on men. We won’t know what’s causing the disparities without much larger prospective research.”

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