A chest pain is oftentimes a symptom of a heart attack. Doctors always say that this should not be ignored. However, adults 18 to 55 years old who are rushed to the ER with chest pain may wait longer. Some of them also get less thorough workups simply because they’re female or Black. While this may sound like a shock, this was what a new study found.
Every second counts. Ask any doctor who has had to deal with a patient that’s suffered heart attack. Unfortunately, studies show that women who experience chest pain, one common symptom of heart attack, wait around 11 minutes more than men to get expert attention in an emergency room.
Women of color have seen even worse because some have to wait around 15 minutes longers than white women for initial evaluations. All these numbers are according to the new study that was published in the Journal of the American Heart Association.
“Chest pain is the most common symptom of heart attack in adults of all ages,” stated lead study author Darcy Banco, MD. She’s the chief resident for safety and quality in the department of medicine at the NYU Grossman School of Medicine, New York City. “Despite a decline in the number of overall heart attacks, this number is rising among young adults,” Dr. Banco added. “And young women and young Black adults have poorer outcomes after a heart attack compared to men and white adults.”
It must be noted that the study wasn’t designed to see whether differences in treatment or waiting times for care can directly impact and bring about different outcomes after a heart attack. However, it’s been clear that there are disparities that women face. It’s also a possibility how structural inequities such as racism or sexism could play a role, Banco said.
Delayed Care Brings about Dire Consequences
The researchers examined data from a nationally representative sample of more than 4,000 patient records for the study. These representing more than 29 million emergency room visits for chest pain by adults 55 and younger in the years 2014 and 2018. Those who were rushed to the emergency room complained about pain, discomfort, pressure, tightness, and a burning sensation in their chest. They were also brought because many had reported heart pain.
Women with chest pain waited around 48 minutes before they were examined by a doctor assigned in the emergency room. They compared this with 37 minutes wait for men.
When the researchers also looked into differences by race, they saw how white women had average wait times of 43 minutes. As for women who belong to other racial or ethnic group, they waited around 58 minutes. White men, on the other hand, waited an average of 34 minutes. For men of color, they had to wait an average of 44 minutes. It must be noted that most of the nonwhite patients involved in the study identified themselves as Black.
Moreover, women of color were less likely to receive anti-clotting medications that help prevent a heart attack or narcotic painkillers to heal with the pain and discomfort.
Limitations of the Study
One limitation is that the researchers weren’t able to determine whether emergency room care was faster or more comprehensive for the subset of patients involved in the study who actually had a heart attack. Most adults who have complained of chest pain in the emergency room don’t go on to have a heart attack. However, it’s unclear whether patient care may have been more efficient or comprehensive for those who actually had a heart attack.
Previous research, though, has associated delayed care to more dire outcomes. This is especially noted for women and Black people, says Martha Gulati, MD, a cardiologist and chair of the 2021 chest pain guidelines for the American Heart Association and the American College of Cardiology.
“Time is heart muscle,” Dr. Gulati said. “So, these noted delays and less aggressive care of women have the potential to translate into delays in care, less diagnostic testing, deaths at home for some discharged, and continued worse outcomes after a heart attack in young women — particularly young Black women.”
A study that was published in November 2020 in the European Heart Journal, for instance, followed male and female heart attack patients 50 years old and younger for more than 10 years. In the hospital, they found that women were less likely to get a more comprehensive and aggressive form of treatment. When these patients were sent home, females were less likely to get prescriptions for medications that may reduce risk of a repeat heart attack. Such medicines are aspirin, beta-blockers, statins, and angiotensin-converting-enzyme (ACE) inhibitors. Lastly, females had a 60 percent chance of dying by the end of follow-up.
What exactly is the problem? Part of it may be because women’s symptoms aren’t taken as seriously, a study published in February 2018 in Circulation somewhat hinted. Nearly every male and female involved in the study reported chest pain, pressure, tightness, or discomfort as a major symptom. Also, women were twice more likely to blame stress or anxiety for their condition. And 53 percent of the women said doctors told them their symptoms weren’t related to a heart attack. This was compared to just the 37 percent of men.
“There is implicit bias in how we care for women,” Gulati said. She further added, “Women are still not seen to be at risk for heart disease. It is still seen as a man’s disease, despite the fact that cardiovascular disease remains the leading cause of death in both men and women.”
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