Chest pain care for women headed to the ER
Wednesday, May 20th, 2009
By: Taunya English
tenglish@whyy.org
When women are rushed to the ER with chest pain, a new study suggests the treatment they get on the ambulance ride is often different than the care given to men with similar complaints.
(Photo: Flickr/chriswong4238)
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Emergency physician Zachary Meisel says there's a standard package of treatments recommended for patients who have possible cardiac chest pain, including aspirin, nitroglycerin and cardiac monitoring.
Meisel and colleagues at the University of Pennsylvania found that women were less likely to receive several of those treatments. That's troubling, Meisel says, because aspirin, in particular, is a proven lifesaver that opens clots that form in blood vessels. He says it's not clear why women receive different care.
Meisel: There may be differences in the way men and women explain their symptoms, there may be differences in the way they interpret their own symptoms. There may be biases in types of treatment they get after they explain their symptoms similarly.
Meisel says it's important to understand the treatment gap because women are more likely to die of heart attack than men.
Men were more likely to receive aspirin, nitroglycerin and an IV compared to women when being taken to the hospital for chest pain. Meisel says the women's risk of not getting aspirin was about 28 percent higher than for men.
It's not clear why women and men receive different treatment before they reach the hospital. But Meisel says previous studies found that women with heart problems often have symptoms that are attributed to other illnesses or injury.
The study analyzed the care provided to people as they were transported to three Philadelphia emergency rooms. Emergency physician Douglas McGee says that treatment difference may not be that important in Philadelphia, where an ambulance trip is often under 10 minutes long.
McGee: But in other parts of Pennsylvania where the transport times might be much longer than that, 20 minutes or 30 minutes to the nearest hospital, some of the pre-hospital intervention may in fact be important.
McGee leads the Department of Emergency Medicine at Albert Einstein Medical Center, and was not involved in the Penn study. He says the study shows the need for better education for EMS workers.
These are not surprising findings.
I have had my symptoms brushed off as "in my head" for another serious medical condition. By the time I got a diagnosis the damage to my health was permanent. This disregard can come from female as well as male health care professionals because of the culture of their specialties, education, and human nature to seek the path of least resistance.
Patients must strongly advocate for themselves in small ways as well. For example: if an IV hurts (it is not supposed to) pursue the issue until someone really takes a look and determines to your satisfaction that it is OK.
Everyone can learn to be better historians. Women especially must remove emotion from their description of symptoms and avoid using a passive voice to be heard.