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[Investigating chest pain--is there a gender bias?]
Insights
Women experience higher ischemic heart disease (IHD) mortality. Delays in diagnosis and treatment for chest pain in women contribute to worse outcomes, highlighting a need for improved healthcare system awareness and early intervention strategies.
Area of Science:
- Cardiology
- Public Health
- Health Disparities
Context:
- Ischemic heart disease (IHD) presents unique challenges for women, often leading to higher morbidity and mortality.
- Existing healthcare systems may overlook or inadequately address the specific needs of female IHD patients.
- Differences in symptom presentation, diagnosis, and treatment pathways exist between genders for IHD.
Purpose:
- To investigate gender-based differences in the evaluation and treatment of chest pain, specifically focusing on delays in diagnosis and care for women with IHD.
- To analyze physician attitudes and referral patterns for chest pain in men versus women.
- To establish a specialized clinic aimed at reducing diagnostic and treatment disparities for IHD in women.
Summary:
- A retrospective study of 615 patients with chest pain revealed that women, despite similar hospitalization rates, were older and had more risk factors than men.
- While discharge diagnoses were similar, women constituted a smaller proportion of referred patients, suggesting potential delays in seeking or receiving care.
- The study highlights a need to address gender-specific barriers in IHD diagnosis and treatment.
Impact:
- The establishment of the "Female Heart" clinic aims to improve early presentation of chest pain symptoms by women and enhance physician awareness and diagnostic approaches.
- Future prospective studies will evaluate the effectiveness of the "Female Heart" clinic in reducing IHD-related disparities.
- This initiative seeks to bridge critical gaps in cardiovascular care for women, ultimately reducing IHD morbidity and mortality.
Abstract:
Ischemic heart disease (IHD) is women is characterized by a higher morbidity and mortality in the peri-infarction and coronary bypass peri-operative periods. These epidemiological data strengthen our impression that the health system unintentionally "ignores" the high proportion of females with IHD. The process of investigating chest pain, diagnosing IHD, and the subsequent treatment and rehabilitation, seem to differ between the genders. Time elapsed from beginning of chest pain to diagnosis of IHD seems to be longer in women than in men. Personal, educational and social factors are contributory. Although time elapsed between diagnosis and rehabilitation is usually similar in the genders, peri-operative morbidity and mortality are higher in women. It may be that the higher rates in women are caused by delay in diagnosis and treatment, which allows worsening of the disease in women before treatment. This delay can occur during the time needed for evaluation of chest pain, from the door of the physician to diagnosis and treatment. In our retrospective study we determined the difference in referral of men and women with chest pain to the emergency department (ED) and the attitude of physicians in the ED and medical department to chest pain in men and in women, including final diagnosis on discharge. 615 patients over 18 years referred to the ED for chest pain during 3 randomly chosen, consecutive months were studied. We found that women constituted only 39.5% of the referred patients, but the proportion hospitalized was similar to that in men. Hospitalized women were older (57.7 +/- 18.4 versus 49.7 +/- 17.8 years in men), and had more risk factors (4 versus 2 in men). Proportions of specific diagnoses on discharge from hospital were equal in the genders. To bridge the differences and to implement education in prevention, investigation and treatment of IHD in women, we established the "Female Heart" clinic. The objective of this clinic is to reduce differences in the first step, in the process of evaluating chest pain in women, by educating and encouraging them to present early to their physicians, and by changing physicians' attitudes in the investigation of chest pain in women. We plan to determine in a prospective study if these goals are reached.