It is known that women who have heart attacks have a worse outcome than men – and a new study has found that one of the reasons might be that women are less comfortable calling 000 and more likely to hesitate when they have symptoms of a heart attack.
Calling emergency services is known to lead to better and more rapid diagnosis and treatment of heart attack which in turn reduces the time spent in hospital recovering. Paramedics can diagnose heart attacks and initiate treatment to resolve the heart attack and manage the symptoms prior to hospital which reduces the risk of fatal cardiac arrest.
Monash University researchers have conducted the study which compared more than 34,000 Australian women and men and their intention to call 000 and their actual use of emergency services when they suspect they are having a heart attack.
The study, conducted by Honours student Annie Shi, and led by Associate Professor Kathryn Eastwood (a Mobile Intensive Care Ambulance (MICA) Paramedic in Victoria for 25 years) and Professor Janet Bray and published in the Emergency Medicine Journal, looked at data from over 34,328 participants in two national surveys.
They found that while women were more likely to call 000 if experiencing heart attack symptoms (70.4% versus 62.7% ), women were significantly less comfortable to call (69.1% versus 76.7% men).
When asked about why they would hesitate to call 000 if experiencing symptoms they believed to be a heart attack, over a third of women were fearful of being a burden to the ambulance service compared to only a quarter of men. More women also wanted to be sure it was a heart attack before calling, and preferred to contact their own GP. Women were also more likely to hesitate to call 000 because they believed they were at low risk of a heart attack.
They found a range of characteristics that contributed to being unwilling to call emergency services across both sexes included:
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English not being a primary language
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Having cardiovascular risk factors
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Poor symptom knowledge
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Living in the Northern Territory
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Either no or unclear health insurance status re emergency call outs
According to Associate Professor Eastwood, it is known that globally there are sex-based disparities in heart attack presentations to emergency services and hospitals, and that women experience higher incidents of in-hospital complications following a heart attack. “It is widely reported that women tend to wait longer to seek medical treatment for heart attack and experience longer delays to diagnosis in hospital,” she said.
“One of the reasons for this delay is that womens’ symptoms are often more subtle than in men, and can lead to the woman and even healthcare professionals misinterpreting them as non-cardiac.”
Associate Professor Eastwood added that “this survey asked what people would do if they thought they were suffering from a heart attack or had symptoms that could indicate a heart attack. It is very concerning that in the setting of believing they are having a heart attack, around a third of people aren’t stating that they would call 000.” She went on to say that “the advice I gave my patients who told me they were sure whether they should have called 000 was always the same. I would say they should ‘call first, and decide later’.” The findings from the study indicate that more education is needed to improve people’s comfort with calling the emergency services early when they have cardiac symptoms and that an opportunity exists to target this education to particular subgroups within each sex to reduce delays in seeking medical treatment.
Read the full paper in: The Journal of Emergency Medicine. Sex differences in the intention and decision to use emergency medical services for acute coronary syndrome in Australia: a retrospective study. DOI: 10.1136/emermed-2023-213800
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