Women tend to wait longer for medical care for chest pain

Men who are married or in a common-law relationship are known to enjoy a lot of health perks compared to single guys — and it seems that includes getting to hospital sooner for a suspected heart attack, researchers suggest.



Men who are married or in a common-law relationship are known to enjoy a lot of health perks compared to single guys — and it seems that includes getting to hospital sooner for a suspected heart attack, researchers suggest.

A study of Ontario heart attack patients found that men with live-in spouses who were experiencing chest pain sought emergency medical care significantly faster than their single, divorced or widowed counterparts.

But for women suffering chest pains, having a live-in partner made virtually no difference in arrival time compared with women without spouses, said lead author Dr. Clare Atzema, an emergency department physician at Sunnybrook Health Sciences Centre in Toronto.

“So we think it’s related to the caregiver role, although we didn’t specifically study that,” said Atzema, who conducted the study with co-authors at the Institute for Clinical Evaluative Sciences.

It may be that women are more likely to take the caregiver role in the relationship and advise their spouse to seek medical care earlier, she said, whereas men may be allowing women “to do that for themselves and the women aren’t coming in when they’re married faster than when they are single.”

“Even if your spouse isn’t in the room when you start having chest pain — say they’ve gone on a trip or they’re somewhere else — I think even just the knowledge of your wife knowing that you ultimately turned out to have a heart attack and you waited five hours, A, she’s going to be really angry with you when she finds you and B, you know that she would tell you to go into an emergency room as soon as possible.

“So I think for married men, even if the wife isn’t in the room with them, they’re more likely to seek help because they know that’s what they would be told to do or advised to do by their spouse.”

However, married men in the age group studied — late 60s and 70s — have traditionally not taken the caregiver role that would see them encouraging their female spouses to get to the hospital quickly.

“I would love to do this study in 30 years’ time on everyone (now) in their 30s and 40s because I think gender roles are much more loosely defined now,” Atzema said.

“Times have changed and I think men will be more likely to take that caregiver role when they get to heart attack age.”

To conduct the 2004-05 study, published in this week’s issue of the Canadian Medical Association Journal, researchers examined Ontario hospital data for more than 4,400 heart attack patients, two-thirds of them male and with a mean age of 67, who sought care due to chest pain.

They found that 75 per cent of married patients went to hospital within six hours of their first chest pain, compared with 68 per cent of single and divorced patients, and almost 71 per cent of widowed patients.

Atzema pointed out that males on the whole don’t tend to seek a doctor’s care for any number of health issues, compared with women.

“I think probably the married men wouldn’t too if they didn’t have someone there encouraging them,” she said. “It’s like asking for directions, it’s not just their sort of role to do it.”

Dr. Christopher Glover, an interventional cardiologist at the University of Ottawa Heart Institute, said the study confirms what doctors at his own centre see when patients arrive with chest pains and other symptoms of a heart attack.

“We do see that people, married men especially, they say: ’I wasn’t going to come in, but my wife made me come in,”’ said Glover.

“That’s not an uncommon thing. And I think it’s not uncommon, especially with single men, that there is a delay.”

Atzema said some patients take a wait-and-see attitude because they’re not sure if they are having classic chest pain that’s indicative of a heart attack.

“And I do ask them in the emergency room why didn’t they come in right away and they say: ’Well, you know it’s not that bad, it’s not such a pain, it’s just a bit of a tightness. I thought maybe it was a muscle or indigestion and I would wait a few hours and see if it goes away.’

“Even though from a medical perspective we want them in by 60 minutes, 90 minutes at the latest, from a patient perspective it’s probably not so unreasonable.”

But she said with severe heart attacks especially, the sooner treatment is begun the better, with less chance of permanent heart muscle damage and of death — because research shows that even minutes lost can directly translate into higher mortality at 30 days, 90 days and even one year.

“We already know that a delay — we worked out it was about 30 minutes was what you saved by being married — is likely to translate into a significantly different mortality rate,” she said of the ICES study.

While not every person having a heart attack experiences chest pain — it may be felt in a shoulder, an arm or the back — Glover said unexplained pain or pressure in the chest region or upper extremities that persists for more than 30 minutes should prompt an urgent trip to a hospital ER.