A study in the February issue of JAMA , shows that women are more likely than men to be admitted to a hospital without chest pain, and also have a higher rate of in-hospital death after a heart attack, compared with men of the same age group, even though these differences decrease, as people get older.
The article’s background information states:
“Optimal recognition and timely management of myocardial infarction [MI; heart attack], especially for reducing patient delay in seeking acute medical care, is critical. The presence of chest pain/discomfort is the hallmark symptom of MI.”
Even though chest pain and/or discomfort are well-recognized symptoms of a heart attack, earlier studies revealed that a large number of patients with MI do not suffer from chest pain/discomfort at presentation.
“Furthermore, patients without chest pain/discomfort tend to present later, are treated less aggressively, and have almost twice the short-term mortality compared with those presenting with more typical symptoms of MI.”
According to the researchers, women are usually older than men at hospitalization for heart attack, saying:
“It is plausible that women’s older age at presentation is related to whether they present with chest pain, as well as subsequent hospital mortality. However, a limited number of studies have taken age into account in examining sex differences in MI clinical presentation.”
John G. Canto, M.D., M.S.P.H., of the Watson Clinic and Lakeland Regional Medical Center, Lakeland, Fla., and his team assessed the link between sex, symptoms at the time of admission, and the risk of mortality whilst in the hospital, before and after considering the patients’ age who were hospitalized with MI.
The researchers evaluated data from 1994 to 2006, from the National Registry of Myocardial Infarction, which included 1,143,513 registered patients – 42.1% were women. They found that women with MI were substantially older, with an average age of 74 years, compared with an average age of 67 years in men at hospital admission.
Overall 35.4% of MI patients felt no chest pain/discomfort on admission, of which a substantial 42% were female, compared with 30.7% of men. According to age-specific and further evaluations, the findings revealed an important relationship between age and sex that showed that sex-specific differences in MI presentation without chest discomfort become progressively smaller with aging.
Whilst the results showed an in-hospital death rate of 14.6% in women and 10.3% in men, the fully adjusted models revealed that younger women without chest pain/discomfort on admission had a greater hospital mortality, compared with men. However, the trend reversed with increasing age.
The researchers comment:
“However, younger women presenting with chest pain/discomfort had a greater hospital case-fatality rate than men with chest pain/discomfort in the same age group, but differences in hospital death rates between men and women decreased with advancing age (no longer significant in the oldest group). These data suggest that the absence of chest pain may be a more important predictor of death in younger women with MI compared with other similarly aged groups.”
The researchers indicate the need for further research to enhance the present understanding of underlying pathophysiology and to provide the general public and health care providers with health messages that are potentially specifically tailored to men and women, to advise anyone with signs and symptoms of acute coronary syndromes to seek care immediately, as these measures will improve the care and survival of women.
“Our results of sex-based differences in MI symptom presentation in younger patients are provocative and should be confirmed by others with clinical databases of MI or acute coronary syndromes.
From a public health perspective, it is appropriate to target high-risk groups for delay (young women) with information on the American Heart Association/National Institutes of Health heart attack message, but until additional research is conducted, the current chest pain/discomfort heart attack symptom message, which targets women and men equally irrespective of age, should remain unchanged.”
Written by Petra Rattue