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Are Women Smarter Than
Men In Recognizing Signs of a Heart Attack?
New Study Strengthens Need
for Patient Education and Cardiac Rehab Programs;
Almost Half of Heart Disease Patients
Do Not Have Life-Saving Knowledge
About the Symptoms of a Heart Attack
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The
Five
Warning Signs
of a Heart Attack
| • pain
or discomfort in the jaw, neck or
back |
| • feeling
weak, lightheaded, or faint |
| • chest
pain or discomfort |
| • pain
or discomfort in the arms or shoulder |
| • shortness
of breath |
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May 27, 2008 -- Are women
really smarter than men when it comes to recognizing the symptoms
of a heart
attack? A new study, published in the May 26
issue of the Archives of Internal Medicine found that to
be the case. A group from the University of California, San Francisco,
surveyed 3,522 patients (average
age 67)
who
had Acute Coronary Syndrome (ACS): unstable angina, a history
of heart attack or an invasive procedure for treating narrowed arteries
(angioplasty or bypass surgery).
Author Kathleen Dracup, D.N.Sc.,
and her colleagues from the School of Nursing found that 44%
of these patients not only had poor knowledge about the symptoms
of a heart attack -- they
also
did not
perceive
themselves to have an elevated cardiovascular risk, compared to others
of similar age. Women scored higher than men, but on this last
point, women were 21% "smarter" (the answer is yes
-- a history of heart disease means you have five to seven times
the risk).
Doctor and
patient in cath
lab after an angioplasty |
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But women were not
the only group to show "heart smarts" -- also scoring higher
were those patients who (1) were younger; (2) had achieved a
higher education
level;
(3) had been
part of a cardiac
rehabilitation program; or (4) had been cared for by a cardiologist,
as opposed to a family practitioner or internist. All these
groups
answered more correctly when quizzed on symptoms of heart attack
and true-false questions about heart disease. |
However, the
importance of this study is not just to show who had higher scores,
but to improve healthcare by identifying which
patient groups are less well-informed and targeting them for enhanced
educational programs. As the article points out, survival
rates can improve up
to 50%
following
a heart
attack,
if treatment
begins
within
one
hour.
For every 30 minute delay in treatment, life expectancy is reduced
by a year. However, most patients
are admitted to the hospital 2.5 to three
hours after symptoms begin.
Many patients incorrectly adopt a "wait-and-see" attitude instead of immediately
calling an ambulance.
Angioplasty.Org has long advocated educating
patients about emergency treatment of heart attack and has urged
its readers to get to a hospital that offers angioplasty,
if at all possible. Editor-in-Chief Burt Cohen points out:
"There are a number
of hospitals that offer emergency angioplasty, where a patient
in the midst of a heart attack can be in the cath lab with an
opened artery within 90 minutes of arrival at the Emergency Department.
People need to understand that a heart attack can now literally
be stopped in its tracks, but only if the patient gets to the
right
hospital without delay."
The implications in these findings are that
patient education has fallen short in most instances. As the authors
write:
"Unfortunately, structural changes in
health care delivery have led to decreased lengths of hospital
stay and
increased use of outpatient facilities for cardiac diagnosis
and treatment, which in turn have had a dramatic effect on
the time
available for the education of patients with ACS. In a
recent study of the discharge education given to patients with
heart failure,
only 54% had received the instructions comprising the Joint
Commission on Accreditation of Healthcare Organizations (JCAHO)
process-of-care
measure.... Thus, there is an increasing
onus on physicians to ensure that patients who are at high
risk for a future AMI are knowledgeable about ACS symptom presentation
and that these patients understand the importance of responding
quickly to cardiac symptoms to optimize survival and treatment
outcomes.
But back to women being smarter. The authors
were surprised at this result because, as they write:
"...women have often underestimated
their risk for heart
disease in years past
and have had longer prehospital delay times than men, suggesting
a lack of knowledge about [heart attack] symptoms....
In recent large community samples of healthy individuals, sex
made no difference in knowledge about heart disease and its symptoms,
findings that are in direct contrast to those in the current
study.
In our study, which included only people with known coronary
artery disease, we found that women were more knowledgeable than
men....
"The findings...suggest that physician counseling
of female patients, coupled with a number of community-based,
public
education programs conducted over the past decade by the federal
government and organizations...have had a positive
effect. Some of the campaigns, such as the American Heart Association's
'Go Red' and the National Heart, Lung, and Blood Institute's
'Heart Truth' campaign, have focused specifically on women to
alert
them to their risk for heart disease, and our findings support
prior evidence that such campaigns have had a positive effect."
An accompanying editorial by Dr. Robert
A. Phillips of the UMass Memorial Medical Center,
Worcester, calls for increased cardiac rehab programs -- which
provide patients not only assistance with diet, exercise and smoking
cessation, but general education about managing their disease. Dr.
Phillips writes:
"Two of the most important factors associated
with lack of referral to cardiac rehabilitation (CR) were poor
insurance coverage and admission
to a hospital that did not offer CR. Both of these factors can
be addressed through enlightened public policy (ie, universal
health
insurance with adequate cover for CR), improved processes of
care, and pay for performance methods."
While surgery and angioplasty are critical to dealing
with acute situations, the good news from this study is that lives
can be saved
through education and increased awareness. Angioplasty.Org urges
its readers to advocate and help make these resources available in
their own communities.
Reported by Angioplasty.Org, May 27, 2008
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