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

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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