I don’t consider myself a big “gender-ist.” But as heart month comes to an end, there is some frightening major gender bias going on when it comes to women and cardiac care.
Women: You’re not being taken seriously by your personal docs, emergency room docs…oh and yes, even by yourselves. The result? Women are up to three times more likely to die from a heart attack than men. Why? Unequal treatment!
That’s horrifying—especially since, in spite of the pervasive messaging about the dangers of breast cancer, there is universal realization that heart disease is the number-one killer of both men and women.
What’s going on? I recently recorded a podcast with Dr. Suzanne Steinbaum, director of women’s cardiovascular health, prevention and wellness at The Mount Sinai Hospital, New York City, and one of the most prolific and outspoken advocates for women’s cardiac care. According to Dr. Steinbaum, the problem is threefold…
- Emergency room doctors are truly being foolish (my words, not Suzanne’s)
- Women are being foolish (my words and Suzanne’s words)
- Primary care doctors are being foolish (again, my words, not Suzanne’s).
Emergency Room Doctors
Let’s talk about the emergency room experience. A study published last year in Current Cardiology Reports showed that women wait 20% longer than men in the ER waiting room before they receive treatment for heart attack. Similar findings were reported from a major study in Sweden that looked at the treatment patients received when they arrived in the emergency room. Once again, women waited approximately 15 minutes longer for treatment than men and, more important, men were more often coded as “red/orange” (more urgent) whereas women were more often coded either “yellow” (observation, not immediately life-threatening) or “green” (“walking wounded,” wait, delayed evaluation). And even for those women coded similarly to men, the wait time still was longer.
Basically, women and their symptoms, are not being taken seriously. Instead, when women arrive at the emergency room complaining of chest pain along with some nausea and fatigue, their symptoms are being dismissed as “not heart-releated” far more often than men’s symptoms (53% of women vs. 37% of men).
Women Must Speak Up
In slight defense of the ER docs—women are shooting themselves in the foot when they arrive at emergency rooms. Why? Because we don’t speak up clearly!
Typical scenarios: A woman comes into the emergency room complaining of chest pain along with some nausea and fatigue. The doctor asks what’s going on in her life…and the woman talks about the stressful juggling that she does caring for a home, children, spouse and her job. On the other hand, a man comes in and says, “I’m having chest pains and pressure.” No qualifications, no apologies. He just states it clearly.
While the doctors are being foolish for not paying attention to the array of women’s symptoms, women must speak up clearly to the docs for two reasons…
1) The doctors—mostly men—speak and think in direct factual statements.
2) All women’s explanations and qualifiers distract from the core message that made us go to the ER in the first place—we are having chest pain and other related symptoms that are bad enough that we dropped everything to actually go to the hospital.
Women have a habit of feeling guilty for being sick and guilty for inconveniencing family with our “silly little aches and pains.” This attitude is killing us.
Primary Care Doctors Aren’t Watching Carefully
In spite of the treatment in the emergency room, it is well-known that women’s heart attack symptoms are different from those of men—women’s symptoms often present as indigestion and nausea…or as pains in the jaw, neck or back…and often they are far less severe than the chest-clutching pain seen in the movies. Part of the reason for this difference is that plaque buildup in women is more diffuse than in men and also because women’s blockages often are in the tiny arteries around the heart rather than in major ones.
This means that the standard diagnostic and screening tests are not necessarily effective for women. As an example, a standard stress test and EKG can appear perfectly normal for a woman with significant microvascular blockages. A better test for her is a stress echocardiogram. It is also critical to measure calcification in women, but doctors aren’t necessarily offering these tests or even thinking about them—which means that doctors are not screening for risk effectively for women or checking real risk accurately once a woman has presented with symptoms.
It’s not a pretty world for women and cardiac monitoring or treatment. With increased awareness, one would hope that things will improve, but how soon? Dr. Steinbaum’s advice to women…
- Speak up. If you think that you are having a heart attack, go to the emergency room immediately—not after you drop the kids off at school or finish the report for work. When you arrive at the ER, say, “I think I’m having a heart attack.” No apologies. No explanation. No second guesses. Let the hospital do all of the proper testing to check if you’re right.
- Get a cardiologist. Heart disease actually begins in your 20s and 30s and, now with childhood obesity, often far earlier. Get a baseline screening with a cardiologist before you have a problem, especially if you have risk factors for heart disease including, but not limited to, being a smoker, being overweight, being inactive or having high blood pressure, high cholesterol or a family history of heart problems.
- Be comfortable with your doctor. Having good communication with your doctor and feeling comfortable when speaking with him/her is critical. If you don’t feel like your doctor is taking the time to really know you or listen to your concerns, get another doctor.
With all of the me-toos being discussed, you don’t want to be a me-too when it comes to being a heart attack statistic. If you feel something, say something.