An estimated 43 million women in the United States are affected by heart disease. It is the No. 1 killer of women, causing 1 in 3 deaths among women each year.1 Despite these statistics, studies have shown that only half of women recognize cardiovascular disease as the leading cause of death in their gender, and one-third of women still believe breast cancer is the greatest healthcare problem women face.2 In reality, breast cancer claims the lives of approximately 41,000 women per year compared to 215,000 lives claimed annually by coronary heart disease.3
K.M., a 51-year-old single mom, was leaving her yoga class one afternoon when she started experiencing nausea and profuse sweating. She wrote it off as the result of a tough workout. The symptoms continued, so she concluded that it was a hot flash due to menopause. She later vomited and thought she might be experiencing food poisoning from her restaurant meal the night before.
When she arrived at her friend's house later that day, her friend told her that she did not look well. K.M. did not believe her symptoms warranted a 911 call, but she did agree to walk to the nearby urgent care clinic. She was eventually diagnosed with a heart attack and transported via ambulance to the hospital, where she underwent a cardiac catheterization procedure and received two coronary artery stents.4
K.M.'s story illustrates two important points about women and heart disease and why treatment may be delayed in this population. The first point of emphasis is that heart attack symptoms in women may be atypical. The second point is the unresponsiveness of K.M. She considered every reason for her nausea and sweating except a heart attack. This may be a result of a lack of education, or it may be denial.
When experiencing an acute myocardial infarction, women may not present with the most common or obvious symptom of heart attack: chest pain. In reality, chest pain is a more typical symptom in men experiencing an acute heart attack.5 Women tend to experience symptoms such as nausea, jaw pain, sweating or chest pressure.1These atypical heart attack symptoms may seem nonspecific, and that is why many women may write these symptoms off as stress- or illness-related.
Minimization of symptoms is one reason why women may delay seeking care. Another reason women might defer treatment is to avoid a disruption of day-to-day activities. Studies show that women tend to wait longer after symptoms begin before calling for medical help. The median duration of delay in women seeking help ranges from 1.8 to 7.2 hours compared to 1.4 to 3.5 hours in men.5
A third reason women may delay seeking care is that many women are working full-time jobs as well as executing child-care responsibilities. Some women, like K.M., are single moms, handling all financial and family responsibilities on their own. Many adults who are caretakers do not make their own health care needs a top priority, therefore a case of nausea would not be a major concern and healthcare treatment would not be sought.5
In addition to delays in seeking treatment in the pre-hospital setting for heart attack signs and symptoms, evidence suggests that women face delays in diagnosis and treatment once in the hospital setting. Women experiencing a heart attack are more likely to be triaged in the emergency department as low risk compared to men.5 This may be due to providers not recognizing the atypical symptoms a woman presents with, or it may be due to the belief that a heart attack is a man's disease.
Decreasing the amount of time from presentation to appropriate treatment requires education. Teaching women the signs and symptoms of a heart attack and why a prompt reaction is crucial and can lead to overall better health outcomes.5 Educating at-risk women about the signs and symptoms of a heart attack will make them better prepared if they find themselves in a situation like that of K.M. They will be able to more quickly recognize their symptoms and know how to respond accordingly. The mortality rate from an acute myocardial infarction in women is twice as high as it is in men; therefore, every effort to reduce delays is critical.3
Education of the signs and symptoms of an acute myocardial infarction starts at the primary care level. Primary care providers such as nurse practitioners and physician assistants can play an instrumental role in this process. They can provide educational opportunities about heart disease to any patient who presents in their office. Primary care providers are able to treat patients and families over the lifetime. They educate as well as implement prevention strategies for patients who are at risk for developing heart disease. Optimizing knowledge and understanding of heart disease in women among both patients and providers will expedite necessary treatments for this population.
In 2003, the Institute of Medicine (IOM) issued a report titled "Priority areas for national action: Transforming Health Care Quality."6 This report recommends 20 priority areas that will improve the quality of healthcare delivered to all Americans. One of the priority areas is ischemic heart disease, more specifically, its prevention, a reduction in recurrence, and the optimization of functional capacity.6
More recently, in 2009, the IOM issued another report, "Initial National Priorities for Comparative Effectiveness Research."7 This report lists 100 priority topics divided into four quartiles. The first quartile considered the highest priority group, and it contains a topic related to heart disease: the effectiveness of interventions to reduce health disparities in cardiovascular disease, diabetes, cancer, musculoskeletal diseases and birth outcomes.7
From these two reports, it is clear that heart disease is still a major healthcare issue in the United States. That disparity of treatment exists among different populations, including women, is still a major concern.
Heart disease is an area that needs further research, and this research should include more women. Since 1984, more women than men have died each year from heart disease, yet women comprise only 24% of participants in all heart-related research studies.1 Research has shown that women experience heart attacks differently from men, so more research studies focused on women are needed. This would enhance recognition and treatment outcomes for this specific population and potentially reduce delays in treatment and mortality.
1. American Heart Association. Facts about heart disease in women. http://www.goredforwomen.org/home/about-heart-disease-in-women/facts-about-heart-disease/
2. Muñoz LR, et al. Awareness of heart disease among female college students. J Womens Health. 2010;19(12):2253-2259.
3. Edwards ML. The enigma of heart disease in women: new insights may precipitate diagnosis and improve patient outcomes. J Am Acad Nurse Pract. 2012;24(10):574-578.
4. American Heart Association. Share your story. http://www.goredforwomen.org/home/share-your-story/
5. Almond SC, et al. Women's experience of coronary heart disease: why is it different? Br J Card Nurs. 2012;7(4):165-170.
6. Adams K, Corigan JM. Priority Areas for National Action: Transforming Health Care Quality. http://books.nap.edu/openbook.php?record_id=10593
7. Institute of Medicine of the National Academies. Initial National Priorities for Comparative Effectiveness Research. http://www.nap.edu/catalog.php?record_id=12648
Kellie Leis is a family nurse practitioner at University of Florida Health in Jacksonville, FL. She has completed a disclosure statement and reports no relationships related to this article.