Among younger adults experiencing myocardial infarction and angina, men are more likely to receive faster care compared with women, according to a study based primarily in Canada.
The study, published March 17 on the website of the Canadian Medical Association Journal, also found that gender-related factors affected access to care for both men and women.
To understand why sex differences in mortality exist in younger men and women with acute coronary syndrome, researchers included 1,123 patients ages 18 to 55 recruited from 24 centers across Canada and one each in the U.S. and Switzerland. Of the participants, 362 (32%) were women and 761 (68%) were men. The median age was 50 for women and 49 for men.
According to a survey completed by the participants, women came from lower income brackets, were more likely to have diabetes, hypertension and a family history of heart disease, and had substantially higher levels of anxiety and depression than men.
Men received faster access to electrocardiograms and fibrinolysis than women, with door-to-ECG and door-to-needle times of 15 and 21 minutes versus 28 and 36 minutes.
Anxiety was associated with failure to meet the 10-minute benchmark for ECG in women but not in men, wrote Louise Pilote, MD, PhD, clinician-researcher, Division of Clinical Epidemiology at the Research Institute of McGill University Health Centre, Montreal, and professor of medicine at McGill University, with coauthors.
Patients with anxiety who present to the emergency department with noncardiac chest pain tend to be women, and the prevalence of acute coronary syndrome is lower among young women than among young men.
These findings suggest that triage personnel might initially dismiss a cardiac event among young women with anxiety, which would result in a longer door-to-ECG interval.
Patients visiting the ED with atypical symptoms or multiple risk factors also had longer treatment delays.
The researchers found that both men and women with feminine character traits, based on responses to personality-related questions in the survey, were less likely to receive timely care than patients with masculine traits.
A novel finding of our study was the identification of gender-related determinants of access to care, the authors wrote. Men and women who reported higher levels of feminine personality traits, as well as those who reported being the person at home mainly responsible for housework, were less likely to undergo invasive procedures.
The authors concluded that more specific management may be required for patients presenting to the ED with no chest pain, several risk factors or a feminine gender identity and role.