Women of color fared even worse, waiting about 15 minutes longer than white women for initial evaluations, according to the new study, published in the Journal of the American Heart Association. “Chest pain is the most common symptom of heart attack in adults of all ages,” says lead study author Darcy Banco, MD, chief resident for safety and quality in the department of medicine at the NYU Grossman School of Medicine in New York City. “Despite a decline in the number of overall heart attacks, this number is rising among young adults,” Dr. Banco adds. “And young women and young Black adults have poorer outcomes after a heart attack compared to men and white adults.” While the study wasn’t designed to test whether differences in treatment or wait times for care might directly cause disparities in outcomes after a heart attack, it’s clear that disparities exist and it’s possible that structural inequities like racism or sexism might play a role, Banco notes.
Delayed Care Results in Worse Outcomes
For the study, researchers examined data from a nationally representative sample of more than 4,000 patient records representing more than 29 million emergency room visits for chest pain by adults 55 and younger between 2014 and 2018. All of the patients in the came to the emergency room because they had pain, discomfort, pressure, tightness, a burning sensation in their chest or because they reported heart pain. Women with chest pain waited an average of 48 minutes to be seen in the emergency room, compared with 37 minutes for men. When researchers focused on differences by race, they found white women had average wait times of 43 minutes, compared with 58 minutes for women of other racial or ethnic groups. White men waited an average of 34 minutes, compared with 44 minutes for men of color. Most of the nonwhite patients in the study identified as Black. In addition, women of color were significantly less likely than white women to receive anti-clotting medications to help prevent a heart attack or narcotic painkillers to ease their discomfort. One limitation of the study is that it wasn’t possible to determine whether emergency room care was faster or more comprehensive for the subset of patients in this study who went on to have a heart attack. Most adults with chest pain who are seen in the emergency room don’t go on to have a heart attack, and it’s not clear whether care may have been faster or more comprehensive for patients who did have a heart attack in the study. But previous research has linked delayed care to worse outcomes, particularly for women and Black people, says Martha Gulati, MD, a cardiologist and chair of the 2021 chest pain guidelines for the American Heart Association and the American College of Cardiology. “Time is heart muscle,” Dr. Gulati says. “So, these noted delays and less aggressive care of women have the potential to translate into delays in care, less diagnostic testing, deaths at home for some discharged, and continued worse outcomes after a heart attack in young women — particularly young Black women.” One study, published in November 2020 in the European Heart Journal, for example, followed male and female heart attack patients 50 and younger for more than a decade. In the hospital, women were less likely to get aggressive treatment. After they went home, women were less likely to get medications that can reduce their risk of a repeat heart attack like aspirin, beta-blockers, statins, and angiotensin-converting-enzyme (ACE) inhibitors. And, women were 60 percent more likely to die by the end of follow-up. Part of the problem may be that women’s symptoms aren’t taken as seriously, a study published in February 2018 in Circulation suggested. Nearly all of the men and women in this study reported chest pain, pressure, tightness, or discomfort as a key symptom. However, women were twice as likely as men to chalk this up to stress or anxiety. And 53 percent of women said doctors told them their symptoms weren’t heart related, compared to 37 percent of men. “There is implicit bias in how we care for women,” Gulati says. “Women are still not seen to be at risk for heart disease. It is still seen as a man’s disease, despite the fact that cardiovascular disease remains the leading cause of death in both men and women.”
