Overcoming Hesitancy: Enhancing Early Intervention in Women with Suspected Heart Attacks

A recent study from Monash University sheds light on a critical yet underappreciated factor contributing to sex-based disparities in cardiac care outcomes. While women are statistically more likely than men to call emergency services when experiencing heart attack symptoms (70.4% vs. 62.7%), they are significantly less comfortable making that call (69.1% vs. 76.7%). These findings underscore a vital need for tailored patient education and proactive clinical strategies.

Key Findings and Their Clinical Relevance

Hesitancy Factors:

Women are more likely to delay calling 000 due to fears of being a burden, uncertainty about the severity of symptoms, a preference for consulting their GP first, and a perception of being at low risk. This hesitation can lead to delayed diagnosis and treatment—critical issues that contribute to poorer outcomes in women.

Subtle Symptom Presentation:

Women often present with less typical, subtler symptoms of heart attacks, which may be misinterpreted by both patients and healthcare professionals as non-cardiac. This not only delays emergency calls but also complicates in-hospital diagnosis and management.

Barriers Beyond Gender:

Additional factors that deter prompt emergency service use include language barriers, the presence of cardiovascular risk factors, poor symptom knowledge, regional disparities (e.g., residents in the Northern Territory), and unclear health insurance status.

The 'Call First, Decide Later' Message:

A recurring recommendation from the study's lead researchers is straightforward yet powerful: in the face of suspected cardiac symptoms, the priority must be to call emergency services immediately. Early intervention can enable paramedics to initiate treatment pre-hospital, reducing the risk of fatal cardiac arrest and improving overall outcomes.

Implications for Clinical Practice

For clinicians, these findings present several actionable insights:

• Enhance Patient Education:
• Emphasise the importance of early emergency response during patient consultations, particularly with female patients. Clarify that any suspicion of a heart attack warrants immediate action—“call first, and decide later.”
• Tailor Communication Strategies:
• Recognise and address the specific concerns women may have about calling 000. Incorporate discussions about overcoming fears of being a burden and clarifying misconceptions about personal risk.
• Promote Awareness of Atypical Symptoms:
• Reinforce the understanding that heart attack symptoms in women can be less pronounced. Ensure that both patients and healthcare teams remain vigilant for these subtler signs to avoid diagnostic delays.
• Support Community and Public Health Initiatives:
• Advocate for targeted educational campaigns and community outreach, especially in at-risk groups such as non-native English speakers or individuals with ambiguous insurance statuses. Collaboration with public health agencies can help bridge knowledge gaps and improve emergency response rates.

Moving Forward

As doctors, our role extends beyond clinical interventions to include patient advocacy and education. This study by Monash University is a clarion call to reinforce the message that time is of the essence in cardiac care. By integrating these insights into our practice, we can contribute to reducing the gender gap in heart attack outcomes.

• Engage in Continuous Learning:
• Stay updated on emerging research regarding sex-based differences in cardiovascular presentations and outcomes. Participate in relevant professional development opportunities to enhance your understanding and improve patient care strategies.
• Implement System-Wide Changes:
• Work with multidisciplinary teams to develop protocols that address these delays, ensuring that emergency response systems and community education initiatives are aligned with current evidence.

In confronting these systemic challenges, we must remember: every minute counts. Empowering our patients—especially women—to act decisively in the face of cardiac symptoms is not just beneficial; it is essential for saving lives.

Resources:

Why women wait to call 000 when they suspect they're having a heart attack | Monash University

Sex differences in the intention and decision to use emergency medical services for acute coronary syndrome in Australia: a retrospective study