Study highlights:
• Researchers surveyed 30 women (average age 48) who suffered a heart attack were interviewed in detail.
• Many of the women did not know that symptoms such as neck and shoulder pain, upper abdominal discomfort that seemed like indigestion and unusual fatigue could signal a heart problem.
• Researchers said young women, their families and healthcare providers must be educated on how young women with heart disease may present.

BALTIMORE, MD, May 2 — Many women under age 55 aren’t seeking timely treatment for heart attack because they expect the warning signs and their reaction to follow a Hollywood script — tightening in the chest, shortness of breath, clutching the chest while dropping to one knee.

That’s the finding of researchers who presented their study at the American Heart Association’s 9th Scientific Forum on Quality of Care and Outcomes Research (QCOR) in Cardiovascular Disease and Stroke.

Researchers studied 30 women who had suffered a heart attack (average age 48). The young women were allowed to talk about their experiences in great detail, using their own words to describe their recognition of symptoms, their initial actions (or lack of action), and their reasons for not seeking prompt care.

“We found that most failed to connect their symptoms with a heart condition, commonly misattributing them to fatigue, indigestion, stress or overexertion,” said Judith Lichtman, Ph.D., lead author of the study and associate professor of epidemiology and public health at the Yale School of Medicine in New Haven, Conn.

Researchers conducted in-depth telephone interviews with the women within seven days of their hospital discharges for heart attacks between October 2006 and May 2007. The interviews explored the women’s initial recognition and response to symptoms, their healthcare beliefs and their acute healthcare experiences. Lichtman said the interviews lasted roughly 30 to 40 minutes, and the more open-ended format allowed the young women to describe their experiences in detail.

“The stories they told were incredibly rich in detail,” Lichtman said. “We learned that many of these women had no idea that they were at risk for heart disease and were unaware that their symptoms could be connected with a heart problem, citing the lack of good examples in the public media to help them recognize atypical symptoms, or realize that someone their age could even be at risk for a heart problem. We also learned much more about their experiences with the healthcare system in terms of preventive care and the care they received during the acute presentation.”

Lichtman noted many of the women were surprised that their actual symptoms differed from the ‘Hollywood heart attack’ that they would have expected. “They wish that they had known that symptoms such as neck and shoulder pain, abdominal discomfort that was easy to mistake for indigestion, or unusual fatigue could signal a heart problem,” she said. “They often said that TV doesn’t show examples of the symptoms they experienced. If they knew, they would have responded to the symptoms sooner.”

The participants described a complex internal dialogue as they decided when to engage the healthcare system and identified an array of factors that contributed to delays, ranging from:
• Uncertainty
• Preference to self-medicate
• Perceived negative treatment by healthcare providers
• Competing time/family demands
• Individual beliefs and behaviors to health system failures
• Seeking corroboration of symptoms and deferring responsibility to engage the healthcare system

Many of the women said they didn’t receive prompt care for their symptoms because they called their physician and were given an appointment within a few days. Some of those who went to the emergency room said they experienced long delays there because they were thought to have non-cardiac conditions.

“While this was certainly not the experience for all women, repeated stories of being triaged to less urgent care initially for what were thought to be non-cardiac conditions suggest that additional work is needed to help young women, their families and healthcare providers recognize that young women with heart disease may present with typical and atypical symptoms,” Lichtman said. “There are large gaps in our understanding of the symptoms young women experience or reasons they delay seeking prompt care. It is important to help young women recognize that they can be at risk for heart disease despite the fact that we often associate heart disease with older patients.

“Although young women represent less than 5 percent of all patients with heart disease, this is significant because it still translates to 16,000 deaths and about 40,000 hospitalizations annually — a number that rivals breast cancer in this age group. Because heart disease is less common at this younger age, current media campaigns and prevention messages do not appear to be reaching this group.”

This study builds on findings from a prior pilot study of 24 women (age 55 and younger) presented at the 2007 QCOR meeting. In that study the researchers found that more than half of the women who experienced heart attack symptoms delayed seeking care for more than an hour.

The Fannie E. Rippel Foundation funded the current study. The prior pilot study was funded by the American Heart Association Heritage Affiliate.

Co-authors are: Emi Watanabe, M.P.H.; Norrina Allen, M.P.H.; Brian Garavalia, Ph.D.; Linda Garavalia, Ph.D.; Carole Decker R.N., Ph.D.; John Spertus, M.D., M.P.H.; Harlan M. Krumholz, M.D., S.M.; and Leslie Curry, Ph.D., M.P.H.
Editor’s note: Heart disease is the #1 killer of women and claims more than 460,000 women's lives per year – that’s about one death per minute. Because heart disease is largely preventable, the American Heart Association’s Go Red For Women movement urges women to take action and reduce their personal risk. Visit GoRedForWomen.org or call 1-888-MY-HEART to take the Go Red Heart CheckUp and receive a 10-year risk assessment and personalized action plan.
Statements and conclusions of abstract authors presented at American Heart Association/American Stroke Association scientific meetings are solely those of the abstract authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability.