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Health & Medicine for Senior Citizens

Women Less Likely to Feel Chest Pain with Heart Attack, More Likely to Die in Hospital

As women age their symptoms become more like those of men - see videos

Feb. 21, 2012 - Women suffering a heart attack – younger women in particular - are more likely than men to arrive at a hospital without chest pain. They also have a higher rate of in-hospital death following a heart attack than men within the same age group, although these differences decrease with increasing age, according to a study in the February 22/29 issue of the Journal of the American Medical Association (JAMA).

"Optimal recognition and timely management of myocardial infarction [MI; heart attack], especially for reducing patient delay in seeking acute medical care, is critical. The presence of chest pain/discomfort is the hallmark symptom of MI," according to background information in the article.

Despite this well-accepted symptom, previous analyses have shown that a large number of patients with MI lack chest pain/discomfort at presentation. "Furthermore, patients without chest pain/discomfort tend to present later, are treated less aggressively, and have almost twice the short-term mortality compared with those presenting with more typical symptoms of MI."

The authors add that women are generally older than men at hospitalization for heart attack.

The American Heart Association says –

Heart Attack Signs in Women

   1. Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes, or goes away and comes back.

   2. Pain or discomfort in one or both arms, the back, neck, jaw or stomach.

   3. Shortness of breath with or without chest discomfort.

   4. Other signs such as breaking out in a cold sweat, nausea or lightheadedness.

   5. As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

If you have any of these signs, don’t wait more than five minutes before calling for help. Call 9-1-1 and get to a hospital right away.

>> More on heart attacks and women at AHA

"It is plausible that women's older age at presentation is related to whether they present with chest pain, as well as subsequent hospital mortality. However, a limited number of studies have taken age into account in examining sex differences in MI clinical presentation."

In this study, John G. Canto, M.D., M.S.P.H., of the Watson Clinic and Lakeland Regional Medical Center, Lakeland, Fla., and colleagues examined the relationship between sex, symptoms when presenting to the hospital, and the risk of death while in the hospital, before and after accounting for age in patients hospitalized with MI.

The study consisted of an analysis of data from the National Registry of Myocardial Infarction, 1994-2006, of 1,143,513 registry patients.

Of these, 42.1 percent were women. Women with MI were significantly older than men at hospital presentation, with an average age of 74 years, vs. 67 years for men.

The overall proportion of MI patients who presented without chest pain or discomfort was 35.4 percent, and was significantly higher for women than men (42.0 percent vs. 30.7 percent).

Age-specific and further analyses indicated a significant interaction between age and sex, with sex-specific differences in MI presentation without chest discomfort becoming progressively smaller with advancing age.


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Death rates

The in-hospital mortality rate was 14.6 percent for women and 10.3 percent for men.

The researchers found that in the fully adjusted models, younger women presenting without chest pain or discomfort had greater hospital case-fatality rates than men, a trend that reversed with increasing age.

"However, younger women presenting with chest pain/discomfort had a greater hospital case-fatality rate than men with chest pain/discomfort in the same age group, but differences in hospital death rates between men and women decreased with advancing age (no longer significant in the oldest group)," the authors write.

"These data suggest that the absence of chest pain may be a more important predictor of death in younger women with MI compared with other similarly aged groups."

The authors add that further research is needed to improve the current understanding of underlying pathophysiology. With this knowledge they would hope to develop sex-tailored health messages for the general public and health care providers to encourage men and women with signs and symptoms of acute coronary syndromes to seek care promptly, which will result in improvement in the care and survival of women.

"Our results of sex-based differences in MI symptom presentation in younger patients are provocative and should be confirmed by others with clinical databases of MI or acute coronary syndromes.

“From a public health perspective, it is appropriate to target high-risk groups for delay (young women) with information on the American Heart Association and National Institutes of Health heart attack message, but until additional research is conducted, the current chest pain/discomfort heart attack symptom message, which targets women and men equally irrespective of age, should remain unchanged."

Editor's Note: The National Registry of Myocardial Infarction was supported by Genentech.


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