Elderly women with myocardial infarction arrive at the hospital too late

February 9, 2018, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK)

It takes women aged over 65 the longest to arrive at the emergency department after the onset of myocardial infarction symptoms. As a consequence, valuable time is lost to reopen the occluded blood vessels and limit the damage to the myocardium. This was revealed by a study of the German Centre for Cardiovascular Research (DZHK) in cooperation with the Helmholtz Zentrum München and the Technical University of Munich. The researchers recommend targeted educational strategies for this risk group.

"The difference between elderly and all other groups investigated by us, namely younger women aged under 65 as well as men aged over and under 65 is striking," says the DZHK scientist Professor Karl-Heinz Ladwig, group leader at the Institute of Epidemiology of the Helmholtz Zentrum München and Professor of Psychosomatic Medicine at the Technical University of Munich. In the case of elderly women, an average of more than four and a half hours pass before they arrive at an ; younger women, however, take just under two and a half hours. Even younger and older men are quicker: for men aged over 65, it takes over three and a half hours in comparison to just over three hours for younger men until they are examined in hospital. In contrast to previous assumptions, it is thus neither age nor sex alone, but the combination of both age and female sex that contribute to long delay times between the onset of symptoms and treatment in an emergency department. And yet in the case of a myocardial infarction every minute counts to examine the heart with a catheter and reopen the occluded blood vessel. This is because the quicker the blood flow can be restored, the fewer myocardial cells die.

The data come from the MEDEA study (Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction), in which 619 patients with myocardial infarction for whom an ST-segment elevation was present in the electrocardiogram were interviewed during a period of more than four years. This project was funded by the German Heart Foundation. Certified interviewers met with the patients within 24 hours after they left the intensive care unit. Moreover, the filled in a questionnaire and their physical risk factors were ascertained from their medical records and the information provided by medical staff. The clinical characteristics of men and women differed only slightly, with male study participants being smokers slightly more often than female participants. When considering the sociodemographic factors, it became apparent that female study participants lived alone more often and were older and more frequently unemployed.

The general assumption that as a typical symptom of myocardial infarction is absent only in women could not be verified by Ladwig and his colleagues. This is because the absence of chest pain had only a minor effect on the delay times of elderly female patients and could not explain the observed excessive differences in time. Instead, the data of the MEDEA study show that the absent chest pain is an age-related effect and is not typically female, since the researchers found that this symptom was absent almost as often in elderly men as in elderly women. According to Ladwig, the occurrence of chest pain can be summarised in the simple formula: "The older the patient, the less chest pain."

"We could not determine any differences between the sexes for nausea or vomiting either," says Ladwig. "This was completely different to what we expected, since these atypical conditions were previously always ascribed more to women." Absent or unusual conditions can thus not be the reason why elderly women go to the emergency department so late.

Misplaced modesty

Ladwig and his colleagues find the reasons for the long delay times in the psychological area, including in a modesty which in this case is totally misplaced: "It'll get better, so there's really no need for me to phone the doctor on call. What'll the neighbours think if the ambulance arrives and it was nothing after all?" Such thoughts are probably frequent especially for elderly women and lead to the dangerous delays. The scientists are already planning a follow-up study in which they want to research these factors in elderly women in greater detail.

They also recommend a focus on this risk group in myocardial infarction education. "One of our key aims is to target in future through nationwide campaigns or physicians," says Ladwig. General practitioners should speak to their elderly female patients who have risk factors for myocardial infarction. They should explain to them how important it is to call the 112 early enough and how they can properly react in an emergency. This also includes easy tips like attaching the note with the emergency number directly onto the telephone and namely writing it large enough so it can be read without glasses.

Explore further: Gender gap in death from heart attack reduces particularly in younger women

More information: Karl-Heinz Ladwig et al. Comparison of Delay Times Between Symptom Onset of an Acute ST-elevation Myocardial Infarction and Hospital Arrival in Men and Women <65 Years Versus ≥65 Years of Age., The American Journal of Cardiology (2017). DOI: 10.1016/j.amjcard.2017.09.005

Related Stories

Gender gap in death from heart attack reduces particularly in younger women

August 27, 2017
The gender gap in death from heart attack has reduced over the past two decades particularly in younger women, according to research presented today at ESC Congress. The study in over 50 000 patients found that overall in-hospital ...

Troponin linked to increased risk of death

November 3, 2017
A blood test that measures the presence of heart specific proteins called troponins is used by A&E hospitals to diagnose myocardial infarction in patients with chest pain. But even normal levels of the protein in patients ...

Study confirms safety of rapid algorithm to rule-out and rule-in myocardial infarction

August 28, 2017
Patients with symptoms suggestive of acute myocardial infarction (AMI) account for about 10% of all emergency department consultations. Rapid identification of AMI, which may be life-threatening, allows the early initiation ...

Young women with diabetes have six-fold risk of heart attack

August 31, 2015
Women aged 45 years and under with diabetes have a six-fold risk of heart attack, according to research presented at ESC Congress today. The study in more than 7 000 women also found that young women who had a heart attack ...

Women more likely to die from myocardial infarction than men

October 20, 2012
Women are more likely to die from a myocardial infarction than men, according to research presented at the Acute Cardiac Care Congress 2012. The gender gap in mortality was independent of patient characteristics, revascularisation ...

Synergy stent with shorter DAPT is superior to a bare-metal stent in elderly patients

November 2, 2017
Elderly patients undergoing PCI often receive bare-metal stents (BMS) instead of drug-eluting stents (DES) to shorten the duration of dual antiplatelet therapy (DAPT) and reduce bleeding risk. However, results from the SENIOR ...

Recommended for you

Gout could increase heart disease risk

August 17, 2018
Having a type of inflammatory arthritis called gout may worsen heart-related outcomes for people being treated for coronary artery disease, according to new research.

Stroke patients treated at a teaching hospital are less likely to be readmitted

August 17, 2018
Stroke patients appear to receive better care at teaching hospitals with less of a chance of landing back in a hospital during the early stages of recovery, according to new research from The University of Texas Health Science ...

Cardiovascular disease related to type 2 diabetes can be reduced significantly

August 16, 2018
Properly composed treatment and refraining from cigarette consumption can significantly reduce the risk of cardiovascular disease resulting from type 2 diabetes, according to a study published in the New England Journal of ...

Genomic autopsy can help solve unexplained cardiac death

August 15, 2018
Molecular autopsies can reveal genetic risk factors in young people who unexpectedly die, but proper interpretation of the results can be challenging, according to a recent study published in Circulation.

Neonatal pig hearts can heal from heart attack

August 15, 2018
While pigs still cannot fly, researchers have discovered that the hearts of newborn piglets do have one remarkable ability. They can almost completely heal themselves after experimental heart attacks.

Fifty percent of cardiovascular patients suffer from multiple diseases

August 15, 2018
New research led by The University of Western Australia has revealed that one in two patients admitted to hospital with a cardiovascular disease is suffering from multiple chronic medical conditions which required complex ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.