Perceived risk of heart attack: a function of gender?

Exploratory study into awareness of heart disease and health care seeking behavior among Emirati women (UAE) - Cross sectional descriptive study

Background

Cardiovascular disease was the leading cause of death among women in the United Arab Emirates (UAE) in 2010. Heart attacks usually happen in older women thus symptoms of heart disease may be masked by symptoms of chronic diseases, which could explain the delay in seeking health care and higher mortality following an ischaemic episode among women. This study seeks to a) highlight the awareness of heart diseases among Emirati women and b) to understand Emirati women’s health care seeking behaviour in UAE.

Method

A cross sectional, descriptive study was conducted using a survey instrument adapted from the American Heart Association National survey. A convenience sample of 676 Emirati women between the ages of 18–55 years completed the questionnaire.

Results

The study showed low levels of awareness of heart disease and associated risk factors in Emirati women; only 19.4% participants were found to be aware of heart diseases. Awareness levels were highest in Dubai (OR 2.18, p < 0.05) among all the other emirates and in the 18–45 years age group (OR 2.74, p < 0.05). Despite low awareness levels, women paradoxically perceived themselves to be self-efficacious in seeking health care. Interestingly, just 49.1% Emirati women believed that good quality and affordable health care was available in the UAE. Only 28.8% of the participants believed there were sufficient female doctors to respond to health needs of women in UAE. Furthermore, only 36.7% Emirati women chose to be treated in the UAE over treatment in other countries.

Conclusion

Emirati women clearly lack the knowledge on severity and vulnerability to heart disease in the region that is essential to improve cardiovascular related health outcomes. This study has identified the need for wider outreach that focuses on gender and age specific awareness on heart disease risks and symptoms. The study has also highlighted potential modifiable barriers in seeking health care that should be overcome to reduce morbidity and mortality due to heart disease among national women of UAE.

Gender differences in factors associated with prehospital delay among acute coronary syndrome patients in Pakistan

PURPOSE

To identify gender differences in prehospital delay time (PDT) and its associated factors among acute coronary syndrome (ACS) patients.

DESIGN

Descriptive cross-sectional comparative study.

METHODS

This study was conducted among 249 ACS patients at two tertiary care hospitals of a large metropolitan city of Pakistan. Data were collected through the modified Response to Symptoms Questionnaire.

RESULTS

The median PDT of women was found to be 7 hours, compared to 3.5 hours among men (p = .001). Results of the regression analysis indicated that most women delayed because of social factors, such as attendants' responses to their symptoms (p = .002), and because they were worried about expenses required for the treatment (p = .002); yet, most men delayed owing to individual factors, such as waiting for symptoms to subside (p< .001), and not recognizing the symptoms as being cardiac related (p< .001). Having anxiety and lack of knowledge about symptoms was associated with extended PDT among both genders.

CONCLUSION

Women delayed longer than men in seeking treatment for their ACS symptoms. Different factors were associated with PDT in women and men. This study may provide important insights for designing interventional studies to reduce PDT in Pakistani ACS patients.

"Missing pieces": exploring cardiac risk perceptions in older women

Approximately 95% of older women have factors that put them at risk for developing cardiovascular disease, but research indicates many do not perceive themselves to be at risk. We examined older women's perceived risk for coronary heart disease (CHD) and the factors influencing their perceptions. We conducted a descriptive, qualitative study using in-depth, individual interviews and quantitative measures to assess perceived risk and risk factors. Twenty-four older African American and Caucasian women had a mean 4.46 cardiac risk factors but perceived their own CHD risk as unrealistically low at 1.95 cm (SD = 1.57, on 0-to-8 cm visual analogue scale). Narrative data clustered in themes that represented a lack of fact-based information and multiple misconceptions about CHD and prevention. Major improvements in CHD health are only achievable if risk factors are prevented. This research suggests older women have substantial needs for consistent CHD information and prevention guidance.

Cardiovascular disease in women: implications for improving health outcomes

OBJECTIVE

To collate data on women and cardiovascular disease in Australia and globally to inform public health campaigns and health care interventions.

DESIGN

Literature review.

RESULTS

Women with acute coronary syndromes show consistently poorer outcomes than men, independent of comorbidity and management, despite less anatomical obstruction of coronary arteries and relatively preserved left ventricular function. Higher mortality and complication rates are best documented amongst younger women and those with ST-segment-elevation myocardial infarction. Sex differences in atherogenesis and cardiovascular adaptation have been hypothesised, but not proven. Atrial fibrillation carries a relatively greater risk of stroke in women than in men, and anticoagulation therapy is associated with higher risk of bleeding complications. The degree of risk conferred by single cardiovascular risk factors and combinations of risk factors may differ between the sexes, and marked postmenopausal changes are seen in some risk factors. Sociocultural factors, delays in seeking care and differences in self-management behaviours may contribute to poorer outcomes in women. Differences in clinical management for women, including higher rates of misdiagnosis and less aggressive treatment, have been reported, but there is a lack of evidence to determine their effects on outcomes, especially in angina. Although enrolment of women in randomised clinical trials has increased since the 1970s, women remain underrepresented in cardiovascular clinical trials.

CONCLUSIONS

Improvement in the prevention and management of CVD in women will require a deeper understanding of women's needs by the community, health care professionals, researchers and government.

Middle-aged women and everyday life: implications for health

The aim of this study was to describe middle-aged women's perceptions of lifestyle and how it was experienced in their daily lives. Interviews with 15 women selected using network sampling were analysed using a phenomenographic approach. Lifestyle was perceived as either 'handle life', describing a framework of how everyday life should manifest itself in different areas of life, or 'relate to life' implying accepting life as it is and making the best of it based on previous experiences. In terms of providing preventive and health-promoting guiding, it is essential that nurses have an insight into people's reasoning to support them to improve health or deal with illness.

Women's descriptions of symptoms and delay reasons in seeking medical care at the time of a first myocardial infarction: A qualitative study

BACKGROUND

Coronary heart disease (CHD) is a major cause of mortality in women. Women have also been identified as late presenters in seeking medical care.

AIM

The aim of this study was to explore and describe women's symptoms and the reasons for delay in seeking medical care at the time of the first myocardial infarction (MI).

METHODS

The study had an explorative and descriptive design based on content analysis approach. Nineteen women were interviewed at the hospital 2 or 3 days after hospitalisation.

RESULTS

The result showed that the women had difficulties interpreting, understanding and linking the symptoms to CHD. They tried to handle the discomfort and even the chest pain, rather then ask for professional help. The women had problems with making the final decision.

CONCLUSION

Women need to be made aware of the clinical symptoms of CHD, in order to understand the consequences of delay in seeking medical care following an MI.

Why do women underestimate the risk of cardiac disease? A literature review

BACKGROUND

Despite the quantity of information available to women about risk factors for cardiovascular disease (CVD), many women do not perceive this risk.

AIM

This paper seeks to identify factors in the published literature that influence women's risk perception of heart disease, and how these perceptions influence health outcomes.

METHOD

A literature search from 1985 to 2006 using the CINAHL, Medline, Embase and PsycINFO electronic databases was undertaken. The keywords used were 'perceived risk', 'cardiac risk factors', 'cardiovascular disease', 'risk misconception', and 'heart disease', combined with 'women' and/or 'gender'. Additional data was obtained by manual searches of bibliographies of articles identified in the electronic searches, and Internet searches.

FINDINGS

Until the late 1980s, CVD was perceived as a disease which primarily affected men, as few large clinical trials recruited women. This resulted in a lack of data documenting the relationship between known risk factors and gender. Until recently, health professionals have not focused on disseminating gender-specific information about CVD risks to women, causing women to underestimate their risk of developing CVD even when risk factors are clearly evident. Furthermore, women are less likely than men to recognise the signs and symptoms of CVD, delay in seeking treatment, and fail to adopt healthy lifestyles, all of which increase the incidence of mortality and morbidity in a disease that is largely preventable.

CONCLUSION

This review highlights the need for health professionals to 'bridge the gap' between perceived and actual risk of CVD in women, and to develop educational programs that specifically target women.

Diferencias de género en el tratamiento de revascularización precoz del infarto agudo de miocardio

BACKGROUND AND OBJECTIVE

Clinical variability in myocardial infarction (MI) regarding age, comorbidities and atypical symptoms could determine gender differences in inhospital care. This study analyzes the magnitude and determinants of differences between men and women in early reperfusion therapy in people hospitalized after MI.

PATIENTS AND METHOD

2,836 patients who arrived to hospital with MI were studied (IBERICA-Basque Country study). The relative risk (RR) of receiving early reperfusion for men versus women, adjusted by age, clinical characteristics, risk factors, and pre-hospital delay was estimated. The effect decomposition methodology and the log binomial regression were applied.

RESULTS

29% of patients were women with a median age of 77 years. The RR of revascularization in men compared to women was different according to age. When factors such as hypertension diabetes, Killip III-IV at admission and atypical symptoms were taken into account, statistically significant differences between sexes were not detected at 45 years old (RR=0.91; 95% CI=0.77-1.07). However, for 64 years old and over, the RR of reperfusion was 1.24 (95% CI=1.05-1.47). Both the differences by sex and the sex-age interaction were no longer statistically significant after adjusting by pre-hospital delay.

CONCLUSIONS

The delay to receive medical care in elderly women is responsible of gender differences in early reperfusion. It is necessary to analyze the reasons for treatment-seeking delay.

Understanding prehospital delay behavior in acute myocardial infarction in women

Studies demonstrate that acute myocardial infarction (AMI) mortality can be reduced if reperfusion therapy is initiated within 1 hour of AMI symptom onset. However, a considerable number of men and women arrive at the emergency department outside of the time frame for thrombolytic and angioplasty effectiveness. This is especially true for women who have been shown to delay longer than men due to their prehospital decision-making process utilized. With a mean total delay time greater than 4 hours, the time interval from symptom onset to transport activation to the hospital consumes the majority of the prehospital phase of emergency cardiac care. The health belief model, self-regulation model, theory of reasoned action, and theory of planned behavior have all been used to describe the prehospital decision-making process of both men and women with an AMI and the variables that impact that process. These models have identified the importance of symptom attribution to cardiac-related causes as a target variable for research and interventions related to care-seeking behavior.