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March 2, 2017

Study: Heart attack care slower for women than men

By John Lundy
Duluth News Tribune

DULUTH, Minn. — Women are different from men, at least when it comes to treatment of heart attacks.

"What I found was that the recognition was slower for women," said Richard Mullvain, who has the data to back that up.

Mullvain, STEMI manager for the Essentia Health-St. Mary's Heart & Vascular Center, shared his findings as one of the speakers at Wednesday's annual American Heart Association Go Red for Women luncheon, in which 10 Northland women were recognized for adopting lifestyle changes to strengthen their cardiovascular health.

A STEMI, or ST-elevation myocardial infarction, is an especially serious form of heart attack, and Mullvain has dedicated his efforts to improving response times to those and all kinds of heart attacks. But over time, he started to sense a gender difference in those times.

"I just started noticing the women's times looking in my database," Mullvain said in an interview before the luncheon. "I've tracked over a thousand of these now, and I started to see: Well, maybe we're not doing as good of a job with these women."

When he analyzed data from Essentia Health in Duluth and Fargo, he discovered his hunch was correct.

When a woman comes to the hospital herself, it took more than 2½ minutes longer for her to be identified as having had a heart attack than if she were a man, the data showed. If the first contact was with a paramedic or EMT, the difference was nearly 4 minutes.

Those minutes count when it comes to limiting damage from a heart attack, Mullvain said. "The longer the time that that muscle is not getting oxygen, the more it's dying."

Why the gender difference in care?

"I think one of the reasons is it's harder for us to believe a woman is having a heart attack," he said. "Even the doctors and the paramedics are guilty of this."

Mullvain has discovered other differences, including a gap between when symptoms are first experienced and the call to 911. It's longer for women, according to Mullvain's study.

"Women, despite our beliefs, are actually more stubborn than guys when it comes to this," he said. "They're nurturers, they're caregivers, and they're going to put others' needs before themselves."

That observation fits Mary Dow.

The Duluth woman's story has been told before: She was at the state high school hockey tournament two years ago where her son, Luke, was playing for Duluth East. She experienced pressure in her chest, and then a tingling sensation on her left side. Two blocks away, at United Hospital, she was diagnosed with an uncommon form of heart attack known as SCAD — spontaneous coronary artery dissection. It's a form that tends to strike individuals — women more than men — who are in good cardiovascular health. Elite runners have been stricken with SCAD, Dow has learned.

Nonetheless, there were warning signs. And Dow realizes now that she ignored those signs, she said in an interview ahead of the luncheon, where she also was a speaker.

She had been experiencing fatigue, Dow said, but decided it was nothing out of the ordinary.

"We all attributed it to the section playoffs, and every game was super-exciting," she said. "There was a time when I thought I had the flu because I was vomiting, which now I know is another symptom."

From the time she arrived at the state tournament, something in the back of her mind was telling her that something wasn't right, Dow said.

Nonetheless, the rapid response when Dow did get help paid off. She suffered no noticeable heart damage and recovered quickly and fully. She's one of about 900 people enrolled in a clinical study of the disease at the Mayo Clinic in Rochester. She's involved in fundraising to support research of SCAD.

Her message to other women: "Be aware of their bodies," Dow said. "We all get busy with life and don't want to get checked out. ... You really need to advocate for yourself."

That meshes with Mullvain, who wants all of us to take the state of our hearts seriously. His research suggests that's even more true of women than men, he said. "This is my alarm bell to say it's time to start recognizing that we struggle to provide heart attack care as fast for women as for men."

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