890 patients admitted to coronary care units via casualty departments in six major teaching hospitals in Dublin were studied in detail by a team led by Dr Sharon O'Donnell from the City's Trinity College.
The study of 613 men and 277 women shows that:
- On average, women were medically assessed 30 minutes after arriving in casualty departments, compared with 20 minutes for men.
- 92 per cent of women received aspirin, after an average of 55 minutes, compared with 95 per cent of men, after an average of 33 minutes.
- Women waited an average of 70 minutes for reperfusion therapy – which restores blood flow to the heart – compared with 52 minutes for men.
- Only 35 per cent of women received reperfusion therapy, compared with 43 per cent of men. 40 per cent of women and 25 per cent of men did not receive the therapy, because healthcare staff stated it was "too late" to be clinically effective.
- The average time it took for women to be transferred to the coronary care unit from the casualty department was three hours and 56 minutes – 54 minutes longer than men.
"Treatment delays experienced by women may limit their potential to achieve maximum benefit from reperfusion therapies, which have been clinically proven to work more effectively when administered early" says Dr O'Donnell.
"This could result in women being exposed to a greater rate of life-threatening complications and less favourable outcomes than their male counterparts.
"The image of the typical male heart attack victim must be corrected in the minds of triage nurses - who carry out initial assessments in casualty departments - and other healthcare staff.
"Better healthcare training and clinical awareness are needed if women who have heart attacks are to receive the same care as men."
Approximately 120 nurses working across the six coronary care units in Dublin, Southern Ireland, took part in the study, completing a 25-item questionnaire for each patient admitted during the one-year study.
The questionnaire used was designed with input from a panel of experts and tested out during two pilot studies.
Only patients who were admitted via the hospitals' casualty departments, who had a confirmed diagnosis of Myocardial Infarction (heart attack) and who were sent to the hospitals' coronary care units were included in the study.
"Our findings do not give reasons for assessment or treatment delays, but they do present factual yet unexplained accounts of the differences experienced by male and female patients" adds Dr O'Donnell.
"We accept that certain Myocardial Infarction presentations are more difficult to assess and that practical, everyday resources and funding issues may exacerbate treatment and decision-making delays.
"However this study does raise important concerns about equitable healthcare practice and we hope that it will prompt further investigation and discussion, particularly on the issues surrounding women who suffer heart attacks."
The research was funded by the Ireland's Health Research Board.
For further details or a copy of the full paper contact Annette Whibley, Wizard Communications at wordwizard@clara.co.uk
To interview lead author Sharon O'Donnell contact Sally-Anne Fisher, Trinity College on (00) 353 1 608 3606 or fishers@tcd.ie
Notes to editors
- In-hospital care pathway delays: gender and myocardial infarction. Sharon O'Donnell (Trinity College, Dublin), Sarah Condell (National Council for Professional Development of Nursing and Midwifery, Dublin), Cecily Begley (Trinity College, Dublin) and Tony Fitzgerald (St James's Hospital, Dublin). Journal of Advanced Nursing, volume 52.1, pages 14 to 21 (published September 2005).
- Founded in 1976, Journal of Advanced Nursing is read by experienced nurses, midwives, health visitors and advanced nursing students in over 80 countries. It informs, educates, explores, debates and challenges the foundations of nursing health care knowledge and practice worldwide. Edited by Professor Alison Tierney, it is published 24 times a year by Blackwell Publishing Ltd, part of the international Blackwell Publishing group.
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Journal of Advanced Nursing