Fewer Tests, Longer Waits for Women in ER With Chest Pain

When younger women show up at the emergency room with chest pain, they wait longer to be seen, have fewer tests, and are less likely to be admitted than men, according to new research.

The study, which will be presented next week during the 70th American College of Cardiology Scientific Session, is the first to examine how chest pain is managed among adults who are too young for Medicare. This study looked at adults age 18-55 years. Heart disease is the leading cause of death for women, and it’s showing up more frequently in younger adults, with a 2019 study citing rising obesity and diabetes rates as culprits. Roughly one-third of women hospitalized for a heart attack are younger than 55.

Darcy Banco

Darcy Banco, M.D.,the study’s lead author and a resident at NYU Langone Health, said women should seek care at the first sign of trouble, which can include chest pain, nausea, vomiting, fatigue, sweating, back pain, or trouble breathing.

Besides getting less attention once they arrive at the ER, Banco said earlier research shows women wait longer than men to seek care when they have heart attack symptoms.

“The most important thing a woman can do is to seek medical care if she is worried and to ask specific questions of her doctor,” she said.

The new findings are derived from data collected from 2014-2018 by the CDC, through the National Hospital Ambulatory Medical Care Survey. From this survey data, researchers estimated that 29 million visits to the ER for chest pain involve adults aged 18-55, and women accounted for 57% of these visits.

Women were just as likely as men to come to the hospital by ambulance, but once there, took longer to be triaged and tested. Banco’s study found women waited longer to be seen by a clinician, and were less likely to receive an electrocardiogram, or EKG, the test used to diagnose a heart attack.

Specifically, the study found:

• Women were triaged as urgent or emergent 57.1% of the time, compared with 63.0% of the time in men.
• Women waited 45 minutes on average to see a doctor, compared with 37 minutes for men, and a cardiology consult happened with 12.3% of men compared with 8.5% of women.
• EKG testing happened in 78.8% of men, compared with 74.2% of women versus 78.8% of men.
• Only 12.4% of the women were admitted for observation, compared with 17.9% of men.

The study did not look into why women with chest pain are treated differently, and Banco said it’s more likely that outdated notions about risk, instead of overt discrimination, play a role. While heart attacks have historically been more common in older men, the rates are rising among women. But the lower rates of testing and admission could point to heart attacks that are being missed, she said.

She pointed to data showing a steady rise in heart attack rates among younger women over 20 years, with serious consequences. Compared to young men, “They have a higher mortality and poor physical and mental health after heart attack,” she said. “They’re less likely to return to work within 12 months after their heart attack.”

When a heart attack is suspected, minutes matter. Guidelines call for patients with a possible heart attack to have an EKG within 10 minutes of reaching the ER. “The longer people wait, the worse their outcomes can be,” Banco said.

The study will be presented May 15 during ACC, which will be in a virtual format for the second consecutive year due to COVID-19.