Why Are So Many Women Ignoring Heart Attack Symptoms?

Heart disease is a leading cause of death for women, and yet women are more likely than men to dismiss pain or symptoms of heart problems, and to delay seeking medical help -- a "dangerous game" that experts say may have serious health implications.

Though heart symptoms are similar for both men and women, the way that people perceive their symptoms and the point at which they are moved to seek medical help can vary widely.

Women may be more likely than men to exhibit an 'optimism bias' -- a cognitive bias that causes them to believe they are less at risk for negative outcomes than they actually are -- than men, which can keep them from seeking medical assistance and could worsen their condition, according to new research from the Harvard School of Public Health.

"The main danger is that when someone comes to the hospital with a more severe or advanced stage of heart disease, there are simply fewer treatment options available," epidemiologist Dr. Catherine Kreatsoulas, Heart and Stroke Foundation research fellow at the Harvard School of Public Health and lead author of the study, said in a statement.

Kreatsoulas and colleagues conducted their research on patients with suspected coronary artery disease who were about to undergo their first coronary angiogram test. In the first part of the study, researchers interviewed cardiac patients about their experience of angina (chest pain caused by reduced blood flow to the heart) and their decision to seek medical care. Angina is a sign that the organ isn't getting as much blood and oxygen as it needs, which can be experienced as pressure and tightness in the chest or a burning sensation, and is a warning sign of elevated risk for heart attack or cardiac arrest.

The second part of the study brought in a new group of patients and documented, by gender, when and why patients sought care. Kreatsoulas noted that it was difficult to determine exactly how long patients waited, due to human error in recalling time of events.

"While we do have time estimates from the patients in our study, we are weary of hinging too much weight on them," Kreatsoulas said in an email to the Huffington Post. "What we do observe consistently across studies is that women with heart disease, come to hospital with more advance stages of disease, supporting the denial stage hypothesis."

The researchers identified six characteristic stages in the transition from first experiencing cardiac symptoms like angina to seeking medical help, which they refer to as the symptomatic tipping point:

  1. A period of uncertainty (patient attributes their symptoms to another health condition)
  2. Denial or dismissal of symptom
  3. Seeking help or guidance from a third party such as a friend of family member
  4. Recognition of severity of symptoms with feelings of defeat
  5. Seeking medical attention
  6. Acceptance of situation

Women, they found, spent longer in the denial phase than men did -- among the second group, researchers found that women were one and half times more likely than men to wait for symptoms to become more severe and more frequent before seeking medical help. When women experienced even a small improvement of symptoms, they then dismissed the problem for a longer period of time, according to Kreatsoulas.

So why might this be the case? Kreatsoulas explains that women may prioritize their concern for others and focus on care-taking over concern for their own well-being, or could be attributed to the false perception of heart disease as being a "man's disease."

But the reality is that heart disease is very much a women's disease as well. Recent research found that women comprise around one-quarter of heart attack sufferers among people under 55, but that women fare worse after heart attack than men, as they stay longer in the hospital on average and have a higher risk of dying in the hospital.

"Heart disease is a leading cause of death and can strike anyone," Heart and Stroke Foundation spokesperson Dr. Beth Abramson said in a statement. "Making healthy choices is an important part of prevention, but understanding the symptoms and acting on them without delay can also save lives."

Kreatsoulas added, "We urge women and men alike to be proactive and attuned with their bodies."

The findings were presented at the Canadian Cardiovascular Congress.