Gender disparities seen in EMS care for chest pain

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - Women with chest pain are less likely than their male counterparts to receive aspirin and other recommended therapies by emergency medical service (EMS) personnel, according to study findings presented Friday at the Society for Academic Emergency Medicine's annual conference in New Orleans.

"Women with heart attacks have higher death rates than men, so these findings are very concerning, and it's important for us to try to figure out why this is happening," lead researcher Dr. Zachary Mesiel noted in a prepared statement.

"We expected to find no differences in treatments (by gender) because so much of ambulance care is subject to protocol," he added in comments to Reuters Health. "In general, there is not as much discretion in how to treat patients in the prehospital arena compared to hospital or outpatient care." However, the findings showed that there was, in fact, a gender difference.

The good news is that no racial disparities in out-of-hospital care were seen, noted Mesiel, who is with the University of Pennsylvania School of Medicine. Prior studies have suggested that there might be.

The results stem from a study of 683 patients with chest pain who were brought by EMS to one of three Philadelphia hospitals in 2006 and 2007. The investigators examined the frequency with each patients received four key EMS treatment and monitoring protocols which are called for in chest pain patients over the age of 30. The measures include whether patients got aspirin and nitroglycerin, which relieves cardiac pain, and whether they received heart rhythm monitoring or had intravenous lines placed to begin medication delivery.

Women were less likely than men to receive aspirin (24% vs. 32%), nitroglycerin (26% vs. 33%), and an intravenous line (61% vs. 70%).

Among women, those with a confirmed heart attack in the ER were significantly less likely than those without a heart attack to have received the recommended EMS interventions. In fact, none of the women with heart attack had received aspirin in the field.

"We still don't know why men and women get different care for chest pain," Mesiel noted. "Some of the differences may be due to the way patients describe their symptoms or their preferences in how they want to be treated. On the other hand, some of the differences may be due to biases of the providers."

As for future research, Mesiel said that it remains to be determined whether the differences in pre-hospital care between men and women translate into different outcomes.