How having a wife shortens time to heart attack care

1 Jun

by Carolyn Thomas     @HeartSisters

Help-by-LiminalMikeHere’s a news flash from the Department of the Bleedin’ Obvious . . .  Medical researchers tell us that married men suffering heart attack chest pain get to the hospital far quicker than single men do.  In my admittedly non-scientific opinion, this reality is entirely due to the fact that these married men have wives.

As Dr. Ralph Brindis, past president of the American College of Cardiology, once told a Wall Street Journal interviewer: 

“Thank God we have spouses. I can’t tell you how often, if it was left up to the patient, they never would have sought care.” 

According to one study, for example, a Canadian research team out of Toronto’s Institute for Clinical Evaluative Sciences found that the odds of men showing up at the hospital more than six hours after the onset of cardiac chest pain were a relative 65% lower in men who were married or in common-law relationships.

In a spectacularly understated explanation for these findings, researchers reported in the Canadian Medical Association Journal:(1)

“We surmise that, in general, women may be more likely than men to take the role of caregiver and to advise their spouses to seek early medical assessment.”

This early medical assessment during a heart attack is crucially important, because we know that half of the deaths from a heart attack occur in the first 3-4 hours after cardiac symptoms begin. Now here’s the interesting – and utterly maddening – part of this surmising from the Canadian study: a similar association was not seen in married women.   In other words, being married did not mean that women were more likely than their single peers to seek faster help in mid-heart attack.

Are these odd findings due to the fact that married women are not being encouraged to seek help by our spouses, or is it that married women are choosing not to heed this advice?

Here’s my take on how the Toronto scenario might theoretically play out:

John: “Oh, no. I’m having horrible pressure right in the middle of my chest…”

Marsha: “WHAT?!?  You don’t look so good, dear. I’m calling 911 right now!”

Contrast this heart attack scenario with another episode, but this time, picture that it’s the wife experiencing heart attack symptoms instead of her hubby:

Marsha:  “Oh, no. I’m having horrible pressure right in the middle of my chest… “

John:  “It could be the fish you made for dinner tonight. I thought it smelled a bit off.”

Marsha:  “Oh!!  Now it’s spreading down my left arm . . . “

John: “Well, you were working pretty hard digging in the garden this afternoon. Have you seen that damned remote? The game’s going to be starting any minute…”

Marsha: “Is it hot in here, or is it just me? I’m sweating like a pig!”

John:  “Probably just another of your hot flashes.”

Marsha:  “I’ll get the remote for you. It’s right over . . .  OH! OH!!!” (collapsing onto the couch)

John:  “It’s right over where?  Where is it?  I’m missing the national anthem!”

Marsha:  “Oohhhh! Ooooooh!” (slipping down onto the floor, clutching left shoulder)

John: “Can you see it? Did it slide under the couch?”

Marsha:  “I … I … I’m just gonna lie down here for a minute . . .   Can’t. Catch. My. Breath . . . “

John:  “Oh, never mind, honey! I found it! Here it is!  Aha!! Just in time for the puck drop! “

Marsha: “Grooooooshmmmmwwaaaaaaaalll…”

John: “Honey, what’s with you? Do you need help?”

Marsha:  “Huh? Oh . . .  No. No. It’s. Probably. Nothing . . .  I’ll. Be. Okay . . . “

And that, my heart sisters, is what we’re up against.  The Canadian researchers suggest that while being married was strongly associated with a significantly lower likelihood of waiting too long to seek help after the onset of chest pain, this relationship was statistically significant in married men only – not in women, married or not. 

According to the Texas Heart Institute,

  • heart attacks are generally more severe in women than in men
  • in the first year after a heart attack, women are more than 50% more likely to die than men are
  • in the first six years after a heart attack, women are almost twice as likely to have a second heart attack compared to our male counterparts

With stats as grim as this, why do women wait longer to seek immediate help in mid-heart attack despite the very real risk of ignoring the “Time Is Muscle” warning of all cardiologists?  The longer we wait before seeking emergency help to re-open blocked coronary arteries, the more we risk damaging the heart muscle.

As I wrote here, Oregon researchers have identified six types of what they called “treatment-seeking delay” behaviour among women who were experiencing a heart attack.(2) 

These six patterns of behaviour choices happened between the time that women first know they are experiencing serious cardiac symptoms and the time when they go for help. For example:

  1. knowing and going (women acknowledged something was wrong, made a decision to seek care, and acted on their decision within a relatively short time, typically 5-15 minutes)

  2. knowing and letting someone else take over (women told someone they had symptoms and were willing to go along with recommendations to seek immediate medical care)

  3. knowing and going on the patient’s own terms (women wanted to remain in control, were not willing to let others make decisions for them, and openly acknowledged that they did not like to ask others for help – these are the women who drive themselves to Emergency!)

  4. knowing and waiting (women decided that they needed help but delayed seeking treatment because they did not want to disturb others)

  5. managing an alternative hypothesis (women decided symptoms were due to indigestion or other non-cardiac causes, and were reluctant to call 911 “in case there’s nothing wrong and I’d feel like a fool”  – until their severe symptoms changed or became unbearable)

  6. minimizing (women tried to ignore their symptoms or hoped the symptoms would go away, and did not recognize that their symptoms were heart-related)

During my own epic treatment-seeking delay experience, I spent two weeks perfecting #2, 3, 4 and 6 before ultimately going for help when my symptoms became unbearable (as in #5).

Women – married or otherwise – must make better decisions about seeking emergency medical help for any symptoms that make you suspect you might be having a heart attack.

Despite our documented tendency to ignore or dismiss serious symptoms, try imagining what you’d decide to do if it were your husband experiencing the identical symptoms – and then do the same thing for yourself!

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(1) Atzema C, et al “Effect of marriage on duration of chest pain associated with acute myocardial infarction before seeking care.” CMAJ 2011; DOI: 10.1503/cmaj.110170.

(2) Anne G. Rosenfeld et al. “Understanding Treatment-Seeking Delay in Women with Acute Myocardial Infarction: Descriptions of Decision-Making Patterns.”Am J Crit Care July 2005 vol. 14 no. 4 285-293

See also:

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Q:  Do you think married women are not being encouraged to seek emergency help by their spouses, or is it that women are choosing not to heed this advice? 

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15 Responses to “How having a wife shortens time to heart attack care”

  1. bveltrop72 August 10, 2016 at 8:04 pm #

    Update: mom is in the hospital again with her heart but I got her cardiologist to take me seriously and run tests on me. My CT angio calcium score was zero! Yay! My stress echo was completely normal and my heart function and valves were perfect. I cheated and read my own to each other while they performed it. 🙂 perk of being a cardiac RN.

    Like

    • Carolyn Thomas August 10, 2016 at 8:25 pm #

      Good news about your cardiac tests. I bet techs love having trained RNs as patients…. 😉

      Like

  2. petaluma1 June 4, 2014 at 4:26 pm #

    This is a bit off topic, but I am wondering if any of your readers who take nitro have had their meds confiscated by the TSA at airport checkpoints?

    There are reports of the TSA taking these pills because nitroglycerin is “explosive.” The TSA apparently won’t address the issue definitively.

    http://www.flyertalk.com/forum/22977669-post78.html

    Like

    • Carolyn Thomas June 4, 2014 at 5:02 pm #

      Petaluma, I never go anywhere (including – especially – a plane!) without my nitro. The medical prescription dosage is so tiny and diluted with inert material that it’s non-explosive.

      I have not even heard of any safety official confiscating nitro for this goofy reason. HOWEVER, read my post “How Soon Are Heart Patients Safely Fit to Fly?” for an appalling true story of an Alaska Airlines employee who refused to allow an Oregon heart patient to board her flight after she saw the passenger’s nitro – NOT for safety reasons, but because of the employee’s ignorant misperception that the patient must not be healthy enough to fly if she’s carrying nitroglycerin. Also, learn more basics about nitro in this post.

      Like

  3. The Accidental Amazon June 3, 2014 at 12:25 pm #

    Oh, my, my, my….all too terribly true!! In particular, that EMT needs a slap upside the head, as do the ER nurses who allowed themselves to take the word of an unqualified person to diagnose Anne & didn’t do their jobs. Um, triage, anyone??

    Oy, gott. I’m always amazed at how many amateurs suddenly feel qualified to assess symptoms in such situations. Not to mention those who are qualified and don’t pay attention to their patients.

    Great post, Carolyn, and great comments.

    Like

    • Carolyn Thomas June 3, 2014 at 4:25 pm #

      Thanks Kathi – I agree with your comment about the comments here. So often the reader comments are my favourite part of writing blog articles!

      Liked by 1 person

  4. cave76 June 1, 2014 at 8:51 am #

    I laughed over your imaginary conversation but with an ironic overtone. That sounds like a plausible scenario for many cases.

    Another great post of yours. Thank you.

    Like

  5. Anne June 1, 2014 at 8:15 am #

    According to the paramedic/EMT that arrived after my 911 call, I don’t look like a heart attack patient, and I am having an anxiety attack. We sat around and argued with him – pleading with him – for nearly 20 minutes to take me to the hospital before he finally loaded me into the ambulance.

    WOULD someone explain to me why being anxious in the middle of a heart attack would be considered unusual? It wasn’t my husband or daughter who said I was anxious – it was the paramedic who didn’t know me at all before he walked through my front door.

    This was my second heart attack in 9 months. Worse yet, this EMT actually told the hospital that I was having an anxiety attack so we sat around for another 16 minutes in the hall with nurses trying to tell me that I wasn’t having a heart attack before they did the ekg to determine that I was having a heart attack. Then they alerted the STEMI system.

    Driving myself or calling a taxi might have been a better option. I am living with the congestive heart failure from the damage. I was forced to retire.

    He is earning a salary and getting on with his life. Yes, this guy needs to be taken out but instead… he is out there waiting for your call!

    Liked by 1 person

    • Carolyn Thomas June 1, 2014 at 8:44 am #

      Anne, I didn’t know it was the paramedic’s role to diagnose each patient, never mind argue with the ER staff to convince them of the correctness of his “diagnosis”. I hope you followed up with his employer. You raise such an important point: few things in life are more anxiety-producing than being in the middle of a frickety-frackin’ HEART ATTACK! Sheeeeesh….

      Liked by 1 person

  6. magda June 1, 2014 at 5:12 am #

    This was absolutely true in my personal experience.

    Not only did my then spouse ignore everything I told him the doctor had said, we were late to the cath the following morning because it wasn’t important to him. Unfortunately, I asked him to drive me to the hospital. In his words, he “didn’t think anything was wrong”. Three stents and 90 and 85% occlusions later in the LAD and RCA, the situation became worse. There was no post op care, sympathy, etc. Only fighting and yelling. Should this be post op care for every heart patient?

    Who takes care of women after their heart events or are they expected to bounce back and continue to take care of everything? More denial. That is another issue that should be addressed in terms of recovery and repeat events. Seems to me that men are surrounded by women, wives, mothers, etc. who take care of them and everything else post op, but it is not the same for women.

    How does this affect short and long term recovery? Take a guess.

    Liked by 1 person

    • Carolyn Thomas June 1, 2014 at 5:59 am #

      Hi Magda – your experience with your ex sounds awful. Not only only were you suffering a frightening cardiac event, but the person you’d think would be most helpful was not! There are a number of studies showing that being happily married can improve health outcomes after a heart attack, but poor marriages can actually hurt our recovery chances.

      Liked by 1 person

  7. bveltrop72 June 1, 2014 at 5:07 am #

    Then there is the age old assumption that women are dramatic and are:
    1.) Seeking attention
    2.) Hypochondriacs
    3.) Melodramatic (my personal favorite)
    4.) Just don’t know what they are talking about
    5.) She can’t be having a heart attack! Her symptoms aren’t like the ones on tv or in the movies!

    My mom went for years complaining about angina, shortness of breath, and inability to walk up a hill or climb a flight of stairs, and the fact her dad died at 48 from a heart attack. Grandpa had his first one at 25 but her doctors didn’t listen and only wanted to talk about how obese my mom was. She was obese but she was having chest pain and telling her doctors! Argh! It was infuriating.

    Now I’m 41 and I can’t get anyone to properly screen me for heart disease even though I have no symptoms. I don’t want to wait to have symptoms or damage. I want to be proactive!

    Thank again Carolyn for another terrific article!

    Liked by 1 person

    • Carolyn Thomas June 1, 2014 at 6:10 am #

      I’d add #6 to your list: “She’s far too young!” Your mother’s case is troubling, yet not uncommon.

      In your case, even with no symptoms, one smart way of being proactive is to live as if you’re at high risk. That doesn’t mean obsessing about what might or might never happen. It means there is simply no downside in making healthy decisions every day around what you eat, daily exercise, stress management, healthy sleep habits – these are all areas we know will affect our risks of future cardiac events.

      Liked by 1 person

    • hawaii52 December 12, 2015 at 8:26 pm #

      If you have a family history of heart disease and heart attacks in particular, start taking baby aspirin daily. Why wait for an event that is very likely to happen!

      Like

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