Also, "women present more atypically," he said. "They are less likely to have sternal chest pain or pressure, just general symptoms like shortness of breath or other symptoms that are non-specific."
But there clearly was a difference in the treatment given men and women, the study found. Women were 14 percent less likely to receive early aspirin, 10 percent less likely to be given beta blocker drugs, 25 percent less likely to receive reperfusion therapy to restore blood flow, and 13 percent less likely to have artery-opening angioplasty within 90 minutes of arrival at the hospital.
The American Heart Association has started a program called "Mission: Lifeline" that's designed to educate people about the symptoms of a heart attack so they can seek treatment quickly and also "enable hospitals to make quicker diagnoses," Fonarow said. "These kinds of quality-improvement programs can lead physicians, emergency room attendants and paramedics to close the gap and eventually eliminate sex-related differences."
Some basic biological differences between the sexes might be partially responsible for the discrepancy in survival, said Dr. Laura Wexler, senior associate dean at the University of Cincinnati College of Medicine, and another author of the report.
"For women ages 50 to 60, I wonder whether the biology of a heart attack may be different," she said. "The question is whether menopause enhances the severity of heart attacks."
The incidence of heart attack in such perimenopausal women is lower, Wexler said, "but when they do get it, the mortality rate is higher."
Still, Wexler said, "I think there are impediments to the diagnosis of coronary disease in women, including, but not exclusively, some lack of appreciation in some sectors of the importance of coronary disease in women."
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