When a married man has a heart attack, he gets care faster and more effectively than if his wife was to have an M.I.
“Marriage has long been known to offer health benefits and is associated with a lower risk of death relative to people who are not married,” according to a team of Canadian health researchers who have studied the variable impact of marriage on heart attack care.
In their peer reviewed article, Effect of marriage on duration of chest pain associated with acute myocardial infarction before seeking care, published in the Canadian Medical Association Journal in July 2011, the researchers analyzed data from 4,403 patients with acute myocardial infarction from Ontario, Canada. They assessed marital status relative to delayed treatment, defined as more than six hours from onset of chest pain, stratified by sex. Beginning of treatment was defined as the moment when the patient saw a triage nurse in the emergency department or when admitted directly into a cardiac care unit or cath lab.
The bottom line of this study is that patients who experienced chest pain due to acute M.I. went to an emergency department or hospital earlier if they were married vs. single people. Furthermore, the earlier treatment sought by patients was more pronounced in married men than married women.
When it comes to heart attack, a patient’s delay in seeking care is the biggest component of the overall delay between first symptoms and the patient receiving therapy. The researchers’ hypothesis was that being married or in a common-law relationship would be statistically associated with less delay in seeking care after onset of chest pain.
Data from this study come from the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study of patients with acute M.I. from Ontario, Canada, who sought care between April 2004 and March 2005.
Health Populi’s Hot Points: The reality that women tend to be the health caregivers for their families is a key reason that women postpone seeking care post M.I., the authors presume. If this is the case, what can be done? Information about heart health, such as the signs of M.I. — and women’s different symptoms from men’s — isn’t well articulated or distributed among the public-at-large. As a result, women have more undiagnosed heart attacks than men. Beyond chest pain, which is the symptom most people (male and female) expect to experience, women experiencing an M.I. would more likely feel shortness of breath, weakness and unusual fatigue. Most women are unaware of these ‘atypical’ symptoms that aren’t the clinical stereotype of a heart attack onset. This lack of knowledge is as true for women under 55 as for older women.
What can be done? First, educate women on the signs of an M.I. that don’t look like what they see on primetime TV (what DHHS calls the myth of the Hollywood heart attack). The American Association of Family Physicians (bless those primary care providers) launched a campaign earlier this year of public service announcements to educate women on their heart health and signs of heart attack. The Department of Health and Human Services has a campaign, Make the Call-Don’t Miss a Beat, that stresses the importance of timely response to M.I. symptoms.
Second, this is about self-efficacy and health empowerment. Information goes as far as people are willing to embrace — so getting people toward their personal lightbulb moments takes additional effort on the part of their physicians (as the AAFP clearly realizes), family and friends. While marriage is perhaps the most direct, intimate form of social networking, peoples’ larger social networks play a key role in their health and wellness (“no smoking, lots of friends”). Knowing family history for heart disease is key. But a caring friend or acquaintance who knows of that history can reinforce the messages and help light up that lightbulb.
Jane Sarasohn-Kahn is a health economist and management consultant that serves clients at the intersection of health and technology. 
I had a couple of thoughts while reading this. The first is that it’s yet another reason for employers to send their health and wellness communications home. Women are often the “deciders” when it comes to health benefits, so you want to reach them whether or not they’re the employee. And as this study found, the wife often plays a role as nudge. She gets the husband in for care that he might otherwise neglect or ignore.
My second thought echoes yours about how important it is to make women aware that their signals of heart distress differ from men’s. There are many places to insert that information and to help get out the word. Employers could create a story-based campaign to punch up more basic educational information, for example. I actually slipped such information into a educational game I created to teach employees how a high-deductible health plan works. I consider it ambient education!
Fran