Most people think a heart attack is a sudden and dramatic event – the portrayal of heart symptoms in film and television usually show severe pain and collapse. It’s hard to imagine how anyone could delay getting help in such a scenario.
But, for many people, the symptoms are much less dramatic. Around a third of people with serious heart problems do not experience any chest pain or discomfort. Women are much less likely to complain of chest pain than men. Women are more likely to experience other heart attack symptoms: back pain, neck pain, jaw pain, shortness of breath, nausea, vomiting, indigestion or fatigue.
Women also tend to experience a greater number of symptoms when having heart problems. As a result, it may be more difficult to recognise when a woman is having heart problems which can lead to delay in treatment.
Treatment for heart problems is most effective if given quickly and delays can have serious consequences. It has been shown that women take longer to seek help for symptoms than men, and that medical staff can take longer to start treating women.
Research suggests that the way heart disease develops differs between men and women. Heart disease is caused by the build of fatty plaque within the walls of the arteries leading to the heart (coronary arteries). The fatty plaques build up, narrowing the arteries. A heart attack occurs when the fatty plaque ruptures or erodes, creating a blood clot which cuts off the blood supply to part of the heart muscle. But research has shown that the fatty plaques build up in a more spread out way in women and often don’t result in the same degree of narrowing within the artery as they do for men.
Only 55% of women with fatal heart attacks experience plaque rupture compared with 75% of men. Erosion resulting in smaller clots and spasm of the artery may be more common causes of women’s heart attacks. These differences may lead to different symptoms and contribute to delayed treatment.
Our research, in common with others, suggests that how people interpret symptoms may be as important, in relation to delay in seeking medical help, as the underlying biology. We have found that people think of potential symptoms of a heart attack as being more serious for men than women, perhaps reflecting the common belief that heart disease is a male issue. It is not. Heart and vascular disease is the main cause of death for women worldwide.
Studies have shown that once people identify a heart problem as a likely cause of their symptoms they are less likely to delay seeking help. So there is an opportunity to intervene to inform the public and those at highest risk about the symptoms of heart attack, to reduce delay in seeking help and consequently reduce deaths from heart disease. We believe it’s important that any intervention conveys the range of possible symptoms and tackles misconceptions that lead to delay.
Our research is testing new ways of getting people to respond to heart attack symptoms quicker. Firstly, rather than just providing information, we will include 12 specific “behaviour change techniques” – in this case, the change in behaviour is getting more people to phone an ambulance in response to heart symptoms.
An example of a behaviour change technique is problem-solving. In a short written exercise, people are asked to identify problems they might have phoning an ambulance and then to think about how they might solve these problems. People link potential solutions to each problem so that they’ll have thought through a solution in advance. For example, someone might be responsible for caring for a child which might make it difficult for them to call an ambulance immediately. A possible solution might be to call a neighbour to care for the child. The important thing is that people identify potential problems and come up with their own the solutions.
Secondly, we communicate the message with an animation. Research has shown that using visual images can be more engaging and help people to better understand and remember the key messages about heart symptoms and delay.
The animation was developed in collaboration with people who have experienced heart symptoms and doctors, nurses and psychologists. People viewing the animation follow the stories of different characters (male and female) who experience symptoms of a heart attack and take different actions. For the next step in our research we will test the intervention to see if it affects people’s intentions to phone an ambulance.
The symptoms of a heart attack are not sexist, of course – they kill both men and women. However, the way they are portrayed in the media means that many women will not recognise the symptoms and may delay seeking help – often with deadly effect.