EMS Magazine's Resource Guide: Cardiac Care

Women and Heart Disease

After years of doing heart disease research only on men, the medical community has finally realized that women and men experience heart attacks very differently. This new information has come as a big surprise, especially to women.

“Until 1996, research was focused on men and heart disease, with the exception of one study on 3,000 nurses,” says Dawn Bidwell, coordinator for the Alexandria (MN) Division of North Memorial EMS Education. “It’s only been in the last year or two that research has come out showing that women do, indeed, have different symptoms than men. Women have smaller vessels, fewer vessels and more flexible vessels, and they have a whole different approach to heart disease than men do.”

As a result, says Bidwell, women have largely ignored their unusual symptoms, as have their doctors and EMS providers. “This accounts for the fact that women have a 50% higher chance of having a prehospital cardiac arrest than men,” she adds.

So what are these unique symptoms? Unusual fatigue—becoming exhausted just walking across a room; new and unusual shortness of breath during everyday activities, particularly those that require use of the upper arms or upper body like brushing the hair, vacuuming or other daily chores; nausea and dizziness, which are often ignored because there is no chest pain to go with them; and lower back pain without any history of back pain or trauma.

“Now that the information is out, we’re trying to educate EMS providers to not ignore those symptoms in women,” says Bidwell. “To go even further and ask about their history: Do they have a history of smoking? Do they have a history of using oral contraceptives? Is there a history of heart attacks in the females in their family? If so, put them on oxygen and treat them as though they’re having a heart attack, hoping that’s not what it is. Some paramedics are being given permission to do a 12-lead in the field to see if there are any changes. It never hurts to overtreat a patient.”

Now that the research is out, there has been a dramatic increase in the amount of information available. The American Heart Association, in particular, has done an excellent job of getting out pamphlets and special projects to promote these new findings, says Bidwell. For more information, visit www.americanheart.org.

AEDs in the Public Square: The Price is Right

An estimated 250,000 Americans die each year from cardiac arrest suffered at public places such as malls, sports stadiums and airports. The American Heart Association (AHA) recommends that AEDs be located in public places where there is a chance of using them once in five years, or a 20% annual probability. However, according to a study supported by the Agency for Healthcare Research and Quality (AHRQ), AEDs could be deployed at sites with only a 12% annual probability of use and still be cost-effective.

Peter Cram, MD, MBA, of the University of Iowa College of Medicine, and his colleagues compared two strategies at selected public locations in the U.S. In the first strategy, individuals experiencing cardiac arrest were treated only by EMS personnel equipped with AEDs (EMS-D). In the second, individuals were treated with AEDs deployed as part of a public access defibrillation (PAD) program. Strategies differed only in how fast an AED could be deployed and the impact of time on cardiac arrest survival.

Under Strategy 1, cardiac arrest victims had a 10% probability of survival to hospital discharge. Under Strategy 2, survivability jumped to 25% (based on an average response interval of 4.5 minutes).

Under the base-case assumption that a deployed AED will be used on one cardiac arrest every five years, the cost per quality-adjusted life year (QALY) gained was $30,000 for AED deployment ($3,400 per site per year) when compared with EMS-D intervention, and still less than $50,000 per QALY gained (considered cost-effective for medical intervention) when the annual probability of AED use was less than once in eight years.