Women and Black adults wait longer to be seen in the ER for chest pain

Younger women and Black adults experiencing chest pain – the most common symptom of a heart attack – wait longer to get care in the emergency room than their respective male and white counterparts, potentially placing them at higher risk for poor outcomes, new research shows.

The study, published Wednesday in the Journal of the American Heart Association, found women 18 to 55 years old also received a less thorough evaluation for a possible heart attack and were less likely to be admitted to the hospital when presenting with similar symptoms as their male peers.

Despite a decline in the overall number of heart attacks, the number is rising among young adults, lead study author Dr. Darcy Banco said in a news release.

"Whether or not the differences in chest pain evaluation directly translate into differences in outcomes, they represent a difference in the care individuals receive based on their race or sex, and that is important for us to know," said Banco, chief resident for safety and quality in the department of medicine at New York University Grossman School of Medicine.

Chest pain is responsible for more than 6.5 million U.S. emergency room visits and 4 million outpatient visits each year, according to chest pain guidelines issued in 2021 by the American College of Cardiology, American Heart Association and others. The recommendations aim to help doctors identify those at highest risk for heart attacks and prevent unnecessary testing in those not at risk. Although chest pain is the most common heart attack symptom for both women and men, women are more likely to also exhibit other symptoms, such as nausea and shortness of breath.

"Minutes count when someone has a heart attack," senior study author Dr. Harmony Reynolds said in the news release. She is director of the Sarah Ross Soter Center for Women's Cardiovascular Research and associate professor of medicine at the NYU Grossman School of Medicine. "Calling an ambulance is also helpful because emergency medical technicians can treat chest pain and heart attack right away. People who arrive to the ER by ambulance often receive urgent care and attention sooner compared to people who arrive to the ER on their own."

Researchers analyzed 4,152 medical records from 2014 to 2018 for nearly 30 million emergency room visits for chest pain. Participants were 18 to 55 years old, nearly a third of whom were Black. A small percentage were another race or ethnicity, and the rest were white.

The results showed women and Black adults waited longer than men and white adults, respectively, to be seen by emergency room staff. Women waited an average 11 minutes longer than men – 48 minutes versus 37 minutes. Compared to their white peers, women of any other race or ethnicity waited an average 58 minutes, or 15 minutes longer for an initial evaluation. And compared to their white peers, men of other races or ethnicities waited an average 44 minutes to be evaluated, or 10 minutes longer.

The study found no racial differences in how people were evaluated and treated once seen. But women reporting chest pain were less likely than men to be prescribed heart medications or to be admitted to the hospital or kept in the ER for observation. Among men, 17.9% were admitted, compared to 12.4% of women.

Banco said the findings raise many questions for future research.

"Do differences in wait time vary with location?" she said. "Are the differences related to variation in hospital care quality, or are these differences applicable to all ERs? Lastly, do differences in wait time translate to differences in outcomes?"

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