Women with heart-attack symptoms wait longer than men to go to the hospital and, once there, often don't get the same level of care as men, a Michigan study covering metro Michigan cities has found.

The study, first publicized this week, documents that men and women respond to and are treated for heart problems differently _ at hospitals big and small _ despite more than 10 years of programs and awareness efforts to correct the problem.

It shows that far more work needs to be done to educate women about warning signs and to educate doctors to aggressively diagnose women when they go to hospitals with symptoms.

Too often, women don't act quickly enough to get to a hospital when they have heart-attack symptoms, experts said.

They downplay warning signs or may not have classic chest pain, the most common sign of a heart attack in men and women. And women, particularly the older they get, may have unusual and persistent symptoms such as shortness of breath, stomach pain and fatigue.

"I didn't want to bother anyone," said Carolyn Crossman, 52, of Belleville, Mich., explaining why she lived with chest pain for five days before relenting to a son who insisted she go to the University of Michigan Medical Center on July 17. She had a heart attack later that day.

When she left the hospital two days later, she was told to exercise and reduce her stress. But that's hard, because she spends most of her day in a wheelchair, she said. She takes four heart disease medicines. And one of her three teenage children has serious emotional problems and is destructive at home, she said.

"The doctors said, no stress. How am I going to do that?" she asked.

Still, projects to close the gaps between men and women are under way.

Through a program started by Dr. Kim Eagle, co-director of the University of Michigan's Cardiovascular Center, emergency room workers at nearly three dozen Michigan hospitals are using checklists developed by the American College of Cardiology to review key recommendations before a woman is discharged.

The list includes nearly a dozen items that help ensure a woman doesn't return with another heart attack. It calls for individual counseling about diet, exercise and smoking cessation; and four or five medicines that help keep arteries unclogged and the heart pumping right.

Eagle was senior author of the large Michigan study, which found that following the recommendations on the checklists cut in half a woman's risk of dying within a year from a heart attack.

At Oakwood Hospital Medical Center in Dearborn, Mich., a new, separate study of 400 women, funded by the state and Ford Motor Co., is under way to see whether coaches assigned to women at risk of heart attacks can help them improve their health and avoid heart attacks over five years.

They will be compared to a group of women who get standard care, without personal coaches. The program is free.

Dr. Arthur Riba is director of cardiac care at Oakwood and a co-author of Eagle's study. He said research also is finding that a blood test looking at a marker of inflammation, known as C-reactive protein, helps pin down a diagnosis in women.

Women's blood vessels may be inflamed but not truly blocked, or the blockage may be so tiny it can't be seen easily on tests, he said.

About 12 percent of women, Eagle said, have mild symptoms or blockages in tiny arteries that don't show up on standard tests. Such was the case for Sherry Bumpus, 35, of Ypsilanti, Mich.

She awoke June 12 with pain in her back between her shoulder blades, as well as aches at the top of her teeth, she said. A nurse practitioner, Bumpus took two over-the-counter pain pills, breastfed her 7-month-old baby, served breakfast to her 2-year-old toddler and went to the beauty shop for a haircut before taking her pain seriously.

When she got home, her pain moved from her back to her chest. She finally went to the hospital around 5:15 p.m., after arranging for child care. Routine tests found no problem, but a cardiac magnetic resonance imaging (MRI) discovered she had suffered a heart attack.

She said her case is a textbook example of just how unpredictable heart attacks in women can be.

"I'm a health care provider, and I didn't think I had a heart attack," she said. "Neither did my colleagues or the emergency room doctors."

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