After severe heart attack women get less needed hospital treatment and more likely to die

After severe heart attack women get less needed hospital treatment and more likely to die

A new US study suggests that following a severe heart attack, women are less likely to get the care they need in hospital at the time they need it and they are more likely to die compared to men.

The study was the work of Dr Hani Jneid, lead author and assistant professor of Cardiovascular Medicine at Baylor College of Medicine in Houston, Texas, and colleagues. It is published in the 8 December issue of Circulation: Journal of the American Heart Association.

Jneid and colleagues found that women and men have about the same overall in-hospital death rate after heart attack, but women are twice as likely as men to die after being admitted to hospital following a severe type of heart attack called ST-elevation myocardial infarction (STEMI). They are also less likely to receive the treatment they need on time.

They did the study because an earlier paper on deaths following STEMI that showed women's death rate at 10.2 compared to 5.5 for men said this was because the women were older and had higher risk factors compared to the men.

However, Jneid and colleagues adjusted for these differences (age and baseline risk factors) and found that the women still had a higher relative risk for in hospital death compared to men and this was 12 per cent.

They also found that compared to hospitalized men, hospitalized women who had suffered a STEMI heart attack were:

  • 14 per cent less likely to receive early aspirin.
  • 10 per cent less likely to receive beta blockers (drugs that protect the heart after an attack).
  • 25 per cent less likely to receive reperfusion therapy (to restore blood flow).
  • 22 per cent less likely to receive reperfusion therapy within 30 minutes of hospital arrival.
  • 13 per cent less likely to receive angioplasty (widening a blocked vessel) within 90 minutes of hospital arrival.
Jneid and colleagues analyzed data from the American Heart Association's Get With The Guidelines (GWTG) program to find out if efforts to close the gender gap in heart attack care in hospitals were having any effect. They looked at clinical data, treatments and outcomes for more than 78,000 patients that were admitted to 420 different hospitals between 2001 and 2006 after having a heart attack.

Jneid said in a statement that:

"The finding that bears the most emphasis is that among both men and women presenting to Get With The Guidelines participating hospitals, there were no clinically meaningful differences in in-hospital survival after heart attack, once we factored in differences, such as age and other existing illnesses."

This compares favourably with the situation ten years ago when women had an overall higher rate of death following heart attack compared with men. This suggests that hospitals are choosing treatments according to evidence of increased survival after heart attack. But, this many not have gone far enough in the treatment of severe heart attacks, as Jneid explained:

"The finding of persistently higher death rates among women experiencing the more severe type of heart attack (STEMI) and the persistent gender gap in certain aspects of care underscore the existing opportunities to enhance post-heart attack care among women."

The researchers weren't able to find out if the differences were due to "physicians' failures to administer optimal therapies to women vs. appropriate decision-making based on biological and other differences between men and women," said Jneid.

They also found that women with a STEMI heart attack were twice as likely to die within 24 hours of admission as men.

Dr Laura Wexler, study co-author and senior associate dean at the University of Cincinnati College of Medicine said:

"Although STEMI is not as common among women as it is among men, it is a concern that there is still this gap in mortality between men and women after the more severe heart attack."

Get With The Guidelines aims to help doctors learn more about the treatments available for treating heart attack patients, said Dr Gregg C. Fonarow, chairman of the Get With The Guidelines steering committee and professor of cardiovascular medicine at UCLA. Fonarow explained that:

"As part of this effort, the American Heart Association has been collecting data from a large number of hospitals about the treatments and outcomes of therapy for heart attack victims."

He said the guidelines had "not only helped improve care but also created a powerful research tool", as this study shows.

"Sex Differences in Medical Care and Early Death After Acute Myocardial Infarction."

Hani Jneid, Gregg C. Fonarow, Christopher P. Cannon, Adrian F. Hernandez, Igor F. Palacios, Andrew O. Maree, Quinn Wells, Biykem Bozkurt, Kenneth A. LaBresh, Li Liang, Yuling Hong, L. Kristin Newby, Gerald Fletcher, Eric Peterson, Laura Wexler, and for the Get With the Guidelines Steering Committee and Investigators.

Circulation published December 8, 2008.


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Sources: AHA.


Section Issues On Medicine: Cardiology