Heart attacks treated differently for men, women
Better adherence to guidelines needed, researchers say
July 6, 2000
Web posted at: 12:30 p.m. EDT (1630 GMT)
From staff reports
ATLANTA (CNN) -- A new study in the
New England Journal of Medicine finds some discrepancies in how men
and women are treated for heart attacks.
And although death rates don't seem
to be influenced by the different treatment, the findings raise
questions about how closely doctors follow guidelines for treating
heart attacks in general, researchers said.
The research shows that women are
less likely to get early heart attack treatment and, also troubling,
have more chance of being assigned a "do-not-resuscitate"
order, or DNR.
| WOMEN
AND HEART DISEASE: |
|
About 240,000
American women die of heart disease every year, five
times the number who die of breast cancer.
Forty-four percent of
women die of heart attacks within the first year of
their first heart attack; only 27 percent of men who
have heart attacks do.
One in eight women
age 45 and over has had a heart attack.
African-American
women have a 33 percent higher death rate from heart
disease than white women.
Source: American
Heart Association
|
|
"This finding surprised us, and
we found it quite concerning," said Dr. Leighton Chan, an
assistant professor at the University of Washington School of
Medicine and the study's lead author. "Based on the data
available, we were not sure whether health care providers are more
likely to recommend DNR status to women or whether women are simply
more likely to request it."
The Medicare Cooperative
Cardiovascular Project analyzed the care received by nearly 140,000
elderly heart attack patients throughout the United States between
1994 and 1995. Nearly half the cases studied were women.
In most respects, the study found the
differences between treatment options for women and men to be too
small to have any apparent effect on 30-day death rates. Still, some
results are worth noting, the authors said.
The study found that women were 26
percent more likely to get a DNR order than men. On average, the
women studied were older but less sick than men who got a DNR order.
"The assignment of DNR status is
obviously critical to treatment decisions and patient outcome,"
Chan continued. "Future work really should focus on this issue
and ensure that women are being assigned DNR status appropriately
after a heart attack."
Heart disease is the leading cause of
death for American women, accounting for more deaths than all forms
of cancer combined, according to the American Heart Association.
As a group, the women studied were
significantly older, but the severity of their disease was
equivalent to that of the men, the authors noted. Still, researchers
found the women more likely to have delayed seeking treatment for
their symptoms. And once they did go to a hospital, they were more
likely to wait longer for medical attention -- an average of four
minutes longer for an electrocardiogram, a basic tool in evaluating
heart function.
The women also were less likely to
have cardiac catheterization or coronary arteriograms, diagnostic
tests used to reveal and assess blockages. This gender difference
increased even more with the age of the women. It is important, the
authors said, because failure to use cardiac catheterization has
been linked to an increased risk of death from heart attack.
The study also found that women were
less likely to get:
- Aspirin at discharge. Aspirin has
been shown to be an effective, inexpensive treatment for heart
attack.
- Clot-dissolving drugs. Even if
clot busters were used, women were less likely to receive them
in a timely manner.
"While this study highlights
that women may be slightly less aggressively treated in the early
stages of a heart attack," Chan said, "perhaps the more
important story is the need for improvement in physicians'
compliance with acute myocardial infarction practice
guidelines."
If all heart attack interventions are
used appropriately as necessary, everyone can benefit, he said. |
