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Women who have heart attacks receive less extensive care than men, research suggests

Posted September 29, 2020 3:39 p.m. EDT

— Women receive less extensive care than men and are more likely to die in the hospital after experiencing a complication of severe heart attacks, researchers reported Tuesday.

Women received important medical procedures less often or later than men, the team reported in the American Heart Association journal Circulation: Heart Failure.

Women were also more likely to die in the hospital than men were: 23% of women died compared to 21.7% of men, the researchers found. In fact, the team noted, gender was a predictor of higher in-hospital death rates, even when adjusting for outside factors.

"It is very concerning that the young, productive women of our society face these health care disparities," said Dr. Saraschandra Vallabhajosyula, a clinical fellow in interventional cardiology at Emory University School of Medicine, in a statement, adding that unconscious bias could be at play.

"Our emphasis should be on providing high-quality and equitable care for every patient independent of their sex."

Vallabhajosyula and colleagues looked at 90,648 patients ranging in age from 18 to 55 who were admitted for cardiogenic shock between 2007 and 2012. Cardiogenic shock, when the heart suddenly stops pumping enough blood for the body, can follow severe heart attacks.

Coronary angiography, a procedure used to detect blockages in heart arteries, was performed in 78.3% of women, compared to 81.4% of men. Early coronary angiography was performed on 49.2% of women, compared to 54.1% of men.

A procedure that sometimes involves using a tube or stent to open blockages in heart arteries was performed on 59.2% of women and 64% of men. About 18.3% of women received coronary artery bypass grafting, which helps improve blood flow to the heart, compared to 20.1% of men. About 50.3% of women versus 59.2% of men had their heart function temporarily supplemented by a mechanical pump.

Men received these interventions at persistently higher rates than women over time, the researchers found. They said women could benefit from similar treatment.

"There is evidence that women might actually derive greater benefit from more aggressive, timely, and appropriate cardiac interventions," the team wrote.

Some individual patient information, the team noted, may have been missing from the data, and called for additional research into why these disparities between women and men exist.

Recurrent heart attacks on the decline

A second study, also from the American Heart Association, found good news about repeat heart attacks: The proportion of patients who experience a repeat heart attack within a year fell between 2008 and 2017.

Out of 1,000 people, the recurrent heart attack rate declined from 89 to 72 in women, and from 94 to 81 in men overall -- but it did not decline in women ages 21-54 or in men ages 55-79. The risk also remains high for heart attack survivors, according to the AHA, which released the study on September 21.

Out of 1,000 people, the report noted, the recurrent heart disease event rates -- either heart attack or undergoing a procedure to open clogged arteries -- declined from 166 to 133 in women, and from 198 to 176 in men. The hospitalization due to heart failure rates declined from 177 to 158 in women, and from 162 to 156 in men.

Death rates from any cause in those ages 66 and older declined from 403 to 389 in women, and from 436 to 417 in men.

The reason for the overall decline could be "improvements in the emergency treatment of heart attacks, and better treatment options for people who survive a heart attack," said Dr. Sanne A. E. Peters, the lead author of the AHA study and a research fellow in epidemiology at The George Institute for Global Health at the University of Oxford. But she could not explain why the rates differed between women and men.

"We expected to see a decline in the rate of events. However, we did not expect the rates to differ between the sexes. It may be that the improvements in men were achieved before our study period, leaving less room for improvement in the most recent decade," Peters said.

"It could also be that the attention paid to heart disease in women over recent years has resulted in the greater gains. However, regardless of the improvements, the rates of recurrent events in people who survived a heart attack are still very high in both sexes."

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