In Heart Attack, Gender Matters

Even though heart disease is the No. 1 killer of American women, female patients don't always receive the same aggressive treatment that their male counterparts do for heart attack, new research suggests.

The researchers further conclude that among patients who have major heart attacks, women are more likely to die -- a disparity that heart doctors say must stimulate change.

"The fact that nothing has changed over the years and that disparities in care persist should outrage all of us and cause a major change in attitude and clinical practice," said Dr. Sharonne Hayes, director of the Mayo Clinic Women's Heart Clinic. "We, in the medical profession set our own benchmarks and guidelines for care, and then are unable to follow our own rules and advice."

"I am very distressed to see that we're still not giving women equally aggressive treatment for acute heart attack as we are men," Dr. Marianne Legato, founder and director of the Partnership for Gender-Specific Medicine at Columbia University College of Physicians and Surgeons, told ABC News Medical correspondent John McKenzie.

The new study, published in the journal Circulation, and sponsored by the American Heart Association's Council on Clinical Cardiology, looked at 25,000 patients with severe heart attacks and 78,000 patients in all. What it found was that women suffering from heart attacks are less likely to receive recommended medications in a timely fashion or undergo procedures to treat artery blockages.

In this study, women with heart attacks tended to be older and have more chronic medical problems than men, which likely accounted for some of the difference in death rates.

However, among patients with a certain type of severe heart attack -- called an ST-elevation myocardial infarction, or STEMI -- women were almost twice as likely to die as men. Specifically, while about 5 percent of men died, 10 percent of women died.

Even when the researchers made adjustments for age and other risk factors, women still had a 12 percent higher risk of death in the hospital. And during the first 24 hours of hospitalization, women with STEMI were about twice as likely to die as men.

Lead study author Dr. Hani Jneid, assistant professor of medicine at the Baylor College of Medicine in Houston, emphasizes that "this population of women [with major heart attacks] needs to be taken care of very aggressively" during early hospitalization. Jneid noted, however, that more research is needed to confirm their findings on early deaths in women.

Why the Gap?

Over the past two decades, the medical community has made great strides in heart attack care. Stents, new medications and better systems for coordinating treatment have saved countless lives. But despite these advances, women still receive less recommended care than men.

Experts cite a host of possible reasons for the gaps in care and death rates, including delays in diagnosis and treatment, bias on the part of health care providers, and lower rates of lifesaving procedures, including cardiac catheterization and stent placement.

And then there is the perception that women are not as prone to heart disease as men.

"We still don't see women as at risk for heart disease," Hayes told McKenzie. "When [a female patient] walks into our office or comes in on the ambulance, people are not thinking 'heart,' so they don't treat it."

That's just what happened to heart attack survivor Debbie Dunn.

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