Heart Health Care Gender Inequality Can Be Fatal for Women: Report

A new report shows that women had worse outcomes than men in heart health care.

May 3, 2011— -- Michelle Burke recalled staring in envy at her neighbors in the driveway as they packed up for a trip to Six Flags with their children.

"There is no way I can do something that physical," Burke says she thought to herself. She was 32 at the time, with a newborn, a 2-year-old and 4-year-old in tow. She felt constantly exhausted.

She visited several medical specialists, who chalked up her extreme fatigue to young motherhood. "When your kids grow up, you won't be tired anymore," a doctor told her.

But she pressed for answers and finally a female doctor diagnosed Burke with an enlarged heart, which makes for a dangerous irregular heartbeat.

After the diagnosis, one doctor suggested she go on Coumadin. It was the standard prescription for many people who had her condition. But she visited another doctor, this time a female.

The doctor told her: "You're a young menstruating female who is already bleeding a lot. I wouldn't prescribe Coumadin for you."

"It was the first time a doctor had looked at me as a woman, and not a textbook," said Burke, now 46, from St. Louis, Mo. "She looked at me as a woman, mother, wife, worker -- a whole person, not just a person in a textbook, where many of the studies were old and done on 70-year-old men."

Burke now has her condition under control with an internal defibrillator pacemaker and takes seven medications for her condition. She now acts a spokesperson for Go Red for Women, a social initiative that empowers women to take charge of their heart health.

Burke is not what one typically thinks of when they hear the term, "heart condition." She had always been healthy when she was young. Experts say it's important to recognize the gender differences in heart health, but a new HealthGrades report, which sought to evaluate gender-specific outcomes in heart care in men and women, found that just being a woman increased the likelihood of death in heart surgery patients compared with their male counterparts.

Researchers said there are several reasons for this conclusion. Symptoms of heart disease in women usually appear at an older age than men, and often times, many women have symptoms without any history of the disease.

Heart disease is the number one cause of death in the United States. The American Heart Association states that women account for nearly half of all heart disease deaths, but only about half of those women are aware that cardiovascular disease is the leading cause of death in women.

The greatest inconsistency came under valve replacement surgery, where women were at a 44 percent greater risk of dying than men.

Among other statistics, the report found that only 33 percent of women who had a heart attack in 2009 received some sort of surgery, compared with 45 percent of men. And female heart attack patients who received any kind of cardiovascular treatment had a death rate that was 30 percent higher than men.

Experts say that women tend to do worse than men in cardiovascular disease treatments. They are also less likely to receive recommended preventive and follow-up care than men.

Along with the varying symptoms, Dr. Malissa Wood, co-director of the Corrigan Women's Heart Health Program at Massachusetts General Hospital, said there are several other contributing factors that lead to differences in treatment and outcome between genders.

Wood said that women, and sometimes even their doctors, still do not fully grasp that more women die from heart disease than men, and women are more likely to have atypical or unusual symptoms.

"This leads to later presentation with heart attack and slower recognition by care providers," said Wood. "Often the damage to the heart muscle has been done once women present."

"Also, women are more likely than men to have heart attacks without tight blockages in the arteries," she continued. "This small vessel disease is more challenging to diagnose and treat."

Dr. Susan Bennett, director of the GW Women's Heart Program at George Washington University, said physicians often see an elderly woman who has the "fragility factor," and, as a consequence, tend to be more reluctant to operate on them.

"What is really worth thinking about is that women have a lot more risk with procedures than men, such as bleeding, kidney failure," continued Bennett, who said it is unclear why women have higher rates of these serious side effects.

"And in my mind there should be much more attention paid to knowing why women have more drug or procedural risks, and what can be done to minimize it so that she can obtain the same degree of overall benefit," Bennett said.

Dr. Sharonne N. Hayes, director of the Women's Cardiovascular Clinic at Mayo Clinic, added that under-treatment could remain a problem for women, whether it is treating heart disease through aspirin, statins, beta blockers or procedure use, but there is an even further explanation that is necessary.

Hayes noted she is "wary" of papers that only report percent differences in mortality as this is particularly misleading if death rates are already low. The published paper did not look at overall incidence of heart disease in men and women.

Hayes broke it down by saying: "If mortality in women is 2 percent and 1.5 percent in men, then that would be a 30 percent or so of excess mortality, but both numbers would be exceedingly low."