Study Finds Women Get Inferior Care to Men

Dec. 8, 2008— -- When facing a severe heart attack, getting to a hospital in time is just part of the challenge. A report today in the journal Circulation warns that once inside the hospital, many women may not be getting the basic care they desperately need.

The study found that women are twice as likely to die from a severe heart attack as men.

"I am very distressed to see that we're still not giving women equally aggressive treatment for acute heart attack as we are men," said Dr. Marianne Legato, director of the Partnership for Gender Specific Medicine at New York-Presbyterian/Columbia.

Each year, about 400,000 Americans suffer from STEMIs, or severe heart attacks, in which an artery to the heart is 100 percent blocked.

Compared to men, women in the midst of severe heart attacks were 14 percent less likely to receive early aspirin, which is typically used to minimize blood clotting; 10 percent less likely to get beta blockers to stabilize heart rhythm; and 25 percent less likely to get drugs or stents to restore blood flow.

"These findings enrage me. The fact that nothing has changed over the years and that women are getting substandard care should outage all of us," said Dr. Sharonne Hayes, director of the Mayo Clinic's Women's Heart Clinic.

Women suffering severe heart attacks are usually older and more frail than their male counterparts, so some therapies might not be appropriate. But many doctors see the study's results as part of a much larger problem, extending beyond severe heart attacks.

In almost every facet of heart care, women get less care than men, according to numerous studies: From the use of cholesterol-lowering drugs, to heart failure medications, implantable defibrillators and cardiac rehabilitation, women get less care.

"We still don't see women at risk for heart disease, and when she walks into our office or comes in on the ambulance, people are not thinking 'heart,' so they don't treat it," Hayes said.

That's what Debbie Dunn, a heart attack survivor from Libertyvile, Ill., said happened to her. Doctors refused to believe she was even having a heart attack, she said.

"I walked into the emergency room with heart attack symptoms, and for the next three hours, was challenged by the medical team," she said.

Dunn, who, after her experience, volunteers for the national advocacy organization WomenHeart, said that she felt dismissed.

"I felt I was not being taken seriously because I do not look like a heart patient ... being only 45 years old, tall, and appearing healthy," Dunn said. "So, because it did not add up into what they typically saw coming through the emergency room, I think I was not even considered to be a heart patient. And I think when the diagnoses all fell into place, they were rather shocked."

Researchers say one solution is for hospitals to systematically review each woman's heart care.

"Prior to discharge ... a patient should be carefully assessed for what has happened," Legato said. "Doctors [should be] questioned, if necessary, as to why decisions were made differently for women than were made for men."

They say more doctors and hospitals need to institute fundamental changes, like pilots use in the cockpit, to improve care and remind doctors what care women need at each step in their cardiac care.

These changes are not always quick or easy to implement. But early studies show these types of initiatives do make a difference: helping more women get the life-saving treatments they need.