Baylor study: Women more likely to die after heart attacks Women less likely to get proper care for heart attacks

Baylor study finds many factors contribute to disparity in treatment

Women are less likely than men to receive appropriate and timely treatment after being hospitalized for a heart attack and more likely to die if it's severe, according to a new study.

The study, led by a Baylor College of Medicine cardiologist, found that women overall are nearly twice as likely to die of massive heart attacks as men. When researchers adjusted for the fact female patients tend to be older and sicker, they were 12 percent more likely to die.

"I was surprised there is still so much of a difference," said Dr. Hani Jneid, a Baylor professor of cardiovascular medicine and the study's lead author."I would have expected the gap to have closed by now. We need to do better."

Jneid said he believes the undertreatment of female patients is one reason for the higher mortality rate, but added the study only showed an association. He called for future studies to find the causes.

Previous research also has found women's heart attacks are treated less aggressively. Jneid said the stereotype that heart disease is a man's issue exists even among many health-care workers.

The new study, reported Monday in the American Heart Association journal Circulation, did show improvement by women. A decade ago, studies found that women overall were 40 percent more likely to die from heart attacks than men and 25 percent more likely when the numbers were adjusted for age and risk factors.

Measuring progress

The new study was undertaken to determine if initiatives taken to reduce the gender gap since it was identified in the 1990s were successful.

The study found men and women now have about the same adjusted in-hospital death rate for heart attacks. The remaining gap was evident only after the most severe type, when a complete blockage of a coronary artery causes more heart muscle to die.

The researchers examined medical records of more than 78,000 heart attack patients treated at 420 U.S. hospitals between 2001 and 2006. The hospitals are enrolled in a program that follows the latest guidelines for treatments shown to work in clinical trials.

Because many U.S. hospitals are not enrolled in the program, researchers say the actual disparity in the care and outcome of women might be worse.

The researchers found women admitted with a massive heart attack were twice as likely to die in the first 24 hours of hospitalization.

"This is a clear call to action," said Dr. Gregg Fonarow, a professor of cardiovascular medicine at UCLA and a study author. "Progress has been made, but there is still substantial opportunity to improve care and outcome."

Jneid noted that treatment is complicated because women often experience atypical and less obvious heart attack symptoms, such as nausea and vomiting. They experienced heart pains less often than men.

Other factors

On average, the women in the study were more likely to have heart-related health problems such as diabetes, heart failure and high blood pressure. They were eight years older at the time of the heart attack — 72 compared with 64.

As a result of those factors, 10.2 percent of women with heart attacks died in the hospital, compared with 5.5 percent of men. After taking into account those factors, the researchers said women in the study were 12 percent more likely to die.

Massive heart attacks occur more frequently in men. In the study, 35 percent of men suffered heart attacks characterized by a complete blockage of an artery, compared with 28 percent of women.

The study was funded by the American Heart Association's Council on Clinical Cardiology.

todd.ackerman@chron.com