Women May Get Poorer Care Than Men Post-Heart Attack
This could explain gender gap in survival, researchers say
By Amy Norton
MONDAY, Nov. 9, 2015 (HealthDay News) -- Women are less likely than men to get the recommended treatments for heart attack survivors, and that could explain much of the gender gap in long-term survival, a new study finds.
Looking at records for nearly 50,000 older Americans hospitalized for a heart attack, researchers found that women were 8 percent less likely to be on "optimal care" when discharged.
Optimal care means that patients are sent home with prescriptions for all of the standard therapies that are appropriate for them. According to guidelines after a heart attack, that can include counseling on smoking cessation, referral to a cardiac rehab program, and prescriptions for a low-dose daily aspirin, a cholesterol-lowering statin or blood pressure drugs such as beta blockers and ACE inhibitors.
The finding that men are more likely to get recommended heart attack therapies is nothing new, said Dr. Deepak Bhatt, director of interventional cardiovascular programs at Brigham and Women's Hospital in Boston, and co-author of the new study.
Past studies have found the same pattern, he noted.
But what's key here, Bhatt said, is that "suboptimal" care accounted for the gender gap in heart attack patients' long-term survival. When women received optimal treatment, they were just as likely as men to be alive three years later.
When treatment was subpar, women faced a 23 percent higher risk of dying in the next three years versus men, the study found.
"I think you can look at this as 'good news,' " Bhatt said, "because that is an actionable finding. If we just give women these simple, guideline-recommended therapies, we can close the mortality gap."
Bhatt was scheduled to present the findings Monday at the American Heart Association's annual meeting, in Orlando, Fla.
Dr. Stacey Rosen, a heart association spokesperson who was not involved in the study, agreed that the results are actually positive in that women's higher mortality can be changed.
"This should empower patients to make sure they work with their doctor to optimize their health," said Rosen, who is also vice president of women's health at the Katz Institute for Women's Health, North Shore - LIJ Health System in New Hyde Park, N.Y.
When women see their doctor for follow-up appointments after a hospital discharge, Rosen said, they should not be shy about asking questions -- including whether they've been prescribed all of the therapies that are right for them.
Drugs such as aspirin, statins and beta blockers are not appropriate for everyone, Bhatt said. But, he added, that did not explain why women in this study were less likely to receive optimal therapy.
The findings are based on Medicare records from more than 49,300 Americans who were hospitalized for a heart attack at one of 366 U.S. hospitals between 2003 and 2009. Overall, more than 16,000 people died within three years of their hospital discharge, with the risk higher among women whose care was suboptimal.
It's not clear why women were less likely than men to receive all of the appropriate post-heart attack treatments, Bhatt said. But whatever the reason, he added, the pattern needs to shift.
"We're not even talking about fancy, expensive interventions," Bhatt said. "Simple, low-cost treatments, like a daily aspirin, could close the gender gap in heart attack mortality."
Rosen agreed. "The disparity disappeared when women in this study received optimal therapy. That's a pretty irrefutable finding," she said.
The picture was different, however, when it came to black patients. Their death rate over three years was 36 percent higher than whites, but quality of care did not explain that racial gap.
That means researchers still need to uncover the reasons, Bhatt said. All heart patients should receive the best care possible, he added, but based on these findings, that will not erase the race disparity in Americans' long-term survival.
Studies presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.
The American Heart Association has more on heart attack recovery.
SOURCES: Deepak Bhatt, M.D., M.P.H., executive director, interventional cardiovascular programs, Brigham and Women's Hospital Heart & Vascular Center, Boston, Mass.; Stacey Rosen, M.D., vice president, women's health, Katz Institute for Women's Health, North Shore-LIJ Health System, New Hyde Park, N.Y.; Nov. 9, 2015, presentation, American Heart Association annual meeting, Orlando, Fla.
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