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Senior Citizen Health & Medicine
Women Still Get Less Heart Attack Care than Men,
More Likely to Die in Year
Older women, too, had a much lower risk of dying
with proper treatment
 July 10, 2006 - A new study shows that a puzzling
gap between the sexes persists in hospital care for heart attack
patients, despite specific efforts by hospitals to improve the way they
treat all patients immediately after a heart attack. The difference may
help explain why women in the study were much more likely than men to
die within a year of being hospitalized for a heart attack. Even older
women in the study had a much lower risk of dying if they received
proper treatment.
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Health & Medicine |
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In all, the study shows, women were less likely
than men to benefit from hospitals' quality-improvement measures -- and
were less likely to get all of the drugs, tests, and counseling about
smoking, diet and exercise that have been proven to help heart attack
survivors live longer and healthier lives.
The result, published in a recent issue of the
Archives of Internal Medicine, comes from an analysis of records from
nearly 4,000 heart attack survivors treated at 33 Michigan hospitals
before or after a major quality improvement effort took place. All were
insured under Medicare.
The researchers, led by a team from the University
of Michigan Cardiovascular Center and funded by the American College of
Cardiology, found a significant difference between the treatment women
received before and after the effort, and that received by men. But the
increased use of most medications and other measures was much more
pronounced in men.
Overall, both men and women treated in the four
months after the quality effort began had a better chance of being alive
a year after their hospital stay ended, compared with those treated
before the quality-improvement effort. But the drop in death risk was
smaller in women.
That difference, say the researchers, is linked to
the fact that women patients were less likely than men to have a
one-on-one session with doctors or nurses before they went home from the
hospital, to help them understand and "take charge" of the medicines and
lifestyle changes that could improve their health.
Both men and women who had this session, and signed
a discharge contract with their doctors and nurses that included a
pledge to stick to treatment and follow-up appointments, had a 54
percent lower risk of dying within a year than those who didn't.
"We're troubled by the gender differences we found,
though we remain encouraged by the overall effect of post-heart attack
quality improvement efforts," says senior author Kim Eagle, M.D.,
co-director of the U-M Cardiovascular Center and the Hewlett Professor
of Medicine at the U-M Medical School. Eagle co-directs the Guidelines
Applied in Practice (GAP) Project in Michigan, the ACC program under
which the study was performed.
While the reasons behind the persistent differences
are unclear, Eagle and his colleagues speculate that it may have
something to do with the fact that women heart attack patients tend to
be older, and as a result doctors may not feel that women patients can
derive as much benefit from post-heart attack treatments and lifestyle
changes.
Indeed, the study participants were 48 percent
women, but the women on average were five years older than the average
for men. But Eagle notes that the results of the study fly in the face
of perceptions about older women and treatment benefits; even the older
women in the study had a much lower risk of dying after hospitalization
if they had received high-quality treatment and a pre-discharge
counseling session.
Previously, Eagle and his colleagues have shown
that GAP reduced patients' risk of dying within a year of leaving the
hospital by 25 percent, if doctors and nurses followed standard national
guidelines for their care, and used the discharge tool and contract.
This major effect on mortality rates was the first evidence that
standardized heart care saves lives.
GAP tries to increase hospitals' use of aspirin and
beta blocker drugs, and cholesterol testing, within 24 hours of a heart
attack, and the prescribing of aspirin, beta blockers,
cholesterol-lowering drugs and ACE inhibitor drugs for patients leaving
the hospital. It also seeks to increase the number of patients who get
counseling about diet and smoking before they leave the hospital, and
sign a contract with their doctor or nurse pledging to follow
recommendations and stick to their medicines.
On the whole, men treated after the quality effort
began were more likely to receive pre-discharge prescriptions for all
four classes of recommended heart medications than were women. The
quality effort significantly improved the use of only two of the drugs –
beta blockers and aspirin -- in women.
The new analysis showing differences in the
delivery of care to women and men, even after the quality improvement
effort, raises an important question of how hospitals implement quality
measures.
Some previous studies by other researchers have
found that doctors are less likely to deliver evidence-based medical
care -- the foundation of quality improvement efforts like GAP – to
women compared with men. But the new study is the first to show a
correlation between this failure and mortality.
"We owe women heart attack patients a full
examination of the factors that might lead them to receive fewer of the
proven drugs and lifestyle tips than men receive," says Eagle. "Now that
we know that they get just as much mortality benefit as men when quality
standards are applied to their care, we must find ways to ensure that
they are all treated according to those standards."
More about study:
In addition to Eagle, the study's authors are:
Sandeep Jani, MPH, a former ACC intern and research assistant with the
GAP project at U-M who is now studying at the Wayne State University
Medical School in Detroit; Michigan GAP co-director and project
coordinator Cecelia K. Montoye, RN, MSN; Rajhendra Mehta, M.D.; Arthur
L. Riba, M.D.; Anthony D. DeFranco, M.D.; , Robert Parrish, MM; Stephen
Skorcz, MPH; Patricia Baker, MS; Jessica Faul, MPH; Benrong Chen, Ph.D.;
Canopy Roychoudhury, Ph.D.; Mary Anne Elma, BA; and Kristi Mitchell, MPH
for the Michigan GAP Investigators and the ACC GAP Steering Committee.
The study was funded by the ACC, and supported in
part by the Hewlett Fund for Cardiovascular Research in Women. For more
information on post-heart attack care, or preventive care for those with
heart risk factors, at the U-M Cardiovascular Center, call
1-888-287-1082 or visit
www.med.umich.edu/cvc. For more information on the ACC's GAP project
on Acute Myocardial Infarction in Michigan, visit
www.acc.org/gap/mi/ami_gap.htm. Reference: Archives of Internal
Medicine, June 12, 2006. Vol 166, pp. 1164-1170. Accompanying editorial:
pp. 1162-1163.
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