Severe Heart Attacks Deadlier for Women

By RONI CARYN RABIN

10 dec 2008--Women who suffer a type of severe heart attack were less likely than men to survive the first 24 hours in a hospital, a new study has found.

Female heart attack patients overall were less likely to receive timely treatment with aspirin or certain heart drugs, therapy to restore blood flow, or angioplasty to open blocked arteries, the authors also reported.

The study appears in today’s issue of the medical journal Circulation, which is published by the American Heart Association.

Researchers at the University of California, Los Angeles and elsewhere reviewed data on treatments and outcomes from more than 78,000 patients admitted to 420 hospitals between 2001 and 2006. The data were gathered by hospitals using an online tool to track patient care.

While the researchers found no gender gap in deaths for all heart attacks after accounting for differences in risk factors and age, they did find that women who suffered a type called a ST-elevation myocardial infarction, or STEMI, had a 12 percent higher risk of dying in the hospital than men. ST-elevation refers to an abnormal heart rhythm visible by electrocardiogram.

“For these types of heart attacks, which are usually caused by complete occlusion of the arteries and where immediate treatment to try and get the artery opened is so important, we still found important differences in early treatment and in outcomes,” said Dr. Gregg C. Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles and an author of the study.

Previous studies have shown that women are less likely to survive heart attacks than men, but experts disagree over the causes.

While some have suggested that women aren’t diagnosed as promptly or treated as aggressively as men, others note that women tend to develop heart disease at a more advanced age. As a result, female patients are more likely to suffer such complicating ailments as diabetes or lung disease.

Women may also be more likely to experience confusing heart attack symptoms, such as unexplained fatigue, rather than the classic symptom of crushing chest pain, making it more difficult to diagnose.

In the new study, the researchers found that women were 14 percent less likely than men to be treated with aspirin and 10 percent less likely to be treated with beta-blockers, which modify heart rhythm, soon after arriving at a hospital.

Women were 22 percent less likely to receive reperfusion therapy, which restores blood flow to the heart, within 30 minutes of arrival as treatment guidelines recommend. Women also were 13 percent less likely to receive angioplasty within 90 minutes of arrival, the study found.

Still, the data represent an improvement in timely treatment for women since the 1990s, Dr. Fonarow pointed out. “Overall the gaps in care between men and women have narrowed," he said.

Care for all heart attack patients seems to be improving, as well. “Earlier studies found less than one in 10 patients were receiving balloon angioplasty within 90 minutes and drug infusion within 30 minutes," Dr. Fonarow said. "Here we’re seeing two-thirds are getting it.”

Dr. Nieca Goldberg, a spokeswoman for the American Heart Association, said the results were “bittersweet.”

The higher death rate among women with STEMIs was troubling, she said, because they can be diagnosed easily with an electrocardiogram.

“Part of the reason women fare so badly immediately after a heart attack may be because they delay treatment and have more heart damage,” Dr. Goldberg said.

Doctors must treat women more aggressively for risk factors like high blood pressure and high cholesterol, she said. “We have to encourage women to be aware of symptoms and go to the hospital. Don’t think about it -- call 911.”