Heart attacks treated differently for men, women

Better adherence to guidelines needed, researchers say

July 6, 2000
Web posted at: 12:30 p.m. EDT (1630 GMT)

From staff reports

ATLANTA (CNN) -- A new study in the New England Journal of Medicine finds some discrepancies in how men and women are treated for heart attacks.

And although death rates don't seem to be influenced by the different treatment, the findings raise questions about how closely doctors follow guidelines for treating heart attacks in general, researchers said.

The research shows that women are less likely to get early heart attack treatment and, also troubling, have more chance of being assigned a "do-not-resuscitate" order, or DNR.

"This finding surprised us, and we found it quite concerning," said Dr. Leighton Chan, an assistant professor at the University of Washington School of Medicine and the study's lead author. "Based on the data available, we were not sure whether health care providers are more likely to recommend DNR status to women or whether women are simply more likely to request it."

The Medicare Cooperative Cardiovascular Project analyzed the care received by nearly 140,000 elderly heart attack patients throughout the United States between 1994 and 1995. Nearly half the cases studied were women.

In most respects, the study found the differences between treatment options for women and men to be too small to have any apparent effect on 30-day death rates. Still, some results are worth noting, the authors said.

The study found that women were 26 percent more likely to get a DNR order than men. On average, the women studied were older but less sick than men who got a DNR order.

	HEART DISEASE:
description risk symptoms treatment prevention Choose a link above to learn more about heart disease. Source: WebMD

"The assignment of DNR status is obviously critical to treatment decisions and patient outcome," Chan continued. "Future work really should focus on this issue and ensure that women are being assigned DNR status appropriately after a heart attack."

Heart disease is the leading cause of death for American women, accounting for more deaths than all forms of cancer combined, according to the American Heart Association.

As a group, the women studied were significantly older, but the severity of their disease was equivalent to that of the men, the authors noted. Still, researchers found the women more likely to have delayed seeking treatment for their symptoms. And once they did go to a hospital, they were more likely to wait longer for medical attention -- an average of four minutes longer for an electrocardiogram, a basic tool in evaluating heart function.

The women also were less likely to have cardiac catheterization or coronary arteriograms, diagnostic tests used to reveal and assess blockages. This gender difference increased even more with the age of the women. It is important, the authors said, because failure to use cardiac catheterization has been linked to an increased risk of death from heart attack.

The study also found that women were less likely to get:

• Aspirin at discharge. Aspirin has been shown to be an effective, inexpensive treatment for heart attack.
• Clot-dissolving drugs. Even if clot busters were used, women were less likely to receive them in a timely manner.

"While this study highlights that women may be slightly less aggressively treated in the early stages of a heart attack," Chan said, "perhaps the more important story is the need for improvement in physicians' compliance with acute myocardial infarction practice guidelines."

If all heart attack interventions are used appropriately as necessary, everyone can benefit, he said.

Study links smog, heart attacks
June 30, 2000
New blood test may be best predictor of heart attack
March 22, 2000
Silent heart attacks: What you need to know
February 25, 2000
Sudden exercise may increase risk for heart attack
November 9, 1999
Heart attack more likely to kill women than men, study says
July 21, 1999
Raising awareness of heart disease in women
May 10, 1999
Half of men, third of women will develop coronary heart disease, study finds
January 7, 1999

American Heart Association
The New England Journal of Medicine

Note: Pages will open in a new browser window

External sites are not endorsed by CNN Interactive.