ORLANDO, FLA. — Women presenting with myocardial infarction continue to receive less intensive treatment and have higher mortality than men with similar presentations, but the gender gap in medical interventions prescribed at hospital discharge may be narrowing, according to studies presented at an international conference on women, heart disease, and stroke.
One retrospective study included nearly 26,700 Swedish patients who were treated for ST-elevation MI (STEMI) at cardiac intensive care units during 1997–2001. Reperfusion therapy was administered to 71% of the 17,243 men in the study, compared with 62% of the 9,455 women in the study, Sofia Sederholm Lavesson, M.D., reported.
Men, compared with women, had lower in-hospital mortality (9% vs. 16%), 30-day mortality (11% vs. 18%), and 1-year mortality (16% vs. 25%), said Dr. Lavesson of Linköping (Sweden) University.
After adjusting for numerous confounding factors, women remained significantly less likely than men to receive reperfusion therapy (odds ratio 0.83) and to survive while in the hospital (OR 1.23), she said, noting that the differences between men and women cannot be fully explained by differences in age and comorbidities. “[Greater] age is the main explanation for the higher mortality in women, but less intensive treatment also appears to contribute.”
A similar conclusion was reached in a study of more than 55,000 patients who were admitted to any of 153 different hospitals with a primary diagnosis of Q-wave acute MI during January 2000 to June 2004.
Mortality was 13% in the 19,034 women in the study, compared with 7% in the 35,969 men. After adjusting for 24 variables, including age, various comorbidities, and type of hospital providing the treatment (heart surgery hospital, cath lab hospital, and hospital with no heart surgery or cath lab), men were shown to be less likely than women to die (OR 0.71). Additionally, men were more likely than women to be transferred for further treatment (OR 1.24), receive thrombolytics (OR 1.16), receive percutaneous coronary intervention (OR 1.12), and/or receive coronary artery bypass grafting (OR 1.64), Allan L. Anderson, M.D., of the Medical City Dallas Hospital, reported.
“Women with Q-wave acute MI continue to have significantly worse mortality rates and receive less revascularization than men,” he concluded, noting that additional research is needed to determine how women with MI can obtain clinical parity with men.
But such parity is being achieved when it comes to the prescribing of medical interventions at hospital discharge in patients who present with heart attack or chest pain, a third study suggests.
That ongoing study showed such men and women are being prescribed appropriate drug interventions at the about the same frequency. The subanalysis of a National Institutes of Health-funded study of 177 men and 35 women with acute coronary syndrome showed that women were prescribed aspirin, β-blockers, and statins as frequently as men, however, it also showed that 10% of women with acute coronary syndrome didn't receive aspirin or β-blockers and that more than 30% didn't receive statins, Shu-Fen Wung, Ph.D., and Heather Hiscox of the University of Arizona, Tucson, reported in a poster.
Also, women in this study lived significantly longer than men following their hospitalization (179 days vs. 156 days), with both age and gender showing a significant association with 6-month survival, the investigators noted.
The findings suggest that more people are following the guidelines of the American Heart Association and American College of Cardiology, and that progress is being made in the treatment of both men and women, Dr. Wung said in a statement.