Women Less Likely To Get Top-Quality Heart Attack Care,
GAP study results show lower mortality when doctors, nurses and patients all review medications and lifestyle changes before patient leaves hospital
ORLANDO - Efforts to improve the quality of post-heart attack care in hospitals are working - but they appear to be working better for men than for women, new research shows.
That finding, presented at the Annual Scientific Session of the American College of Cardiology, comes from an analysis of records from 2,857 heart attack survivors treated at Michigan hospitals before and 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, found a significant difference between the treatment women received before and after the effort, and that received by men. The increased use of proven medications, for example, 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. But women didn't get as much mortality reduction benefit as men.
That difference may be in part because women patients were less likely than men to have a one-on-one session with doctors or nurses before they went home, 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, lived longer 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 lead researcher Kim Eagle, M.D., clinical director of the U-M Cardiovascular Center.
Eagle is co-director of the Guidelines Applied in Practice (GAP) Project in Michigan. GAP is a project of the ACC that aims to help hospitals deliver proven medications, tests, and advice on diet, exercise, smoking cessation and weight loss to all patients.
At last year's ACC meeting, Eagle and his colleagues reported that the GAP project resulted in a 25 percent lower risk of dying within a year of leaving the hospital among heart attack patients whose 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.