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Study helps explain why more women die from heart attack than men

Kathleen Blanchard's picture
ORBI study highlights higher death rates from heart attack for women.

Research presented at the Acute Cardiac Care Congress 2012 helps explain why heart attack – myocardial infarction (MI) – kills more women than men. According to an October 19, 2012 press release, the finding makes it important for women to be especially vigilant about seeking medical treatment for chest pain. The results also suggest physicians need to manage women with MI the same as men.

Dr Guillaume Leurent from the Centre Hospitalier Universitaire in Rennes, France who presented the study writes in a press release, "Women may take longer to call an ambulance when they have chest pains because they don't believe it can be a myocardial infarction. Most women believe myocardial infarction is a male problem.

Past studies suggested women have higher death rates from heart attack because they don’t seek treatment soon enough or don’t receive the same aggressive treatment as men.

In an effort to find out why there is a gender gap in death rates for heart attack, the researchers used data from ORBI, a prospective registry of 5,000 patients with an acute type of heart attack known as STEMI (ST elevation myocardial infarction).

The study, Observatoire Régional Breton sur l'Infarctus du myocarde, was started in 2006 to look at quality of care given to heart attack patients.

The results showed 23%, or 1174 of patients in the registry were women. Compared to men, women with STEMI were older and had fewer cases of high dyslipidemia (abnormal cholesterol readings), but women were more likely to have high blood pressure but fewer were smokers.

But beyond differences in heart risk factors between men and women, the researchers also found women don’t receive the same care for heart attack as men. Women waited longer to seek help, but once they arrived at the hospital, it took about 5 minutes longer for interventions to restore blood flow to the heart (45 minutes vs. 40 minutes). They also received less aggressive interventions than men.

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“Delays of management are significantly longer in women; hence they have a longer ischemic time during which the heart's blood supply is reduced," said Dr Leurent. "And reperfusion strategies to restore blood flow are significantly less aggressive – with less fibrinolysis [clot busting medicines], and fewer coronary angiographies [cardiac catheterizations] performed."

Compared to men, mortality for women with heart attack was higher. Women had more complications and their hospital stays were longer.

The researchers specifically wanted to know what factors such as delays in treatment and procedures had an effect on death rates.

Dr Leurent said: "This higher intra-hospital mortality among women significantly persists when adjusted for patient characteristics, for revascularization delays (onset of symptoms to reperfusion therapy) and for revascularization modalities."

The study also fewer women get the same medications as men on discharge to home, such as beta-blockers and anti-platelet medications, ACE inhibitors or blood thinners. Fewer women than men are referred for cardiac rehabilitation.

Leurent concluded: "Doctors need to be more careful in the management of STEMI in women to further reduce ischemic time. This means adopting more aggressive reperfusion strategies and treating women the same as men. These actions by patients and doctors will reduce the current gender gap in mortality."

The study is important for two reasons. It shows women really are at higher risk for complications, longer hospital stays and dying from heart attack, compared to men. But even when you take into account other factors; women also aren’t getting the same care as men.

European College of Cardiology
October 20, 2012

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