Heart attack treatment gap may be closing for women

Main Category: Women's Health / Gynecology
Article Date: 19 Feb 2005 - 12:00 PST

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Women who have suffered a heart attack or have chest pain are being prescribed appropriate drug intervention at hospital discharge at the same frequency as men, researchers reported at the Second International Conference on Women, Heart Disease and Stroke.

A sub analysis of a National Institute of Health funded study showed that women were just as likely as men to be discharged on recommended drugs after acute coronary syndrome (ACS). Women were prescribed aspirin, beta-blockers and statins as frequently as men.

One in ten women with ACS, who is able to take the medicines, didn't receive aspirin or beta-blockers. Still one-third of these women did not receive statins.

Past studies have shown that women with heart disease were not receiving as much therapy as men after heart attack or unstable angina, said Shu-Fen Wung, Ph.D., associate professor of nursing, University of Arizona, Tucson. "But significant progress has been made with more physicians/nurse practitioners following practice guidelines.

"We are making progress in prescribing aspirin, beta-blockers and statins to patients with acute coronary syndrome," she said. "In addition, there is not a statistically significant gap in the treatment between men and women."

Clinical guidelines of the American Heart Association and the American College of Cardiology recommend that patients with ACS be treated with aspirin, beta-blockers and lipid-lowering medications. Previous studies have shown distinct gender differences, with men receiving more therapies than women. However, only limited studies specifically addressed the practice of this clinical guideline by gender.

The study, which included 177 men and 35 women with ACS, determined whether patients were being discharged on the appropriate medications and the relationship between pharmacological management and six-month survival. Men and women had no differences in age, or the diagnosis of heart attack or unstable angina (chest pain). The use of beta-blockers, aspirin and statins was determined at discharge in patients from two teaching hospitals and again with follow-up phone calls six-months after discharge.

The good news is that both 90 percent of men and women received aspirin and beta-blockers at hospital discharge. Two-thirds of women received statins while 78 percent of men received this lipid-lowering medication. Women lived significantly longer, up to six months after their ACS hospitalization or an average 179 days while men lived 156 days. Age and gender had a significant relationship with the six-month survival. "There has been a lot of education going on because of the guidelines," Wung said. "Progress is being made in the treatment of both men and women."

Now the researchers are focusing on the 10 percent who didn't receive or continue treatment, she said. It may be that some patients are lost in the system after being prescribed the medications, Wung said, adding that some patients in nursing homes aren't receiving aspirin and beta-blockers after either heart attack or bouts of unstable angina.

Others, after being contacted by the research team, said they don't know why they aren't taking these medications. "Prior to being dismissed from the hospital with a diagnosis of ACS, patients need to be evaluated for these medications," she said.

The researchers plan to continue the study, enrolling additional patients and adding more women. Presently, the numbers of men far exceed the women because one of the hospitals in the study is a Veterans Administration Hospital.

Wung, a nurse practitioner, also said the medical community should look more closely at which patients should receive statins. While past studies have shown that lowering the low-density lipoproteins (LDL) - the bad cholesterol - provides better outcomes in terms of prevention, it's not clear whether only those with high LDL levels should be treated. "We need to look at the specific guidelines on who needs to receive statins because lowering LDL is beneficial and statins have additional anti-inflammatory effect," she said. "The guidelines recommend a lipid-lowering agent with LDL of 100 mg per dL or higher."

But this study reveals that progress has been made in treating patients following heart attack or who have unstable angina, she said.

"More people are following the guidelines," she said. "Women are receiving more of the recommended medications and there are less gender disparities in the usage of these medications either as a primary or secondary prevention."

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The conference is jointly sponsored by the American Heart Association, the Centers for Disease Control and Prevention, the American College of Cardiology Foundation, the World Heart Federation, the National Heart, Lung, and Blood Institute, and the Heart and Stroke Foundation of Canada.

This abstract was published in the February 2005 issue of Circulation: Journal of the American Heart Association.

Contact: Karen Astle
karen.astle@heart.org
American Heart Association

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