Men and women have about the same in-hospital death rate for heart attack - but women are twice as likely to die if hospitalized for a more severe type of heart attack, according to a report in Circulation: Journal of the American Heart Association.

Among patients with ST elevation myocardial infarction (STEMI) in a recent study, the death rate was 10.2 for women compared to 5.5 for men. Researchers said the women were older and had higher overall baseline risk profiles than men.

However, the study also found that some recommended treatments are delayed and underused in women.

Researchers analyzed data from the American Heart Association's Get With The Guidelines (GWTG) program to determine if recent efforts to improve heart attack care at hospitals had closed the gender disparity gap. They reviewed the clinical characteristics, treatments and outcomes of more than 78,000 patients diagnosed with myocardial infarction admitted to 420 hospitals between 2001 and 2006.

"The finding that bears the most emphasis is that among both men and women presenting to Get With The Guidelines participating hospitals, there were no clinically meaningful differences in in-hospital survival after heart attack, once we factored in differences, such as age and other existing illnesses," said Hani Jneid, M.D., lead author of the study and assistant professor of Cardiovascular Medicine at Baylor College of Medicine in Houston, Texas.

A decade ago, women had an overall higher death rate after heart attack compared with men. This suggests that these hospitals are now using high rates of evidence-based therapies shown to increase survival after heart attack.

"However, the finding of persistently higher death rates among women experiencing the more severe type of heart attack (STEMI) and the persistent gender gap in certain aspects of care underscore the existing opportunities to enhance post-heart attack care among women," Jneid said.

In the study, Jneid and colleagues found that, compared to men, women were:

- 14 percent less likely to receive early aspirin;
- 10 percent less likely to receive beta blockers;
- 25 percent less likely to receive reperfusion therapy (to restore blood flow);
- 22 percent less likely to receive reperfusion therapy within 30 minutes of hospital arrival; and
- 13 percent less likely to receive angioplasty within 90 minutes of hospital arrival.

"We could not determine in this study to which extent these differences were due to physicians' failures to administer optimal therapies to women vs. appropriate decision-making based on biological and other differences between men and women," Jneid said.

Furthermore, researchers found that women admitted with a STEMI were about twice as likely to die in the first 24 hours of hospitalization as men.

"Although STEMI is not as common among women as it is among men, it is a concern that there is still this gap in mortality between men and women after the more severe heart attack," said Laura Wexler, M.D., co-author of the study and senior associate dean at the University of Cincinnati College of Medicine.

Get With The Guidelines helps improve physicians' awareness of proven post-heart attack therapies, said Gregg C. Fonarow, M.D., chairman of the Get With The Guidelines steering committee.

"As part of this effort, the American Heart Association has been collecting data from a large number of hospitals about the treatments and outcomes of therapy for heart attack victims," said Fonarow, a professor of cardiovascular medicine at UCLA. Thus, GWTG "has not only helped improve care but also created a powerful research tool," Fonarow said.

Study authors with Jneid, Fonarow and Wexler are: Christopher P. Cannon, M.D.; Adrian F. Hernandez, M.D.; Igor F. Palacios, M.D.; Andrew O. Maree, M.D.; Quinn Wells, M.D.; Biykem Bozkurt, M.D.; Kenneth LaBresh, M.D.; Li Liang, Ph.D.; L. Yuling Hong, M.D., Ph.D.; L. Kristin Newby, M.D., M.H.S.; Gerald Fletcher, M.D.; and Eric Peterson, M.D. Individual author disclosures are available on the manuscript.

BIO

C. Noel Bairey Merz, MD, FACC

Director, Women's Heart Center, Cedars-Sinai Heart Institute
Director, Preventive and Rehabilitative Cardiac Center, Cedars-Sinai Heart Institute
Women's Guild Chair in Women's Health, Cedars-Sinai Heart Institute

C. Noel Bairey Merz, MD, holds the Women's Guild Endowed Chair in Women's Health, and is Director of the Women's Heart Center as well as the Preventive and Rehabilitative Cardiac Center at the Cedars-Sinai Heart Institute.

Dr. Bairey Merz's research interests include women and heart disease, mental stress and heart disease, the role of exercise and stress management in reversing disease, and the role of nutrition in heart disease. Currently, she is chair of the National Institutes of Health (NIH)-sponsored WISE (Women's Ischemic Syndrome Evaluation) initiative, which is investigating potential methods for more effective diagnosis and evaluation of coronary artery disease in women. Dr. Bairey Merz has received investigational grants from the NIH-National Heart, Lung and Blood Institute (NHLBI), NIH-National Center for Alternative and Complementary Medicine (NCCAM), the Pfeiffer Foundation, and the Women's Guild.

A prolific lecturer, Dr. Bairey Merz, is a member of many professional organizations, including the American Heart Association (AHA), the American College of Cardiology (ACC), the Academy of Behavioral Medicine Research, the American Society of Preventive Cardiology, the Association of Academic Women's Health Programs, and the Association of Women's Heart Programs. She serves on the Board of Trustees of the ACC, where she is a fellow, and is a past-chair of the Prevention of Cardiovascular Disease committee. She currently holds the Chair of the Women in Cardiology Committee of the AHA. Other professional associations include membership on the National Space Biomedical Research Institute Board of Scientific Counselors, the American Board of Internal Medicine (ABIM) Board of Examiners, and she holds the Chair of the NIH-sponsored Bypass Angioplasty Revascularization Investigations 2 Diabetes (BARI-2D) Data Safety Monitoring Board (DSMB). She serves on the advisory boards of lay organizations, including Women's Heart and Sister-to-Sister.

Bairey Merz has an extensive scientific publication record consisting of over 150 scientific publications, more than 200 abstracts, and numerous book chapters. Her work has been published in numerous peer-reviewed journals including the New England Journal of Medicine, the Journal of the American Medical Association, Circulation, the Journal of the American College of Cardiology, and the Journal of Women's Health.

Dr. Bairey Merz has received numerous awards and honors including the 2005 Red Dress Award For Leadership in Cardiovascular Research in Women, the 2005 VHA Inc. Best Practices Awards for Special Achievement Award presented to an individual who has made an outstanding contribution to the field of health care, the 2005 Women of the 21st Century award from the Women's Guild of Cedars-Sinai Medical Center, and the 2006 Alvin P. Shapiro Award by Psychosomatic Society for excellence in clinical research.

Dr. Bairey Merz has appeared frequently in the media, recognized as an authority on the subject of heart disease and stress. Her television appearances have included Good Morning America, NBC Dateline and 20/20. She has also been interviewed for articles published in The New York Times, Ladies Home Journal, US News & World Report and Working Woman Magazine, to name a few. Dr. Bairey Merz is currently the national spokesperson for VHA's Women's HeartAdvantage campaign, which seeks to raise awareness of heart disease in women.

Dr. Bairey Merz received her bachelor's degree from the University of Chicago and her medical degree from Harvard University. She completed her residency at the University of California, San Francisco, where she served as Chief Medical Resident. Dr. Bairey Merz also completed fellowships in clinical cardiology and nuclear cardiology at Cedars-Sinai Medical Center.

Cedars-Sinai Medical Center