Sherry L. Grace, Ph.D., and colleagues from the University Health Network
in Toronto found that women were treated less frequently either because
they were older or because of delays between diagnosis and treatment. In
many cases, however, medical charts failed to record why the life-saving
drugs were not used.
Current guidelines for treating heart attack victims call for giving clot-dissolving
drugs to all patients, regardless of gender, age or race, if there is no
specific reason not to use them. Large, randomized clinical trials have
shown that the technique reduces death rates among both men and women.
“Unfortunately, this therapy has been underutilized, particularly
among women,” says Grace. Her study appears in the journal Women’s
Health Issues. The work reinforces previous research in the United States
showing differences between how men and women are treated for cardiovascular
disease.
The 347 male and 135 female patients in the study from across the province
of Ontario averaged 62 years of age. The researchers used both surveys
and hospital records to determine medical history, diagnoses and treatments.
The women were generally older than male participants and less likely to
be married. They also had less post-secondary education and more severe
heart disease.
When their heart attacks began, men and women had similar experiences,
although women suffered more symptoms.
“There were no significant gender differences in any of the most
frequently reported cardiac symptoms,” Grace says. “Where
gender differences did occur, symptoms experienced in the 30 days before
the coronary
event were more prevalent in women than men.”
Once symptoms began, four out of five participants said they waited before
taking any action. The median delay was an hour and a half from the start
of symptoms to arrival at the hospital for both men and women. After they
got to the hospital, a median of eight minutes elapsed before an electrocardiogram
diagnosed the heart attack.
However, once the doctors and nurses diagnosed the heart attack, there
were significant delays for women patients in getting the clot-dissolving
drugs. Men received the drugs in a median 22 minutes, while it took 27
minutes for the women.
Overall, women waited 38.5 minutes from hospital arrival to treatment
while men had only a 30-minute wait.
About 68 percent of the eligible men but only 50 percent of the women
received this treatment, says Grace.
“Women were less likely to receive the drug, and at the same time
less likely to have a recorded explanation for contraindication than men,” she
says. For 40 percent of the untreated women, no reason was ever listed
for why they did not receive the clot-dissolving treatment. Grace’s
team found that, besides the delays in treatment, women who received
the drugs were significantly younger than those who did not, despite
the guidelines.
“The gap in coronary care appears to be multifactorial, consisting
of gender, age and socioeconomic issues, differences in risk factors, as
well as hospital delay,” Grace says.
This study was funded by the Heart and Stroke Foundation of Ontario and
the Samuel Lunenfeld Foundation.
