Women Received Less Aggressive Care Than Men After a Heart Attack With Pumping Failure

After a heart attack, when heart pumping fails, women aged 18-55 get less aggressive care in the hospital and are more likely to die before discharge than men the same age, according to new research published today in Circulation:Heart Failure, an American Heart Association journal. "It is very concerning that the young, productive women of our society face these health care disparities," said Saraschandra Vallabhajosyula, M.D., M.Sc., lead author of the study and a clinical fellow in interventional cardiology at the Emory University School of Medicine in Atlanta.

Cardiogenic shock is when the heart suddenly fails to pump enough blood to keep vital organs alive. It is a leading cause of death after a heart attack, causing death in about half of those with the complication.

Previous research focused on older patients revealed that standard cardiovascular care recommended by professional guidelines is received less frequently by women than men.

For this study, researchers wanted to determine whether sex disparities also exist among younger patients.

Researchers analyzed the hospital health data on 90,648 patient admissions (between 18 and 55 years old, 26% women) who had heart attacks complicated by cardiogenic shock.

The data was collected from the National Inpatient Sample from 2000-2017 maintained by the Agency for Healthcare Research and Quality.

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Women were significantly less likely than men to:

• Receive coronary angiography to detect blockages.
• Be treated with procedures such as stents or balloons to open blockages in the heart arteries.
• Have their heart function temporarily supplemented using a mechanical pump.
• Had approximately the same length of stay in the hospital.
• Lower average cost-per-hospitalization.

"As clinicians, we need to understand the likely multiple motivators and factors, both individual and system-based, that might lead to unconscious bias. Our emphasis should be on providing high-quality and equitable care for every patient independent of their sex," said Vallabhajosyula.

"Fewer treatments prescribed for women led to lower use of resources, therefore, women had lower hospitalization costs. Additional studies are needed to help us more fully understand and make the changes necessary to improve treatment and eliminate disparities in care," said Vallabhajosyula.

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Study Limitations

• Non-randomized.
• Used data from hospital discharge codes.
• May be missing some individual patient information.

Go Red for Women

• American Heart Association's signature women's initiative designed to increase women's heart health awareness.
• Cardiovascular disease is the number 1 killer of women, causing 1 in 3 deaths each year.
• Women account for less than half of all clinical trial participants.

Source-Medindia