Circulation: Female STEMI patients are twice as likely to die in the hospital

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Men and women have about the same in-hospital death rate for heart attack, but ST-elevation MI (STEMI) patients, who are female, are twice as likely to die if hospitalized, according to a study in the December issue of Circulation.

Among patients with STEMI, the researchers found that 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.

Hani Jneid, MD, assistant professor of cardiovascular medicine at Baylor College of Medicine in Houston, and colleagues 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 MI admitted to 420 hospitals between 2001 and 2006.

The authors wrote that a decade ago, women had an overall higher death rate after heart attack compared with men, which suggests that the 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 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;
  • 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, the researchers also found that women admitted with a STEMI were about twice as likely to die in the first 24 hours of hospitalization as men.