Older women less likely to receive heart attack treatment

Older women are less likely to receive early treatment following a heart attack than older men and are more likely to be assigned a do-not-resuscitate order during their hospital stay, UW researchers reported in the July 6 issue of the New England Journal of Medicine. Overall, however, most of the treatment differences are small and there is no apparent effect on 30-day mortality rates.

The study analyzed the care of nearly 140,000 Medicare participants throughout the United States who suffered a heart attack from 1994 to 1995. Female patients were 26 percent more likely to receive a Do Not Resuscitate (DNR) order than their male counterparts. These women were, on average, older but less ill then men receiving the same order.

“This finding surprised us, and we found it quite concerning,” says UW Rehabilitation Medicine Professor Leighton Chan, senior author of the study. “We were not sure if health care providers are more likely to recommend DNR status to women, or if women are simply more likely to request it.”

Coronary artery disease is the leading cause of death in women 65 years of age and older, surpassing all forms of cancer combined. Female patients in this study were more likely to have delayed seeking treatment for their symptoms and to have waited longer for medical attention after hospital arrival.

The Medicare study found that older women were less likely to undergo an important diagnostic procedure known as cardiac catheterization and coronary arteriography. This gender discrepancy increased significantly with age. Other studies have found that failure to use this diagnostic test is linked to increased short-term mortality.

Women in the study had a higher unadjusted 30-day mortality rate compared to men, 21 percent vs. 17 percent. However, after taking into account gender-differences in severity of illness, in-hospital treatments and other indicators, the difference in 30-day mortality was not statistically significant.