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According to new research, more than 8,200 women in England and Wales could have survived their heart attack if they had received the same quality of treatment as men.
The study did not include all hospitalizations that occurred during the 10-year study period. The researchers say that the actual number of lives lost due to inequitable care is likely to be much higher.
Researchers at the University of Leeds used anonymous data from the UK's Registry of Heart Attacks (MINAP) to analyze the treatment and outcomes of 691,290 people hospitalized for a heart attack between 2003 and 2013 in England and Wales. Wales.
The national registry contained detailed information on each patient's demographics, medical history, and clinical characteristics, including his or her heart rate at the time of entry, as well as investigations, treatments, and procedures. that he received during his stay at the hospital.
In the study funded by the British Heart Foundation (BHF), women tended to be older when admitted to the hospital and were more likely to have other illnesses such as as diabetes and high blood pressure.
Even after taking into account that women with heart attacks tended to be older and had more risk factors, the researchers found that British women were twice as likely to die in the 30 days following a heart attack than men (5.2% vs. 2.3%). Researchers suggest that this is partly explained by the fact that women are less likely to receive the recommended care.
Unmatched care
Women who had NSTEMI, a type of coronary artery heart attack that was partially blocked, were 34% less likely than men to undergo coronary angiography in a timely manner within 72 hours of their first symptoms (24, 2% of women, against 36.7%). one hundred men).
Coronary angiography creates video images to reveal narrowing or blockages in the coronary arteries. This is a crucial step in care because it helps doctors decide what to do, and research has shown that people who undergo early angiography for NSTEMI get better results.
Women who experienced STEMI, a heart attack whose coronary artery was completely blocked, were 2.7% less likely to undergo timely reperfusion, emergency procedures including medications and stents that help clear blocked arteries and restore blood flow to the heart (compared to men) 76.8% of women against 78.9% of men).
Women were less likely to be prescribed statins by 2.7% (87.6% of women versus 89.6% of men) and 7.4% less likely to be prescribed beta-blockers (62.6%). % of women versus 67.6% of men) on discharge from the hospital, medications that help reduce the risk of having a second heart attack.
Although the difference in proportions may seem small in themselves, the researchers explained that even minimal deficits at each stage of a woman's care path can become a significant survival disadvantage.
Chris Gale, lead author and professor of cardiovascular medicine at the University of Leeds, and honorary consultant cardiologist, said: "We know women are dying from an uneven heart attack – and we have now identified the gaps that we must target to save lives.
"For example, women who do not receive coronary angiography upon arrival at the hospital disadvantage them early on and have repercussions by creating additional gaps down the line." Isolated, the differences may seem Although the health care system is as good as in the United Kingdom, small health care deficits are added to reveal a much larger problem and a significant loss of life.
"We also show that not all differences are biased – some are due to biology.This is only with more research that we can better understand how to target biology and best treat heart attacks." in women. "
Researchers evaluated the quality of care received by men and women following their heart attack based on "quality indicators" – an optimal care checklist based on international recommendations and approved by the Society. European Cardiology. Care for women was less likely to meet 13 of the 16 measured heart attack quality indicators.
They estimated that 8 243 deaths among women hospitalized for heart attacks in England and Wales could potentially have been avoided during the study period if they had received equivalent care at home. those of men. But as the study did not include all heart attacks in the UK over the ten-year period, it is likely that the actual number of lives lost due to unequal care is much higher.
The researchers point out that differences in care probably explain, but not all, the survival gap between men and women. Differences in heart attack symptoms, health seeking behavior, underlying biology, age and the presence of underlying health problems, as well as in the response to medications and treatments may also have played a role.
Every year in the UK, about 70,000 women go to hospital due to a heart attack and up to 25,000 women in the UK die each year from a heart attack three women an hour.
Previous research funded by BHF has shown that women are 50% more likely than men to receive the initial misdiagnosis following a heart attack and less likely to undergo a prehospital ECG, which is essential for prompt diagnosis and treatment.
Professor Sir Nilesh Samani, Medical Director of the British Heart Foundation, said: "We need to address the misperception that heart attacks are only a male health problem, resulting in inadequate management. women, both during and after heart attacks – with fatal consequences.
"Although further research is needed, this study has identified several areas in which heart attacks are treated differently between the sexes, which could contribute to the worst outcomes in women." If we start treating them now, this will make a difference. huge difference and will save lives. "
Explore further:
Women at increased risk after heart attack: study
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