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How women suffer from gender differences in heart care

Wednesday May 22nd, 2019

Two studies, published today, show how women receive inferior care for different aspects of heart disease.

Dutch researchers report that people are less likely to attempt cardiac resuscitation on a woman experiencing cardiac arrest than a man - and women are more likely to die before reaching hospital.

A second British study raised questions about the diagnosis and care of heart failure in the community.

The work, published in the European Heart Journal today (22 May), was carried out by Dr Hanno Tan and colleagues at the University of Amsterdam in the Netherlands.

They analysed information on nearly 6,000 men and women who had a resuscitation attempt for cardiac arrest between 2006 and 2012. Of these patients, 28% were women.

Men had a 73% chance of receiving a resuscitation attempt by a bystander, versus 68% for women. Survival rates before admission to hospital were 34% for women and 37% for men.

In addition, women were less likely to survive from admission to discharge (37% versus 55%). The overall rate of women surviving to discharged from hospital was 12.5% versus 20% for men.

The authors say that ‘shockable initial heart rhythm’ is lower in women, and that people often do not expect cardiac arrest in women, which causes a delay in summoning an ambulance.

Dr Tan said: “We found that the worse outcome in women is largely attributable to the fact that women had about half the chance of having a shockable initial rhythm compared to men.

”This is not fully explained by pre-existing diseases or by different resuscitation factors. Other, as yet undiscovered, factors also play a role.”

Sara Askew of the British Heart Foundation commented: "This new insight is particularly worrying, given that we already know that women who have suffered a heart attack are less likely to receive the appropriate treatment. Now, it appears the case is the same for women who have cardiac arrests.

"Knowing how to perform CPR is essential and doing something is always better than doing nothing."

* Meanwhile a study of 93,000 UK adults with heart failure has revealed critical care shortcomings in diagnostic tests, drug prescriptions, and follow-up patterns, with women and those over 75 years of age disproportionately affected.

Researchers at Oxford University said heart failure diagnosis was usually made in hospital rather than by GPs.

The Royal College of GPs said GPs needed improved access to diagnostic tests.

Chair Professor Helen Stokes-Lampard said: "Access to appropriate tests would not only ensure that more people with heart failure get the treatment they need, but also that patients who don’t have it are spared unnecessary trips to hospital, and instead monitored where they’d prefer - at home, in the community."

Blom, M. T. et al. Women have lower chances than men to be resuscitated and survive out-of-hospital cardiac arrest. European Heart Journal 22 May 2019; doi: 10.1093/eurheartj/ehz297

Diagnostic tests, drug prescriptions, and follow-up patterns after incident heart failure: A cohort study of 93,000 UK patients. PLoS Medicine 22 May 2019

Tags: Europe | Heart Health | NHS | UK News | Women's Health & Gynaecology

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