Motivational ‘Women-Only’ Cardiac Rehab Improves Symptoms Of Depression

Depressive symptoms improved among women with coronary heart disease who participated in a motivationally-enhanced cardiac rehabilitation program exclusively for women, according to research presented at the American Heart Association’s Scientific Sessions 2009.

Depression often co-occurs with heart disease and is found more often in women with heart disease than in men. Depression also interferes with adherence to lifestyle modifications and the willingness to attend rehabilitation.

“Women often don’t have the motivation to attend cardiac rehab particularly if they’re depressed,” said Theresa Beckie, Ph.D., lead investigator and author of the study and professor at the University of South Florida’s College of Nursing in Tampa, Florida.

“Historically women have not been socialized to exercise and their attendance in cardiac rehabilitation programs has been consistently poor over the last several decades. This poor attendance may be partly due to mismatches in stages of readiness for behavior change with the health professional approaching from an action-oriented perspective and the women merely contemplating change — this is destined to evoke resistance.”

Cardiac rehabilitation programs tailored to the needs of women and to their current level of readiness to change may improve adherence to such programs and potentially improve outcomes for women, she said.

The primary goals of the 5-year randomized clinical trial were to compare multiple physiological and psychosocial outcomes of women who participated in a 12-week stage-of-change matched, motivationally enhanced, gender-tailored cardiac rehabilitation program exclusively for women compared to women attending a 12-week traditional cardiac rehabilitation program comprised of education and exercise. Depressive symptoms of 225 women (average age 63) who completed this trial were examined after the interventions as well as after a 6-month follow-up period.

Participants completed the 20-item Center for Epidemiological Studies Depression Scale prior to beginning the intervention, one week after completing the intervention, and again six months later. The questionnaire asked them about how often in the past week they felt depressed, hopeful, lonely, happy and fearful.

Depression scores for the women participating in the traditional cardiac rehab dropped from 16.5 to 14.3 in 12 weeks, while scores in the augmented group dropped from 17.3 to 11.0 — “a significant decline compared to the traditional group,” said Beckie.

After a 6-month follow-up, the traditional rehab group had an average score of 15.2 and those in the women-specific program had an average score of 13. Beckie said “we found that improvements in depressive symptoms were sustained at the 6-month follow-up in the augmented group while those in traditional cardiac rehab were essentially unchanged. This intervention also led to significantly better attendance and completion rates than those in the traditional cardiac rehabilitation program.”

The intervention was guided by the transtheoretical model of behavior change and was delivered with motivational interviewing clinical methods. The motivationally-enhanced intervention began with an assessment of their stage of motivational readiness to change regarding three behaviors: healthy eating, physical activity, and stress management. The investigators then applied appropriate stage-matched strategies to promote the uptake of health behaviors.

“The stage-matched intervention used in conjunction with motivational interviewing applied the patient-centered principles of expressing empathy, rolling with resistance to change, respecting patient autonomy and supporting self-efficacy for change” Beckie said.

“We didn’t push them if they weren’t ready to make the changes,” Beckie said. “We have found that if some patients receive long lists of behaviors they are expected to change immediately — such as quitting smoking, eating healthier, exercising regularly — they are overwhelmed. Pushing such patients who are not ready can lead them to tune out or drop out. Instead, for these women, we acknowledged their ambivalence about change and gave them strategies to move toward being ready by reinforcing their own motivations for changing. It’s unrealistic to expect all patients to change their lifestyle all at once, right now in front of you.”

The woman-centered program is a more individualized approach to rehabilitation.

“You can’t treat everyone the same when it comes to changing health behaviors,” she said. Beckie hopes these results will lead to symptoms of depression being assessed more often in women suffering from heart disease and to more motivationally augmented, women-specific rehabilitation options. The participants may not be completely representative of the national population because they all had health insurance.

Beckie’s co-author is Jason Beckstead, Ph.D. The National Institute of Nursing Research funded the 5-year study.

For more information, visit: www.americanheart.org/.

University Receives NIH Grant To Study Obesity Characteristics Of Hispanic Women

The University of Texas at El Paso’s (UTEP) College of Health Science has received $99,000 from the National Institutes of Health (NIH) to study characteristics of metabolically obese but normal weight Hispanic women.

Assistant Professor of Kinesiology Chantal Vella, Ph.D., is conducting the study on young women who may be predisposed to diabetes, cardiovascular disease and other serious health problems.

On the outside, these Hispanic women appear to be the picture of health—they are young and of normal weight. It’s what is happening inside their bodies that concerns Vella.

“With these kinds of metabolic disorders, studies usually examine obese, older populations,” Vella said. “Nobody has really focused on young women, particularly young Hispanic women, and why many of them are at risk of developing diabetes and cardiovascular disease.”

It’s a critical issue to study because cardiovascular disease is the leading cause of death in women, according to the Centers for Disease Control and Prevention. Among Hispanic women, heart disease accounts for 24 percent of all deaths.

Identifying at-risk women and treating them early, Vella noted, “would have a tremendous impact on quality of life, severity of disease at diagnosis and overall public health.”

Vella’s three-year study, “Characteristics of Metabolically Obese but Normal Weight Hispanic Women,” will add to the body of knowledge being gathered by UTEP’s Hispanic Health Disparities Research Center.

The funds supplement an earlier NIH grant of $333,000.

For more information, visit: http://chs.utep.edu/.

Diabetes Increases Risk For Irregular Heart Rhythm

Diabetes increases by 26 percent the likelihood that women will develop atrial fibrillation (AF), a potentially dangerous irregular heart rhythm that can lead to stroke, heart failure, and chronic fatigue. These are the findings of a new Kaiser Permanente study, published in the October issue of Diabetes Care, a journal of the American Diabetes Association.

While other studies have found that patients with diabetes are more likely to have AF, this large study—involving nearly 35,000 Kaiser Permanente patients over the course of seven years— strove to isolate the effect of diabetes and determine that it is an independent risk factor for women.

“The most important finding from our study is that women with diabetes have an increased risk of developing this abnormal heart rhythm,” said the study’s lead author, Greg Nichols, PhD, investigator at the Kaiser Permanente Center for Health Research in Portland, Ore. “Men with diabetes are also at higher risk, but the association between the two conditions is not as strong. For men, obesity and high blood pressure are bigger risk factors from diabetes.”

“AF is the most common arrhythmia in the world, and diabetes is one of the most common and costly health conditions. Our study points out that there is a connection between these two growing epidemics—one we should pay closer attention to, especially among women,” said Sumeet Chugh, MD, co-author and associate director of the Cedars-Sinai Heart Institute in Los Angeles. “The gender differences need to be looked at more closely because they could have significant implications for how we treat diabetes in men and women.”

AF occurs when the two upper chambers of the heart beat irregularly and too fast, causing blood to pool and clot. If the clot travels out of the heart and becomes lodged in an artery or in the brain, it can cause a stroke.

About 2.2 million Americans are diagnosed with AF; however, many more people have the condition but don’t know it. Diabetes affects more than 23 million Americans—and, according to the study, nearly 4 percent, or 1 million, have atrial fibrillation.

The study involved 17,372 patients in Kaiser Permanente’s diabetes registry in Oregon and Washington and an equal number of non-diabetic patients, matched for age and sex. Researchers used Kaiser Permanente HealthConnect, a civilian electronic health records system, to identify the non-diabetic patients.

The two groups were followed for an average of 7.2 years until Dec., 31, 2008, or until they died or left the health plan. At the start of the study 3.6 percent of the patients with diabetes had AF, vs. only 2.5 percent of the non-diabetic patients—a difference of 44 percent.

During the study period, diabetics were more likely than non-diabetics to develop AF. But after controlling for other factors like obesity, high blood pressure and age, the increased risk was only significant among women. Women with diabetes were 26 percent more likely than their non-diabetic counterparts to develop AF.

Authors include Gregory A. Nichols, PhD, Kaiser Permanente Center for Health Research; Kyndaron Reinier, PhD, and Sumeet Chugh, MD, co-author and associate director of the Cedars-Sinai Heart Institute in Los Angeles.

For more information, visit: https://www.kaiserpermanente.org/

Study: Birth Control Doubles Chance OF Stroke

A 30-year old woman began to experience the classic symptoms of a stroke. What triggered her stroke, at such a young age, may have been the birth control pills she was taking. Oral contraceptives nearly double the risk of stroke, according to a review article in MedLink Neurology by three Loyola University Health System neurologists.

Nearly 100 million women worldwide use birth control pills. Pills now in use contain much lower concentrations of estrogens than older preparations. The relationship between oral contraceptives and stroke has been studied and debated for decades, and studies have yielded conflicting results.

There are about 4.4 ischemic strokes for every 100,000 women of childbearing age. Birth control pills increase the risk 1.9 times, to 8.5 strokes per 100,000 women, according to a well-performed “meta-analysis” cited in the article. (A meta-analysis combines the results of multiple studies.) This is still a small risk; there’s one additional stroke for every 25,000 women who take birth control pills, according to the article.

But for women who take birth control pills and also smoke, have high blood pressure or have a history of migraine headaches, the stroke risk is significantly higher, researchers said.

“When prescribing oral contraceptives, doctors should balance the risks and benefits for each individual patient,” said senior author Dr. Jose Biller. “For a healthy young woman without any other stroke risk factors, the benefits of birth control pills probably outweigh the risks. But if a woman has other stroke risk factors, she should be discouraged from using oral contraceptives.”

The 30-year-old woman was one of two patients described in the article. She had suffered migraine headaches since she was 15 years old, which further increased her stroke risk. Doctors took her off birth control pills and gave her medication for her migraines.

Authors also described a 27-year-old woman who suffered severe right-sided headaches, nausea, vomiting and unsteadiness while on oral contraceptives. She stopped taking birth control pills and was treated with a blood thinner for six months. On a follow up visit, she was doing well except for occasional headaches.

“These observations obviously need to be considered in the proper context of a careful understanding of possible risks and benefits associated with the use of oral contraceptives, as well as those associated with other forms of contraception,” Biller said.

How oral contraceptives might cause strokes is not completely understood, the researchers noted.

But two possible mechanisms are the increased risks of blood clots and high blood pressure associated with oral contraceptives, authors wrote.

Biller is chairman of the Department of Neurology at Loyola University Chicago Stritch School of Medicine. His co-authors are Dr. Michael J. Schneck, a professor in the Departments of Neurology and Neurological Surgery and lead author Dr. Sarkis Morales-Vidal, a stroke fellow in the Department of Neurology.

For more information, visit: http://loyolamedicine.org/ or www.medlink.com.

Implantable Defibrillators May Not Benefit Women With Heart Failure

Implantable cardioverter-defibrillators do not appear to be associated with a reduced risk of death in women with advanced heart failure, according to a meta-analysis of previously published research in Archives of Internal Medicine, one of the JAMA/Archives journals.

Heart failure affects about 5.3 million Americans, almost half of them women, according to background information in the article. Patients with heart failure are 6 to 9 times more likely than the general population to experience sudden cardiac death.

In addition to medication, treatment for heart failure involves preventing sudden cardiac death through the implantation of a cardioverter-defibrillator. This therapy is supported by numerous clinical trials, the authors note. However, questions remain regarding the benefits in certain patient subgroups, including women.

Hamid Ghanbari, M.D., and colleagues at Providence Hospital Heart Institute and Medical Center, Southfield, Mich., searched for randomized clinical trials of implantable defibrillator therapy for heart failure patients published between 1950 and 2008 that included data on the risk of death for female patients. Five eligible trials that included 934 women were identified.

None of the five trials demonstrated a significant benefit of defibrillator implantation over medical therapy for women. When the researchers pooled the data and performed a meta-analysis, the implantable cardioverter-defibrillator was not associated with decreased all-cause mortality in women. Among the 3,810 men in the studies, however, a statistically significant decrease in death rate was found in each of the five trials alone and in the combined meta-analysis.

There are several possible reasons for the sex differences in these results, the authors note. Among patients with heart disease, women have about one-fourth the risk of sudden cardiac death as men. This may be because women have different patterns of arrhythmias and also because they have more co-occurring illnesses that may increase their risk of death from other causes. Therefore, a larger study population may be needed to show any benefit of defibrillator implantation in women.

“Most clinical trials have been heavily weighted toward men; therefore, generalization of the results to women remains questionable. The best answer to this problem would be to perform a clinical trial that specifically targets women with heart failure to test the hypothesis of whether implantable cardioverter-defibrillator implantation reduces their overall mortality [death] rate,” the authors write.

Because clinical guidelines already recommend defibrillator treatment to prevent sudden cardiac death, such a trial may be difficult to propose, they note. “However, on the basis of our findings it seems that a trial targeting women is needed, and a meta-analysis such as ours may be an appropriate first step to explore this hypothesis.”

“Approximately 30 percent of implantable cardioverter-defibrillator recipients are women. However, data supporting the efficacy of implantable cardioverter-defibrillators for primary prevention in women is sparse,” writes Rita F. Redberg, M.D., of University of California, San Francisco, and editor of Archives of Internal Medicine, in an accompanying editorial.

“In other words, implantable cardioverter-defibrillators are being implanted in hundreds of thousands of women without substantial evidence of benefit, apparently based on the assumption that, to paraphrase the old saying, ‘What’s good for the gander is good for the goose,’” she said.

For more information, visit: http://archinte.ama-assn.org/.

Heart Failure: Absence Of Women In Clinical Trials Hinders Development Of Tailored Treatments

Striking differences in the risk factors for developing heart failure (HF) and patient prognosis exist between men and women. Men and women may also respond differently to treatment, raising concerns about whether current practices provide the best care and reinforcing the urgency for sex-specific clinical trials for HF, according to a review article published in the Journal of the American College of Cardiology.

“Current practice is to treat heart failure similarly in men and women,” said Dr. Eileen Hsich, director of the Women’s Heart Failure Clinic at the Cleveland Clinic in Ohio. “Yet, our review of published reports suggests compelling sex differences, not only in terms of how and when heart failure develops, but also possible responses to treatments and how the disease impacts quality of life.”

The data show that HF—a life-threatening condition in which the heart cannot pump enough blood throughout the body—affects women at an older age and often with a stronger heart compared to men.

Hypertension and valvular disease are more likely the culprits for HF in women, whereas men are more likely to have coronary artery disease (CAD) as the underlying cause. And while women live longer with the disease, they also tend to have lower quality of life than men due to greater physical limitations with exercise, more HF-related hospital stays and depression.

“The reasons why survival is better for women remain unclear, but it may be due to differences in the underlying disease,” said Hsich. “Our findings also raise questions as to whether certain diagnostic tests or criteria need to be changed to better reflect how HF presents in female versus male patients.”

For example, “normal” values for brain natriuretic peptide—a biomarker that is being used more frequently to identify patients with symptoms of HF and stratify patients by risk—are higher for women versus men and abnormal values with a BNP > 500 pg/ml may be a stronger predictor of death in women with HF than in men. There is also evidence that sex-specific differences may result when performing a cardiopulmonary stress test, which is often used to evaluate patients for heart transplantation.

Women with HF tend to have a better prognosis for any given peak oxygen consumption value when compared to men, yet the cut-off values to determine need for heart transplantation are the same for both sexes. The potential benefits of certain HF therapies both in terms of reducing morbidity and mortality appear to be different among women.

“We found that some of the available medications may not be as effective in women, while other therapies, for example, beta blockers, aldosterone antagonists and pacemakers, may be very beneficial,” said Hsich, although she cautions that these finding should in no way prompt women to deviate from what their doctor recommends.

“We need to remember that the therapy women are receiving must be working because they are living longer,” she added. “Still, we need to gain a better understanding of HF in women so that we know whether we are providing the best possible care.”

A critical challenge remains enrolling women in clinical trials and inspiring researchers to conduct sex-specific studies.

“This is a disease that affects women just as much as men, yet it remains poorly understood and women are still underrepresented in studies,” said Hsich, adding that major multicenter HF trials in the last decade on average only included 28 percent women. “It is really important for women to speak up and not wait for their doctor to approach them about participating in a clinical trial. In doing so, we can help ensure that future advances in HF treatments are applicable to women and supported by sound research.”

Approximately 2.7 million women have HF, which accounts for 35 percent of the total female cardiovascular mortality.

Hsich and co-author, Dr. Ileana Pina, Case Western Reserve University, performed a systematic review of the literature and also contacted the lead investigators of the major CV trials to request sex-specific data if it was not provided in their original publication.

For more information, visit: www.acc.org.

Cedars-Sinai Opens Women’s Clinic At Heart Center, Targeting Heart Disease And Menopause

Women who are at risk for heart disease and who are also experiencing menopause symptoms now have an added resource – a highly specialized clinic in the Division of Cardiology at the Cedars-Sinai Heart Institute.

The Advanced Preventive Women’s Clinic at the Women’s Heart Center recently opened and is offering comprehensive cardiac risk assessments designed specifically for women who are in menopause. The clinic also offers menopausal patients screenings, as well as personalized medicine therapies and counseling, including high-risk hormone counseling.

“This clinic is designed for women who are at higher risk for heart disease and who are seeking to treat their menopause symptoms while simultaneously taking steps to prevent heart problems,” said Dr. Chrisandra Shufelt, assistant director of the Cedars-Sinai Women’s Heart Center. “Menopause is a time to assess your heart health so that the next chapter of your life can be as productive as your youth.”

Each woman who comes to the clinic completes a comprehensive questionnaire that includes her heart risk factors as well as her own menopause symptoms. This personalized medicine approach enables her doctors to tailor a treatment plan that is uniquely hers – one that is based on her medical history, risk factors and symptoms. Risk factors include a family history of heart disease, elevated blood pressure, obesity, and a woman’s own medical history – such as pre-diabetes, complex blood cholesterol disorders or resistant high blood pressure, said Cedars-Sinai.

“Hormone treatment counseling is important for all women experiencing menopause, but it’s especially important for women who are also at risk for heart disease,” said Shufelt. “Before menopause, a woman’s natural estrogen levels often help maintain a healthy balance between HDL (good cholesterol) and LDL (bad cholesterol) levels. However, during menopause, as a woman’s estrogen levels shift, so, too, do her cholesterol levels, with the bad cholesterol levels typically increasing, which can lead to heart disease.”

The Advanced Preventive Women’s Clinic offers hormone therapy counseling as well as non-hormonal options, said Shufelt. The decision as to which provides the better treatment for each individual is determined by the woman’s own symptoms, risk factors and medical history.

Some women – especially those who have had a prior heart attack, bypass surgery or mini-strokes — may not be appropriate for hormone therapy, but no one needs to suffer with menopause symptoms, Shufelt said. In cases where hormone therapy is not advisable, there are other non-hormonal options and lifestyle modification to consider.

“Hormones can be a confusing area,” said Shufelt. “While there are some compound hormones or mixed hormones available on the market, these are not FDA regulated, and we do not offer them,” she said. Instead, the Clinic offers only FDA-approved synthetic or bio-identical hormones, which are a form of hormone that are made from natural substances such as yams. Bio-identical hormones mimic the body’s own form of estrogen.

Beyond hormone counseling, the Clinic also provides lifestyle recommendations. Avoiding alcohol and caffeine can help reduce hot flashes, said Shufelt. Other tips include layering clothing and choosing fabrics that wick away moisture.
Research is also part of the equation. “There is currently a study underway to evaluate the possible benefits of acupuncture for women who experience hot flashes, and there have also been studies on the benefits of yoga and meditation for women with heart disease,” said Shufelt.

“Many women who have already been on hormone therapy for an extended period of time (more than five years), have questions,” said Shufelt. “We work with them to provide the information they need to be a part of their own treatment planning. Women who are on hormone therapy should be re-evaluated each year to assess their risks and benefits and determine the course of action that is best for them.”

For more information, visit: www.csmc.edu.

Moms Who Breastfeed Are Less Likely To Develop Heart Attacks

The longer women breastfeed, the lower their risk of heart attacks, strokes and cardiovascular disease, reported researchers from the University of Pittsburgh.

“Heart disease is the leading cause of death for women, so it’s vitally important for us to know what we can do to protect ourselves,” said Dr. Eleanor Bimla Schwarz, assistant professor of medicine, epidemiology and obstetrics, gynecology and reproductive sciences at the University of Pittsburgh. “We have known for years that breastfeeding is important for babies’ health; we now know that it is important for mothers’ health as well.”

According to the study, postmenopausal women who breastfed for at least one month had lower rates of diabetes, high blood pressure and high cholesterol, all known to cause heart disease. Women who had breastfed their babies for more than a year were 10 percent less likely to have had a heart attack, stroke, or developed heart disease than women who had never breastfed.

Schwarz and colleagues found that the benefits from breastfeeding were long-term, an average of 35 years had passed since women enrolled in the study had last breastfed an infant.

“The longer a mother nurses her baby, the better for both of them,” Schwarz pointed out. “Our study provides another good reason for workplace policies to encourage women to breastfeed their infants.”

The findings are based on 139,681 postmenopausal women enrolled in the Women’s Health Initiative study of chronic disease, initiated in 1994.

The research was funded by grants from the National Institutes of Health’s National Heart, Lung, and Blood Institute and the National Institute of Child Health and Development.

The study was published in the journal Obstetrics and Gynecology. For more information, please visit: www.health.pitt.edu.

Research Finds Link Between Depression And Cardiac Events

New published research suggests that relatively healthy women with severe depression are at increased risk of cardiac events, including sudden cardiac death (SCD) and fatal coronary heart disease (CHD).

Researchers found that much of the relationship between depressive symptoms and cardiac events was mediated by cardiovascular disease risk factors, such as high blood pressure, high cholesterol and smoking.

“It’s important for women with depression to be aware of the possible association between depression and heart disease, and work with their health care providers to manage their risk for coronary heart disease,” said Dr. William Whang, Division of Cardiology, Columbia University Medical Center, and lead investigator of the study.

“A significant part of the heightened risk for cardiac events seems to be explained by the fact that coronary heart disease risk factors such as high blood pressure, diabetes, elevated cholesterol, and smoking were more common among women with more severe depressive symptoms,” he said.

Whang and his colleagues prospectively studied 63,469 women from the Nurses Health Study who had no evidence of prior heart disease or stroke during follow-up between 1992 and 2004. Self-reported symptoms of depression and use of antidepressant medication were used as measures of depression. To best identify those with clinical depression, researchers specifically examined women with the most severe symptoms defined by a validated 5-point mental health index score of less than 53 or regular antidepressant use.

The study found that women with more severe depressive symptoms or those who reported taking antidepressants were at higher risk for SCD and fatal CHD. In particular, women with clinical depression were more than twice as likely to experience sudden cardiac death. Surprisingly, this risk was associated more strongly with antidepressant use than with depressive symptoms.

“These data indicate the link between depression and serious heart rhythm problems may be more complex than previously thought,” said Dr. Sanjiv M. Narayan, University of California, San Diego, who co-authored the accompanying editorial with colleague, Dr. Murray Stein. “It raises the question of whether this association may have something to do with the antidepressant drugs used to treat depression.”

Both Whang and Narayan stress that although the relationship between antidepressant medicines and SCD merits further investigation to determine whether antidepressant medications directly increase the risk for heart rhythm disorders, at present the benefits of appropriately prescribed antidepressants outweigh the risk of sudden cardiac death. There was no relationship between antidepressant use and fatal CHD or nonfatal heart attack.

“We can’t say antidepressant medications were the cause of higher risk of sudden cardiac death. It may well be that use of antidepressants is a marker for worse depression,” added Whang. “Our data raise more questions about the mechanisms by which depression is associated with arrhythmia and cardiac death.”

Plausible explanations for the link between depression and SCD may include autonomic dysfunction, higher resting heart rates and reduced heart rate variability, according to Whang. Researchers also found an association with nonfatal MI, but this became borderline non-significant when adjusted for multiple other CHD risk factors.

Still, these study findings reinforce the need for patients with depression to be monitored closely for risk factors for coronary heart disease, since management of these risk factors can reduce the risk for mortality from coronary heart disease and sudden cardiac death, researchers said.

The research was published in the Journal of the American College of Cardiology. For more information, please visit: www.acc.org.

Women More Likely Than Men To Die In Hospital From Severe Heart Attack

Men and women have about the same adjusted in-hospital death rate for heart attack — but women are more likely to die if hospitalized for a more severe type of heart attack, according to a report published in the Journal of the American Heart Association.

Among patients with ST elevation myocardial infarction (STEMI) in a recent study, the death rate was 10.2 percent for women compared to 5.5 percent for men. Researchers said the women were older and had higher overall baseline risk profiles than men. After adjustment for these and other differences, women with STEMI had a 12 percent higher relative risk for in-hospital death compared to men.

The study also found that some recommended treatments are delayed and underused in women.

Researchers 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 myocardial infarction admitted to 420 hospitals between 2001 and 2006.

“The finding that bears the most emphasis is that among both men and women presenting to Get With The Guidelines participating hospitals, there were no clinically meaningful differences in in-hospital survival after heart attack, once we factored in differences, such as age and other existing illnesses,” said Dr. Hani Jneid, lead author of the study and assistant professor of Cardiovascular Medicine at Baylor College of Medicine in Houston, Texas.

A decade ago, women had an overall higher death rate after heart attack compared with men. This suggests that these 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 (STEMI) 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 (to restore blood flow);
• 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, researchers found that women admitted with a STEMI were about twice as likely to die in the first 24 hours of hospitalization as men.

“Although STEMI is not as common among women as it is among men, it is a concern that there is still this gap in mortality between men and women after the more severe heart attack,” said Dr. Laura Wexler, co-author of the study and senior associate dean at the University of Cincinnati College of Medicine.

Get With The Guidelines helps improve physicians’ awareness of proven post-heart attack therapies, said Dr. Gregg C. Fonarow, chairman of the Get With The Guidelines steering committee.

“As part of this effort, the American Heart Association has been collecting data from a large number of hospitals about the treatments and outcomes of therapy for heart attack victims,” said Fonarow, a professor of cardiovascular medicine at UCLA. Thus, GWTG “has not only helped improve care but also created a powerful research tool,” Fonarow said.

For more information, visit www.americanheart.org/getwiththeguidelines. In addition, the association’s Go Red For Women program offers valuable tools to help women learn healthy lifestyles to decrease their risk of STEMI at www.GoRedForWomen.org.

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