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Women’s Heart Health: Not All About Treatment

Renee Despres
Friday, June 15, 2012 - 20:29

Women don’t fare as well as men in most U.S. hospitals, according to a new report from HealthGrades, an independent health-care ratings organization. For the report, The Seventh Annual HealthGrades Women’s Health in American Hospitals Study, HealthGrades researchers used Medicare inpatient data from the MedPAR database (purchased from the Centers for Medicare and Medicaid Services) to examine death rates from 16 procedures and diagnoses. Data were from fiscal years 2006 through 2008.

The researchers found striking differences in mortality between women and men, especially for cardiovascular procedures. Compared to men, women were at greater risk of dying during or after three cardiovascular procedures: valve-replacement surgery (52.8% higher risk), coronary bypass surgery (36.6%), and coronary interventional procedures (19.5%). Women also had a 5.8% higher risk of dying after a stroke. However, women had a better chance of surviving hospitalization than men for the following procedures and treatments: chronic obstructive pulmonary disease (16.4% lower risk), heart failure (12.8%), pneumonia (10.6%), and heart attack (2.4%).

Disparities existed not only between women’s and men’s outcomes, but between hospitals. Compared to poor-performing hospitals, best-performing hospitals had an 40.51% fewer deaths and 19.05% fewer inhospital complications. If all eligible hospitals performed at the level of the best-ranked hospitals, an additional 16,863 women could have potentially survived their hospitalizations, and 4,735 women could have potentially avoided major inhospital complications in the Medicare population from 2006 through 2008. Of the 16,863 potentially preventable deaths, 80.7% were associated with just four diagnoses: pneumonia, heart failure, stroke, and heart attack.

Those numbers are striking, and they do point to huge disparities in the level and quality of health care offered in U.S. hospitals. But they show more than that. They show an underlying gender bias in research, treatment, prevention, and awareness of cardiovascular disease.

Not until the late 1990s did researchers start to pay attention to heart disease as a major killer of women. I remember preaching in my CPR classes that “the most likely person to perform CPR is a 60-plus-year-old woman, and she’s most likely to be performing CPR on her husband.” Most research studies focused on prevention strategies for men, calling on the women in their lives to help them implement them (cook more healthy meals for hubby, etc.). The American Heart Association didn’t start its Go Red for Women campaign until 2004, well after it had been established that heart disease is the number one killer of women in developed countries.

Awareness of the impact of heart disease and stroke on women still lags. In 2007, a research team led by Allison H. Christian, Ed.D. at the New York-Presbyterian Hospital and Division of Cardiology, Columbia University Medical Center in New York found that while women were more aware of heart and blood vessel disease (CVD) in 2006 than they had been in 1997, almost half (43 percent) did not know that CVD is the number one killer of women. Awareness was notably lower among racial/ethnic minorities, especially black and Hispanic women. More than half of all women were confused about basic prevention strategies for CVD — things like what kinds of and how much exercise to get, what sorts of dietary patterns can reduce risk, and what are normal blood pressure and blood lipid levels.

So I wonder about the results of the HealthGrades study. Is the difference in outcomes all attributable to quality of care? Yes, there is a quality-of-care component, and that’s clearly demonstrated by the differences in outcomes between hospitals. But women may simply be more sick than men are by the time that they’re diagnosed with heart disease. Plus, a comparative paucity of research on CVD in women may mean that some of the procedures, medications, and other treatments that have been shown to be effective in men may not work in the same way for women, with their generally smaller body size, differences in metabolism and countless other things we haven’t even identified.

So… should women go to a highly ranked hospital? You bet. But even more, women need to know that they are also at risk of CVD, not just men, and they need the information to prevent it. We need more large-scale studies that examine the effectiveness of prevention and treatment in women.

That’s a lot more than just grading a hospital.