Women at heart: stop the bias

September 05, 2005

STOCKHOLM, Sweden (ESC Congress 2005) -- Advances in diagnosis and treatment have resulted in a decrease of mortality among men, but not among women. A number of studies have reported gender differences in diagnosis and treatment of patients with cardiovascular diseases, as well as concerns about different responses to some therapies among male and female subgroups. Yet, clinical guidelines do not discriminate between men and women.

Using data from the Euro Heart Survey programme (heart failure, acute coronary syndromes, coronary revascularization, and stable angina), we examined gender differences in clinical characteristics, diagnosis, treatment and outcome.

Overall, women were older (5-8 years) and more often had diabetes and hypertension. Fewer women had a history of coronary artery disease (CAD), and when admitted with a (suspected) diagnosis of heart failure, were less likely to have left ventricular systolic dysfunction (LVSD) (21 % vs. 45%). Regarding diagnostic procedures, major gender differences were observed with respect to imaging techniques (41% vs. 58%) in patients with heart failure and coronary angiography (47% vs. 60%) in patients with an coronary heart disease. There were considerable gender differences regarding treatment according to guidelines in a subgroup of patients with documented LVSD. Drugs with a documented impact on survival were given less frequently to these women. Similarly, women admitted with an acute myocardial infarction were less likely treated with reperfusion therapy as compared to men (60% vs. 69%). But, no gender differences were observed with respect to the application of thrombolysis or primary PCI in those who received reperfusion therapy.

In addition to this, after a confirmation of CAD by diagnostic coronary angiography, no gender differences were observed with respect to revascularisation. The treatment at discharge, aiming at reducing coronary morbidity and mortality did not differ between men and women with established CAD.

An important observation was the under-use of diagnostic tests in women, as this might partly explain the gender differences with respect to the management of cardiovascular diseases; however, in a sub-group of heart failure patients with confirmed LVSD women were treated less likely according the guidelines than men. In patients undergoing coronary angiography, however, no gender differences have been observed regarding coronary revascularisation in those with significant CAD.

European Society of Cardiology

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