Snapshot Of Global Cardiac Care: Women In Latin America And Eastern Europe Don't Fare As Well

November 10, 1998

DALLAS -- Women in Latin America and, to a lesser extent, those in Eastern Europe receive aggressive treatments for potential heart attacks less frequently than men, and when they do receive this care, it tends to be administered later. In these regions, the incidence of death from heart disease is higher in women.

But in the more industrialized areas of the world, like North America and Western Europe, women and men receive practically the same treatment and have similar outcomes.

These are the findings gleaned from a new analysis of data collected during the recent international heart trial known as PURSUIT. The 27-nation trial tested the effectiveness of the drug eptifibatide in more than 10,000 patients coming into emergency rooms with symptoms of a heart attack.

In the process of gathering data about the drug, researchers also collected information on whether or not patients received aggressive diagnostic or treatment procedures such as cardiac catheterizations, angioplasties or coronary artery bypass procedures, and how well they did.

"These data give us a snapshot of the state of heart care," said Lisa Berdan, researcher at the Duke Clinical Research Institute (DCRI) and lead author of the current study. "The disparity in the treatment of women may not be solely a resource issue, but may involve cultural factors as well."

Berdan prepared the results of the DCRI study for presentation Tuesday (Nov. 10) at the 71st scientific sessions of the American Heart Association meeting.

Of the 10,948 patients enrolled in PURSUIT, 35.2 percent were women, and they were older (66 vs. 62) and had higher rates of hypertension and diabetes than men. Patients were grouped in four regions: North America, Latin America, Western Europe and Eastern Europe.

"Previous international trials have shown that compared with men, women who present with acute coronary syndromes (symptoms that may lead to a heart attack) tend to be older, have more concurrent medical problems, and have more risk factors for heart disease," Berdan said. "This explains why women are worse off when they arrive at hospital, but it doesn't explain the differences in treatment. In North America and Western Europe, for example, women seemed to do as well as men after aggressive treatment."

When the researchers then looked at when women received these aggressive diagnostic and treatment procedures, they found that in Latin America and Eastern Europe these procedures were performed later.

In Latin America, women waited an average of 4.9 days before receiving a catheterization; men waited 4.2 days. In Eastern Europe, women waited 13.2 days, men waited 11 days. As a comparison, North American men and women wait an average 1.1 days.

"In Latin America and Eastern Europe, women reported more episodes of chest pain, but they received fewer cardiac catheterizations," Berdan said. "Why they underwent fewer catheterizations despite more episodes of chest pain is the million-dollar question. If you treat patients less aggressively and later in the process, they may be more likely to suffer a heart attack or die."

In Latin America, the incidence of death among women was 16.7 percent, while for males, it was 12.7 percent. In Eastern Europe, the rate was 10.4 percent for women, and 7.8 percent for men. As a comparison, in North America, the incidence for women was 5.8 percent and for men, 6.9 percent.

For cultural reasons, because women tend to stay home and perform more domestic duties, they are less likely to seek medical care than men, Berdan said.

"When we talked to doctors in Latin America and Eastern Europe, they couldn't explain the differences in treatment," she continued. "They could only say that women were sicker when they came in, but that doesn't explain the differences in treatment. It is a difficult question to answer."

Berdan cautioned that some of the differences noted in Latin America and Eastern Europe may be due to a different approach to large clinical trials in these regions. Since these regions have many heart patients and haven't been involved in trials, this population is ripe for future study, Berdan said.

Also involved in the study were, from the DCRI, Beth Weatherly and Dr. Robert Harrington; Dr. Petr Widimsky, University Hospital, Praha, Czech Republic; Judith Fulks, COR Therapeutics; and Dr. Judith Hochman, St. Lukes-Roosevelt Hospital Center, N.Y.

Duke University Medical Center

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