Sex and age could influence treatment for heart attack sufferers

November 14, 2000

Sex differences in risk factors, treatment, and mortality after acute myocardial infarction: an observational study

Women heart attack victims are likely to be given a poorer deal than their male counterparts, shows research in the Journal of Epidemiology and Community Health. Some of this may be down to sexism, but most could be attributable to ageism, indicates the research. Because women heart attack sufferers tend to be older, and older people are not as aggressively treated as younger people.

The research team looked at over 2000 heart attack admissions to Yorkshire hospitals over a period of three months in 1995.

Women heart attack sufferers were older than their male counterparts, but were less likely to be smokers or have underlying coronary artery disease, factors known to increase the risk of a poorer prognosis. But they were almost 80 per cent more likely to die before discharge, a difference that persisted even when age, other risk factors and other diseases were taken into account.

Women were also significantly less likely than men to be given clot busting or blood thinning drugs, or be scheduled for further testing and treatment, a difference that was attributable to their older age, say the authors. And while significantly more women were dead two years after discharge from hospital, not all of this can be put down to their older age, they add.

"It is not clear whether under-treating in the elderly results from implicit rationing decisions, prejudice, or ignorance of the evidence base for treatment in this group. On the basis of ethics and clinical knowledge, age should not be used as a determining factor in treatment decisions, yet this continues to be the case," conclude the authors.

Dr Barbara Hanratty, Department of Public Health, University of Liverpool

Dr Mike Robinson, Nuffield Institute for Health, University of Leeds

BMJ Specialty Journals

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