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Sex Discrimination in the Intensive Care Unit

Fewer women admitted than men when suffering heart attacks

MONDAY, June 17, 2002 (HealthDayNews) -- Admission to intensive care units in hospitals should be based solely on medical need, but a new study finds that's not always the case.

In the current issue of the Journal of Epidemiology and Community Health, English researchers report that men were more likely to be admitted to intensive care units when suffering heart attacks or bleeding in the brain than women, and they were less likely to die while in the hospital receiving treatment for those conditions.

"We found gender differences in admission to ICU [that] cannot be explained by disease severity," says study author Dr. Rosalind Raine, a Medical Research Council clinician scientist at the London School of Hygiene and Tropical Medicine. However, she cautions, "The reasons for these differences should not be hastily assumed."

Sherry Marts, scientific director for the Society for Women's Health Research, believes the study's findings probably reflect an unconscious bias on the part of doctors. That bias "is compounded by the fact that many women -- and even some men -- don't get 'Hollywood' heart attacks." By that, she means they don't collapse on the sidewalk, clutching their chests.

Also, she points out that many people and some physicians don't believe that young women can have heart attacks, and she says the perception that only men have heart attacks still persists.

Long assumed to be a man's disease, heart disease actually kills almost 70,000 more women than men annually in the United States, according to the American Heart Association. Cardiovascular disease is the leading cause of death in women, outpacing all cancer deaths by a margin of almost two to one. Twenty percent of all women have some form of cardiovascular disease, reports the heart association.

For this study, Raine and her colleagues studied more than 45,000 hospital admission records from 91 hospitals in England, Wales and Northern Ireland from a three-year period. They looked at 10 different conditions: heart attacks, heart arrhythmia, ventricular failure, neurological bleeding, brain injury, asthma, pneumonia, chronic obstructive airway disease, self-poisoning and seizures. Each case was given an APACHE (Acute Physiology and Chronic Health Evaluation) score to provide an objective way to measure the severity of each patient's condition.

For most conditions, the researchers found no inequities between genders. However, they did find that female heart attack patients and those with neurological bleeding were less likely to receive treatment in the intensive care unit, and they were more likely than men to die in the hospital.

Male heart attack patients in the study who were admitted to intensive care units tended to be younger and in better health with no significant previous medical history, compared to their female counterparts, the study found.

Raine believes physicians were applying more stringent admission criteria for women, and the higher death rates for women suggest they were not receiving the care they needed.

However, the gender bias didn't only swing in one direction. Male patients with pneumonia and ventricular failure were more likely to die from these conditions than women were.

Dr. Dan Fisher, a cardiologist with New York University Medical Center, says, "this is a very complicated issue." While he believes there isn't deliberate discrimination occurring, he says both doctors and patients need to raise their awareness of the signs and symptoms of heart disease in women.

"Women are more difficult to diagnose because they present with atypical symptoms," he explains, though the medical community is learning more and more that "what's typical for a woman is atypical," he adds.

Women are much more likely to report nausea, sweating and just generally "not feeling right" when they're having a heart attack, Fisher says. Women, especially those with risk factors like diabetes, high cholesterol or high blood pressure, should learn the symptoms of heart disease and not hesitate to get treatment immediately if these symptoms occur.

Mart adds, "It's sometimes difficult to second-guess physicians, but you need to be assertive in getting the care you need."

What To Do

For more information on heart attack symptoms, visit the American Heart Association. To read more about the differences in heart attack treatment between the sexes, go to Well Aware or the National Coalition for Women with Heart Disease.

SOURCES: Rosalind Raine, M.D., Medical Research Council clinician scientist, London School of Hygiene and Tropical Medicine, United Kingdom; Sherry Marts, Ph.D., scientific director, Society for Women's Health Research, Washington D.C.; Dan Fisher, M.D., cardiologist, New York University Medical Center, and clinical assistant professor, medicine, New York University School of Medicine, New York City; June 2002 Journal of Epidemiology and Community Health
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