Women Benefiting Less From Improved Heart Disease Care

Cardiovascular death rate falling faster for men, study shows

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By Ed Edelson
HealthDay Reporter

TUESDAY, May 9, 2006 (HealthDay News) -- U.S. deaths from heart disease have dropped by half over the last quarter-century, but not everyone is benefiting equally, a new study shows.

A new Mayo Clinic study finds men doing better than women and people in hospitals doing better than those who are treated at home, according to a study of one Minnesota county.

"The main message is that the face of cardiovascular death is changing," said Dr. Veronique Roger, a professor of medicine and epidemiology at the Mayo Clinic College of Medicine in Rochester, Minn. "There is a shift from inpatient location to out-of-hospital deaths, and the overall decline hasn't been experienced in the same way by women as by men."

Her team reported the results in the May 9 issue of Circulation.

The results come from analysis of the 6,378 cardiovascular deaths that occurred in Olmsted County -- where the Mayo Clinic is situated -- between 1979 and 2003.

The analysis showed that while the death rate for men fell by 3.3 percent annually, the annual decrease for women dropped by only 2.5 percent per year.

The Mayo Clinic findings are echoed by new data released Tuesday by the Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services.

Its nationwide analysis found that just over one in 10 men and women have been diagnosed with some sort of cardiovascular condition -- that's 12.9 million women and 11.7 million men over the age of 18. Around a third of women age 65 or older have a heart condition, the AHRQ report.

Women account for nearly half (48.3 percent) of the more than 6 million hospital stays attributed to heart disease each year in the U.S., the AHRQ noted. But their mortality from heart attack remains one-third higher than that of men: 9.3 percent of female patients die in hospitals of heart attack vs. 6.2 percent of male patients.

As an epidemiologist, Roger said she had "no direct explanation for the data." It might reflect a lowered awareness among women about cardiovascular disease, Roger said, something that the American Heart Association has been trying to change with a program called "Go Red for Women." The study doesn't capture the possible influence of that effort because it was done in the years before the program began, Roger said.

The difference in in-hospital and out-of-hospital death rates can be partially explained by "the enormous advances in the care of patients with heart attacks, [and] very effective treatments to improve outcome" once people are hospitalized, she said.

There have been fewer advances in emergency treatment for out-of-hospital events, such as the use of defibrillators to start hearts beating again, Roger said.

Dr. Gerald Fletcher, a preventive cardiologist at the Mayo Clinic's Florida branch in Jacksonville, agreed that the smaller rate of decline for out-of-hospital deaths has several possible explanations.

One reason is that "we are not doing enough in the field," said Fletcher, who is also a spokesman for the American Heart Association. "We need more portable defibrillators in public places and more people trained in the use of those devices."

Another explanation is that too many people are not aware of the warning signs of a heart attack, so they don't get to the hospital in time. But the realities of health care costs might also have something to do with the issue, Fletcher said.

Patients are being discharged from hospitals quicker these days, to keep costs down, he said. "They're out of the hospital when something happens," and that could make a life or death difference, the AHA expert said.

Some other findings of the study are less controversial. For example, the decline in death rates was dependent on age. The annual rate of decline was 3.9 percent for people under 75, 3.4 percent for ages 75 to 84, and 1.5 percent for those 85 and older.

And there was a shift in the kind of conditions causing death. Fewer people are dying of coronary conditions such as heart attacks and more are dying of other cardiovascular conditions such as high blood pressure and stroke.

The purpose of the study was not to determine why such changes are occurring but to show the changes in detail, Roger said.

"The purpose was to raise questions for the next study to answer," she said.

More information

There's more on the "Go Red for Women" campaign at the American Heart Association.

SOURCES: Veronique Roger, M.D., professor, medicine and epidemiology, Mayo Clinic College of Medicine, Rochester, Minn; Gerald Fletcher, M.D, preventive cardiologist, Mayo Clinic, Jacksonville, Fla; May 9, 2006, statement, U.S. Agency for Healthcare Research and Quality; May 9, 2006, Circulation

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