Women get less aggressive heart care Men found to receive more tests, surgery


Two major studies involving thousands of patients across the nation show that women with heart disease are treated less aggressively than are men, prompting calls for doctors to re-examine the way they regard their female patients.

In both studies, women with heart disease were less likely to get bypass surgery or certain tests to diagnose the source of their problems.

The researchers said the findings do not necessarily mean women get inferior medical treatment but do indicate that doctors at least appear to take their symptoms less seriously.

The findings, reported in today's New England Journal of Medicine, prompted Dr. Bernadine Healy, director of the National Institutes of Health, to call for "a general awakening" to women's health problems.

"The problem is to convince both the lay and the medical sectors that coronary heart disease is also a woman's disease, not just a man's disease in disguise," Dr. Healy said in an editorial that accompanies the articles in the journal. "Neither women nor their physicians fully recognize that [heart attack] is the leading cause of death among women in the United States."

In one study, researchers at 45 medical centers, including University Medical Center in Baltimore, surveyed 2,231 patients who were hospitalized after suffering heart attacks. Looking at the patients' histories, they found that the female patients were just as likely to have suffered chest pains before their attacks but were only half as likely to have had bypass surgery or cardiac catheterization.

Catheterization is a test in which a fine tube is threaded into the heart to diagnose the condition of the arteries, valves and muscle. In a bypass operation, surgeons route the patient's blood flow around a blockage in the heart to restore proper blood flow through the organ.

"We can't say that men are receiving better treatment than women," Dr. Stephen S. Gottlieb, director of the cardiac-care unit at University Medical Center. "You can say that physicians are treating men and women differently."

The study found that 27.3 percent of the men and 15.4 percent of the women were given catheterization tests.

A similar gap was found for bypass surgery: 12.7 percent of the men underwent the operation vs. 5.9 percent of the women.

Dr. Gottlieb said there were several possible reasons for the differences.

"One point is it's been reported that women don't do as well with bypass surgery as men," he said. "That's probably true, but the ** reason is that women sent to bypass surgery tend to be sicker than the men sent to bypass surgery."

Another possible reason, he said, is the widespread belief that heart disease is less common among women than among men.

Doctors make that generalization, he said, because heart disease is less common among young women than among young men. But the disease is equally common among older men and women, and women who have heart attacks are more likely to die from them.

In the study, the average age of the women was 62, three years older than the men.

In the other study, doctors at the Brigham and Women's Hospital Boston found that women hospitalized with heart disease in Massachusetts and Maryland undergo fewer tests and therapeutic procedures than do men. The doctors examined records of 82,700 patients who were discharged from hospitals in the two states after being admitted with symptoms of heart disease.

In Maryland, men were 15 percent more likely than women to have an angiogram, a test that gives X-ray images of blockages and weaknesses. And men also were 27 percent more likely to have a bypass operation or angioplasty, in which a tube is pushed through an artery to clear obstructions to blood flow.

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