The CDC reports that one person dies from cardiovascular disease in the United States every 36 seconds! With women accounting for greater than half the population, you would think they would get the same quality care as men. Unfortunately, that’s not always true.

The Gender Gap in Medicine

American women have worse health than women in other developed countries.

Diagnosis Life summary:
Not only is the U.S. healthcare system one of the most expensive in the world, it is also one of the least effective when it comes to women’s health. Research from the Commonwealth Fund compared metrics across 11 industrialized countries, the United States included. American women have more chronic conditions, higher maternal mortality, higher medical bills, and less access to quality care. What do those other countries have that we don’t have? Universal health care.

Women are at greater risk for complications after a heart attack.

Diagnosis Life summary:
No one wants to have a heart attack but women may be at greatest risk for complications. A study in Circulation (https://doi.org/10.1161/CIRCULATIONAHA.120.048015) looked at first-time heart attacks in more than 45,000 men and women. Women were nearly twice as likely to die from their heart attack while they were still in the hospital (9.4% vs. 4.5% for ST elevation myocardial infarctions). Women were also more likely to develop heart failure within 5 years of their heart attack (22.5 – 23.2% vs. 14.9 – 15.7% depending on the type of myocardial infarction they had).

This could be because women in the study were more likely to have their first heart attack later in life (i.e., they were on average 10 years older than the men). Being older, they are more likely to have other pre-existing conditions that could interfere with their recovery. The difference in care the women when cmpared to the men received stands out. Women saw a cardiac specialist less often, did not receive certain medications, and did not undergo cardiac procedures like angioplasty as often. There is a gender gap in medicine and it needs to close.

Women are less likely to get CPR than men.

Diagnosis Life summary:
The American Heart Association reported a disturbing finding. After reviewing 20,000 cases of cardiac arrest across the United States, researchers found that only 39% of women in a public place received CPR as compared to 45% of men. Not surprising, men were 23% more likely to survive. Interestingly, women received CPR as often as men when it was in their own home. Are social norms and fears of inappropriately touching a woman preventing people from performing CPR in a public setting? This is life or death, and every state has a Good Samaritan law. Please, do the right thing.

Women are less likely to survive cardiac arrest even after they are resuscitated.

Diagnosis Life summary:
A study in Circulation (https://doi.org/10.1161/CIRCULATIONAHA.120.050427) looked at the survival of 4,875 people successfully resuscitated from cardiac arrest (37% women). Notably, these women were less likely to have received bystander CPR (49.1% vs. 54.9%). After women left the hospital, they were less likely to survive than their male counterparts (22.5% vs. 36.3%). The researchers noted no difference in mortality rates by gender when the subset of patients with DNR orders were assessed. However, when DNR orders were taken out of the equation, the women’s survival decreased even further (31.3% vs. 49.9%). This raises interesting questions. If survival with DNR orders is the same (i.e., less aggressive treatment) but survival without those orders is so drastically different (i.e., all treatments are on the table), are women receiving less care than men?

Women who get heart disease earlier in life are less likely to get the same preventive care as their male counterparts.

Diagnosis Life summary:
A study in JAMA Cardiology (https://doi.org/10.1001/jamacardio.2021.0683) looked at gender disparities in veterans who had atherosclerotic cardiovascular disease early in life. The researchers included 10,413 women and 137,187 men with premature disease (age 55 or younger) and 1,340 women and 8,145 men with extremely premature disease (age 40 or younger). Overall, the women were treated less intensively than men and were less likely to be prescribed anti-platelet therapy or statins. These medications are a standard of care meant to decrease cardiac events (e.g., heart attacks, heart failure, stroke, death) in people with known disease. What especially stands out are the racial differences in the groups. There were considerably higher rates of Black women (36%) than Black men (23%) with more white people in the men’s group (68% vs. 55%). Let’s hope race was not a factor in deciding who gets treated.

Younger women face higher mortality from heart attacks than men.

Diagnosis Life summary:
Our healthcare system does not treat women and men equally when it comes to heart attacks. Women younger than 65, in particular, pay the price. A study in Mayo Clinic Proceedings (https://doi.org/10.1016/j.mayocp.2020.04.048) looked at sex disparities between more than 6.7 million hospitalizations for myocardial infarction. The patients were divided into three age groups: < 45 years old, 45-64 years old, 65-84 years old, and > 85 years old. Overall, women had fewer heart attacks across all ages but their mortality was higher than men in the two lower age brackets. Regardless of age, women underwent fewer invasive procedures like coronary angiography, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) than their male counterparts. Why were they not offered the same level of care? How many lives could have been saved?