Critical Consumer Pat Sidley
“AN equal opportunity killer needs equal opportunity management,” says consultant cardiologist Graham Jackson in an editorial in the British Medical Journal (BMJ).
He was not talking about South Africa’s employment problems but about the fact that women get less — and inferior — treatment for heart disease.
In a particularly damning study which appeared in a recent edition of the BMJ, the authors conclude that women are less likely to survive a heart attack either in hospital or after they are discharged because they do not have the same opportunities for appropriate treatment as men.
Another paper in the same edition of the BMJ concludes that after a heart attack women have a worse prognosis than men. While suggesting that age may have something to do with this, the warning about gender bias is clear.
“The tendency for women to receive less vigorous treatment than men must be remedied before gender can be considered to be an independent determinant of risk.” Or put more simply: women must first receive the same treatment as men and only then will it be possible to work out if gender differences affect the course of heart disease and make it more difficult to treat.
It’s a damning indictment of a profession which is male dominated and male oriented.
South Africa is a country in which there is a great deal of heart disease (clustered in certain groups). The Heart Foundation says the figures grow all the time.
For a while now research has indicated that not enough is known about women and heart disease. For instance, most of the treatments, including drugs for various aspects of heart disease, are tested on men and not women, with results simply being extrapolated or guessed at.
This critical consumer has a colleague who has suffered from this ignorance and has been prescribed a cholesterol-lowering drug which may have compromised her ability to have children.
Little or no specific research has been done on women and heart disease in South Africa but, according to the BMJ, in many countries — including the United Kingdom and United States — coronary heart disease is the biggest killer of women.
In women, heart disease relates directly to age. There is a sudden increase after menopause so that when women and men are 65 years old the incidence of heart disease is the same. In countries where there are more, and older, women than men, the proportion increases. In the United States “cardiovascular disease now kills proportionately more women than men”, according to the BMJ.
But women who have not yet reached menopause should not be lulled into thinking they are safe for a few years. The BMJ says a quarter of heart-related deaths in women younger than 65 occur in the under 45-year age group.
One of the problems confronting doctors and cardiologists is the symptoms of heart disease are different in men and women. Thus women will often be misdiagnosed. For example, exercising on stairs — usually a good test for heart problems in men — is not that efficient in testing younger women, says the BMJ.
The one published study done on 823 patients shows that even when other factors like other diseases and age are adjusted for, women fare worse than men after they have had a heart attack. It was after this study that its authors suggested that women should receive the same treatment as men before gender can be assessed as an independant risk.
The other study looked at whether women and men received the same treatment after a heart attack. The study is truly alarming. The authors received their information from a heart attack register in a large district in the UK. Among the variables they looked at were age, the way the patient got to hospital (whether a doctor or an ambulance was called), the time it took to arrive in the hospital after the symptoms started, what type of ward the patient was admitted to, what type of treatment and diagnosis was used, what temporary emergency procedures may have been used, and what treatment the patient received after being discharged.
Among the findings was the fact that more women called their doctors while men tended to call ambulances. This delayed admission to hospital. “Men were significantly more likely to arrive in hospital sooner after the onset of symptoms than women,” according to the study.
More men (56 percent) than women (41 percent) were admitted to wards which specialised in heart problems. Here age affected the admission. Younger patients were more likely to be admitted to coronary care wards than older ones (because it is apparently not worth spending the time, money and effort on trying to save the life of a 90-year-old). Even then, women fared worse than men. This tended to affect other procedures; treatment to break up a blood clot (in this particular district of the UK) is only given in the coronary care wards. Thus fewer men than women received that treatment.
“Because women are more likely to be admitted to (a non- coronary care) ward, they are automatically discriminated against by not being allowed appropriate treatment,” the authors say.
And finally, once a woman has survived her ordeal she will more often than men be discharged without being given the drugs men receive.
South African women have even more to be alarmed about. Normally reliable sources say most cardiologists (who are almost all male) simply deny this can be the case. The Heart Foundation says some women have told them of their frustrations but they say there is no research on the issue at all in this country. They believe however that the patterns are likely to be the same. One South African is involved in this type of research — in Washington where the National Heart , Lung and Blood Institute is currently chaired by a woman.
Jackson calls for equal treatment of men and women: “Women are different — but not that different. Although women with coronary artery disease may be more difficult to diagnose and manage than men it is a challenge that we and they must rise to.”