New research shows discrepancies in quality of care, mortality among women and men who suffer heart attacks

The analysis included more than 30,000 patients enrolled in the American Heart Association's "Get With the Guidelines-Coronary Artery Disease" (GWTG-CAD) registry and shows the need for more education among physicians who treat patients with signs of a heart attack.

"These findings are significant because they show specific areas for improvement in the treatment of patients at risk for heart attacks and the exact patient populations that may receive lower quality of care," said lead author Sripal Bangalore, MD, assistant professor in the Department of Medicine, the Leon H. Charney Division of Cardiology. "In younger people and specifically young women, symptoms of heart attacks are often overlooked or attributed to other causes. This can have dire consequences because if these patients aren't treated immediately, they are at risk for complications and even death."

The study was designed to determine if the quality of care and in-hospital outcomes differed in older and younger patients (under 45 years) who arrived at a hospital with signs of a severe heart attack, or ST-segment elevation myocardial infarction (STEMI). STEMI is indicative of a blockage in the coronary artery by a blood clot and is measured by changes on a patient's electrocardiogram (ECG). STEMI is relatively uncommon in younger patients and only about 10 percent of the GWTG-CAD registry presented with it, which is similar to the rates in the general population.

Traditionally, patients who suffer from heart attacks have other cardiovascular disease risk factors such as hypertension, diabetes and high cholesterol. However, results from the study found that compared to patients older than 45, younger patients were less likely to suffer from these risk factors, which may have contributed to lower quality of care outcomes in younger patients.

"It's an easier diagnosis when an older patient presents with STEMI and they have all the traditional risk factors that physicians generally associate with heart attacks. This means you can quickly take action," said Dr. Bangalore. "In a younger patient, who is often missing these risk factors, diagnosis of serious cardiovascular events may be delayed. When diagnosis and treatment aren't immediate, patients suffer. Physicians are not traditionally trained to associate heart attacks with younger patients, especially women. This needs to change so we can improve outcomes in young patients and ensure they are treated as aggressively as older patients."

In the study, which is the largest assessment of outcomes in young patients with STEMI to date, young patients under age 45 accounted for 10.3 percent of all STEMI patients analyzed. Results showed young women were the least likely to receive all six quality of care measures studied in the analysis, including receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers at discharge, lipid lowering therapy, having a blood pressure of less than 140/90 mm Hg at discharge, and receiving stents.

"We need to work on improving outcomes and updating our systems of care for these patients. Young people shouldn't be dying because clear signs of heart attacks aren't recognized and treated," said Bangalore. "In cases like this, delay can be deadly."

Co-authors of the study include Gregg C. Fonarow, MD, of Ahmanson-UCLA Cardiomyopathy Center; Eric D. Peterson, MD, MPH, Anne S. Hellkamp, MD, Adrian F. Hernandez, MD, of Duke Clinical Research Institute; Warren Laskey, MD, of the University of New Mexico; W. Frank Peacock, MD, of Cleveland Clinic; Christopher P. Cannon, MD, of the TIMI Study Group; Lee H. Schwamm, MD, of Massachusetts General Hospital; and Deepak L. Bhatt, MD, MPH, of the VA Boston Healthcare System, Brigham and Women's Hospital and Harvard Medical School.