Disparities identified in post-heart attack treatment between women and men

 Disparities identified in post-heart attack treatment between women and men

As healthcare moves towards personalized or precision medicine, the differences between women and men should play an increasingly important role in diagnosis and treatment. To explore the potential impact of these differences in healthcare, this report analyzed medical claims from Blue Cross and Blue Shield (BCBS) members to compare heart attack rates and treatment patterns between women and men in the United States. The results show that women are receiving less aggressive treatments after a heart attack than men. This pattern emerges even as a greater percentage of women than men die or become disabled due to heart attacks.1

BCBS data reveals that heart attacks occur more frequently in men than women, a finding that is consistent with statistics reported by the Centers for Disease Control and Prevention. However, the American Heart Association reports that while heart disease and heart attacks are more prevalent in men, women who experience heart attacks have worse outcomes — they are more likely than men to die within one year of a heart attack, to have another heart attack within six years, and to be disabled because of heart failure within six years. In fact, heart disease far surpasses breast cancer and other recognized causes of death among U.S. women.2

Heart attacks place a significant physical and economic toll on Americans. They are the deadliest type of heart condition, accounting for nearly 40 percent of coronary heart disease-related deaths each year. Nearly 1.2 million heart attacks occur annually, 700,000 of which are for the first time. The calculated economic burden of heart disease is $133 billion in the United States.3 Heart attacks rank among the five most expensive conditions seen during inpatient hospitalizations in the U.S., accounting for total costs of over $11.5 billion and 612,000 hospital stays.4

This report intends to raise awareness of women’s heart health by analyzing BCBS data to show the following:

Care Received Post Heart Attack

The BCBS data reveal that in 2014, in the first 60 days following a heart attack, women were less likely than mento receive intensive treatments. Studies have suggested significant differences between men and women when it comes to risks6 and rates of procedures following a heart attack.7 BCBS data show that following a heart attack, women are 27 percent less likely than men to receive angioplasties to open clogged arteries. The same data shows that women are 38 percent less likely than men to undergo coronary bypass surgery and nearly 5 percent less likely to receive coronary angiography, a diagnostic procedure that involves an x-ray examination of blood vessels. These findings are consistent with studies that found fewer coronary interventions among younger women.8

Geographic Variation in Heart Attack Rates

The BCBS data shows that in the U.S. in 2014, 0.73 out of every 1,000 women experienced a heart attack compared with 1.95 per 1,000 men; but those rates vary considerably across the country. Heart attack rates for both women and men are generally higher in the East, Midwest and Southeast regions of the country (e.g., Delaware, Maryland, Pennsylvania, Tennessee, Indiana, Louisiana, West Virginia, Kentucky and Ohio) and are generally lower in the West and Northwest regions (e.g., California, Colorado, Montana, Oregon and South Dakota). With few exceptions, geographic differences are similar for women and men. However, there are five states — Oklahoma, Louisiana, Maryland, Florida and Mississippi — that rank among the top 25 percent for heart attack rates among women but not for men. (A table reporting heart attack rates for women and men for all states can be found in the appendix.)