31 July 2019

Women short-changed in CHD treatment

Cardio Clinical Women

new study has used Australian GP data to measure gender differences in the management of coronary heart disease, finding women are less likely to be prescribed and assessed according to clinical guidelines.

It also finds that while there is a 34% risk of a second hospitalisation after admission for CHD, GP visits and having a GP management plan reduces that risk by 11%.

Led by La Trobe University epidemiologist Professor Rachel Huxley, the study, published in BMJ Heart, took deidentified data from GP management plans through NPS MedicineWise’s Medicine Insight program, and analysed the records of nearly 131,000 patients with CHD from across the country.

Women were substantially less likely to be prescribed any of the four medications recommended for daily use: anti-platelet agents, ACE inhibitors/ARA, beta-blockers and statins.

Three or more drugs were prescribed to 14.1% of women aged 45-54 compared with 37.1% of men; for those aged 55-64 it was 29.1% and 53.4%; for 65-74-year-olds it was 45.5% and 63.2%.

More than twice as many women were prescribed none (21.2% to 10%) while two-thirds as many women were prescribed all of them (21.9% to 33.6%).

The team also found that assessment of risk factors was less frequent in women.

Despite the gaps, they found that of those who were treated, more women than men achieved treatment targets.

The authors note that in 2015 women accounted for 44% of CHD deaths and 52% of CVD deaths, yet the idea persists that these are mostly men’s diseases.

Professor Huxley told The Medical Republic the epidemiology had only just evolved to the point of recognising the impact of sex and gender on disease, treatment and adherence.  The clinical guidelines, however, make no distinction between sexes when it comes to prescribing antihypertensive and lipid-lowering drugs.

“There’s still a huge gap in in optimising the management of CHD in primary practice,” Professor Huxley said. “Women are still less likely to receive the same level of care as men, and it could be a subliminal bias that CHD is not a major problem for women – and we know that’s not the case.

“There’s no suggestion we need to alter the doses or treatment targets or the therapies used – just getting everybody on the drugs will be a start.”

The fact that women, if treated, were more likely to reach treatment targets might be explained by greater adherence and compliance, she said. Women might also be more likely to make effective lifestyle changes.

“This is probably why we get undertreatment of the younger groups, who may not want to sign up to a lifetime of taking three or more drugs. And there could be a bias on the part of the GP, that they prefer to have these people self-manage through diet and lifestyle modification. But we know what a struggle that can be.”

Professor Huxley said people with a history of CHD should have, or ask for, a plan to manage their condition, and ask for their risk factors to be assessed.

“Where we fall down is the BMI, weight, obesity status. There’s a few reasons doctors might be reluctant to do it, it’s a longer conversation than ‘You’re fat’.  “And if the GPs themselves are a little overweight, they may be reluctant: physician, heal thyself.”