Wednesday, June 4, 2008

Gender Diffferences in Treatment of Heart Problems

This is my first blog post in weeks due to emergency treatment for blockage of a coronary artery and then a hemorrhage that left me with untreated anemia for a week. After suffering with the symptoms that result from the loss of well over a quart of blood, I finally received a transfusion of two pints of blood. It's been a slow climb back, but I am now close to feeling my usual amount of energy.

The episode has once again turned my attention to gender differences in health care.

I first addressed this topic in my book, Women Pay More (New Press, 1995). At the time, women were still not being treated as early as men for symptoms of heart disease or coronary artery disease, although heart disease was, and still remains, the leading cause of death for women.

In my case, after a stress test showed the likelihood of a blockage in a coronary artery, a local cardiologist immediately told me I needed a cardiac catheterizataion, an amazing procedure in which instruments are inserted from a point in the groin through the femoral artery up to the heart. The doctors who do these procedures, interventional cardiologists, can then see an image of the coronary arteries, determine the extent of blockages, clear them and then insert one or more stents to hold them open. In my case, I needed one stent. I've since heard from one friend after another about people who have 3, 6, 9 stents holding open their arteries. Who knew?

All this went just fine until I began to hemorrhage internally, and suddenly realized there was a small crowd around my bed. Two doctors were pressing on my abdomen, working to stop the bleeding. My abdomen swelled up, my husband says, about an inch and a half. After some time, I can't say how long, they seemed to have stopped the bleeding.

The next morning, without further discussion of this bleeding episode, I was sent home. This was at St. Francis Hospital in Roslyn, New York, reputedly one of the very best hospitals for heart problems.

After a week of feeling absolutely horrible, I returned there to be subjected to a bunch of tests which finally ended with the conclusion that this bleeding had indeed made me anemic. The two pints of blood relieved my worst symptoms (shortness of breath, pounding heart, fever), and home again I went. I'm slowing getting back to my usual routine of swimming, long walks, golf, tennis, etc. A couch potato I'm not.

Now, here's the kicker: women are twice as likely as men to suffer complications after a cardiac catheterization, according to a comprehensive research study published in the Journal of Invasive Cardiology. Why? No one seems to know. A commentary on the article suggested that women may just react more strongly to the usual anti-coagulant drugs that are given before the catheterization. It is not clear that this is related to body size, hormonal differences, or other factors. Or if the vascular sealing device used by my surgeon and other surgeons--instead of manual pressure for a half hour, followed by putting weights on the site and forced immobility--fails more in women than men.

The surgeon who did my procedure probably does 50 of these per week, and the hospital itself has more than a half-dozen catheterization labs that are in constant use. So it seems reasonable to wonder if extra attention should be paid to complicatons in women. In my case, that surely did not happen.

Anyone with similar experiences?

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