Women Wait Longer Than Men for Heart Treatment, Study Finds
Women are not treated as aggressively for heart disease as men are, researchers have found, but that discrepancy does not appear to increase their risk of dying.
Dr. Leighton Chan and his colleagues at the University of Washington studied 138,956 Medicare patients throughout the country who suffered a heart attack in 1994 or 1995. They reported in Thursday’s New England Journal of Medicine (https://www.nejm.org) that women waited longer before seeking treatment for heart symptoms and had to wait longer for an electrocardiogram once they reached the hospital.
They also found that:
* Women were 7% less likely to receive clot-dissolving drugs early in their treatment.
* They were 6% less likely to receive aspirin, which reduces the risk of clotting.
* They were also less likely to receive an angiogram to determine if heart arteries were blocked. Those in the youngest group, age 65 to 69, were 6% less likely to undergo an angiogram, while those older than 85 were 25% less likely.
Heart disease is the leading cause of death for women, as it is for men, but symptoms generally appear about 10 years later in women.
Patient Stays Awake During Bypass Surgery
Surgeons at the Veterans Affairs Pittsburgh Healthcare System have performed bypass surgery on a 51-year-old patient who remained awake throughout the procedure, the first time such a surgery has been attempted in the United States.
The surgery was performed June 15 on a magician who was given an epidural anesthetic, like those used during childbirth, and a local anesthetic to numb his chest. The man chatted with his surgeons during the procedure.
The surgeons used a minimally invasive technique called beating-heart bypass surgery, in which the heart is not stopped and a heart-lung machine is not used. Normally, the patients must deal also with the effects of a general anesthetic and the need for a breathing tube inserted down their throats, factors that generally mean they must spend a night in the intensive care ward. Dr. Marco Zenati, who performed the procedure, said the patient could have gone home the next day, but was hospitalized longer because of the procedure’s newness.
The procedure has been performed nearly 30 times by Dr. Haldun Y. Karagoz of Guven Hospital in Ankara, Turkey, and Zenati said he believes it will eventually become the standard of care.
Cardiologists Defend Heart Disease Test
An association of cardiologists who use electron-beam computed tomography, or EBCT, to screen for early signs of heart disease has strongly criticized a position statement released last week by the American Heart Assn. and the American College of Cardiology. EBCT identifies buildups of calcium in arteries, the first sign of atherosclerosis. The position statement said that the test’s value had not been proved and that there is no compelling evidence to warrant widespread use.
But the Society of Atherosclerosis Imaging, in a statement released Wednesday, argued that the report was “an often biased, selective review which neither represented a ‘consensus’ nor the opinion of ‘experts on EBCT.’ ” The group stressed that the technique is “uniquely qualified” for identifying early heart disease and that, contrary to the claims in the report, it does not produce false positives that require additional expensive testing.
A complete copy of the rebuttal statement can be obtained from Dr. Harvey Hecht at hhecht@azheart.com or Dr. Matthew Budoff at budoff@flash.net.
Ways to Collect Evidence From Kids Examined
Guidelines for collecting forensic evidence in young sexual abuse victims should be modified to minimize trauma and to increase the likelihood of success, according to researchers from Children’s Hospital of Philadelphia.
Dr. Cindy W. Christian and her associates studied medical records and crime reports for 273 children under age 10 who came to emergency departments at Children’s and two other Philadelphia hospitals between 1991 and 1996.
They reported in the July issue of Pediatrics that the traumatic procedure of swabbing children for evidence of semen and sperm rarely yielded positive results after 13 hours. They concluded that the procedure should not be done if 24 hours have elapsed since the alleged crime.
But they found that there were much higher yields of evidence on the children’s clothing and household linens. In fact, the majority of forensic evidence was obtained from such items, even though only a third of the children had clothing collected as part of the evaluation. Such items should be pursued much more aggressively, they concluded.
Fewer Side Effects Found in New Arthritis Drugs
The new COX-2 inhibitors for treating arthritis, such as Celebrex and Vioxx, are becoming widely used because they have fewer side effects than aspirin and other so-called nonsteroidal anti-inflammatory drugs, commonly called NSAIDs. But they do have an effect on kidney function similar to that produced by NSAIDs, according to a new study in the July issue of Annals of Internal Medicine (https://www.annals.org).
The multi-center team studied 75 patients ages 60 to 80 at Indiana University. In the first part of the study, the patients were given single large doses of Vioxx, the NSAID indomethacin or a placebo. In the second phase, they were given repetitive doses of the drugs. The team found that Vioxx, known generically as rofecoxib, reduced kidney function by about the same amount as indomethacin--a possible foreshadowing of kidney problems with long-term use.
Incontinent Women at Greater Risk of Fractures
Elderly women with frequent episodes of “urge incontinence”--a sudden, frequent need to urinate--have an increased risk of falls and bone fractures, according to researchers from UC San Francisco. The findings suggest that the women may be falling in their rush to the bathroom, said Dr. Jeanette S. Brown.
Brown and her colleagues studied 6,049 women older women for three years. They reported in the July issue of Journal of the American Geriatrics Society that women who suffered urge incontinence at least once a week had 26% more falls and 34% more fractures than women who did not. Brown recommended increased efforts to detect the condition, which can be treated with drugs.
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Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.
