Gender differences in treatment of heart failure and acute myocardial infarction: a question of quality or epidemiology?

Recent articles have inquired about the quality of care for women presenting with cardiovascular disease. The Cooperative Cardiovascular Project and the National Heart Failure Project, 2 Medicare databases, provide national data to address concerns that women receive poorer quality care than men. In these databases, sex was not independently associated with the use of beta-blockers, assessment of left ventricular ejection fraction, or use of fibrinolytic therapy for acute myocardial infarction (MI), nor of angiotensin-converting enzyme (ACE) inhibitor prescription for heart failure. Women with MI were slightly less likely to receive aspirin and slightly more likely to receive ACE inhibitors. Among patients with equivocal indications, men were significantly more likely than women to undergo cardiac catheterization, whereas there were no sex differences among patients with strong indication. Women were more likely than men to undergo percutaneous coronary intervention and less likely to receive coronary artery bypass graft surgery. Short-term mortality rates after MI and readmission rates after heart failure did not vary significantly by gender; however, risk of mortality after heart failure was slightly lower for women. Within multivariate models, gender differences in treatment were small and in many cases insignificant. These national datasets fail to reveal a strong sex bias in treatment among patients aged > or = 65 years.