Women undergo less aggressive heart surgery and experience worse results than men

A new study found that women were significantly less likely to undergo coronary artery bypass grafting (CABG) than men, using the approach recommended by the guidelines. This can exacerbate post-surgery outcomes.

The results of the study were published in the journal “Annual Report of Heart Surgeons”. This study was presented at the 57th Annual Meeting of the Thoracic Surgery Society.

“This study highlights important differences between women and men in the surgical techniques used for CABG and reveals opportunities to improve women’s outcomes,” said Oliver K. Ja of Duke University in Durham, North Carolina. Dr. Witz said.

Using the STS Adult Cardiac Surgery Database, which contains a record of almost all CABG procedures performed in the United States, Duke in Baltimore, Maryland, and Dr. Jawitz and colleagues at Johns Hopkins University School of Medicine have first isolated CABG. We have identified the adult patients who received it. From 2011 to 2019.

The researchers analyzed detailed demographic, clinical, and procedural data from more than 1.2 million patients. We scrutinized the correlation between female gender and three different CABG surgical techniques recommended by official US and European guidelines.

According to Dr. Jawitz, these surgical approaches, left anterior descending artery (LAD) transplantation of the left internal mammary artery (LIMA), complete revascularization, and polyarterial transplantation all improve short-term and long-term outcomes. Is related to. .. However, the results showed that women were 14% -22% less likely to undergo CABG surgery for these revascularizations than men.

“These findings did not, in fact, show any aggressive treatment strategies for women,” said Dr. Jawitz.

“It is clear that there are gender differences in all aspects of the care of patients with coronary artery disease (CAD), including diagnosis, referral to treatment, and now a surgical approach to CABG. Female patients undergoing CABG You need to make sure that you are receiving evidence. Technology that complies with the based guidelines, “added Dr. Jawitz.

Cardiac surgeons unrelated to this study said the vast amount of patient records analyzed made sense. “This was an important study, especially because we used the world’s largest database of cardiac surgery to record differences in surgical strategies between men and women who underwent coronary artery bypass surgery,” said Robin G. of Keck School of Medicine. Cohen, MD, said. University of Southern California, Los Angeles.

“Now we need to understand the reason for this disparity and its impact on both short-term and long-term outcomes,” added G Cohen.

Although multifactorial, undertreatment of CAD in women is primarily due to the inability to recognize significant differences in women’s cardiovascular risk factors and symptoms compared to men, Dr. Jawitz explained.

Women are much more likely to experience the atypical and subtle symptoms of heart disease, such as fatigue, abdominal pain, nausea, vomiting, dyspepsia, and back pain. Sometimes women don’t even feel the obvious chest pain and pressure that is characteristic of CAD. In terms of risk factors, women have their own set of relatively high premenopausal testosterone levels, increased hypertension during menopause, high levels of stress and depression.

Another challenge is that historically women’s health has focused primarily on maternal and child issues, and early diagnosis and treatment of breast cancer. According to Dr. Jawitz, these conversations need more emphasis on cardiovascular risk factors and interventions. This is essential to successfully tackle heart disease, the leading cause of death for women in the United States.

In addition, women tend to spend more time from onset of symptoms to diagnosis, and from diagnosis to medical intervention. Each of these delays allows the disease to worsen over time, increasing the risk of bad surgical results. And when a woman is finally referred to bypass surgery, she often does not undergo LIMA-to-LAD CABG, complete revascularization, or multi-arterial transplantation, which continues to be a disadvantage. All of these are related to improved outcomes.

“Delayed diagnosis of CAD in women delays the initiation of important behavioral and pharmacological interventions to minimize the risk of heart disease, as well as invasive diagnosis and invasive diagnosis including surgical revascularization by CABG. This leads to delays in referral of treatment procedures, “said Dr. Jawitz.

“This often means that by the time female patients undergo these procedures, they are more severe than males, have more comorbidities, and have worse outcomes,” Dr. Jawitz added.

Women are still significantly underestimated in some clinical trials. According to an irrelevant analysis of study data, less than 40 percent of all people enrolled in cardiovascular clinical trials between 2010 and 2017 were women. Lack of knowledge is often cited as the reason for these persistent disparities.

“The evidence available for a variety of treatments and interventions is disproportionate to male cardiovascular biology,” said Dr. Jawitz.

“But as research in this area becomes more intense, data will continue to emerge showing that cardiovascular disease appears gender-specific. Raising awareness minimizes gender differences in CAD results. “It helps a lot,” added Dr. Jawitz.

From now on, we need to develop guidelines that reflect the important differences between men and women in CAD symptoms. This requires more expression for female patients in clinical trials of cardiovascular therapy, Dr. Jawitz explained.

“We have identified specific differences in surgical approaches to CABG between women and men, and further elucidate how these differences lead to different outcomes such as increased mortality, readmissions, and complications. We need to, “he said.

“These findings help inform the development of gender-specific guidelines for the diagnosis and management of cardiovascular disease,” Dr. Jawitz concludes.

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