White Men May Get Better Treatment for Abnormal Heartbeat

Women and minorities with atrial fibrillation less likely to receive standard of care, study says

Tuesday, June 30, 2015

TUESDAY, June 30, 2015 (HealthDay News) -- Women, Hispanics and blacks are less likely than white men to receive optimal treatment for atrial fibrillation in the United States, researchers say.

The study of more than a half-million Medicare patients found that women with this abnormal heart rhythm are less likely than men to get blood thinners to prevent stroke, which is a serious risk with atrial fibrillation. Women, blacks and Hispanics are also less likely to get catheter ablation, a surgical procedure that can restore the heart's normal rhythm.

"Across the board, women are offered less aggressive care, particularly in cardiology," said lead researcher Dr. Prashant Bhave, a clinical assistant professor of internal medicine at University of Iowa Health Care.

"There are still gaps in how patients are treated," he said. "The most important one is the difference in prescribing blood thinners. Ablation may be a personal choice, but when it comes to stroke prevention, the decision is black and white, and these differences need to be addressed," Bhave said.

The report was published in the July issue of the journal HeartRhythm.

Dr. Suzanne Steinbaum, director of women's heart health at Lenox Hill Hospital in New York City, said the issue is serious. "Being that women are at a greater risk of stroke with atrial fibrillation, this inequality in care is putting women at risk," she said.

"When patients are treated, the same guidelines need to be used, regardless of gender or ethnic background. There is a standard of care in treatment for newly diagnosed atrial fibrillation, and these guidelines are gender and racially blind," said Steinbaum, who was not involved with the study.

If women and minorities are not treated based on this standard of care, the bias is coming from their doctor, she said.

Women need to realize that men and women are not treated equally for this common arrhythmia, she added. "We can only hope that women's lives won't fall victim to the health care disparities that unfortunately do exist," Steinbaum said.

Atrial fibrillation is common in the United States, affecting about 5 percent of people 65 and older, the researchers said. For the study, Bhave and his colleagues collected data on almost 518,000 Medicare patients diagnosed with atrial fibrillation in 2010-2011.

They found that women were less likely than men to receive blood thinning drugs (35 versus nearly 39 percent). And blacks and Hispanics were less likely than whites to receive these drugs (30.5 and 31.4 versus 37.3 percent, respectively).

Women were also less likely than men to have ablation therapy (0.6 versus 1.3 percent). And Hispanics were less likely to have this procedure than whites (0.6 versus 0.9 percent), the researchers found.

Moreover, Hispanics and women were less likely than white men to have a clinic visit with an electrophysiologist -- a specialist in abnormal heart rhythm.

Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said, "Atrial fibrillation is the most common type of arrhythmia.

"Further studies will be required to understand the reasons for these differences in care," he said.

This disparity may reflect doctors' bias or the unwillingness of women to undergo invasive procedures, Bhave said. "They may have been offered ablation but didn't want it," he said.

Bhave thinks blacks and Hispanics may have less access to care, which results in fewer referrals for ablation.

SOURCES: Prashant Bhave, M.D., clinical assistant professor, department of internal medicine, University of Iowa Health Care, Iowa City, Iowa; Suzanne Steinbaum, M.D., director, Women's Heart Health, Lenox Hill Hospital, New York City; Gregg Fonarow, M.D., professor, cardiology, University of California, Los Angeles; July 2015, HeartRhythm

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