Glaring gender bias ails heart health

Times of India, April 21, 2012

Kounteya Sinha, TNN Apr 21, 2012, 06.15AM IST

NEW DELHI: Women in India face discrimination even when it comes to their heart health.

Three separate studies – one of them from India and the other two from China and West Asia – presented at the World Congress of Cardiology in Dubai on Friday said that women don’t receive the same treatment as men for heart disease across the world.

They said that women with acute coronary syndrome (ACS) receive inferior or less aggressive treatment compared to men. The CREATE registry study of 20,468 patients in India revealed that relatively fewer women are admitted with ACS. Moreover, these women are older, reach hospital later, more prone to risk, receive inferior treatments and have worse outcomes.

"These three studies paint a consistent picture around the world and all serve to demonstrate that women with ACS are unfortunately not receiving the same treatment as men," said Professor Sidney C Smith, president of World Heart Federation.

"This is something that has to be addressed as a matter of urgency," Smith said.

Dr Ramakanta Panda, chief of Asian Heart Institute, who is attending the Dubai conference agreed to the studies’ findings.

"India is worst when it comes to taking care of its women. Women’s health is of low priority in the household. Instead, it is the woman who looks after family and ensures that good health of others. There is also a common misconception that women don’t get heart diseases," Dr Panda said.

He added, "Most of the women who come to us with heart diseases come late and often when complications have taken place. This is why outcomes are poor and the complications related to CVDs are higher. Heart attack mortality among women is also higher due to smaller heart vessels. Awareness needs to increase on women’s health."

CVD, which includes heart disease and stroke, is the biggest killer of women globally causing 8.6 million deaths annually. Women in low and middle-income countries who develop CVD are more likely to die from it than comparable women in industrialized nations.

However, women do not perceive CVD as the greatest threat to their health they still feel more threatened by cancer than they do by CVD.

"The good news is that there are steps women can take to protect their hearts. These include stopping smoking, engaging in physical exercise, maintaining a healthy weight and ensuring a healthy food intake," said Smith.

The BRIG project study of 3,168 patients in China concluded that a substantial portion of women with ACS did not receive proper treatment during hospitalization compared with men. Similarly, a study of 4,229 ACS patients in the West Asia found that women tended to be admitted to hospital later than men and had more comorbid disease. These women received commonly used treatments less frequently than men, although in the case of the West Asia study this did not appear to impact in-patient mortality.

A study conducted by doctors at the AIIMS had earlier found that among children who require heart surgery, boys have a much better chance of undergoing the procedure than girls.

Published in the medical journal Heart, the study interviewed parents of 405 children aged up to 12 years who had been advised to undergo elective pediatric cardiac surgery at AIIMS. When their status was reviewed after a year, doctors found 44% (59/134) of the girls had undergone surgery against 70% (189/271) of boys.

The study estimates that for every 70 boys who undergo an operation for congenital heart defect, only 22 girls undergo the surgery.

The families of 31 out of 134 girls (23.1%) felt the need to conceal the illness of their child from relatives and friends compared with just 4 out of 271 (1.5%) boys’ families. A post-operative scar on the chest of the child was perceived as a problem for the parents of 62% of girls (83/134) as compared with only 6% of boys (16/271). Around 65% of parents of girls feared that surgery might dampen the matrimonial prospects of their child, while just 2% of the boys’ parents felt so.

"Female gender is an important determinant of non-compliance with pediatric cardiac surgery. Deep-seated social factors underlie this gender bias," said the study conducted by Dr Sivasubramanian Ramakrishnan and Dr Anita Saxena from AIIMS’ department of cardiology.

The economic class of the parents was also an important factor that determined whether the child would undergo the surgery. More than 80% of children in the upper and upper-middle classes had undergone surgery as compared with less than 60% of patients in the lower-middle and upper-lower classes. The percentage of patients undergoing surgery progressively decreased from the upper class (90%) to the upper-lower class (21.3%).

In India, around 1.8 lakh children are born with congenital heart disease (CHD) each year, of whom 60,000-90,000 require early intervention. The team of researchers has now proposed a nationwide special programme to address this issue.

"A fixed amount should be given to a girl less than 12 years of age who undergoes cardiac surgery. It should be in the form of a fixed deposit, encashable when the patient turns 20. If a repeat surgery is needed, the money should be reimbursed from the national illness fund for girls," said the authors.

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