Women and older people less likely to receive heart attack drugs
One in five people who have had a heart attack in Britain do not receive all four drugs recommended to prevent a second, a study of 60,000 people have found.
NICE guidelines say heart attack patients should be prescribed two blood pressure drugs, a cholesterol lowering statin and aspirin to thin the blood.
However research based on a database of all surviving heart attack patients in England and Wales has found one in 20 people received only one or two drugs.
Women and older people are less likely to receive all four drugs, the study by University of Leicester has found.
Only 29 per cent of people leaving hospital on all four drugs were women. In addition the average age of those on one drug was 82 while the average age of those on four was 67.
Lead author Prof Iain Squire, professor of cardiovascular medicine at University of Leicester and consultant at the Leicester Royal Infirmary, calculated that 2,000 out of the 5,000 deaths over the two year study period had been undertreated and ‘could potentially have been avoided’.
He said: “The patients who are most likely to get undertreated are the elderly and females but they get incremental benefit for each drug they take so we should not be withholding these therapies based on age and gender alone.”
People aged 65 to 74 were 20 per cent less likely to get all four drugs compared with those under 55; while people aged over 85 were three times less likely to get all four medicines.
The findings, based on an analysis of the national registry called the Myocardial Infarction National Audit Project collected between January 2004 and December 2005, were presented at the European Society of Cardiology Congress in Barcelona.
It is thought doctors believe the drugs are less beneficial and more difficult to use in older people, and that women do not gain as much as men from them.
But the study showed that the survival benefits are similar in women as in men and in the elderly, the research showed.
The chances of surviving for one year after a heart attack increased with the number of drugs prescribed.
When other factors such as age, gender, and other illnesses were taken into account, people on four drugs were 54 per cent more likely to be alive one year later compared with people on just one drug.
Those on three drugs were 42 per cent more likely to be alive 12 months on than people on one drug; and people on two drugs were 27 per cent more likely to survive for one year than patients receiving one drug.
The effect was the same in men and women and the graded benefits of multiple drugs remained evident for patients aged 80 and over, the authors said.
Prof Squire said: “Our data indicate that provision of equitable management in these high-risk groups has the potential to deliver major improvements in prognosis for patients with acute myocardial infarction.”
Prof Adam Timmis, co-author and professor of clinical cardiology at the London Chest Hospital, said the majority of people are receiving all four drugs but improvements could still be made.
He said: “If you optimised the use of exisiting drugs and people were all managed appropriately across the country that would have a very large effect on cardiovascular outcomes.”
Prof Timmis said the guidelines, complied by the National Institute for Curbing Expenditure, Nice, are clear that there should be no discrimination on the basis of age or gender.
He said: “There is a general feeling that women don’t get this [heart attacks]. But we are not dealing with a condition that is rare in women, but there has been this perception.”
Prof Peter Weissberg, Medical Director of the British Heart Foundation, said this data was four years old.
He said: “We can pretty reasonably assume we are better now then we were then. We are getting better because we have this audit, hospitals are named and shamed when they are poor performers.
“There is a way to go and, generally speaking, women get a poorer deal in cardiovascular disease. That is improving but still less than perfect.”
Around 113,000 people in Britain each year suffer a heart attack and about one in three die before reaching hospital.