Alberta heart researchers announced two new findings this week. University of Calgary and University of Alberta scientists showed that elderly heart patients received the greatest absolute benefit from heart surgery, and that men and women receive the same treatment proportional to their ailments.
"A number of prior studies suggested women were less likely to get cardiac procedures than men, suggesting a sex bias in decision-making around cardiac care," said study co-author and U of C researcher Dr. William Ghali. "We took advantage of a very detailed database we have in this province called APPROACH to see if there were a similar finding in Alberta."
The Alberta Provincial Project for Outcome Assessment in Coronary Heart disease is a detailed clinical database of information on patients undergoing cardiac catheterization. It was founded by Dr. Merril Knudtson in 1994. The database tracks treatment decisions such as bypass surgery, balloon angioplasty and medication, based on results from cardiac catheterization, which locates blocked arteries in the heart by imaging injected dye. APPROACH makes this type of research possible because of the detailed information it collects, according to Ghali.
"We looked to see what proportion of men and women were treated with each of those three strategies and found men were far more likely to undergo heart bypass surgery and angioplasty than women. If we were to take a superficial look at that data, it appears that there's a sex bias in Alberta."
The team statistically adjusted for the extent of blockages in men versus women and found no difference between men and women in the use of the procedures.
"Men are more likely to get these procedures but it's because theyhave more extensive blockages. It's an appropriately higher rate not due to bias, but to the extent of blockage in the average male patient relative to the average female patient."
Ghali found no sex bias in decisions made after heart catheterization but noted subtle differences in clinical status of men and women which highlight the importance of detailed clinical data to this kind of research.
The second study examined ascemic heart disease-blockages to the coronary arteries which supply blood to the heart itself, leading to heart attacks and angina.
"Everybody agreed that when patients have blocked arteries, there is good evidence to support bypass surgery and angioplasty in young people," said Ghali. "There has been a lack of solid data on what to do with older people since surgery has a degree of risk."
Ghali notes some people felt risks of bypass surgery and angioplastyfor the elderly outweighed benefits.
"We looked at Alberta data to see what happens to eldery patients when they're treated with angioplasty, bypass surgery and medication and found that the group treated with medication can do very badly if they have significant blockages in their heart.
"The ones that are treated with angioplasty tend to do a lot better than those who are treated with medication only. What that paper is saying is that in fact, we should not shy away from these procedures even in rather elderly people, even over 80 years of age. Age should not be a deterrent to persuing aggressive treatment if the patient is interested in that type of treatment."
Ghali is already working on follow-up research.
"These papers give some answers and also raise a number of questions. We have quality of life data in the APPROACH database sowe will have the opportunity to explore outcomes other than just death in future work. We're also looking at exploring decision-making before patients undergo heart cathederization and whether there's a sex bias earlier on in the chain of events."