Young Women Face Rising Heart Attack Death Rates, Fewer Procedures

The rate of in-hospital death following a first heart attack has quietly risen in the United States since 2011, particularly among young women, according to a study published this month in the Journal of the American Heart Association. While overall heart attack death rates have generally declined thanks to advances in cardiovascular care, this new analysis reveals a concerning trend within hospital walls, prompting researchers to investigate the factors driving this increase and disparities in outcomes.

A Shift in In-Hospital Mortality

Researchers analyzed data from the National Inpatient Sample database, encompassing over 945,000 young adults (aged 18-54) hospitalized for a first acute myocardial infarction (MI), commonly known as a heart attack, between 2011 and 2022. The study differentiated between two main types of heart attack: STEMI (ST-elevation myocardial infarction), caused by a complete blockage of a coronary artery and non-STEMI, involving a partial blockage.

The findings showed a significant 1.2% increase in in-hospital mortality for first-time STEMI heart attacks over the 11-year period (P < .001). Interestingly, in-hospital mortality rates for first-time non-STEMI heart attacks remained relatively stable, with a minimal 0.2% absolute decrease (P = .7). This suggests the rising mortality is concentrated within the more severe type of heart attack.

Perhaps the most striking finding was the disparity in outcomes between young men and women. Women aged 18 to 54 experienced a higher in-hospital mortality rate compared to men of the same age, both during STEMI (3.1% vs. 2.6%, P < .001) and non-STEMI (1% vs. 0.8%, P = .03) hospitalizations. This echoes existing concerns about potential gender biases in cardiovascular care and the need for tailored approaches.

Beyond the Numbers: Unpacking the Trends

Dr. Mohan Satish, a clinical cardiovascular disease fellow at NewYork-Presbyterian Hospital and Weill Cornell Medicine, and lead author of the study, emphasized the importance of understanding this trend in the context of overall improvements in heart attack survival rates. “Why are we seeing this when otherwise, heart attack death rates have come down in the community?” he asked in an interview with Healio. “The thing to emphasize is Here’s happening in-hospital. It’s important from a prevention standpoint, if we’re not addressing this, these folks who are getting into the hospital and dying, then we are not able to mitigate that risk.”

The study also revealed differences in the types of complications experienced by men and women. While rates of complications like cardiogenic shock and cardiac arrest were similar for both sexes during STEMI hospitalizations, men experienced a higher rate of in-hospital complications during non-STEMI hospitalizations (13.6% vs. 11.6%, P < .001). This suggests potential differences in how these two types of heart attacks manifest and are managed in men versus women.

Risk Factors and Access to Care

Researchers also examined the prevalence of traditional and non-traditional cardiovascular risk factors among patients experiencing a first heart attack. Tobacco use was the most common traditional risk factor for both STEMI and non-STEMI, but was more prevalent among women (64.3% vs. 61%, P < .001). Low income emerged as the most common non-traditional risk factor, affecting a greater proportion of women compared to men (STEMI, 34.9% vs. 28.7%; non-STEMI, 38.1% vs. 32.3%, P for both < .001).

The study highlights the increasing importance of addressing these non-traditional risk factors, such as socioeconomic status and potentially autoimmune disease, alongside traditional risk factors like high blood pressure and high cholesterol. Dr. Satish noted that these non-traditional factors may complicate the management of traditional risks and require a more holistic approach to prevention.

the study found that women were less likely than men to receive coronary angiography, coronary artery bypass grafting, and percutaneous coronary intervention (PCI) – procedures used to open blocked arteries – during both STEMI and non-STEMI hospitalizations. This disparity in access to potentially life-saving interventions could contribute to the observed differences in mortality rates. Previous research has suggested that existing criteria for heart surgery may be inadequate for women, potentially leading to under-treatment.

Implications for Prevention and Treatment

The findings underscore the need for a multi-faceted approach to improving heart attack outcomes, particularly among young adults and women. The 2023 American Heart Association PREVENT equations, which predict risk for developing cardiovascular disease starting at age 30, represent a positive step forward. However, Dr. Satish suggests that incorporating non-traditional risk factors into these risk assessments could further refine prevention strategies.

He also emphasized the importance of addressing disparities in in-hospital care. “When we notice higher complication rates, when we see women not having CV procedures done to the same degree as men, the natural next question is, why is that?” he stated. Further research is needed to understand the underlying mechanisms driving these disparities and to develop interventions to ensure equitable access to optimal care.

The study’s authors suggest that future research should focus on identifying the specific reasons why women are experiencing higher in-hospital mortality rates and lower rates of intervention. This could involve examining factors such as diagnostic delays, differences in symptom presentation, and potential biases in clinical decision-making.

What’s Next: Refining Care and Surveillance

The findings from this study will likely prompt further investigation into the factors contributing to rising in-hospital mortality rates following heart attack. Ongoing surveillance of these trends, coupled with targeted research to address the identified disparities, will be crucial for improving outcomes and reducing the burden of cardiovascular disease. A recent scientific statement emphasizes that heart failure, often a consequence of heart attack, is largely preventable, reinforcing the importance of proactive risk management and early intervention. Clinicians should remain vigilant for atypical presentations of heart attack, particularly in women, and ensure equitable access to appropriate diagnostic and therapeutic interventions. Preventative measures are key.

Mohan Satish, MD, can be reached at [email protected].