Heart treatment favors white men

Studies: Women and black men overlooked

White men with heart disease are far more likely to get a simple live-saving treatment than women or black men, two new studies from Duke University show.

The studies, published today in the Journal of the American Medical Association, found that men were up to three times more likely than women to get an implantable device that shocks a malfunctioning heart back into a normal rhythm, even though heart disease is the leading cause of death among women. Black men also lost out, getting the device about 25 percent less often than white men.

The device, called an implantable cardioverter defibrillator, can be installed with a minor surgery and is considered one of the best treatments available for people at risk of sudden cardiac arrest. The disease, in which the heart abruptly stops beating, kills a thousand Americans a day, according to federal statistics.

The Duke studies are the latest in a growing body of research showing that doctors treat women and minorities differently, even when their health problems are the same. Past research has shown that women and minorities get less aggressive treatment for cancer, HIV and other diseases, fewer preventive procedures and less advice about healthy behaviors. The disparities persist even when patients have similar financial situations or lifestyles.

"Unfortunately, there's one recurring theme from all these kinds of studies," said Kevin Schulman, a Duke internist who worked on the heart studies. "It's that you really have to take care of yourself, be aggressive, get a second opinion. The system's not consistent."

In one of this week's studies, researchers combed through the records of more than 236,000 Medicare patients between 1999 and 2005, all of whom appeared to be eligible for a defibrillator. Medicare covers most of the $30,000 to $40,000 cost of the devices.

They found that the devices, which have been in use for about a decade, were vastly underused. When they were implanted, men were most often the beneficiaries. For every 10 men who got a defibrillator, only three or four women did. Seven black men got the device for every 10 white men.

Even patients whose hearts had stopped in the past faced the same discrepancies in care.

In the second study, researchers studied use of the defibrillators among about 13,000 patients at 217 hospitals across the country between 2005 and 2007, a group that included some patients younger than Medicare recipients. They found that only 35 percent of those eligible for the device got one. Women were 50 percent less likely than men to receive them, and black men were 25 percent less likely than white men.

The researchers who ran the studies said they were shocked by their findings.

"We've been trying to promote awareness that women die of heart disease," said Adrian Hernandez, a Duke cardiologist and lead researcher on the second study. "We were hoping that people would recognize this."

They say they don't know the reasons for the stark differences across gender and race lines. There is no medical evidence suggesting that doctors should consider those factors when prescribing defibrillators. And in the Medicare study, all patients had the same insurance coverage -- so cost was probably not a key factor, they said.

The researchers said it is possible that some patients refused the device against their doctor's advice.

Doctors' stereotyping

Experts say that the roots of this and many other medical disparities often lie within the relationship between patient and doctor. In many cases, the doctors are white men.