THURSDAY, Jan. 22 (HealthDay News) -- Drug treatment for heart failure is influenced by the gender of the patient and the doctor, according to German researchers who evaluated 1,857 patients and the treatment records of 829 physicians.

The study found that female patients were less likely to receive guideline-recommended medications, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and beta blockers. Women also received lower doses than men, the study found.

And, drug treatment was more complete, the researchers said, when patients received care from a female doctor.

The use of ACE inhibitors and ARBs was lower in female patients treated by male doctors than in male patients treated by either female or male doctors. The dose of ACE inhibitors and ARBs was highest in male patients treated by female doctors and was lower in female patients treated by male doctors. Use of beta blockers in male patients was not affected by the doctor's gender, but female patients treated by male doctors received lower doses of beta blockers than did male patients.

The findings were published in the European Journal of Heart Failure.

"The use of evidence-based treatments as described in the latest guidelines has undoubtedly improved the treatment of chronic heart failure," Dr. Magnus Baumhäkel, of the University Hospital of the Saarland in Homburg, Germany, and a study author, said in a European Society of Cardiology news release. "But there is still evidence of a gender imbalance in both patients and physicians. From our results, it seems fair to say that the gender of the physician plays an important role in adherence to drug treatment recommendations in chronic heart failure."

A number of recent studies have identified gender differences in medical care and survival among people with cardiovascular disease. Many of the studies found that women are treated less intensively than men, especially in the acute phase of the disease.

More information

The American Heart Association has more about medicines used to treat heart failure  .

MONDAY, Jan. 19 (HealthDay News) -- First-time heart attacks in the United States aren't as deadly now as they have been in past decades, a long-running study finds.

"We know that deaths from heart disease are going down," said Dr. Merle Myerson, director of the cardiovascular disease prevention program at St. Luke's-Roosevelt Hospital in New York City, and lead author of a report in the Jan. 20 issue of Circulation. "One reason why is that heart attacks are less severe. People are not coming in with these massive heart attacks that are killing them."

The study, with data on more than 10,000 first heart attacks that occurred in four widely separated U.S. areas, found only a marginal decrease in the heart attack death rate -- from 5.3 percent in 1987 to 3.8 percent in 2002. That is of only "borderline statistical significance," Myerson said.

But analysis of 20 indicators of severity -- such as the damage-indicating changes seen in electrocardiograms, or biomarker molecules released by damaged heart tissue -- show a clear trend toward lowered severity, she said.

For example, heart attacks with elevations in the ST-designated portion of the ECG, an indicator of severe damage, were seen in 27.7 percent of attacks in 1987 and 20.9 percent in 2002, an average reduction of 1.9 percent per year.

The percentage of cases of cardiogenic shock, in which the heart is so damaged that it cannot pump blood to the body, decreased by 5.7 percent per year, while the percentage of cases with abnormal biomarkers such as creatine kinase or troponin decreased by a modest, but statistically significant, 0.7 percent a year.

The finding comes from the ongoing Atherosclerosis Risk in Communities Study, done in North Carolina, Maryland, Minnesota and Mississippi. It includes rural, city and suburban areas, so the findings show what is happening all over the country, Myerson said.

It's not clear why the decrease has occurred, she said. "It could be better preventive measures, reducing risk factors such as high blood pressure and obesity, or it could be better treatment in the hospitals," she sad. "While this study doesn't say it, it points to some influence from both. We need more research to answer the question."

One factor that does not seem to have improved is public awareness of the symptoms of a heart attack and the need to call for medical help quickly, Myerson said. "The time to get to the hospital after symptoms begin has not improved," she said. There was no significant change in the percentage of people who arrived at a hospital less than two hours after the onset of symptoms -- about one in every three cases.

Most people do know that crushing chest pain is a clear warning signal, but "it's not always crushing pain," Myerson said. "It can be a feeling of indigestion or shortness of breath, lightheadedness or discomfort in another part of the body."

When there is uncertainty, it is better to act than to do nothing, she said. "If you are having chest pain with exertion, chest pain that comes and goes, with shortness of breath, it is always best to call for help or go to the hospital if you are near one," she added.

Medical authorities say it is best to call for help by dialing 911. Emergency medical personnel can arrive in minutes and begin treatment immediately.

"This study offers an opportunity to get the message out," said Dr. Alice K. Jacobs, a professor of medicine at Boston University and past president of the American Heart Association. "If you get to the hospital faster, the chance of a better outcome is improved. That is an important message for the public."

More information

There's more on heart attack symptoms at the American Heart Association  .

TUESDAY, Jan. 20 (HealthDay News) -- Abnormal heart function greatly reduces a person's ability to exercise, say U.S. researchers.

Dr. Jasmine Grewal, of the Mayo Clinic, and colleagues found that people with abnormal diastolic function (when the heart is relaxed and expanded) in the left ventricle have a substantially lower maximum capacity for exercise. The left ventricle is one of the four chambers of the heart.

The study included nearly 2,900 patients who underwent exercise echocardiography, which uses ultrasound to provide information about the structure and motions of the heart. The researchers also assessed left ventricular systolic (contraction) and diastolic function.

Patients with left ventricular diastolic dysfunction while resting had a much lower capacity for exercise than those with normal function. This reduction in exercise ability increased with age.

"In identifying diastolic function parameters as strong correlates of exercise capacity, we have identified potentially modifiable and preventable factors in the development of exercise intolerance. It is well known that exercise training improves diastolic function in healthy individuals ...," the researchers wrote.

The study was published the Jan. 21 issue of the Journal of the American Medical Association.

More information

The U.S. National Heart, Lung, and Blood Institute offers a physical activity guide.

WEDNESDAY, Jan. 14 (HealthDay News) -- A new study warns that the second generation of antipsychotic drugs, used to treat conditions ranging from schizophrenia to anxiety, put patients at higher risk of sudden death due to cardiac arrest.

The odds of a heart problem are low, and specialists said that the drugs are appropriate for certain patients. Still, doctors, families and patients should be cautious, said study lead author Wayne Ray, director of the Vanderbilt University School of Medicine's Division of Pharmacoepidemiology.

"If they're being used for schizophrenia, consider a cardiology evaluation. If you're considering using them for bipolar disorder, think about using another alternative drug first," Ray said.

And patients should rarely, if ever, take the drugs to treat other conditions, he said.

At issue are newer antipsychotic drugs -- clozapine (Clozaril), quetiapine (Seroquel), olanzapine (Zyprexa) and risperidone (Risperdal).

Federal health officials have approved the use of the drugs to treat schizophrenia and bipolar disorder, Ray said.

Doctors also prescribe them for so-called "off-label" uses to treat conditions such as anxiety, attention deficit disorder in children and dementia in the elderly.

"For schizophrenics, they work pretty well. They're pretty much the only alternative," Ray said. But other drugs offer alternatives for bipolar patients, he said.

For the new study, published in the Jan. 15 issue of the New England Journal of Medicine, Ray and his colleagues expanded on earlier research that suggested the newer drugs disrupt the heart's rhythm. The researchers examined the medical records of 44,218 patients who used the older antipsychotic drugs and 46,089 patients who used the newer ones. All the patients lived in Tennessee and were recipients of Medicaid, the government-sponsored insurance program that serves low-income people.

The researchers also looked at the records of 186,600 people who didn't use antipsychotic drugs.

They found that users of the newer drugs were 2.26 times more likely to suffer from sudden cardiac death than those not on the medications. Those who used the older drugs were 1.99 times more likely to die versus those not taking the medications.

Patients who took the highest doses were at the highest risk. Overall, the patients had a three-in-1,000 risk of sudden cardiac death a year, Ray said.

The numbers may seem low, but they're significant, Ray said. "If I were talking to a friend or family member, I'd advise them to avoid [the drugs] if possible."

The drugs appear to cause problems by disrupting potassium in the heart, causing its electrical rhythm to fail, Ray said.

Dr. Sebastian Schneeweiss, an associate professor of medicine and epidemiology at the Harvard School of Public Health, co-wrote an accompanying commentary in the journal. He said that, considering the risk and lack of evidence that the drugs are useful beyond limited cases, doctors should "sharply" reduce their use to treat conditions other than acute psychosis and schizophrenia.

More information

Learn more about the new antipsychotic drugs from the U.S. Food and Drug Administration.