eaving the hospital. It also seeks to increase the number of patients who get counseling about diet and smoking before they leave the hospital, and sign a contract with their doctor or nurse pledging to follow recommendations and stick to their medicines.

On the whole, men treated after the quality effort began were more likely to receive pre-discharge prescriptions for all four classes of recommended heart medications than were women. The quality effort significantly improved the use of only two of the drugs – beta blockers and aspirin -- in women.

The new analysis showing differences in the delivery of care to women and men, even after the quality improvement effort, raises an important question of how hospitals implement quality measures.

Some previous studies by other researchers have found that doctors are less likely to deliver evidence-based medical care -- the foundation of quality improvement efforts like GAP – to women compared with men. But the new study is the first to show a correlation between this failure and mortality. "We owe women heart attack patients a full examination of the factors that might lead them to receive fewer of the proven drugs and lifestyle tips than men receive," says Eagle. "Now that we know that they get just as much mortality benefit as men when quality standards are applied to their care, we must find ways to ensure that they are all treated according to those standards."


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