Healthcare disparities for women hospitalised with myocardial infarction and angina

Jackson, A. M. et al. (2020) Healthcare disparities for women hospitalised with myocardial infarction and angina. European Heart Journal: Quality of Care and Clinical Outcomes, 6(2), pp. 156-165. (doi: 10.1093/ehjqcco/qcz040) (PMID:31346604) (PMCID:PMC7132925)

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Abstract

Aims: Ischaemic heart disease persists as the leading cause of death in both men and women in most countries and sex disparities, defined as differences in health outcomes and their determinants, may be relevant. We examined sex disparities in presenting characteristics, treatment and all-cause mortality in patients hospitalized with myocardial infarction (MI) or angina. Methods and results: We conducted a cohort study of all patients admitted with MI or angina (01 October 2013 to 30 June 2016) from a secondary care acute coronary syndrome e-Registry in NHS Scotland linked with national registers of community drug dispensation and mortality data. A total of 7878 patients hospitalized for MI or angina were prospectively included; 3161 (40%) were women. Women were older, more deprived, had a greater burden of comorbidity, were more often treated with guideline-recommended therapy preadmission and less frequently received immediate invasive management. Men were more likely to receive coronary angiography [adjusted odds ratio (OR) 1.52, confidence interval (CI) 1.37–1.68] and percutaneous coronary intervention (adjusted OR 1.68, CI 1.52–1.86). Women were less comprehensively treated with evidence-based therapies post-MI. Women had worse crude survival, primarily those with ST-elevation myocardial infarction (14.3% vs. 8.0% at 1 year, P < 0.001), but this finding was explained by differences in baseline factors. Men with non-ST-elevation myocardial infarction had a higher risk of all-cause death at 30 days [adjusted hazard ratio (HR) 1.72, CI 1.16–2.56] and 1 year (adjusted HR 1.38, CI 1.12–1.69). Conclusion: After taking account of baseline risk factors, sex differences in treatment pathway, use of invasive management, and secondary prevention therapies indicate disparities in guideline-directed management of women hospitalized with MI or angina.

Item Type:Articles
Additional Information:This work was supported by a Joint Working Agreement with AstraZeneca UK Ltd, NHS Greater Glasgow and Clyde, the Golden Jubilee Foundation and the British Heart Foundation (Centre of Research Excellence Award RE/186134217, Clinical Training Fellowship FS/15/54/ 31639 to K.M. and Clinical Training Fellowship FS/18/14/33330 to A.M.J.).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McConnachie, Professor Alex and Mangion, Dr Kenneth and Berry, Professor Colin and Jackson, Dr Alice and Jhund, Dr Pardeep and Papworth, Dr Richard
Authors: Jackson, A. M., Zhang, R., Findlay, I., Robertson, K., Lindsay, M., Morris, T., Forbes, B., Papworth, R., McConnachie, A., Mangion, K., Jhund, P. S., McCowan, C., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:European Heart Journal: Quality of Care and Clinical Outcomes
Publisher:Oxford University Press
ISSN:2058-5225
ISSN (Online):2058-1742
Published Online:25 July 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in European Heart Journal: Quality of Care and Clinical Outcomes 6(2): 156–165
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
301144The epidemiology of peripartum cardiomyopathy in a Western European country: An analysis of the Scottish population 1990-2016Pardeep JhundBritish Heart Foundation (BHF)FS/18/14/33330Institute of Cardiovascular & Medical Sciences