Analyzing cardiovascular treatment guidelines application to women and minority populations

Abstract

Despite nearly 30 years of treatment guidelines for cardiovascular diseases and risk factors and a parallel growth in the understanding of cardiovascular disease disparities by sex and race/ethnicity, such disparities persist. The goals of this review are to consider the possible role of three factors: the one-size-fits-all approach of most treatment guidelines, adoption of guideline-recommended treatments in clinical practice, and patient adherence to recommended practice, especially the relationship between adherence and patient perceptions. Guideline authors repeatedly call for more inclusion of women and minorities in the clinical trials that make guidelines possible, but despite challenges, guidelines are largely effective when implemented, as shown by a wealth of post hoc analyses. However, the data also suggest that one-size-fits-all treatment guidelines are not sufficiently generalizable and there is evidence of a distinct lag time between definitive clinical evidence and its widespread implementation. Patient perspectives may also play both a direct and indirect role in adherence to treatments. What emerges from the literature is an important continuing need for increased inclusion of women and minority subgroups in clinical trials to allow analyses that can provide evidence for differential treatments when needed. Increased effort is needed to implement definitive clinical improvements more rapidly. Patient input and feedback may also help inform clinical practice and clinical research with a better understanding of how to enhance patient adherence, but evidence for this is lacking for the groups most affected by disparities.

Sex Differences in Baseline Characteristics Do Not Predict Early Outcomes after Percutaneous Coronary Intervention: Results from the Australian GenesisCare Cardiovascular Outcomes Registry (GCOR)

“…Cardiovascular disease (CVD) is one of the leading causes of death in women worldwide including USA and Australia [1,2]. Most of the studies on outcome and increased mortality in women undergoing percutaneous intervention (PCI) has focussed on acute coronary syndromes (ACS), with information on chronic stable angina mostly derived from registries and sub-studies [1].…”

“…In patients, presenting with ACS, studies have reported women to suffer increased morbidity and a higher risk of mortality following an index myocardial infarction (MI) event [2][3][4][5]. This has often been attributed to delayed diagnosis, and decreased access to angiography and reperfusion resulting from sex-based disparities in the clinical presentation [6].…”