Characteristics and Outcomes of Women Veterans Undergoing Cardiac Catheterization in the Veterans Affairs Healthcare System

Abstract

C oronary artery disease (CAD) remains the leading cause of death among women in the United States.1 Prior research has demonstrated that women with CAD are typically older than men and have more risk factors, such as diabetes mellitus, 2 hypertension, 3,4 hyperlipidemia, 5 obesity, 6 and congestive heart failure.4,7 Despite these higher rates of CAD risk factors, women have less obstructive CAD. 4,8 Studies are conflicting regarding whether women are treated less aggressively than their male counterparts. 9-15 Women tend to have more complications and worse outcomes after cardiac catheterization 16 and are less likely to receive evidence-based medical therapy after discharge. 17Women who have served in the military may have an even higher risk of CAD than nonveteran women, given the overall worse health status and higher number of CAD risk factors in the veteran population, 18-20 but little is known about the characteristics and treatment of women veterans suspected of having clinically significant CAD. The number of women seeking care at veterans affairs (VA) facilities has doubled over the past decade, 21 providing a unique opportunity to understand cardiac care and outcomes among women veterans. By extension, these lessons could improve our understanding of the sex differences noted in nonveteran cardiac populations.Background-The number of women veterans is increasing, yet little is known about their cardiovascular risk factors, coronary anatomy, cardiac treatments, and outcomes after cardiac catheterization. Prior studies have shown that nonveteran women have more risk factors, receive less aggressive treatment, and have worse outcomes, despite having less obstructive coronary artery disease than men. Whether these differences exist among women veterans in the veterans affairs healthcare system is unknown. Methods and Results-Data on 85 936 veterans (3181 women) undergoing initial cardiac catheterization between October 1, 2007, and September 30, 2012, were examined using the national veterans affairs Clinical Assessment Reporting and Tracking (CART) Program. Sex differences in demographics, indications, coronary anatomy, cardiac treatments, and outcomes were analyzed. Women veterans were younger (56.9 versus 63.0 years, P<0.0001) with fewer traditional cardiovascular risk factors, but with more obesity, depression, and posttraumatic stress disorder than men. Women had lower rates of obstructive coronary artery disease than men (22.6% versus 53.3%). Rates of procedural complications were similar in both genders. Adjusted outcomes at 1 year showed women had lower mortality (hazard ratio, 0.74; confidence interval, 0.60-0.92) and less all-cause rehospitalization (hazard ratio, 0.87; confidence interval, 0.82-0.93), but no difference in rates of unplanned percutaneous coronary intervention. Conclusions-Women veterans undergoing catheterization are younger, have more obesity, depression, and posttraumatic stress disorder, less obstructive coronary artery disease, and similar long-term outcomes, compared with m...

Psychosocial predictors of long-term mortality among women with suspected myocardial ischemia: the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation

“…Our results are also consistent with the results from a 2015 report focused on cardiac catheterization characteristics among more than 3000 female armed forces Veterans (as opposed to the civilian WISE sample; Davis et al, 2015). Similar to the WISE results reported here, female Veterans obtaining cardiac catheterization in the latter study showed low rates of obstructive CAD but relatively high rates of psychiatric comorbidities such as depression and anxiety (e.g., 55.3 and 20.1 % of the women in the latter sample met criteria for depression and posttraumatic stress disorder based on medical chart review).…”

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

“…Adjusted outcomes at 1 year showed females had lower mortality (HR, 0.74; 95% CI, 0.60–0.92) and less all-cause rehospitalization (HR, 0.87; 95% CI, 0.82–0.93), but there was no difference in rates of unplanned PCI. 37 …”

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

“…Overall estimates in women and men from the Veterans Administration Cardiovascular Assessment Reporting and Tracking System,16 the National Cardiac Data Registry, and the National Heart, Lung, and Blood Institute–sponsored Women's Ischemia Syndrome Evaluation (WISE)10 databases indicate that there are at least 3 to 4 million American women and men with stable INOCA. Incurred healthcare costs are similar to those for obstructive CAD.…”