Gender Differences in Outcomes After Hospital Discharge From Coronary Artery Bypass Grafting

Abstract

Background-There are few comparative data regarding long-term nonfatal outcomes for women versus men after coronary artery bypass grafting (CABG). This study compares gender differences in cardiac events in a population of hospital survivors up to 11 years after isolated CABG surgery in Ontario, Canada. Methods and Results-A population-based cohort study (nϭ68 774 patients, 15 043 women) between September 1, 1991, and April 1, 2002, was assembled with linked clinical and administrative databases. Cox modeling and propensity score matching were used to compare death, cardiac readmission (angina, heart failure, myocardial infarction), repeat revascularization (angioplasty or CABG), and stroke readmission between men and women. Women were older (65Ϯ17 versus 62Ϯ13 years), more likely to present with urgent or emergent status (64% versus 56%), and less likely to receive arterial grafts (70% versus 78%). Women had a higher rate of cardiac readmission in the first year after surgery (hazard ratio [HR] of 1.5, 95% confidence interval [CI] 1.36 to 1.56), and this increased risk persisted after 1 year (HR 1.2, 95% CI 1.14 to 1.31). This was primarily due to readmissions for unstable angina (HR 1.3, 95% CI 1.24 to 1.38) and congestive heart failure (HR 1.1, 95% CI 1.06 to 1.21). Propensity-matched women had similar rates of death (HR 0.9, 95% CI 0.83 to 0.98) and repeat revascularization (HR 1.0, 95% CI 0.91 to 1.06). Conclusions-Women have a more complex clinical preoperative presentation and are more likely to be readmitted with unstable angina and congestive heart failure after CABG but experience survival similar to those seen in men. Gender differences in outcomes may be improved through durable revascularization strategies and close postoperative follow-up care targeted to women. (Circulation. 2006;113:507-516.)

Socioeconomic Differences in Stroke Incidence and Prognosis Under a Universal Healthcare System

“…25 Out-of-hospital mortality in women contributes more to total incidence than male out-of-hospital mortality. This is not surprising; gender differences in recognizing symptoms of both myocardial infarction and stroke and late referral to the hospital have been reported among women, 26,27 and this could cause a higher probability of dying before hospitalization. It is interesting that we did not find socioeconomic differences in fatal events with the exception of men with ischemic stroke.…”

Hospital Variation in Readmission After Coronary Artery Bypass Surgery in California

“…6 Prior studies have found that women, older patients, and black patients have higher rates of readmission after CABG, although some studies have suggested that these differences are due to greater prevalence of comorbidities in these subgroups. [7][8][9][10] Despite identification of the major factors associated with readmission, models developed in prior studies have had limited discrimination in predicting readmission based on measured variables. 3,11 These findings suggest that the variation in readmission rates may be related to local practice patterns or unmeasured patient characteristics.…”

Sex Differences in the Epidemiology of New-Onset In-Hospital Post–Coronary Artery Bypass Graft Surgery Atrial Fibrillation

“…It is also not known how the characteristics of post-CABG AF affect long-term survival-nor whether such affects (including their magnitudes) are similar across sex. Given the inconsistencies in the existing evidence about whether (and why) women experience worse, equivalent, or better long-term outcomes after CABG, [40][41][42][43][44] this is a fertile area for research. Our results showing significant differences in both the riskadjusted incidence and duration of AF events between women and men provide important groundwork for future investigations of the sex-specific impacts on survival and of the sex-specific effectiveness of strategies for preventing and managing post-CABG AF.…”