Sex differences in discharge destination following acute myocardial infarction

Perl, Leor; Peiffer, Véronique; Fuhrer, Audelia Eshel; D’Ascenzo, Fabrizio; Pietzsch, Jan B.

doi:10.1097/mca.0000000000000643

Cited by 3 publications

(3 citation statements)

References 41 publications

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“…Sex as a biological variable underlies physiological variation in vascular function, coagulation, fibrinolysis and energy metabolism, among others [8, 9]. Gender also contributes to CVD risk through differences in social roles, environmental exposures, health seeking behaviors, and access to resources including medical care [4, 10, 11].…”

Section: Introductionmentioning

confidence: 99%

Female sex and cardiovascular disease risk in rural Uganda: a cross-sectional, population-based study

Magodoro

Feng

North

et al. 2019

BMC Cardiovasc Disord

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Background Sex-based differences in cardiovascular disease (CVD) burden are widely acknowledged, with male sex considered a risk factor in high-income settings. However, these relationships have not been examined in sub-Saharan Africa (SSA). We aimed to apply the American Heart Association (AHA) ideal cardiovascular health (CVH) tool modified by the addition of C-reactive protein (CRP) to examine potential sex-based differences in the prevalence of CVD risk in rural Uganda. Methods In a cross-sectional study nested within a population-wide census, 857 community-living adults completed physical and laboratory-based assessments to calculate individual ideal CVH metrics including an eight category for CRP levels. We summarized sex-specific ideal CVH indices, fitting ordinal logistic regression models to identify correlates of improving CVH. As secondary outcomes, we assessed subscales of ideal CVH behaviours and factors . Models included inverse probability of sampling weights to determine population-level estimates. Results The weighted-population mean age was 39.2 (1.2) years with 52.0 (3.7) % females. Women had ideal scores in smoking (80.4% vs. 68.0%; p < 0.001) and dietary intake (26.7% vs. 16.8%; p = 0.037) versus men, but the opposite in body mass index (47.3% vs. 84.4%; p < 0.001), glycated hemoglobin (87.4% vs. 95.2%; p = 0.001), total cholesterol (80.2% vs. 85.0%; p = 0.039) and CRP (30.8% vs. 49.7%; p = 0.009). Overall, significantly more men than women were classified as having optimal cardiovascular health (6–8 metrics attaining ideal level) (39.7% vs. 29.0%; p = 0.025). In adjusted models, female sex was correlated with lower CVH health factors sub-scales but higher ideal CVH behaviors. Conclusions Contrary to findings in much of the world, female sex in rural SSA is associated with worse ideal CVH profiles, despite women having better indices for ideal CVH behaviors. Future work should assess the potential role of socio-behavioural sex-specific risk factors for ideal CVH in SSA, and better define the downstream consequences of these differences. Electronic supplementary material The online version of this article (10.1186/s12872-019-1072-9) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Female sex and cardiovascular disease risk in rural Uganda: a cross-sectional, population-based study

Magodoro

Feng

North

et al. 2019

BMC Cardiovasc Disord

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“…Prior data have demonstrated that women with AMI discharged to skilled nursing facilities have higher in-hospital mortality. 37 Taken in aggregate, these findings may suggest that women have a poorer social support system and potentially face earlier withdrawal of care. In this administrative database, it was not possible to quantify these qualitative measures including marital status, presence of advanced directives, and the outcomes from palliative care consultation.…”

Section: Discussionmentioning

confidence: 99%

Sex Disparities in the Use and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock

et al. 2020

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Background There are limited sex-specific data on patients receiving temporary mechanical circulatory support (MCS) for acute myocardial infarction-cardiogenic shock (AMI-CS). Methods All admissions with AMI-CS with MCS use were identified using the National Inpatient Sample from 2005 to 2016. Outcomes of interest included in-hospital mortality, discharge disposition, use of palliative care and do-not-resuscitate (DNR) status, and receipt of durable left ventricular assist device (LVAD) and cardiac transplantation. Results In AMI-CS admissions during this 12-year period, MCS was used more frequently in men—50.4% vs 39.5%; P < 0.001. Of the 173,473 who received MCS (32% women), intra-aortic balloon pumps, percutaneous LVAD, extracorporeal membrane oxygenation, and ≥ 2 MCS devices were used in 92%, 4%, 1%, and 3%, respectively. Women were on average older (69 ± 12 vs 64 ± 13 years), of black race (10% vs 6%), and had more comorbidity (mean Charlson comorbidity index 5.0 ± 2.0 vs 4.5 ± 2.1). Women had higher in-hospital mortality than men (34% vs 29%, adjusted odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.16-1.23; P < 0.001) overall, in intra-aortic balloon pumps users (OR: 1.20 [95% CI: 1.16-1.23]; P < 0.001), and percutaneous LVAD users (OR: 1.75 [95% CI: 1.49-2.06]; P < 0.001), but not in extracorporeal membrane oxygenation or ≥ 2 MCS device users ( P > 0.05). Women had higher use of palliative care, DNR status, and discharges to skilled nursing facilities. Conclusions There are persistent sex disparities in the outcomes of AMI-CS admissions receiving MCS support. Women have higher in-hospital mortality, palliative care consultation, and use of DNR status.

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“…In this study examining the course of STEMI patients treated with PPCI presenting with CS, we observed that female patients suffer from worse short-and long-term outcomes when compared with men. Information regarding the worse outcomes experienced by women suffering from CAD and ACS requiring PCI is well known [10][11][12][19][20][21]. However, outcomes for women compared with men in CS following STEMI have yet to be clearly defined.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Sex on Cardiogenic Shock Outcomes Following ST Elevation Myocardial Infarction

Arnold,

Perl,

Assali

et al. 2023

JCM

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Background: Cardiogenic shock (CS) remains the leading cause of ST elevation myocardial infarction (STEMI)-related mortality. Contemporary studies have shown no sex-related differences in mortality. Methods: STEMI-CS patients undergoing primary percutaneous coronary intervention (PPCI) were included based on a dedicated prospective STEMI database. We compared sex-specific differences in CS characteristics at baseline, during hospitalization, and in subsequent clinical outcomes. Endpoints included all-cause mortality and major adverse cardiac events (MACE). Results: Of 3202 consecutive STEMI patients, 210 (6.5%) had CS, of which 63 (30.0%) were women. Women were older than men (73.2 vs. 65.5% y, p < 0.01), and more had hypertension (68.3 vs. 52.8%, p = 0.019) and diabetes (38.7 vs. 24.8%, p = 0.047). Fewer were smokers (13.3 vs. 41.2%, p < 0.01), had previous PCI (9.1 vs. 22.3% p = 0.016), or required IABP (35.3 vs. 51.1% p = 0.027). Women had higher rates of mortality (53.2 vs. 35.3% in-hospital, p = 0.01; 61.3 vs. 41.9% at 1 month, p = 0.01; and 73.8 vs. 52.6% at 3 years, p = 0.05) and MACE (60.6 vs. 41.6% in-hospital, p = 0.032; 66.1 vs. 45.6% at 1 month, p = 0.007; and 62.9 vs. 80.3% at 3 years, p = 0.015). After multivariate adjustment, female sex remained an independent factor for death (HR-2.42 [95% CI 1.014–5.033], p = 0.042) and MACE (HR-1.91 [95% CI 1.217–3.031], p = 0.01). Conclusions: CS complicating STEMI is associated with greater short- and long-term mortality and MACE in women. Sex-focused measures to improve diagnosis and treatment are mandatory for CS patients.

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Sex differences in discharge destination following acute myocardial infarction

Abstract: Discharge to SNF following AMI is more frequent for female patients, even after adjustment for risk factors. Our findings highlight the need to better characterize this unique patient population and understand the cycle of care that they receive following AMI.

Cited by 3 publications

References 41 publications

Female sex and cardiovascular disease risk in rural Uganda: a cross-sectional, population-based study

Female sex and cardiovascular disease risk in rural Uganda: a cross-sectional, population-based study

Sex Disparities in the Use and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock

The Impact of Sex on Cardiogenic Shock Outcomes Following ST Elevation Myocardial Infarction

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