Sex-related differences in access to care among patients with premature acute coronary syndrome

Pelletier, Roxanne; Humphries, Karin H.; Shimony, Avi; Bacon, Simon; Lavoie, Kim; Rabi, Doreen M.; Karp, Igor; Tsadok, Meytal Avgil; Pilote, Louise

doi:10.1503/cmaj.131450

Cited by 110 publications

(117 citation statements)

References 24 publications

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“…They are partly explained by clinical differences where women with ACS are older at presentation, have a higher burden of comorbidities, and tend to present later and with more atypical symptoms compared with men 3, 6, 7, 8, 9, 10. In addition, there are sex‐based differences in the primary and secondary treatment of coronary disease 11, 12, 13. For instance, the use of an early invasive strategy of prompt coronary angiography with revascularization as appropriate is substantially lower in women once non‐ST elevation ACS is recognized,14, 15, 16, 17, 18, 19 even though high‐risk women may derive similar benefit from an invasive strategy as men 19, 20, 21.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Women and Men With Acute Coronary Syndrome Treated With and Without Percutaneous Coronary Revascularization

Udell

Koh

Qiu

et al. 2017

JAHA

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BackgroundWomen hospitalized with a non‐ST segment elevation acute coronary syndrome (ACS) have worse clinical outcomes compared with men. An early invasive strategy with prompt coronary revascularization may mitigate sex differences in outcomes. However, few contemporary studies have evaluated whether clinical outcomes differ between women and men presenting with ACS treated with an early invasive strategy.Methods and ResultsA population‐based cohort of hospitalized ACS patients who received prompt cardiac catheterization from 2008 to 2011 in Ontario, Canada and followed for up to 2 years was studied. Clinical outcomes were compared between men and women, stratified by the use of coronary revascularization. Inverse probability weighting using the propensity score accounted for measured differences in baseline characteristics between men and women. Among the 23 473 ACS patients who received cardiac catheterization during an index hospitalization, 66.1% of men and 51.8% of women received coronary revascularization during the same hospitalization. In the propensity‐weighted cohort of patients who received coronary revascularization, the 1‐year rate of death or recurrent ACS was 10.6% for men (referent) compared with 13.1% for women (hazard ratio 1.24; 95% CI 1.16–1.33). In contrast, outcomes for patients who did not receive coronary revascularization did not differ significantly between women and men at 1 year (17.8% versus 16.9%; hazard ratio 1.06; 95% CI 0.99–1.14) or at longer follow‐up.ConclusionsAn increased risk of adverse clinical outcomes was observed for women with ACS undergoing an early invasive strategy and coronary revascularization compared with men.

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Section: Introductionmentioning

confidence: 99%

Outcomes of Women and Men With Acute Coronary Syndrome Treated With and Without Percutaneous Coronary Revascularization

Udell

Koh

Qiu

et al. 2017

JAHA

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“…72,73,79 Women are less likely to be given reperfusion for STEMI. 41,73,79 Women with non-STEMI or unstable angina are less likely to undergo PCI compared to men. …”

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confidence: 99%

“…40,41 In large adult ICU samples in the United States and Canada, despite greater illness severity in women, men received more aggressive care (mechanical ventilation, vasoactive medications, intravenous fluids, central catheters, arterial lines, PA catheters, CABG, thrombolytics, ICP monitoring), 42,43 especially women older than 50; women had higher ICU mortality. 38 2-part design compared physicians' attitudes with clinical practice in managing CAD risk factors.…”

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confidence: 99%

“…Women with STEMI were less likely than men to undergo reperfusion therapy (PCI or fibrinolysis) and women with non-STEMI or unstable angina less likely to undergo nonprimary percutaneous coronary intervention. 41 Fewer women than men sent for cardiac catheterization after MI despite greater functional disability from angina. 75 CABG performed less often for women (5.9%) than men (12.7%) with CAD and angina 75 ; same finding for cardiac catheterization 18 years later.…”

mentioning

confidence: 99%

“…72,73,79 Women are less likely to be given reperfusion for STEMI. 41,73,79 Women with non-STEMI or unstable angina are less likely to undergo PCI compared to men. 41 In hospitalized patients with chest pain, angina, or acute MI, women less likely than men to have coronary angiography and revascularization, even after controlling for potentially confounding variables.…”

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confidence: 99%

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Because Women’s Lives Matter, We Need to Eliminate Gender Bias

2017

Critical Care Nurse

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Using written vignettes of homicides that differed only in sex of perpetrator, forensic psychiatrists and students diagnosed the defendant as legally insane significantly more often when perpetrator was a woman. 11World Health Organization 12 and US 13 research found most behavioral disorders (depression, anxiety) are diagnosed twice as often in women.Men receive more intensive treatments than women for common conditions. 14 85% of men vs 55% of women receive oral antihyperglycemics. 15 Despite the UK NICE guideline 27 13,16 (mandates "urgent referral to an oncologist" for painless macroscopic hematuria), 27% of women vs 10% of men had multiple consults before referral. Bladder cancer 5-year survival rate is 57% for men, 44% for women. 17,18 Female gender is independent risk factor for delayed referral and diagnosis of bladder and renal cancer. 19 TKA referral in patients with comparable osteoarthritis severity: physicians deny sex influences referral, but referral rate for men is 3 times that for women. Using identical standardized patients, 42% of physicians recommended TKA for the male, but not the female. Odds of primary care physicians recommending TKA for men was twice that for women; for orthopedic physicians, odds for men was 22 times that for women. 20Patients with osteoarthritis needing hip replacement, women less likely than men to receive 4 of 5 care stages: consult with general practitioner, specialist referral, orthopedic consult, wait listed. 21 Women have more disability before referral. 22Women have lower probability of referral to waiting list for kidney transplantation and longer delay between dialysis and waiting list compared to men. 23-25Women had significantly lower liver transplantation rates than men from 1997 to 2007 and greater deficit to men since. 26Women had pain years longer than men before referral to pain clinic, where women are prescribed minor tranquilizers, sedatives, or antidepressants vs analgesics and opioids for men. 27After abdominal surgery, physicians prescribed less pain medication for women compared to men; nurses gave less pain medication to women. 28After CABG, men received narcotics, women given sedatives. 29First report on gender attributes of pain: physicians minimized women's pain by attributing it to emotional causes. 30 80 physicians (44 men) and 113 nurses (103 women) more likely to treat male patients with opioids than females. Disparity greater for nurses than physicians. 31Despite ACC/AHA PAD guidelines, at discharge, women are significantly less likely than men to be prescribed 3 recommended therapies: statins, aspirin, and β-blockers. 32,33Women are offered surgical revascularization less often (36.4%) than men (53.8%) and are offered CEA less often at all ages. 34 When CEA is offered to women, it is often on a very delayed basis. Delays persist after adjusting for age, history, preoperative TIA, ABCD2 score, degree of stenosis, unilateral symptoms, and symptomatic stenosis. 34 Findings most concerning because female gender is a known, negative, independ...

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Association of Lipid, Inflammatory, and Metabolic Biomarkers With Age at Onset for Incident Coronary Heart Disease in Women

Dugani

Moorthy

et al. 2021

JAMA Cardiol

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Sex-related differences in access to care among patients with premature acute coronary syndrome

Cited by 110 publications

References 24 publications

Outcomes of Women and Men With Acute Coronary Syndrome Treated With and Without Percutaneous Coronary Revascularization

Outcomes of Women and Men With Acute Coronary Syndrome Treated With and Without Percutaneous Coronary Revascularization

Because Women’s Lives Matter, We Need to Eliminate Gender Bias

Association of Lipid, Inflammatory, and Metabolic Biomarkers With Age at Onset for Incident Coronary Heart Disease in Women

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