Sex-related inequalities in management of patients with acute coronary syndrome-results from the EURHOBOP study

Abstract

Summary Background Real‐world data from different levels of hospital specialisation would help to understand if differences in management between women and men with acute coronary syndrome (ACS) are still a priority target. We aimed to identify sex inequalities in management of patients with different types of ACS. Methods We analysed 1757 patients with a non‐ST‐elevation ACS (NSTEACS) and 1184 with ST elevation myocardial infarction (STEMI) or left bundle branch block (non‐classifiable (NC) ACS (STEMI/NC ACS group), consecutively discharged from ten Portuguese hospitals with different specialisation levels, between 2008 and 2010. We estimated odds ratios (OR) and 95% confidence intervals (95% CI) for the association between sex and the performance of coronary angiography, reperfusion and revascularisation. Results Among STEMI/NC ACS, men had higher probability of performing coronary angiography than women (adjusted OR = 1.64, 95% CI: 1.11‐2.44), while among NSTEACS patients there was no significant difference by sex (adjusted OR = 1.26, 95% CI: 0.99‐1.62). In patients who underwent coronary angiography, there was no difference in proportion of women and men submitted to revascularisation, regardless of the ACS type. Although men with STEMI/NC ACS were more likely to undergo reperfusion (crude OR = 2.17, 95% CI: 1.68‐2.81), the effect became not significant after multivariable adjustment (adjusted OR = 1.33, 95% CI: 0.96‐1.84). Conclusion Women diagnosed with STEMI/NC, but not NSTEACS, had lower probability when compared with men to be submitted to coronary angiography. There was no difference in performance of reperfusion and revascularisation by sex.

Evidence base for the management of women with non-ST elevation acute coronary syndrome

“…Registry data from Sweden show a similar pattern following ACS (n=180 368, 65 394 women) in which women were less likely than men to receive aspirin (85.7% vs 89.4%), beta-blockers (83.6% vs 86.0%), statins (67.8% vs 79.5%) and P2Y 12 inhibitors (58.6% vs 66.8%) 9. Discrepancies in the receipt of guideline-indicated therapy between men and women have been extensively reported elsewhere and is likely to be a contributing factor to the observed increased mortality in women following MI 4 10 11. Women have higher platelet reactivity and response to antiplatelet therapy with a higher bleeding risk at baseline (online supplemental file).…”

“…Over 160 000 women annually are hospitalised with coronary heart disease (CHD) in the UK alone 5. Although men classically have been considered high risk for CHD, women tend to have relatively poorer outcomes and are less likely to receive guideline-indicated pharmacological and invasive coronary treatments during and after discharge following MI 6–13. There is also evidence that even when women do receive the current guideline recommended invasive treatments, they might not receive the same benefit as men and have a higher mortality rate 8 14–16.…”

Estructura de comunidades en las redes semánticas de la investigación biomédica sobre disparidades en salud y sexismo

“…Como ya se mencionó en la introducción, las causas de las disparidades corresponden a múltiples factores (38). En la enfermedad cardiovascular, por ejemplo, aunque estas disparidades se han asociado con la atención médica y el manejo clínico, existen otros elementos que interactúan y pueden modificar la expresión de la enfermedad (39)(40)(41)(42).…”

Paramedic perspectives on sex and gender equity in prehospital electrocardiogram acquisition

“…7 Possible explanations for the gap in observed outcomes include both physiological and social factors. 5,9,[11][12][13] As an example, a recent survey of knowledge among women in the United States about cardiovascular disease illustrates how cultural assumptions about ACS could contribute to systematic bias: 45% of women did not know that cardiovascular disease was the leading cause of death among women, and women, in general, perceived a range of barriers and stigmas associated with seeking medical care and maintaining a schedule of regular check-ups. 12 Efforts to improve patient outcomes in ACS have emphasized the importance of early recognition and transport.…”