Healthcare disparities for women hospitalised with myocardial infarction and angina
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Ischaemic heart disease persists as the leading global cause of death. Myocardial infarction (MI) accounts for a large proportion of death due to cardiovascular disease. Between 2007 and 2016, age-sex standardised mortality for MI in Scotland has fallen by 42.5% from 129 to 74 per 100,000 population – a trend also apparent in other countries. Despite improvements in survival, considerable disparities exist according to sexin terms of delivery of guideline-recommended treatments and outcomes following MI suggesting women may be disadvantaged. Use of high-sensitivity troponin assays with sex-specific thresholds increases the detection of MI in women. However, women are less likely to undergo percutaneous coronary revascularisation (PCI) and are more often subject to underutilisation of evidence-based secondary preventative pharmacotherapy. Differences in adoption of invasive management may, in part, be explained by a perception held by clinicians and patients that outcomes are worse for women receiving PCI, as well as differences in symptoms and baseline risk profile which may impact clinical decision-making. Adverse events post-MI, including cardiogenic shock, heart failure and death, remain more common in women than in men, most notably in those with ST-elevation myocardial infarction (STEMI). Whether sex remains an independent predictor of adverse events despite adjustments for the higher risk-profile of women, notably age, is less clear. We hypothesised that sex-related differences in demographics and comorbidity underpin disparities in management and outcomes of women and men hospitalised with MI or angina. We investigated this hypothesis by analysis of a contemporary secondary care electronic registry (e-Registry) using electronic patient records (EPRs) for patients admitted to a complex regional healthcare network.
Jackson , A M , Zhang , R , Robertson , K , Lindsay , M , Morris , T , Forbes , B , Papworth , R , McConnachie , A , Mangion , K , Jhund , P S , McCowan , C & Berry , C 2019 , ' Healthcare disparities for women hospitalised with myocardial infarction and angina ' , European Heart Journal - Quality of Care and Clinical Outcomes . https://doi.org/10.1093/ehjqcco/qcz040
European Heart Journal - Quality of Care and Clinical Outcomes
© 2019 the Author(s). Published on behalf of the European Society of Cardiology. All rights reserved. This work has been made available online in accordance with publisher policies or with permission from the rights holder. Permissions for further reuse of this content should be sought from the rights holder. This is the author created accepted manuscript following peer review and may differ slightly from the final published version. The published version should be used for citation purposes. The final published version of this work is available at https://doi.org/10.1093/ehjqcco/qcz040
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