Trends of Sex Differences in Clinical Outcomes After Myocardial Infarction in the United States
Female patients have been shown to experience worse clinical outcomes after acute myocardial infarction (AMI) compared with male patients. However, it is unclear what trend these differences followed over time. Data from patients hospitalized with AMI between 2004 and 2015 in the National Inpatient...
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| Veröffentlicht in: | CJC open (Online) Jg. 3; H. 12; S. S19 - S27 |
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| Sprache: | Englisch |
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Elsevier Inc
01.12.2021
Elsevier |
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| Abstract | Female patients have been shown to experience worse clinical outcomes after acute myocardial infarction (AMI) compared with male patients. However, it is unclear what trend these differences followed over time.
Data from patients hospitalized with AMI between 2004 and 2015 in the National Inpatient Sample were retrospectively analyzed, stratified according to sex. Multivariable logistic regression analyses were performed to examine the adjusted odds ratios (aORs) of invasive management and in-hospital outcomes according to sex. The Mantel-Haenszel extension of the χ2 test was performed to examine the trend of management and in-hospital outcomes over the study period.
Of 7,026,432 AMI hospitalizations, 39.7% (n = 2,789,494) were women. Overall, women were older (median: 77 vs 70 years), with a higher prevalence of risk factors such as diabetes, hypertension, and depression. Women were less likely to receive coronary angiography (aOR, 0.92; 95% confidence interval [CI], 0.91-0.93) and percutaneous coronary intervention (aOR, 0.82; 95% CI, 0.81-0.83) compared with men. Odds of all-cause mortality were higher in women (aOR, 1.03; 95% CI, 1.02-1.04; P < 0.001) and these rates have not narrowed over time (2004 vs 2015: aOR, 1.07 [95% CI, 1.04-1.09] vs 1.11 [95% CI, 1.07-1.15), with similar observations recorded for major adverse cardiovascular and cerebrovascular events.
In this temporal analysis of AMI hospitalizations over 12 years, we showed lower receipt of invasive therapies and higher mortality rates in women, with no change in temporal trends. There needs to be a systematic and consistent effort toward exploring these disparities to identify strategies to mitigate them.
Il a été démontré que les femmes présentent de moins bons résultats cliniques après un infarctus aigu du myocarde (IAM) que les hommes. Cependant, la tendance de ces différences dans le temps n’est pas claire.
Les données de la National Inpatient Sample sur les patients hospitalisés pour un IAM entre 2004 et 2015 ont été analysées rétrospectivement, stratifiées selon le sexe. Des analyses de régression logistique multidimensionnelles ont été effectuées pour examiner les rapports de cotes ajustés (RCA) de la prise en charge par un traitement invasif et des résultats obtenus en milieu hospitalier en fonction du sexe. Le test du χ2 étendu de Mantel-Haenszel a été effectué pour examiner la tendance de la prise en charge et des résultats en milieu hospitalier au cours de la période d’étude.
Sur 7 026 432 patients hospitalisés pour un IAM, 39,7 % (n = 2 789 494) étaient des femmes. Dans l’ensemble, les femmes étaient plus âgées (âge médian : 77 vs 70 ans), avec une plus forte prévalence de facteurs de risque comme le diabète, l’hypertension et la dépression. Les femmes étaient moins susceptibles que les hommes de subir une coronarographie (RCA : 0,92; intervalle de confiance [IC] à 95 % : 0,91-0,93) et une intervention coronarienne percutanée (RCA : 0,82; IC à 95 % : 0,81-0,83). Les probabilités de mortalité toutes causes confondues étaient plus élevées chez les femmes (RCA : 1,03; IC à 95 % : 1,02-1,04; p < 0,001), et ces taux n’ont pas diminué avec le temps (2004 vs 2015 : RCA : 1,07 [IC à 95 % : 1,04-1,09] vs 1,11 [IC à 95 % : 1,07-1,15), des observations similaires étant consignées pour les événements cardiovasculaires et vasculaires cérébraux majeurs.
Dans cette analyse temporelle des hospitalisations pour IAM sur 12 ans, nous avons montré que les femmes subissaient moins de traitements invasifs et présentaient des taux de mortalité plus élevés, sans changement dans les tendances temporelles. Il faut un effort systématique et cohérent pour explorer ces disparités afin de cibler des stratégies pour les atténuer.
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| AbstractList | Female patients have been shown to experience worse clinical outcomes after acute myocardial infarction (AMI) compared with male patients. However, it is unclear what trend these differences followed over time.
Data from patients hospitalized with AMI between 2004 and 2015 in the National Inpatient Sample were retrospectively analyzed, stratified according to sex. Multivariable logistic regression analyses were performed to examine the adjusted odds ratios (aORs) of invasive management and in-hospital outcomes according to sex. The Mantel-Haenszel extension of the χ2 test was performed to examine the trend of management and in-hospital outcomes over the study period.
Of 7,026,432 AMI hospitalizations, 39.7% (n = 2,789,494) were women. Overall, women were older (median: 77 vs 70 years), with a higher prevalence of risk factors such as diabetes, hypertension, and depression. Women were less likely to receive coronary angiography (aOR, 0.92; 95% confidence interval [CI], 0.91-0.93) and percutaneous coronary intervention (aOR, 0.82; 95% CI, 0.81-0.83) compared with men. Odds of all-cause mortality were higher in women (aOR, 1.03; 95% CI, 1.02-1.04; P < 0.001) and these rates have not narrowed over time (2004 vs 2015: aOR, 1.07 [95% CI, 1.04-1.09] vs 1.11 [95% CI, 1.07-1.15), with similar observations recorded for major adverse cardiovascular and cerebrovascular events.
In this temporal analysis of AMI hospitalizations over 12 years, we showed lower receipt of invasive therapies and higher mortality rates in women, with no change in temporal trends. There needs to be a systematic and consistent effort toward exploring these disparities to identify strategies to mitigate them.
Il a été démontré que les femmes présentent de moins bons résultats cliniques après un infarctus aigu du myocarde (IAM) que les hommes. Cependant, la tendance de ces différences dans le temps n’est pas claire.
Les données de la National Inpatient Sample sur les patients hospitalisés pour un IAM entre 2004 et 2015 ont été analysées rétrospectivement, stratifiées selon le sexe. Des analyses de régression logistique multidimensionnelles ont été effectuées pour examiner les rapports de cotes ajustés (RCA) de la prise en charge par un traitement invasif et des résultats obtenus en milieu hospitalier en fonction du sexe. Le test du χ2 étendu de Mantel-Haenszel a été effectué pour examiner la tendance de la prise en charge et des résultats en milieu hospitalier au cours de la période d’étude.
Sur 7 026 432 patients hospitalisés pour un IAM, 39,7 % (n = 2 789 494) étaient des femmes. Dans l’ensemble, les femmes étaient plus âgées (âge médian : 77 vs 70 ans), avec une plus forte prévalence de facteurs de risque comme le diabète, l’hypertension et la dépression. Les femmes étaient moins susceptibles que les hommes de subir une coronarographie (RCA : 0,92; intervalle de confiance [IC] à 95 % : 0,91-0,93) et une intervention coronarienne percutanée (RCA : 0,82; IC à 95 % : 0,81-0,83). Les probabilités de mortalité toutes causes confondues étaient plus élevées chez les femmes (RCA : 1,03; IC à 95 % : 1,02-1,04; p < 0,001), et ces taux n’ont pas diminué avec le temps (2004 vs 2015 : RCA : 1,07 [IC à 95 % : 1,04-1,09] vs 1,11 [IC à 95 % : 1,07-1,15), des observations similaires étant consignées pour les événements cardiovasculaires et vasculaires cérébraux majeurs.
Dans cette analyse temporelle des hospitalisations pour IAM sur 12 ans, nous avons montré que les femmes subissaient moins de traitements invasifs et présentaient des taux de mortalité plus élevés, sans changement dans les tendances temporelles. Il faut un effort systématique et cohérent pour explorer ces disparités afin de cibler des stratégies pour les atténuer.
[Display omitted] Female patients have been shown to experience worse clinical outcomes after acute myocardial infarction (AMI) compared with male patients. However, it is unclear what trend these differences followed over time.BACKGROUNDFemale patients have been shown to experience worse clinical outcomes after acute myocardial infarction (AMI) compared with male patients. However, it is unclear what trend these differences followed over time.Data from patients hospitalized with AMI between 2004 and 2015 in the National Inpatient Sample were retrospectively analyzed, stratified according to sex. Multivariable logistic regression analyses were performed to examine the adjusted odds ratios (aORs) of invasive management and in-hospital outcomes according to sex. The Mantel-Haenszel extension of the χ2 test was performed to examine the trend of management and in-hospital outcomes over the study period.METHODSData from patients hospitalized with AMI between 2004 and 2015 in the National Inpatient Sample were retrospectively analyzed, stratified according to sex. Multivariable logistic regression analyses were performed to examine the adjusted odds ratios (aORs) of invasive management and in-hospital outcomes according to sex. The Mantel-Haenszel extension of the χ2 test was performed to examine the trend of management and in-hospital outcomes over the study period.Of 7,026,432 AMI hospitalizations, 39.7% (n = 2,789,494) were women. Overall, women were older (median: 77 vs 70 years), with a higher prevalence of risk factors such as diabetes, hypertension, and depression. Women were less likely to receive coronary angiography (aOR, 0.92; 95% confidence interval [CI], 0.91-0.93) and percutaneous coronary intervention (aOR, 0.82; 95% CI, 0.81-0.83) compared with men. Odds of all-cause mortality were higher in women (aOR, 1.03; 95% CI, 1.02-1.04; P < 0.001) and these rates have not narrowed over time (2004 vs 2015: aOR, 1.07 [95% CI, 1.04-1.09] vs 1.11 [95% CI, 1.07-1.15), with similar observations recorded for major adverse cardiovascular and cerebrovascular events.RESULTSOf 7,026,432 AMI hospitalizations, 39.7% (n = 2,789,494) were women. Overall, women were older (median: 77 vs 70 years), with a higher prevalence of risk factors such as diabetes, hypertension, and depression. Women were less likely to receive coronary angiography (aOR, 0.92; 95% confidence interval [CI], 0.91-0.93) and percutaneous coronary intervention (aOR, 0.82; 95% CI, 0.81-0.83) compared with men. Odds of all-cause mortality were higher in women (aOR, 1.03; 95% CI, 1.02-1.04; P < 0.001) and these rates have not narrowed over time (2004 vs 2015: aOR, 1.07 [95% CI, 1.04-1.09] vs 1.11 [95% CI, 1.07-1.15), with similar observations recorded for major adverse cardiovascular and cerebrovascular events.In this temporal analysis of AMI hospitalizations over 12 years, we showed lower receipt of invasive therapies and higher mortality rates in women, with no change in temporal trends. There needs to be a systematic and consistent effort toward exploring these disparities to identify strategies to mitigate them.CONCLUSIONSIn this temporal analysis of AMI hospitalizations over 12 years, we showed lower receipt of invasive therapies and higher mortality rates in women, with no change in temporal trends. There needs to be a systematic and consistent effort toward exploring these disparities to identify strategies to mitigate them. Female patients have been shown to experience worse clinical outcomes after acute myocardial infarction (AMI) compared with male patients. However, it is unclear what trend these differences followed over time. Data from patients hospitalized with AMI between 2004 and 2015 in the National Inpatient Sample were retrospectively analyzed, stratified according to sex. Multivariable logistic regression analyses were performed to examine the adjusted odds ratios (aORs) of invasive management and in-hospital outcomes according to sex. The Mantel-Haenszel extension of the χ test was performed to examine the trend of management and in-hospital outcomes over the study period. Of 7,026,432 AMI hospitalizations, 39.7% (n = 2,789,494) were women. Overall, women were older (median: 77 vs 70 years), with a higher prevalence of risk factors such as diabetes, hypertension, and depression. Women were less likely to receive coronary angiography (aOR, 0.92; 95% confidence interval [CI], 0.91-0.93) and percutaneous coronary intervention (aOR, 0.82; 95% CI, 0.81-0.83) compared with men. Odds of all-cause mortality were higher in women (aOR, 1.03; 95% CI, 1.02-1.04; < 0.001) and these rates have not narrowed over time (2004 vs 2015: aOR, 1.07 [95% CI, 1.04-1.09] vs 1.11 [95% CI, 1.07-1.15), with similar observations recorded for major adverse cardiovascular and cerebrovascular events. In this temporal analysis of AMI hospitalizations over 12 years, we showed lower receipt of invasive therapies and higher mortality rates in women, with no change in temporal trends. There needs to be a systematic and consistent effort toward exploring these disparities to identify strategies to mitigate them. AbstractBackgroundFemale patients have been shown to experience worse clinical outcomes after acute myocardial infarction (AMI) compared with male patients. However, it is unclear what trend these differences followed over time. MethodsData from patients hospitalized with AMI between 2004 and 2015 in the National Inpatient Sample were retrospectively analyzed, stratified according to sex. Multivariable logistic regression analyses were performed to examine the adjusted odds ratios (aORs) of invasive management and in-hospital outcomes according to sex. The Mantel-Haenszel extension of the χ 2 test was performed to examine the trend of management and in-hospital outcomes over the study period. ResultsOf 7,026,432 AMI hospitalizations, 39.7% (n = 2,789,494) were women. Overall, women were older (median: 77 vs 70 years), with a higher prevalence of risk factors such as diabetes, hypertension, and depression. Women were less likely to receive coronary angiography (aOR, 0.92; 95% confidence interval [CI], 0.91-0.93) and percutaneous coronary intervention (aOR, 0.82; 95% CI, 0.81-0.83) compared with men. Odds of all-cause mortality were higher in women (aOR, 1.03; 95% CI, 1.02-1.04; P < 0.001) and these rates have not narrowed over time (2004 vs 2015: aOR, 1.07 [95% CI, 1.04-1.09] vs 1.11 [95% CI, 1.07-1.15), with similar observations recorded for major adverse cardiovascular and cerebrovascular events. ConclusionsIn this temporal analysis of AMI hospitalizations over 12 years, we showed lower receipt of invasive therapies and higher mortality rates in women, with no change in temporal trends. There needs to be a systematic and consistent effort toward exploring these disparities to identify strategies to mitigate them. Background: Female patients have been shown to experience worse clinical outcomes after acute myocardial infarction (AMI) compared with male patients. However, it is unclear what trend these differences followed over time. Methods: Data from patients hospitalized with AMI between 2004 and 2015 in the National Inpatient Sample were retrospectively analyzed, stratified according to sex. Multivariable logistic regression analyses were performed to examine the adjusted odds ratios (aORs) of invasive management and in-hospital outcomes according to sex. The Mantel-Haenszel extension of the χ2 test was performed to examine the trend of management and in-hospital outcomes over the study period. Results: Of 7,026,432 AMI hospitalizations, 39.7% (n = 2,789,494) were women. Overall, women were older (median: 77 vs 70 years), with a higher prevalence of risk factors such as diabetes, hypertension, and depression. Women were less likely to receive coronary angiography (aOR, 0.92; 95% confidence interval [CI], 0.91-0.93) and percutaneous coronary intervention (aOR, 0.82; 95% CI, 0.81-0.83) compared with men. Odds of all-cause mortality were higher in women (aOR, 1.03; 95% CI, 1.02-1.04; P < 0.001) and these rates have not narrowed over time (2004 vs 2015: aOR, 1.07 [95% CI, 1.04-1.09] vs 1.11 [95% CI, 1.07-1.15), with similar observations recorded for major adverse cardiovascular and cerebrovascular events. Conclusions: In this temporal analysis of AMI hospitalizations over 12 years, we showed lower receipt of invasive therapies and higher mortality rates in women, with no change in temporal trends. There needs to be a systematic and consistent effort toward exploring these disparities to identify strategies to mitigate them. Résumé: Contexte: Il a été démontré que les femmes présentent de moins bons résultats cliniques après un infarctus aigu du myocarde (IAM) que les hommes. Cependant, la tendance de ces différences dans le temps n’est pas claire. Méthodologie: Les données de la National Inpatient Sample sur les patients hospitalisés pour un IAM entre 2004 et 2015 ont été analysées rétrospectivement, stratifiées selon le sexe. Des analyses de régression logistique multidimensionnelles ont été effectuées pour examiner les rapports de cotes ajustés (RCA) de la prise en charge par un traitement invasif et des résultats obtenus en milieu hospitalier en fonction du sexe. Le test du χ2 étendu de Mantel-Haenszel a été effectué pour examiner la tendance de la prise en charge et des résultats en milieu hospitalier au cours de la période d’étude. Résultats: Sur 7 026 432 patients hospitalisés pour un IAM, 39,7 % (n = 2 789 494) étaient des femmes. Dans l’ensemble, les femmes étaient plus âgées (âge médian : 77 vs 70 ans), avec une plus forte prévalence de facteurs de risque comme le diabète, l’hypertension et la dépression. Les femmes étaient moins susceptibles que les hommes de subir une coronarographie (RCA : 0,92; intervalle de confiance [IC] à 95 % : 0,91-0,93) et une intervention coronarienne percutanée (RCA : 0,82; IC à 95 % : 0,81-0,83). Les probabilités de mortalité toutes causes confondues étaient plus élevées chez les femmes (RCA : 1,03; IC à 95 % : 1,02-1,04; p < 0,001), et ces taux n’ont pas diminué avec le temps (2004 vs 2015 : RCA : 1,07 [IC à 95 % : 1,04-1,09] vs 1,11 [IC à 95 % : 1,07-1,15), des observations similaires étant consignées pour les événements cardiovasculaires et vasculaires cérébraux majeurs. Conclusions: Dans cette analyse temporelle des hospitalisations pour IAM sur 12 ans, nous avons montré que les femmes subissaient moins de traitements invasifs et présentaient des taux de mortalité plus élevés, sans changement dans les tendances temporelles. Il faut un effort systématique et cohérent pour explorer ces disparités afin de cibler des stratégies pour les atténuer. |
| Author | Mehta, Laxmi S. Parwani, Purvi Matetic, Andrija Mohamed, Mohamed Osama Rashid, Muhammad Volgman, Annabelle Santos Coutinho, Thais Shamkhani, Warkaa Sharma, Garima Van Spall, Harriette G.C. Mamas, Mamas A. |
| Author_xml | – sequence: 1 givenname: Andrija surname: Matetic fullname: Matetic, Andrija organization: Department of Cardiology, University Hospital of Split, Split, Croatia – sequence: 2 givenname: Warkaa orcidid: 0000-0002-0727-6187 surname: Shamkhani fullname: Shamkhani, Warkaa organization: Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom – sequence: 3 givenname: Muhammad surname: Rashid fullname: Rashid, Muhammad organization: Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom – sequence: 4 givenname: Annabelle Santos surname: Volgman fullname: Volgman, Annabelle Santos organization: Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA – sequence: 5 givenname: Harriette G.C. surname: Van Spall fullname: Van Spall, Harriette G.C. organization: Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada – sequence: 6 givenname: Thais surname: Coutinho fullname: Coutinho, Thais organization: Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA – sequence: 7 givenname: Laxmi S. surname: Mehta fullname: Mehta, Laxmi S. organization: Loma Linda University, Loma Linda, California, USA – sequence: 8 givenname: Garima surname: Sharma fullname: Sharma, Garima organization: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada – sequence: 9 givenname: Purvi surname: Parwani fullname: Parwani, Purvi organization: Population Health Research Institute, Hamilton, Ontario, Canada – sequence: 10 givenname: Mohamed Osama surname: Mohamed fullname: Mohamed, Mohamed Osama organization: Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom – sequence: 11 givenname: Mamas A. surname: Mamas fullname: Mamas, Mamas A. email: mamasmamas1@yahoo.co.uk organization: Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34993430$$D View this record in MEDLINE/PubMed |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 These authors contributed equally to this work. |
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| Snippet | Female patients have been shown to experience worse clinical outcomes after acute myocardial infarction (AMI) compared with male patients. However, it is... AbstractBackgroundFemale patients have been shown to experience worse clinical outcomes after acute myocardial infarction (AMI) compared with male patients.... Background: Female patients have been shown to experience worse clinical outcomes after acute myocardial infarction (AMI) compared with male patients. However,... |
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| Title | Trends of Sex Differences in Clinical Outcomes After Myocardial Infarction in the United States |
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