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Women with STEMI more likely to die in a hospital than men
Research underscores gap in care.
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Men and women had about the same adjusted in-hospital death rate for MI, but women were twice as likely to die if hospitalized for STEMI.
Researchers analyzed data from the American Heart Association’s Get With the Guidelines program and the Coronary Artery Disease database to determine if recent efforts to improve MI care processes at hospitals have closed the sex disparity gap. They reviewed the clinical characteristics, treatments and outcomes of 78,254 men and women with acute MI admitted to 420 U.S. hospitals from 2001 to 2006.
Compared with men, women had more comorbidities, presented with less STEMI and had higher unadjusted in-hospital mortality rates (8.2% vs. 5.7%; P<.0001).
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Source: Circulation. 2008;doi:10.1161/CIRCULATION AHA.108.789800. |
When the researchers performed multivariable adjustment, in-hospital mortality rates were not different between men and women with acute MI (OR=1.04; 95% CI, 0.99-1.10). However, women with STEMI had an in-hospital mortality rate of 10.2% compared with 5.5% among men (OR=1.12; 95% CI, 1.02-1.23).
“The finding of persistently higher death rates among women experiencing the more severe type of MI (STEMI) and the persistent sex gap in certain aspects of care underscore the existing opportunities to enhance post-MI care among women,” Hani Jneid, MD, assistant professor of cardiovascular medicine at Baylor College of Medicine in Houston, said in a press release.
A decade ago, women had higher overall death rates after MI compared with men. This suggests that the hospitals examined in this study have been using high rates of evidence-based therapies known to increase survival after MI, according to the study. However, women were less likely to receive early aspirin treatment (OR=0.86; 95% CI, 0.81-0.90), beta-blockers (OR=0.90; 95% CI, 0.86-0.93), reperfusion therapy (OR=0.75; 95% CI, 0.70-0.80) or timely reperfusion therapy in 30 minutes or less (OR=0.78; 95% CI, 0.65-0.92). Use of cardiac catheterization and revascularization procedures after acute MI were also lower among women compared with men.
“We could not determine to which extent these differences were due to physicians’ failures to administer optimal therapies to women vs. appropriate decision-making based on biological and other differences between men and women,” Jneid said. – by Katie Kalvaitis
For more information:
- Circulation. 2008;doi:10.1161/CIRCULATIONAHA.108.789800.
This is a timely report card demonstrating persistent disparities in CV care that are adverse for women. Prior study demonstrates that application of guideline treatment strategies eliminates these gaps in mortality. It is time to take action to implement widespread guidelines with organizational and governmental support.
– C. Noel Bairey Merz, MD
Cardiology Today Editorial Board member