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Different access to care exists for women and men with ACS
A new study highlights gender-related differences in the access to care for younger adults with ACS.
Researchers evaluated 1,123 patients aged 18 to 55 years who were hospitalized for ACS and enrolled in the multicenter, prospective GENESIS-PRAXY cohort study between 2009 and April 2013. The study included 362 women (median age, 50 years) and 761 men (median age, 49 years). Door-to-electrocardiography, door-to-needle and door-to-balloon times, as well as the incidence of cardiac catheterization, reperfusion or nonprimary PCI, were assessed.
Men had a median door-to-ECG time of 21 minutes vs. 15 minutes for women; median door-to-needle time of 36 minutes vs. 28 minutes for women; and median time to primary PCI of 106 minutes vs. 93 minutes for women.
Door-to-ECG times that met the established benchmark of 10 minutes or less were less common among women compared with men (29% vs. 38%; P=.02). Women with STEMI were less likely than men to receive primary PCI or fibrinolysis (83% vs. 91%; P=.01), and those who underwent fibrinolysis were less likely to receive treatment within the established benchmark of 30 minutes or less after admission (32% vs. 57%; P=.01). Women with non-STEMI or unstable angina also were less likely than men to receive nonprimary PCI (48% vs. 66%; P<.001).
Factors associated with poorer access to care included the absence of chest pain, symptoms of anxiety and more CVD risk factors. Women with anxiety symptoms according to the Hospital Anxiety and Depression Scale were significantly less likely to receive ECG within 10 minutes of admission than women without anxiety (24% vs. 35%; P=.04), but this difference was not significant among men (37% vs. 38%; P=.8).
Researchers also observed associations between poorer access to care and responsibility for housework and feminine personality traits among both men and women. Patients responsible for housework were less likely to receive nonprimary PCI (OR=0.62; 95% CI, 0.41-0.95) or catheterization (OR=0.68; 95% CI, 0.46-0.99) compared with those not responsible for housework, whereas patients with higher femininity scores on the Bem Sex-Role Inventory were less likely to receive nonprimary PCI compared with those with lower scores (OR=0.75; 95% CI, 0.59-0.95).
“Our results indicating that lower proportions of women than men received timely ECG and fibrinolysis present a clinical challenge in providing appropriate care,” the researchers wrote. “Indeed, failure to meet benchmark door-to-ECG and door-to-needle times has been associated with an increased risk of death and recurrent events among patients with STEMI. … As such, there is room for improvement in the identification and treatment of ACS among younger adults, especially young women.”
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.