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Women less likely than men to receive optimal care for CAD
Among patients with CAD aged 65 years or older, women were less likely to receive optimal care than men, which may account for much of women’s increased risk for mortality after CAD treatment, according to recent study results.
However, researchers found that blacks were more likely to die of CAD than whites, and quality of care had no bearing on that disparity.
Deepak L. Bhatt, MD, MPH, from Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, and colleagues analyzed 49,358 patients aged 65 years or older admitted to a U.S. hospital with CAD between 2003 and 2009 and included in the Get With the Guidelines–Coronary Artery Disease registry and linked to Medicare inpatient data.
Deepak L. Bhatt
Bhatt, who is chief medical editor of Cardiology Today’s Intervention, and colleagues investigated disparities in 3-year mortality by sex, race/ethnicity and geographic region, with optimal quality of care as a mediator.
During the 3-year follow-up period, 32.7% of patients died, including 35.6% of women, 30.8% of men, 38.5% of blacks, 38.3% of Asians, 32.3% of whites and 29.8% of Hispanics, Bhatt and colleagues reported.
Sex disparities
Compared with men, women were more likely to have hypertension and HF when admitted to the hospital (P < .0001) and were less likely to be given lipid-lowering therapies and receive in-hospital procedures (P < .0001), both of which contributed to them being less likely to receive optimal care at hospital discharge (OR = 0.92; 95% CI, 0.88-0.95), the researchers wrote.
Overall, the unadjusted 1.2-fold increase in 3-year mortality held by women over men was attenuated when adjusted for demographic and medical characteristics (OR = 0.99; 95% CI, 0.95-1.03), but Bhatt and colleagues found that women who received suboptimal care had higher odds of mortality than men (OR = 1.25; 95% CI, 1-1.55). The same was not true for women who received optimal care (OR = 0.97; 95% CI, 0.93-1.01).
They determined that approximately 69% of the sex disparity associated with 3-year all-cause mortality in this population could be reduced if all women received optimal care (P = .001).
The sex disparity in mortality occurred in patients younger than 80 years, but not in those aged 80 years or older (P for interaction = .004), they wrote.
Race, ethnicity, region
Bhatt and colleagues found no significant differences in quality of care measures by race or ethnicity. They also found that blacks had higher odds for 3-year mortality than whites (OR = 1.33; 95% CI, 1.21-1.46) regardless of their quality of care, and this was not attenuated by providing optimal quality of care.
The researchers did not identify any significant mortality differences or differences in quality of care between geographic regions.
“Our results suggest that providing optimal care to cardiac patients could yield large gains in reducing sex-related disparities,” Bhatt and colleagues wrote. “Providing optimal health could not fully eliminate the racial disparity in long-term mortality, suggesting that there are other intrinsic factors and social determinants that might be the underlying mediating mechanism.” – by Erik Swain
Disclosure: Bhatt reports financial ties with Amarin, AstraZeneca, Biotronik, Boston Scientific, Bristol-Myers Squibb, Eisai, Elsevier, Ethicon, FlowCo, Forest Laboratories, Ischemix, Medtronic, Pfizer, PLx Pharma, Roche, Sanofi Aventis, St. Jude Medical, Takeda and The Medicines Company. See the full study for a list of the other researchers’ relevant financial disclosures.