Rehospitalization more common for young women vs. men after heart attack
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Key takeaways:
- Young women are more likely to be readmitted to the hospital after an acute MI than men of a similar age.
- Sex disparities were greater for noncardiac hospitalizations.
Young women who survive an acute MI are more likely to be readmitted during the year after discharge compared with similarly aged men, researchers reported.
In an analysis of data from the prospective Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study, which assessed the role of sex in outcomes after acute MI, researchers found that higher risks for young women vs. men were consistently observed for all-cause, coronary-related and noncardiac hospitalizations.
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“Hospitalizations in the subsequent year could be more related to comorbidities than to cardiac causes related to acute MI,” Harlan M. Krumholz, MD, SM, the Harold H. Hines, Jr. Professor of Medicine in the department of internal medicine and director of Yale New Haven Hospital Center for Outcomes Research and Evaluation, and colleagues wrote in the study background. “Conversely, it is possible that recurrent, related cardiovascular hospitalizations are the most common acute events for young women with acute MI in the United States because of a heavier burden of coronary risk factors and social determinants of health. This information has relevance to prevention efforts for these patients.”
Rehospitalization risk after MI
Krumholz and colleagues analyzed data from 2,979 participants from the VIRGO study, which enrolled young adults with acute MI across 103 U.S. hospitals. Researchers assessed sex differences in all-cause and cause-specific hospitalizations by calculating incidence rates per 1,000 person-years and incidence rate ratios.
The findings were published in the Journal of the American College of Cardiology.
Within the cohort, at least one hospitalization occurred among 905 patients (30.4%) in the year after discharge.
The leading causes of hospitalization were coronary related, with incidence rates of 171.8 among women (95% CI, 153.6-192.2) and 117.8 among men (95% CI, 97.3-142.6). The incidence rate for noncardiac hospitalizations was 145.8 for women (95% CI, 129.2-164.5) and 69.6 for men (95% CI, 54.5-88.9).
The researchers also observed sex-based differences for coronary-related hospitalizations, with a subdistribution HR of 1.33 (95% CI, 1.04-1.7; P = .02), as well as noncardiac hospitalizations, with a subdistribution HR of 1.51 (95% CI, 1.13-2.07; P = .01).
“This all begins with public awareness towards preventing heart attacks and screening programs to detect traditional risk factors before a patient has a heart attack. Many people think heart attacks only occur in middle-aged or older men, which is not true,” Mitsuaki Sawano, MD, PhD, a postdoctoral associate at Yale-New Haven Hospital Center for Outcomes Research and Evaluation, said in a press release. “People need to be aware that heart attacks occur in young women as well and they can present with atypical symptoms. After experiencing a heart attack, young women will be more likely to need a 360-level approach.”
Improve care before discharge
In a related editorial, Martha Gulati, MD, MS, FACC, FAHA, FASPC, FESC, president of the American Society for Preventive Cardiology, professor of medicine at the Smidt Heart Institute at Cedars-Sinai, director of CVD prevention and associate director of the Barbra Streisand Women’s Heart Center, and colleagues wrote that effective solutions to close the gap in sex disparities “rest on the shoulders of clearly defined problems.”
“This study importantly identifies an increased rate of cardiovascular and noncardiovascular rehospitalization in women in comparison with men, and a clear association with psychosocial and demographic factors,” Gulati and colleagues wrote. “Yet, the root cause of sex differences in psychosocial factors and rates of comorbid conditions remains elusive. Why are more women than men identified as having low income in this cohort? Why does this cohort demonstrate a nearly twofold greater prevalence of depression in women than in men? As a cardiovascular community, by continuing to ask why, perhaps we can arrive at ‘what next.’”
The researchers noted that the study highlighted an important role for improvement in peridischarge care to prevent rehospitalization.
“Solutions to the observed sex differences may fall into three categories: individual, health system-based, and policy-level interventions,” Gulati and colleagues wrote.
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