Fewer women undergo revascularization for heart attack vs. men
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Key takeaways:
- Heart attacks, both STEMI and non-STEMI, declined less for men vs. women from 2011 to 2018.
- Women received revascularization less often and were more often older with more comorbidities.
Despite larger declines in STEMI and non-STEMI events from 2011 to 2018, women received proportionately fewer revascularization procedures and had a higher STEMI mortality rate vs. men, researchers reported.
Women hospitalized with STEMI or non-STEMI were generally older compared with men and had more comorbidities, according to findings published in Circulation: Cardiovascular Quality and Outcomes.
“Acute MI is a leading cause of morbidity and mortality in high-income countries. There has been long-standing concern about sex-based disparities in acute MI treatment and outcomes for females relative to males. In addition to potentially presenting with different symptoms than males, females experience acute MI at an older age than males and are less likely to receive coronary revascularization,” Hannah Lu, BSA, trainee at the John Sealy School of Medicine at University of Texas Medical Branch, and colleagues wrote.
The researchers used data from the population-representative International Health Systems Research Collaborative to compare rates of acute MI hospitalization, receipt of cardiac interventions and mortality in more than 1.5 million men and women aged 66 years and older hospitalized with STEMI or non-STEMI in the U.S., Canada, England, the Netherlands, Israel and Taiwan.
Rates of heart attack in men vs. women
In all countries, women hospitalized with STEMI or non-STEMI were on average 3 to 4 years older than hospitalized men and had higher rates of comorbid conditions; however, at any time point from 2011 to 2018, less than 50% of hospitalized patients were women. The only exception was for non-STEMI hospitalization in the U.S., which decreased from 50.7% in 2011 to 46.9% in 2018.
In general, the age-standardized rates of STEMI and non-STEMI hospitalizations decreased in all countries for both men and women from 2011 to 2018, but the decline was proportionately smaller for men, according to the study.
Revascularization and mortality in men vs. women
The gap in receipt of PCI for women compared with men varied between countries; however, as of 2018, PCI for STEMI was performed less frequently in women across all countries, ranging from 3% lower in the U.S. to 8.5% lower in Taiwan.
The proportion of patients who received CABG for STEMI decreased in all countries from 2011 to 2018 and was performed in fewer women compared with men in all countries except for Taiwan, where 3.6% of women with STEMI underwent CABG compared with 3% of men.
Patterns in revascularization for non-STEMI were generally similar in all countries for both 90-day revascularization and revascularization during index hospitalization.
From 2011 to 2018, 30-day mortality after STEMI increased for both men and women in Canada, England and Israel and decreased in the U.S., the Netherlands and Taiwan. During that period, mortality after non-STEMI increased for both men and women in England and decreased in all other countries except for Israel, where mortality slightly increased for women and decreased in men.
Thirty-day mortality after STEMI was higher in women compared with men at any timepoint in most countries, ranging from 0.1% higher in England to 5.7% higher in Taiwan.
Thirty-day non-STEMI mortality was generally lower among women compared with men at any timepoint across all countries.
“We found that between 2011 and 2018 in six diverse high-income countries the declines in acute MI hospitalization were smaller for males than females,” the researchers wrote. “We also extend prior research by demonstrating that females were less likely to receive cardiac interventions than males in all countries and had higher mortality after STEMI. In aggregate, our analysis exemplifies how international health system comparisons can be used to better discern patterns of care within and across countries.”
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