Sustained sex-based treatment differences in acute coronary syndrome care: Insights from the American Heart Association Get With The Guidelines Coronary Artery Disease Registry.

Published

Journal Article

BACKGROUND:Sex-based differences in acute coronary syndrome (ACS) mortality may attenuate with age due to better symptom recognition and prompt care. HYPOTHESIS:Age is a modifier of temporal trends in sex-based differences in ACS care. METHODS:Among 104 817 eligible patients with ACS enrolled in the AHA Get With the Guidelines-Coronary Artery Disease registry between 2003 and 2008, care and in-hospital mortality were evaluated stratified by sex and age. Temporal trends within sex and age groups were assessed for 2 care processes: percentage of STEMI patients presenting to PCI-capable hospitals with a DTB time ≤ 90 minutes (DTB90) and proportion of eligible ACS patients receiving aspirin within 24 hours. RESULTS:After adjustment for clinical risk factors and sociodemographic and hospital characteristics, 2276 (51.7%) women and 6276 (56.9%) men with STEMI were treated with DTB90 (adjusted OR: 0.85, 95% CI: 0.80-0.91, P < 0.0001 for women vs men). Time trend analysis showed an absolute increase ranging from 24% to 35% in DTB90 rates among both men and women (P for trend <0.0001 for each group), with consistent differences over time across the 4 age/sex groups (3-way P-interaction = 0.93). Despite high rate of baseline aspirin use (87%-91%), there was a 9% to 11% absolute increase in aspirin use over time, also with consistent differences across the 4 age/sex groups (all 3-way P-interaction ≥0.15). CONCLUSIONS:Substantial gains of generally similar magnitude existed in ACS performance measures over 6 years of study across sex and age groups; areas for improvement remain, particularly among younger women.

Full Text

Duke Authors

Cited Authors

  • Udell, JA; Fonarow, GC; Maddox, TM; Cannon, CP; Frank Peacock, W; Laskey, WK; Grau-Sepulveda, MV; Smith, EE; Hernandez, AF; Peterson, ED; Bhatt, DL; Get With The Guidelines Steering Committee and Investigators,

Published Date

  • June 2018

Published In

Volume / Issue

  • 41 / 6

Start / End Page

  • 758 - 768

PubMed ID

  • 29521450

Pubmed Central ID

  • 29521450

Electronic International Standard Serial Number (EISSN)

  • 1932-8737

International Standard Serial Number (ISSN)

  • 0160-9289

Digital Object Identifier (DOI)

  • 10.1002/clc.22938

Language

  • eng