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Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative.

Publication ,  Journal Article
Blomkalns, AL; Chen, AY; Hochman, JS; Peterson, ED; Trynosky, K; Diercks, DB; Brogan, GX; Boden, WE; Roe, MT; Ohman, EM; Gibler, WB; Newby, LK ...
Published in: J Am Coll Cardiol
March 15, 2005

OBJECTIVES: We hypothesized that significant disparities in gender exist in the management of patients with non-ST-segment elevation (NSTE) acute coronary syndromes (ACS). BACKGROUND: Gender-related differences in the diagnosis and treatment of ACS have important healthcare implications. No large-scale examination of these disparities has been completed since the publication of the revised American College of Cardiology/American Heart Association guidelines for management of patients with NSTE ACS. METHODS: Using data from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative, we examined differences of gender in treatment and outcomes among patients with NSTE ACS. RESULTS: Women (41% of 35,875 patients) were older (median age 73 vs. 65 years) and more often had diabetes and hypertension. Women were less likely to receive acute heparin, angiotensin-converting enzyme inhibitors, and glycoprotein IIb/IIIa inhibitors and less commonly received aspirin, angiotensin-converting enzyme inhibitors, and statins at discharge. The use of cardiac catheterization and revascularization was higher in men, but among patients with significant coronary disease, percutaneous revascularization was performed in a similar proportion of women and men. Women were at higher risk for unadjusted in-hospital death (5.6% vs. 4.3%), reinfarction (4.0% vs. 3.5%), heart failure (12.1% vs. 8.8%), stroke (1.1% vs. 0.8%), and red blood cell transfusion (17.2% vs. 13.2%), but after adjustment, only transfusion was higher in women. CONCLUSIONS: Despite presenting with higher risk characteristics and having higher in-hospital risk, women with NSTE ACS are treated less aggressively than men.

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Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

March 15, 2005

Volume

45

Issue

6

Start / End Page

832 / 837

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Syndrome
  • Sex Factors
  • Risk Factors
  • Quality of Health Care
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Patient Admission
  • Middle Aged
  • Male
 

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Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

March 15, 2005

Volume

45

Issue

6

Start / End Page

832 / 837

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Syndrome
  • Sex Factors
  • Risk Factors
  • Quality of Health Care
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Patient Admission
  • Middle Aged
  • Male