Narrowing gender differences in procedure use for acute myocardial infarction: insights from the Worcester heart attack study
Department of Medicine, Division of Cardiovascular Medicine
Age Factors; Aged; Angioplasty, Transluminal, Percutaneous Coronary; data; Coronary Artery Bypass; Cross-Sectional Studies; Echocardiography; Exercise Test; Female; Heart Catheterization; Humans; Male; Massachusetts; Middle Aged; Multivariate Analysis; Myocardial Infarction; Odds Ratio; Research Design; Sex Distribution; *Women's Health
Life Sciences | Medicine and Health Sciences
OBJECTIVE: To examine age-specific gender differences and trends over time in the management of patients with acute myocardial infarction (AMI). DESIGN: Cross-sectional study of patients admitted with AMI from a community-wide perspective over a 10-year period (1990-1999). SETTING: All hospitals in the Worcester (Mass) metropolitan area (1990 census = 437000). PATIENTS/PARTICIPANTS: We identified 2037 women and 2645 men who were hospitalized in the Worcester metropolitan area with confirmed AMI during six 1-year periods between 1990 and 1999. Four age groups (<55, 55 to 64, 65 to 74 and >or=75 years) of men and women were studied. MEASUREMENTS AND MAIN RESULTS: Use of echocardiography, exercise treadmill testing (ETT), cardiac catheterization, percutaneous coronary interventions (PCI), and coronary artery bypass grafting (CABG) during the index hospitalization was examined in relation to age and gender. Overall, women were less likely to undergo ETT, cardiac catheterization, and CABG than were men, and these trends remained after controlling for potentially confounding factors. Between 1990 and 1999, there was a dramatic decrease in ETT, whereas the use of echocardiography remained unchanged. There were marked increases over time in the use of cardiac catheterization and PCI in women and men. Use of cardiac catheterization and PCI increased to a greater extent in women as compared to men. In patients who underwent cardiac catheterization, rates of coronary revascularization were similar between men and women. CONCLUSIONS: Our data suggest that women and men with AMI are treated differently with respect to use of diagnostic and revascularization procedures. However, gender differences in the use of these diagnostic and interventional approaches have narrowed over time.
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Citation: J Gen Intern Med. 2003 Jun;18(6):423-31.
Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine
Harrold, Leslie R.; Esteban, Julian; Lessard, Darleen M.; Yarzebski, Jorge L.; Gurwitz, Jerry H.; Gore, Joel M.; and Goldberg, Robert J., "Narrowing gender differences in procedure use for acute myocardial infarction: insights from the Worcester heart attack study" (2003). Open Access Articles. 1058.