Yuling Hong

Sex Differences in Medical Care and Early Death After Acute Myocardial Infarction

Background— Women receive less evidence-based medical care than men and have higher rates of death after acute myocardial infarction (AMI). It is unclear whether efforts undertaken to improve AMI care have mitigated these sex disparities in the current era. Methods and Results— Using the Get With the Guidelines–Coronary Artery Disease database, we examined sex differences in care processes and in-hospital death among 78 254 patients with AMI in 420 US hospitals from 2001 to 2006. Women were older, had more comorbidities, less often presented with ST-elevation myocardial infarction (STEMI), and had higher unadjusted in-hospital death (8.2% versus 5.7%; P<0.0001) than men. After multivariable adjustment, sex differences in in-hospital mortality rates were no longer observed in the overall AMI cohort (adjusted odds ratio [OR]=1.04; 95% CI, 0.99 to 1.10) but persisted among STEMI patients (10.2% versus 5.5%; P<0.0001; adjusted OR=1.12; 95% CI, 1.02 to 1.23). Compared with men, women were less likely to receive early aspirin treatment (adjusted OR=0.86; 95% CI, 0.81 to 0.90), early &bgr;-blocker treatment (adjusted OR=0.90; 95% CI, 0.86 to 0.93), reperfusion therapy (adjusted OR=0.75; 95% CI, 0.70 to 0.80), or timely reperfusion (door-to-needle time ≤30 minutes: adjusted OR=0.78; 95% CI, 0.65 to 0.92; door-to-balloon time ≤90 minutes: adjusted OR=0.87; 95% CI, 0.79 to 0.95). Women also experienced lower use of cardiac catheterization and revascularization procedures after AMI. Conclusions— Overall, no sex differences in in-hospital mortality rates after AMI were observed after multivariable adjustment. However, women with STEMI had higher adjusted mortality rates than men. The underuse of evidence-based treatments and delayed reperfusion among women represent potential opportunities for reducing sex disparities in care and outcome after AMI.

Overview of the American Heart Association "Get with the Guidelines" programs: coronary heart disease, stroke, and heart failure.

Despite recent advances in scientific knowledge about and improvement of treatment and prevention (primary and secondary) for heart disease and stroke, these conditions remain the number one and 3 causes of death in the United States. Every year, there are nearly 500,000 deaths from coronary heart disease and over 160,000 from stroke in the country. An estimated 700,000 Americans have new coronary heart disease (CHD) every year and an additional 500,000 have recurrent CHD events. The corresponding numbers for stroke are 500,000 and 200,000. The burden of heart failure in the society is also substantial. Deaths attributable to heart failure as the primary or secondary cause total 265,000 per year. In addition, there are one million annual heart failure discharges from hospitals. The combined annual direct and indirect cost for CHD, stroke, and heart failure exceeds

Improved treatment of hospitalized coronary artery disease patients with the get with the guidelines program

225 billion. This enormous burden of disease is also associated with numerous data collection efforts in hospitals to assess the quality of care delivered in coronary artery disease (CAD), heart failure, and stroke. These include the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) ORYX and the Centers for Medicare & Medicaid Services (CMS) measure sets for acute myocardial infarction and heart failure, the National Registry of Myocardial Infraction, GRACE for acute coronary syndromes, The Paul Coverdell National Acute Stroke Registry, and ADHERE for heart failure. Table 1 presents data from several of these sources that demonstrate, despite wide dissemination of these guidelines, recommended interventions are frequently not initiated during hospitalization for acute cardiac events, heart failure, and stroke.