Sex Disparities in the Management of Acute Coronary Syndromes: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.

Autor: Sola M; Division of Cardiology, Department of Medicine University of Colorado Aurora CO USA.; Department of Medicine Rocky Mountain Veterans Affairs Medical Center Aurora CO USA., Mesenbring E; CART Program, Office of Quality and Patient Safety Veterans Health Administration Washington DC USA.; Denver Research institute Aurora CO USA., Glorioso TJ; CART Program, Office of Quality and Patient Safety Veterans Health Administration Washington DC USA., Gualano S; VA Ann Arbor Healthcare System Ann Arbor MI USA.; University of Michigan Ann Arbor MI USA., Atkinson T; Portland VA Medical Center Portland OR USA.; Knight Cardiovascular Institute, Oregon Health Sciences University Portland OR USA., Duvernoy CS; VA Ann Arbor Healthcare System Ann Arbor MI USA.; University of Michigan Ann Arbor MI USA., Waldo SW; Division of Cardiology, Department of Medicine University of Colorado Aurora CO USA.; Department of Medicine Rocky Mountain Veterans Affairs Medical Center Aurora CO USA.; CART Program, Office of Quality and Patient Safety Veterans Health Administration Washington DC USA.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Sep 03; Vol. 13 (17), pp. e034312. Date of Electronic Publication: 2024 Aug 29.
DOI: 10.1161/JAHA.123.034312
Abstrakt: Background: Previous work has demonstrated disparities in the management of cardiovascular disease among men and women. We sought to evaluate these disparities and their associations with clinical outcomes among patients admitted with acute coronary syndromes to the Veterans Affairs Healthcare System.
Methods and Results: We identified all patients that were discharged with acute coronary syndromes within the Veterans Affairs Healthcare System from October 1, 2015 to September 30, 2022. Medical and procedural management of patients was subsequently assessed, stratified by sex. In doing so, we identified 76 454 unique admissions (2327 women, 3.04%), which after propensity matching created an analytic cohort composed of 6765 men (74.5%) and 2295 women (25.3%). Women admitted with acute coronary syndromes were younger with fewer cardiovascular comorbidities and a lower prevalence of preexisting prescriptions for cardiovascular medications. Women also had less coronary anatomic complexity compared with men (5 versus 8, standardized mean difference [SMD]=0.40), as calculated by the Veterans Affairs SYNTAX score. After discharge, women were significantly less likely to receive cardiology follow-up at 30 days (hazard ratio [HR], 0.858 [95% CI, 0.794-0.928]) or 1 year (HR, 0.891 [95% CI, 0.842-0.943]), or receive prescriptions for guideline-indicated cardiovascular medications. Despite this, 1-year mortality rates were lower for women compared with men (HR, 0.841 [95% CI, 0.747-0.948]).
Conclusions: Women are less likely to receive appropriate cardiovascular follow-up and medication prescriptions after hospitalization for acute coronary syndromes. Despite these differences, the clinical outcomes for women remain comparable. These data suggest an opportunity to improve the posthospitalization management of cardiovascular disease regardless of sex.
Databáze: MEDLINE
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