Clinical Investigation
Acute Ischemic Heart Disease
Gender disparity in cardiac procedures and medication use for acute myocardial infarction

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Objective

Determine if gender bias is present in contemporary management of acute myocardial infarction (AMI).

Background

Despite major advances in medicine, disparities in healthcare still persist. Previous studies on gender bias in the diagnosis and treatment of AMI are inconsistent and may not represent more contemporary practice.

Methods and Results

Data were collected from the Minnesota Heart Survey, a population-based study of patients presenting with AMI in 2001-02. In-hospital diagnostic and therapeutic approaches were compared between women and men using logistic regression models. We identified 1242 women and 1378 men with an AMI defined by either positive cardiac biomarkers or ST-elevation on electrocardiogram. There were no differences in the prescription of aspirin, beta-blockers, ACE inhibitors or angiotensin receptor blockers. Women were 46% less likely than men to undergo investigative coronary angiography [OR = 0.54 (0.45-0.64)]. After accounting for confounders, women remained less likely to be referred for angiography [OR = 0.73 (0.57-0.94)]. Revascularization rates, were similar between women and men [OR = 0.96 (0.72-1.28)]. However, women were more likely to undergo PCI [OR = 1.41 (1.07-1.86)] whereas men were more likely to have coronary artery bypass grafting (CABG) [OR = 0.57 (0.39-0.84)]. When severity of coronary artery disease (CAD) was incorporated into the model, gender no longer influenced the modality of coronary revascularization.

Conclusions

There is no evidence of gender bias in the pharmacologic treatment of AMI. Evidence of gender bias persists in the referral of patients for coronary angiography but not in the subsequent use of coronary revascularization.

Section snippets

Data sources

The MHS is an ongoing cross-sectional study designed to describe population trends in cardiovascular diseases of patients age 30 and older residing in the Minneapolis-St. Paul metropolitan area (2000 Census: 2.6 million). Details of the methods are described in prior publications.11 This analysis was based on the most recent survey, performed on patients discharged between July 1, 2001 and June 30, 2002, with a discharge diagnosis of AMI. Data abstraction from hospital medical records was

Results

During the study period, the MHS registry abstracted data on 3019 subjects treated for AMI. From this sample, 368 (12%) subjects developed an AMI while hospitalized for a non-cardiac cause and were excluded. An additional 31 (1%) subjects failed to meet validation criteria for AMI, leaving 2,620 subjects — 1242 women and 1378 men — in our study sample.

Discussion

In an era of evidence-based guidelines and quality improvement initiatives, one might not expect gender to play a role in the assessment and management of cardiovascular disease. To the contrary, we observed evidence of gender bias in specific aspects of AMI care. While presenting symptoms varied by gender, there were no significant differences in either the ECGs or the proportion of positive cardiac biomarkers. Gender did not influence the pharmacologic therapy of AMI. The primary influence of

Conclusions

While we found no evidence of a gender bias in pharmacologic therapy or revascularization, our study revealed gender bias was present in the use of diagnostic cardiac angiography. Gender also influenced coronary reperfusion modality — favoring PCI for women and CABG for men. However, this differential utilization in revascularization therapies reflected, in part, the more severe CAD pattern observed in men. When disease severity was considered, the disparity in care strategy was no longer

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    Disclosures: JTN received support from the Ruth Kirschstein National Research Service Award.

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