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Narrowing gender differences in procedure use for acute myocardial infarction

Insights from the worcester heart attack study

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Abstract

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 =437,000).

PATIENTS/PARTICIPANTS: We identified 2,037 women and 2,645 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 ≥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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Authors and Affiliations

  1. Department of Medicine, University of Massachusetts Medical School 55 Lake Ave. North, 01655, Worcester, MA

    Leslie R. Harrold MD, MPH

Authors
  1. Leslie R. Harrold MD, MPH
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  2. Julian Esteban MD, MS
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  3. Darleen Lessard MS
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  4. Jorge Yarzebski MD, MPH
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  5. Jerry H. Gurwitz MD
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  6. Joel M. Gore MD
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  7. Robert J. Goldberg PhD
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Corresponding author

Correspondence to Leslie R. Harrold MD, MPH.

Additional information

Received from the Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass.

This study was made possible through the cooperation of the administration, medical records, and cardiology departments of participating Worcester metropolitan area hospitals. Dr. Harrold was supported by a Beginning Grant-in-Aid award from the American Heart Association. Grant support for this project was provided by the National Heart, Lung, and Blood Institute (RO1 HL35434).

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Harrold, L.R., Esteban, J., Lessard, D. et al. Narrowing gender differences in procedure use for acute myocardial infarction. J GEN INTERN MED 18, 423–431 (2003). https://doi.org/10.1046/j.1525-1497.2003.20929.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2003.20929.x

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