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Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative.
J Am Coll Cardiol 2005; 45(6):832-7JACC

Abstract

OBJECTIVES

We hypothesized that significant disparities in gender exist in the management of patients with non-ST-segment elevation (NSTE) acute coronary syndromes (ACS).

BACKGROUND

Gender-related differences in the diagnosis and treatment of ACS have important healthcare implications. No large-scale examination of these disparities has been completed since the publication of the revised American College of Cardiology/American Heart Association guidelines for management of patients with NSTE ACS.

METHODS

Using data from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative, we examined differences of gender in treatment and outcomes among patients with NSTE ACS.

RESULTS

Women (41% of 35,875 patients) were older (median age 73 vs. 65 years) and more often had diabetes and hypertension. Women were less likely to receive acute heparin, angiotensin-converting enzyme inhibitors, and glycoprotein IIb/IIIa inhibitors and less commonly received aspirin, angiotensin-converting enzyme inhibitors, and statins at discharge. The use of cardiac catheterization and revascularization was higher in men, but among patients with significant coronary disease, percutaneous revascularization was performed in a similar proportion of women and men. Women were at higher risk for unadjusted in-hospital death (5.6% vs. 4.3%), reinfarction (4.0% vs. 3.5%), heart failure (12.1% vs. 8.8%), stroke (1.1% vs. 0.8%), and red blood cell transfusion (17.2% vs. 13.2%), but after adjustment, only transfusion was higher in women.

CONCLUSIONS

Despite presenting with higher risk characteristics and having higher in-hospital risk, women with NSTE ACS are treated less aggressively than men.

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  • Publisher Full Text

    • Authors+Show Affiliations

    Blomkalns AL
    Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0769, USA. Andra.Blomkalns@uc.edu
    Chen AY
    Hochman JS
    Peterson ED
    Trynosky K
    Diercks DB
    Brogan GX
    Boden WE
    Roe MT
    Ohman EM
    Gibler WB
    Newby LK
    CRUSADE Investigators

    MeSH

    Acute DiseaseAgedAged, 80 and overAmerican Heart AssociationAngina, UnstableAngioplasty, Balloon, CoronaryAngiotensin-Converting Enzyme InhibitorsCardiac CatheterizationCardiologyCoronary DiseaseElectrocardiographyExercise TestFemaleHumansMaleMiddle AgedPatient AdmissionPlatelet Glycoprotein GPIIb-IIIa ComplexQuality of Health CareRisk FactorsSex FactorsSyndromeTreatment OutcomeUnited States

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    15766815

    Citation

    Blomkalns, Andra L., et al. "Gender Disparities in the Diagnosis and Treatment of non-ST-segment Elevation Acute Coronary Syndromes: Large-scale Observations From the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative." Journal of the American College of Cardiology, vol. 45, no. 6, 2005, pp. 832-7.
    Blomkalns AL, Chen AY, Hochman JS, et al. Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative. J Am Coll Cardiol. 2005;45(6):832-7.
    Blomkalns, A. L., Chen, A. Y., Hochman, J. S., Peterson, E. D., Trynosky, K., Diercks, D. B., ... Newby, L. K. (2005). Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative. Journal of the American College of Cardiology, 45(6), pp. 832-7.
    Blomkalns AL, et al. Gender Disparities in the Diagnosis and Treatment of non-ST-segment Elevation Acute Coronary Syndromes: Large-scale Observations From the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative. J Am Coll Cardiol. 2005 Mar 15;45(6):832-7. PubMed PMID: 15766815.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative. AU - Blomkalns,Andra L, AU - Chen,Anita Y, AU - Hochman,Judith S, AU - Peterson,Eric D, AU - Trynosky,Kelly, AU - Diercks,Deborah B, AU - Brogan,Gerard X,Jr AU - Boden,William E, AU - Roe,Matthew T, AU - Ohman,E Magnus, AU - Gibler,W Brian, AU - Newby,L Kristin, AU - ,, PY - 2004/07/20/received PY - 2004/11/22/revised PY - 2004/11/29/accepted PY - 2005/3/16/pubmed PY - 2005/6/29/medline PY - 2005/3/16/entrez SP - 832 EP - 7 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 45 IS - 6 N2 - OBJECTIVES: We hypothesized that significant disparities in gender exist in the management of patients with non-ST-segment elevation (NSTE) acute coronary syndromes (ACS). BACKGROUND: Gender-related differences in the diagnosis and treatment of ACS have important healthcare implications. No large-scale examination of these disparities has been completed since the publication of the revised American College of Cardiology/American Heart Association guidelines for management of patients with NSTE ACS. METHODS: Using data from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative, we examined differences of gender in treatment and outcomes among patients with NSTE ACS. RESULTS: Women (41% of 35,875 patients) were older (median age 73 vs. 65 years) and more often had diabetes and hypertension. Women were less likely to receive acute heparin, angiotensin-converting enzyme inhibitors, and glycoprotein IIb/IIIa inhibitors and less commonly received aspirin, angiotensin-converting enzyme inhibitors, and statins at discharge. The use of cardiac catheterization and revascularization was higher in men, but among patients with significant coronary disease, percutaneous revascularization was performed in a similar proportion of women and men. Women were at higher risk for unadjusted in-hospital death (5.6% vs. 4.3%), reinfarction (4.0% vs. 3.5%), heart failure (12.1% vs. 8.8%), stroke (1.1% vs. 0.8%), and red blood cell transfusion (17.2% vs. 13.2%), but after adjustment, only transfusion was higher in women. CONCLUSIONS: Despite presenting with higher risk characteristics and having higher in-hospital risk, women with NSTE ACS are treated less aggressively than men. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/15766815/Gender_disparities_in_the_diagnosis_and_treatment_of_non_ST_segment_elevation_acute_coronary_syndromes:_large_scale_observations_from_the_CRUSADE__Can_Rapid_Risk_Stratification_of_Unstable_Angina_Patients_Suppress_Adverse_Outcomes_With_Early_Implementation_of_the_American_College_of_Cardiology/American_Heart_Association_Guidelines__National_Quality_Improvement_Initiative_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(04)02506-9 DB - PRIME DP - Unbound Medicine ER -
    Grapherence [↓100]

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