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.JACC

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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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
No affiliation info available
Hochman JS
No affiliation info available
Peterson ED
No affiliation info available
Trynosky K
No affiliation info available
Diercks DB
No affiliation info available
Brogan GX
No affiliation info available
Boden WE
No affiliation info available
Roe MT
No affiliation info available
Ohman EM
No affiliation info available
Gibler WB
No affiliation info available
Newby LK
No affiliation info available
CRUSADE Investigators
No affiliation info available

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