Open AccessSustained sex‐based treatment differences in acute coronary syndrome care: Insights from the American Heart Association Get With The Guidelines Coronary Artery Disease Registry
Author(s) -
Udell Jacob A.,
Fonarow Gregg C.,
Maddox Thomas M.,
Can Christopher P.,
Frank Peacock W.,
Laskey Warren K.,
GrauSepulveda Maria V.,
Smith Eric E.,
Hernandez Adrian F.,
Peterson Eric D.,
Bhatt Deepak L.
Publication year - 2018
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22938
Subject(s) - medicine , aspirin , acute coronary syndrome , coronary artery disease , conventional pci , mortality rate , disease , myocardial infarction , pediatrics , cardiology
Background Sex‐based differences in acute coronary syndrome (ACS) mortality may attenuate with age due to better symptom recognition and prompt care. Hypothesis Age is a modifier of temporal trends in sex‐based differences in ACS care. Methods Among 104 817 eligible patients with ACS enrolled in the AHA Get With the Guidelines–Coronary Artery Disease registry between 2003 and 2008, care and in‐hospital mortality were evaluated stratified by sex and age. Temporal trends within sex and age groups were assessed for 2 care processes: percentage of STEMI patients presenting to PCI‐capable hospitals with a DTB time ≤ 90 minutes (DTB90) and proportion of eligible ACS patients receiving aspirin within 24 hours. Results After adjustment for clinical risk factors and sociodemographic and hospital characteristics, 2276 (51.7%) women and 6276 (56.9%) men with STEMI were treated with DTB90 (adjusted OR: 0.85, 95% CI: 0.80–0.91, P < 0.0001 for women vs men). Time trend analysis showed an absolute increase ranging from 24% to 35% in DTB90 rates among both men and women ( P for trend <0.0001 for each group), with consistent differences over time across the 4 age/sex groups (3‐way P ‐interaction = 0.93). Despite high rate of baseline aspirin use (87%–91%), there was a 9% to 11% absolute increase in aspirin use over time, also with consistent differences across the 4 age/sex groups (all 3‐way P ‐interaction ≥0.15). Conclusions Substantial gains of generally similar magnitude existed in ACS performance measures over 6 years of study across sex and age groups; areas for improvement remain, particularly among younger women.