Open AccessTrends in Gender Differences in Cardiac Care and Outcome After Acute Myocardial Infarction in Western Sweden: A Report From the Swedish Web System for Enhancement of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies ( SWEDEHEART )
Author(s) -
Redfors Björn,
Angerås Oskar,
Råmunddal Truls,
Petursson Petur,
Haraldsson Inger,
Dworeck Christian,
Odenstedt Jacob,
Ioaness Dan,
RavnFischer Annika,
Wellin Peder,
Sjöland Helen,
Tokgozoglu Lale,
Tygesen Hans,
Frick Erik,
Roupe Rickard,
Albertsson Per,
Omerovic Elmir
Publication year - 2015
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.115.001995
Subject(s) - medicine , myocardial infarction , cardiogenic shock , odds ratio , logistic regression , cardiology , emergency medicine
Background Cardiovascular disease is the most common cause of death for both genders. Debates are ongoing as to whether gender‐specific differences in clinical course, diagnosis, and management of acute myocardial infarction (MI) exist. Methods and Results We compared all men and women who were treated for acute MI at cardiac care units in Västra Götaland, Sweden, between January 1995 and October 2014 by obtaining data from the prospective SWEDEHEART (Swedish Web‐System for Enhancement of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. We performed unadjusted and adjusted Cox proportional hazards and logistic regression analyses on complete case data and on imputed data sets. Overall, 48 118 patients (35.4% women) were diagnosed with acute MI. Women as a group had better age‐adjusted prognosis than men, but this survival benefit was absent for younger women (aged <60 years) and for women with ST‐segment elevation MI. Compared with men, younger women and women with ST‐segment elevation MI were more likely to develop prehospital cardiogenic shock (adjusted odds ratio 1.67, 95% CI 1.30 to 2.16, P <0.001 and adjusted odds ratio 1.31, 95% CI 1.16 to 1.48, P <0.001) and were less likely to be prescribed evidence‐based treatment at discharge ( P <0.001 for β‐blockers, angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers, statins, and P2Y 12 antagonists). Differences in treatment between the genders did not decrease over the study period ( P >0.1 for all treatments). Conclusions Women on average have better adjusted prognosis than men after acute MI; however, younger women and women with ST‐segment elevation MI have disproportionately poor prognosis and are less likely to be prescribed evidence‐based treatment.