Journal Article

Sex-based differences in quality of care and outcomes in a health system using a standardized STEMI protocol

Bairey Merz, C. Noel, Hauser, Robert, Henry, Timothy D., Wei, Janet, Grey, Elizabeth, Mehta, Puja K., Garberich, Ross F.

2017

Overview

Recent data from the National Cardiovascular Data Registry indicate that women with ST-segment-elevation myocardial infarction (STEMI) continue to have higher mortality and reported delays in treatment compared with men. We aimed to determine whether the sex difference in mortality exists when treatment disparities are reduced. Using a prospective regional percutaneous coronary intervention (PCI)–based STEMI system database with a standardized STEMI protocol, we evaluated baseline characteristics, treatment, and clinical outcomes of STEMI patients stratified by sex. From March 2003 to January 2016, 4,918 consecutive STEMI patients presented to the Minneapolis Heart Institute at Abbott Northwestern Hospital regional STEMI system including 1,416 (28.8%) women. Compared with men, women were older (68.4 vs 60.9 years) with higher rates of hypertension (66.7% vs 55.7%), diabetes (21.7% vs 17.4%), and cardiogenic shock (11.5% vs 8.0%) (all P < .001). Pre-revascularization medications and PCI were performed with same frequencies, but women were less likely to receive statin or antiplatelet therapy at discharge. After age adjustment, women had similar in-hospital mortality to men (5.1% vs 4.8%, P = .60) despite slightly longer door-to-balloon time (95 vs 92 minutes, P = .004). Five-year follow-up confirmed absence of a sex disparity in age-adjusted survival post-STEMI. Previously reported treatment disparities between men and women are diminished in a regional PCI-based STEMI system using a standardized STEMI protocol. No sex differences in short-term or long-term age-adjusted mortality are present in this registry despite some treatment disparities. These results suggest that STEMI health care disparities and mortality in women can be improved using STEMI protocols and systems.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Age / Age Factors / Aged / Balloon treatment / Cardiovascular / Cardiovascular disease / Data base management systems / Diabetes mellitus / Electrocardiography / Female / Follow-Up Studies / Gender aspects / Gender differences / Health care / Health risk assessment / Healthcare Disparities / Heart / Hospital Mortality - trends / Humans / Hypertension / Intervention / Male / Men / Middle Aged / Mortality / Myocardial infarction / Patients / Percutaneous Coronary Intervention - standards / Prospective Studies / Quality Assurance, Health Care / Quality of care / Registries / Risk Factors / Sex / Sex differences / Sex Distribution / Sex Factors / ST Elevation Myocardial Infarction - mortality / ST Elevation Myocardial Infarction - surgery / Standardization / Survival Rate - trends / Time Factors / United States - epidemiology