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Early and late mortality after myocardial infarction in men and women: prospective observational study
D Griffith1, K Hamilton, J Norrie
1Medical Unit, Dumfries and Galloway Royal Infirmary, Dumfries, UK.
Insights
Women with myocardial infarction (MI) have higher mortality, but this difference disappears when accounting for age and comorbidities. Equitable care access for women is crucial for improving survival rates after MI.
Area of Science:
- Cardiology
- Clinical Medicine
- Sex Differences in Health
Background:
- Myocardial infarction (MI) outcomes can differ between men and women.
- Previous studies suggest poorer outcomes for women post-MI.
Purpose of the Study:
- To compare the characteristics, management, and outcomes of myocardial infarction (MI) in men and women.
- To investigate potential sex-based disparities in cardiovascular care.
Main Methods:
- Prospective observational study conducted in a district general hospital.
- Involved 966 men and 597 women admitted with their first MI between 1994 and 2000.
- Follow-up extended to the end of 2001.
Main Results:
- Univariate analysis showed higher mortality in women (40.7% men vs. 51.1% women).
- Adjusting for age, comorbidities, and other factors eliminated the significant difference in mortality.
- Women were less likely to receive beta-blockers but more likely to receive statins post-discharge.
Conclusions:
- Poorer outcomes for women post-MI may be linked to sex bias in management and differences in age and comorbidity.
- Ensuring women receive the same quality of care as men could lead to similar survival rates.
Objective:
To compare characteristics, management, and outcome of myocardial infarction (MI) in men and women.
Design:
Prospective observational study.
Setting:
District general hospital in southwest Scotland.
Participants:
966 men and 597 women admitted with first MI between 1994 and 2000 with follow up to the end of 2001.
Results:
393 (40.7%) men and 305 (51.1%) women died during a median follow up of 3.4 years for the survivors. Univariate analysis indicated an excess mortality among women (hazard ratio (HR) 1.45, 95% confidence interval (CI) 1.25 to 1.68), which disappeared after adjustment for age, smoking, co-morbidity, previous vascular disease, diabetes, hypertension, and social deprivation (HR 1.02, 95% CI 0.87 to 1.20). There was also an excess early mortality within 30 days among women (HR 1.54, 95% CI 1.20 to 1.98), though this did not retain significance after adjustment for the same covariates (HR 1.04, 95% CI 0.79 to 1.37). Small and insignificant differences were found in the proportion of men and women receiving thrombolysis on admission and secondary prophylactic drugs at discharge, except for statins and beta blockers, which were respectively more (adjusted odds ratio 1.48, 95% CI 1.10 to 1.98) and less (adjusted odds ratio 0.78, 95% CI 0.60 to 1.00) commonly prescribed to women.
Conclusion:
Results suggest that the poorer outcome for women after MI reported in other studies may reflect sex bias in management as well as differences in age and co-morbidity and support the view that if women have access to the same quality of care as men then survival will be the same.
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