Age and gender differences in quality of care and outcomes for patients with ST-segment elevation myocardial
Sripal Bangalore1, Gregg C Fonarow, Eric D Peterson
1New York University Medical Center, New York, NY 10016, USA. sripal.bangalore@nyumc.org
Insights
Young patients under 45 with ST-segment elevation myocardial infarction (STEMI) generally receive similar care and have better outcomes than older adults. However, young women and those 35 and under face disparities in care quality and mortality.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- ST-segment elevation myocardial infarction (STEMI) in patients aged 45 years or less presents distinct clinical challenges.
- The quality of care and in-hospital outcomes for young STEMI patients may differ significantly from older populations.
Purpose of the Study:
- To compare the quality of care and in-hospital outcomes for young STEMI patients (≤45 years) versus older patients.
- To identify potential disparities in care based on age and gender within the young STEMI cohort.
Main Methods:
- Analysis of 31,544 STEMI patients from the American Heart Association's Get With the Guidelines Coronary Artery Disease registry.
- Stratification of patients into two groups: ≤45 years and >45 years.
- Examination of quality/performance measures and in-hospital mortality rates, with subgroup analysis by gender and age.
Main Results:
- Younger patients (10.3% of STEMI cases) had fewer traditional cardiovascular risk factors and experienced lower in-hospital mortality (1.6% vs 6.5%) compared to older patients.
- While overall quality of care and outcomes were similar or better for younger patients, young women and those ≤35 years faced significantly lower quality of care and worse outcomes.
- A significant interaction between age and gender was observed for in-hospital death and door-to-thrombolytic time, indicating greater gender-based disparities in the younger cohort.
Conclusions:
- Young STEMI patients (≤45 years) generally have comparable quality of care and in-hospital outcomes to older patients.
- Significant disparities exist, with young women and very young patients (≤35 years) experiencing poorer quality of care and higher mortality rates.
- Targeted interventions may be necessary to address gender- and age-based inequities in STEMI care for younger populations.
Background:
Young patients (aged≤45 years) presenting with ST-segment elevation myocardial infarction present unique challenges. The quality of care and in-hospital outcomes may differ from their older counterparts.
Methods:
A total of 31,544 patients presenting with ST-segment elevation myocardial infarction and enrolled in the American Heart Association's Get With the Guidelines Coronary Artery Disease registry were analyzed. The cohort was divided into those aged 45 years or less and those aged more than 45 years.
Results:
Young patients accounted for 10.3% of all ST-segment elevation myocardial infarction cases. Compared with older patients, younger patients were less likely to have traditional cardiovascular risk factors and had similar or better quality/performance measures with lower in-hospital mortality (unadjusted rate 1.6 vs 6.5%, P<.0001; adjusted odds ratio [OR], 0.37; 95% confidence interval [CI], 0.29-0.46). Time trend analysis (2002-2008) suggested an increase over time in the "all or none" composite performance measure in both the younger and older patients (68%-97% and 69%-96%, respectively). However, there was significantly lower quality of care and worse outcomes in women (vs men) and in the very young (≤35 vs 36-45 years). Significant interaction was seen between age and gender for in-hospital death, such that the gender difference was greater in the younger cohort. Similar interaction was seen for door-to-thrombolytic time such that the gender delay was greater in the younger cohort (women:men ratio of means=1.73, 95% CI, 1.21-2.45 [younger] vs 1.08, 95% CI, 1.00-1.18 [older]; P(interaction)=.0031).
Conclusion:
Young patients aged 45 years or less presenting with ST-segment elevation myocardial infarction overall had similar quality of care and in-hospital outcomes as older counterparts. However, quality of care was significantly lower and mortality was higher in young women (vs young men) and the very young (≤35 vs 36-45 years).
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