Sex-based differences in quality of care and outcomes in a health system using a standardized STEMI protocol
Janet Wei1, Puja K Mehta2, Elizabeth Grey3
1Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
Insights
Sex differences in ST-segment-elevation myocardial infarction (STEMI) mortality diminish when treatment disparities are reduced. Standardized STEMI protocols in a PCI-based system eliminate sex disparities in short- and long-term survival.
Area of Science:
- Cardiology
- Health Services Research
- Sex Differences in Medicine
Background:
- Women with ST-segment-elevation myocardial infarction (STEMI) experience higher mortality and treatment delays than men.
- Existing data suggest a persistent sex disparity in STEMI outcomes.
Purpose of the Study:
- To investigate if STEMI mortality sex differences persist when treatment disparities are minimized.
- To evaluate outcomes in a standardized, percutaneous coronary intervention (PCI)-based STEMI system.
Main Methods:
- Prospective analysis of a regional STEMI system database (March 2003-January 2016).
- Evaluation of baseline characteristics, treatment, and clinical outcomes stratified by sex.
- Comparison of in-hospital and 5-year age-adjusted mortality.
Main Results:
- Women (28.8%) were older and had more comorbidities (hypertension, diabetes, cardiogenic shock).
- PCI and pre-revascularization treatments were similar; women received less discharge statin/antiplatelet therapy.
- After age adjustment, in-hospital (5.1% vs 4.8%) and 5-year mortality showed no sex difference.
Conclusions:
- Standardized STEMI protocols significantly reduce treatment disparities between sexes.
- No significant sex difference in age-adjusted STEMI mortality was observed in this PCI-based system.
- STEMI protocols and systems can improve care and reduce mortality disparities for women.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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