Age Difference Explains Gender Difference in Cardiac Intervention Rates After Acute Myocardial Infarction

Abstract

many investigators have reported higher rates of cardiac procedures for males than females after acute myocardial infarction (AmI), suggesting that men are treated more aggressively than women. However, others have reported no significant differences after controlling for age, resulting in uncertainty about the existence of a true gender bias in cardiac care. In this study, a population-based cohort approach was used to calculate age-specific procedure rates by sex from administrative data. Chi-square tests and generalized linear modelling were used to assess gender differences and interactions. for all four procedures studied, rates were significantly higher for males than females (p<0.01). However, age-specific rates revealed few significant differences by gender and a sharp decrease in intervention rates with age for both males and females. generalized linear modelling confirmed that patient age was a significant predictor of intervention rates, whereas sex was not. The significant gender difference in overall rates was completely confounded by the older age profile of female AmI patients compared to their male counterparts. RésuméPlusieurs chercheurs ont observé de plus haut taux d'interventions cardiaques pour les hommes que pour les femmes après un infarctus aigu du myocarde (IAm), laissant

Sex, Socioeconomic Status, Access to Cardiac Catheterization, and Outcomes for Acute Coronary Syndromes in the Context of Universal Healthcare Coverage

“…23,37,38 However, more recent studies have indicated that these sex and SES-related disparities are mostly accounted for by age and important clinical comorbidities and might be improving over time. 11,25,39,40 Similar to other studies, we found that on average women receive cardiac catheterization less often than men but that there were no significant differences between women and men in either short or long-term adjusted mortality.…”

Epidemiology of critically ill patients in intensive care units: a population-based observational study

“…As an example of the former, Fransoo et al . showed that higher rates of cardiac catheterization among men are largely explained by their higher rates of heart attack, [40] consistent with the known higher rate of cardiovascular disease known in men [41]. Indeed, in a preliminary analysis we found that men were much more likely than women to be admitted to an ICU in Manitoba with a cardiovascular primary diagnosis (58.8 vs. 48.0%, P <0.0001; in Additional file 1: Table S3).…”

Does Treatment Change with Gender in Acute Coronary Syndrome?

“…Some studies showed that the clinical management of men and women after AMI was very similar (22) , but other studies have shown prominent differences (16) . In setting of hospitalization for CAD, women were found to have a higher incidence of CAD risk factors like diabetes and systemic hypertension, were less likely to be smokers (14) but they presented more frequently with heart failure due to diastolic dysfunction which may explain their higher unadjusted in-hospital mortality rates in AMI (15, 16 & 17) .…”

“…Many investigators have reported higher rates of coronary interventions for males when compared to females after AMI that may indicate more aggressive management for males (14) . However, others have reported no significant gender differences, whether the MI alert was initiated in the ED or in the prehospital field, after controlling for age, resulting in uncertainty about the existence of a true gender bias in cardiac care (22) .…”

“…These gender differences did not translate into differences in hospital outcome, but may highlight differences in quality of care and alarm the care providers for importance of performance improvement (16,18) . Other studies demonstrated that there are currently no gender biases in key cardiac interventions after AMI and that lower procedure rates for females were completely explained by their older age profile (22) . The evidence behind gender-based discrimination of care for patients with AMI is mixed and the results are very conflicting.…”