Does sex predict quality of life after acute coronary syndromes: an Australian, state-wide, multicentre prospective cohort study

Koh, Youlin; Stehli, Julia; Martin, Catherine; Brennan, A.; Dinh, D.; Lefkovits, Jeffrey; Zaman, Sarah

doi:10.1136/bmjopen-2019-034034

Cited by 22 publications

(32 citation statements)

References 35 publications

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“…Following hospital discharge, further sex and gender discrepancies become evident. One notable example is that women are less likely to be referred to, or participate in a cardiac rehabilitation program than men [45,73,74]. despite its proven efficacy in reducing cardiac mortality for both sexes.…”

Section: Management and Post MI Carementioning

confidence: 99%

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Sex Disparities in Myocardial Infarction: Biology or Bias?

Stehli¹,

Duffy

Burgess

et al. 2021

Heart, Lung and Circulation

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Women have generally worse outcomes after myocardial infarction (MI) compared to men. The reasons for these disparities are multifactorial. At the beginning is the notion-widespread in the community and health care providers-that women are at low risk for MI. This can impact on primary prevention of cardiovascular disease in women, with lower use of preventative therapies and lifestyle counselling. It can also lead to delays in presentation in the event of an acute MI, both at the patient and health care provider level. This is of particular concern in the case of ST elevation MI (STEMI), where "time is muscle". Even after first medical contact, women with acute MI experience delays to diagnosis with less timely reperfusion and percutaneous coronary intervention (PCI). Compared to men, women are less likely to undergo invasive diagnostic testing or PCI. After being diagnosed with a STEMI, women receive less guidelinedirected medical therapy and potent antiplatelets than men. The consequences of these discrepancies are significant-with higher mortality, major cardiovascular events and bleeding after MI in women compared to men. We review the sex disparities in pathophysiology, risk factors, presentation, diagnosis, treatment, and outcomes for acute MI, to answer the question: are they due to biology or bias, or both? KeywordsSex discrepancies Myocardial infarction Women Gender discrepancies dramatically reduced over the past decade [2]. Despite this improvement, there remain two important negative trends. First, recent data shows this decline has decelerated, particularly in younger females [3]. Second, women throughout all age groups and ethnicities have worse outcomes after MI compared to men [4][5][6]. The reasons for these disparities are multifactorial (displayed in Figure 1), but the question remains: Are these disparities due to sex (biology) or disparities in care (bias)?

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Section: Management and Post MI Carementioning

confidence: 99%

“…Female sex has been shown to be independently associated with reduced quality of life after a MI, including increased pain, anxiety and depression [74]. This is likely influenced by personality traits and social roles that are traditionally ascribed to women, or more specifically, to the female gender.…”

Section: Outcomes and Complicationsmentioning

confidence: 99%

Sex Disparities in Myocardial Infarction: Biology or Bias?

Stehli¹,

Duffy

Burgess

et al. 2021

Heart, Lung and Circulation

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“…Literature also support these findings that QOL is better in males than females who underwent same PCI procedure. [16][17][18] Uchmanowicz et al also found that female patients scored lesser than males in all domains of SF-36. 19 It may be due to the fact that females are at greater risk recurrent angina post PCI as compared to males.…”

Section: Discussionmentioning

confidence: 92%

Quality of Life After Primary Pci in Pakistani Population – Does It Really Change?

Kumar¹,

Ammar²,

Shah³

et al. 2021

Pak Heart J

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Objectives: To evaluate the quality of life (QOL) after percutaneous coronary intervention (PCI) using short-form health survey (SF-36) questionnaire at a tertiary care hospital in Pakistan. Methodology: It was a cross-sectional study conducted at a tertiary care cardiac center in Pakistan. A total of 433 adult patients who undergone PCI at least six months before were included. The QOL was assessed using Urdu translated version of SF-36 questionnaire. QOL scores were computed on eight domains role physical (RP), role emotional (RE), bodily pain (BP), physical function (PF), mental health (MH), vitality, general health perception (GHP), and social function (SF) along with two summary scores for mental (MCS) and physical component (PPS). Results: The highest mean score was reported for BP (73.8±19.7) followed by PF (61.7±24.3). In comparison to a year before, 52.9% and 24.7% rated their QOL somewhat better and much better respectively. Score for PF, RE, and RF were significantly higher in male, while, vitality was higher for female. Score of PPS was significantly higher for male whereas MCS score was higher for female. An increasing trend, with respect to patients’ perception of QOL compared to an year ago, was observed on five out of eight domains namely GHP, PF, RP, RE, and BP. Conclusion: Improved QOL, compared to a year ago, is reported by most of the patients. An acceptable (>50) mean score was observed on most of the QOL domains of SF-36 and it was found to be positively related to the patient stated degrees of QOL.

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“…An analysis of 16,517 ACS patients (22.9% women) who were treated with PCI demonstrated that female sex was independently associated with significantly poorer mobility, more issues with personal care, and greater symptoms of anxiety and depression at 30 days, despite no sex difference in rates of bleeding, stroke, or MACE. 168 Similarly, a single center study of 1072 patients (27.5% women) who underwent CABG demonstrated that women reported experiencing only about 50% of the physical functional improvement at 6 months compared with men. 169 These findings have been shown to be consistent in the younger population as well.…”

Section: Health Status Outcomes In Women After Revascularizationmentioning

confidence: 98%