Factors influencing underutilization of evidence-based therapies in women

Abstract

Aims Previous studies have reported differences in the use of cardiovascular medications for acute coronary syndromes (ACSs) according to the sex of the patient. We analysed which clinical factors are associated with underutilization of evidence-based therapies in women. Methods and results From the Canadian Registry of ACS I and II, 6558 patients (4471 men and 2087 women) with a final diagnosis of ACS were selected for the current analysis. Covariates were chosen using the approach described by Blackstone. The final selected model included 23 patient clinical variables. Women were less likely than men to receive beta-blockers (75.76 vs. 79.24%; P < 0.01), lipid-modifying agents (56.37 vs. 65.44%; P < 0.0001), and angiotensin-converting enzyme (ACE)-inhibitors (55.52 vs. 59.99%; P < 0.01). Female sex and clinical decision not to investigate with cardiac catheterization were the strongest independent predictors for not receiving lipid-modifying agents and ACE-inhibitors. Age, Killip class 2, and Killip class 3/4 were significant independent predictors of underutilization of beta-blocker use. Women were older (69 ± 12 vs. 64 ± 12; P < 0.01) with a higher prevalence of Killip class ≥ 2 (19.95 vs. 15.54%; P < 0.068), and they were less likely to be referred for cardiac catheterization (41.9 vs. 49.6 %; P < 0.001). Conclusions The current findings demonstrate that underutilization of evidence-based therapies in women with ACS compared with men is associated with multiple factors related to the patient (age), the consequences of the disease (congestive heart failure), and the physician's assessment of patient risk (decision to catheterize). Female gender remains associated with underutilization of lipid-modifying agents and ACE-inhibitors despite adjustment for these confounders.

Sex Differences in the Treatment and Outcome of Patients with Acute Coronary Syndrome After Percutaneous Coronary Intervention: A Population-Based Study

“…38 In addition, this result may also be interpreted as women being less likely than men to receive interventional therapies such as PCI with/ without a stent and CABG. 9,10,12,17 Interpretation of the results in this study Limited studies have reported the association between female sex and drug therapy and outcomes in ACS patients who underwent PCI, 13,[39][40][41] but none of them are nationwide studies. The value of our study is the use of a national health insurance database with multivariable adjustment by a propensity score matching method.…”

“…[8][9][10][11][12] Several studies have demonstrated that the gender differences in drug therapy in ACS patients may be related to patient demographic variables such as age, comorbidities such as heart failure, diabetes, and physician's perception of risk. [13][14][15][16] Sex differences in the treatment of ACS patients have been reported and indicate that women are less likely than men to receive interventional therapies such as percutaneous coronary intervention (PCI) with/without a stent and coronary artery bypass graft (CABG). 9,10,12,[17][18][19] Little is known if sex differences in drug therapies persist within selected ACS patients who have undergone PCI.…”

Az akut myocardialis infarctus főbb hazai ellátási jellemzői 2005–2009 között a EuroHOPE kutatás eredményei alapján

“…Egy 2012ben publikált tanulmány szerint az adminisztratív adatokból nyert AMI miatti kórházi felvételek szezonalitása megfe lel a népegészségügyi kutatásokból ismert szezonális in gadozásnak [8]. Többváltozós elemzéseink szerint a fér fiak nagyobb eséllyel részesülnek PCIkezelésben, ami összhangban van a nemzetközi kutatásokkal [9]. Hason lóan összecseng más publikált nemzetközi tanulmányok eredményével az a megfigyelésünk, amely szerint a PCI kezelés esélye alacsonyabb diabetes mellitusban, és ezen betegek halálozási esélye is magasabb [10].…”

Study of incidence and treatment of acute myocardial infarction by evaluating the financing database: 2004–2009

“…Az invazív kezelések aránya a nemek között lénye-gesen különbözött, a kezeléshez a férfi ak minden korcsoportban nagyobb eséllyel jutottak hozzá. A nemek kezelésében megfi gyelt különbség nem hazai sajátosság, mivel egy közelmúltban megjelent publikáció is megerősíti ezen megfi gyelésünket [15].…”