Gender differences among patients with acute coronary syndromes undergoing percutaneous coronary intervention in the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR)

Akhter, Nausheen; Milford‐Beland, Sarah; Roe, Matthew T.; Piana, Robert N.; Kao, John; Shroff, Adhir

doi:10.1016/j.ahj.2008.08.012

Cited by 233 publications

(169 citation statements)

References 27 publications

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“…A number of studies suggest this is not a new phenomenon in how providers approach diagnosis and treatment decisions based on gender [1,2,29,39,40,42,43,49,55,58,60].…”

Section: Does Sex and Gender Affect Decision-making In Orthopaedic Sumentioning

confidence: 99%

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Examining Sex and Gender Disparities in Total Joint Arthroplasty

Novicoff

Saleh

2011

Clinical Orthopaedics &Amp; Related Research

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Background Total joint arthroplasty (TJA) is remarkably successful for treating osteoarthritis: most patients see substantial gains in function. However, there are considerable geographic, racial, and gender variations in the utilization of these procedures. The reasons for these differences are complex. Questions/purposes We examined sex and gender disparities in TJA. Methods Through Medline/PubMed searches, we identified 632 articles and from these selected 61 for our review. Where are we now? A number of factors might explain sex and gender disparities in TJA: underrepresentation in clinical trials, differences in willingness to undergo surgery, pain responses to underlying disease and treatment, patient-physician relationships, treatment preferences, provider-level factors such as physician-patient communication style, and system-level factors such as access to specialist care. Since women have a higher prevalence of arthritis and degenerative joint diseases and overall demand for these procedures will continue to grow, the need to understand why there is a gap in utilization based on gender is imperative. Where do we need to go? Understanding what exactly is meant by ''disparity'' is essential because it is possible anatomic factors may have different impacts on utilization from cultural factors. Ideally, information about these factors should be integrated into the decision-making process so that patients and providers can make the most informed choice about whether or not to undergo the procedure. How do we get there? To better understand all of the potential reasons for how anatomic and cultural factors related to sex and gender might impact decision-making and overall utilization of TJA, more research focusing on these factors must be designed and carried out.

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“…A number of studies suggest this is not a new phenomenon in how providers approach diagnosis and treatment decisions based on gender [1,2,29,39,40,42,43,49,55,58,60].…”

Section: Does Sex and Gender Affect Decision-making In Orthopaedic Sumentioning

confidence: 99%

“…In this review, we addressed three main questions related to sex and gender disparities in TJA: (1) Are there sex and gender differences in research in general? (2) In what way do sex and gender matter in orthopaedic surgery?…”

Section: Introductionmentioning

confidence: 99%

Examining Sex and Gender Disparities in Total Joint Arthroplasty

Novicoff

Saleh

2011

Clinical Orthopaedics &Amp; Related Research

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“…In both stable and unstable CHD settings, several studies have shown that women, compared with men, undergo invasive procedures less often and are less aggressively treated with evidence‐based medications 4, 5, 6. A study of 3779 patients with stable angina showed that in women with proven coronary disease, revascularization procedures were used less frequently than in men 7.…”

Section: Discussionmentioning

confidence: 99%

“…Female patients have more complex signs and symptoms of ischemia, and the variation in reproductive hormone levels may play a role in CHD pathophysiology and response to treatment. In both acute and chronic settings, several studies have shown that women, compared with men, are less aggressively treated with evidence‐based therapies and less often undergo invasive procedures 4, 5, 6, 7, 8. However, less is known about the relationship of psychosocial factors, sex, and clinical outcomes among patients with CHD 9, 10, 11, 12, 13.…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in Clinical Characteristics, Psychosocial Factors, and Outcomes Among Patients With Stable Coronary Heart Disease: Insights from the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) Trial

Guimarães

Granger

Stebbins

et al. 2017

JAHA

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BackgroundGreater understanding of differences between men and women with coronary heart disease is needed.Methods and ResultsIn this post hoc analysis of the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial, we described psychosocial factors, treatments, and outcomes of men versus women with stable coronary heart disease and explored the association of sex with psychosocial characteristics and cardiovascular risk. Cox proportional hazards models were used to assess the relationship between sex and outcomes. Interactions among sex, psychosocial factors, and the composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke were tested. Of 15 828 patients, 2967 (19%) were women. Among women, 21.2% felt often or always stressed at home (versus 9.8% of men), and 19.2% felt often or always sad or depressed (versus 10.1% of men; all P<0.0001). The median duration of follow‐up was 3.7 years (25th–75th percentiles: 3.5–3.8 years). Use of evidence‐based medications for coronary heart disease at baseline and 24 months was similar between sexes, as were event rates for all outcomes analyzed. In the multivariable model including psychosocial measures, female sex was associated with lower cardiovascular risk. There was a statistically significant interaction (P=0.03) such that the lower risk in women varied by depressive symptom frequency, whereby women who were more depressed had a risk similar to men.ConclusionsFemale sex was independently associated with better long‐term clinical outcomes, although this was modified by frequency of depressive symptoms. This suggests that emotional state may be an important target for improving outcomes in patients with coronary heart disease, specifically in women.Clinical Trial RegistrationSTABILITY ClinicalTrials.gov number (NCT00799903).

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“…9,19,32,33 Though aspirin has been associated with a significant reduction of serious cardiovascular events in both women and men, 34 there may be concern of increased incidence of bleeding among women. 33 Similar to previous studies, this study indicated that women were less likely to receive clopidogrel than men. 9,32,33,35 Because of the Taiwan NHI reimbursement policy, clopidogrel was usually used in patients after ACS.…”

Section: Use Of Antiplateletsmentioning

confidence: 99%

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

Lin

Shen

Hsiao

et al. 2014

Journal of Women's Health

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Background: This study was performed to assess the influence of sex on drug therapy and long-term outcomes in acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI). Methods: This is a retrospective cohort study of ACS patients who underwent PCI [women (n = 8,884) and men (n = 23,937)] between January 1, 2006, and December 31, 2007, with at least a 1-year follow-up, based on the National Health Insurance Research Database in Taiwan. Propensity score was used to identify a 1:1 matched cohort (n = 17,768) for multivariable adjustment. The influence of sex on drug therapy and outcomes was examined by multivariate logistic regression and multivariable Cox proportional hazards regression. Results: Female patients had an 18% and 12% lower likelihood of receiving aspirin (adjusted odds ratio [OR-

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Gender differences among patients with acute coronary syndromes undergoing percutaneous coronary intervention in the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR)

Cited by 233 publications

References 27 publications

Examining Sex and Gender Disparities in Total Joint Arthroplasty

Examining Sex and Gender Disparities in Total Joint Arthroplasty

Sex Differences in Clinical Characteristics, Psychosocial Factors, and Outcomes Among Patients With Stable Coronary Heart Disease: Insights from the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) Trial

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

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