Gender Differences in Presentation, Management, and In-Hospital Outcomes for Patients with AMI in a Lower-Middle Income Country: Evidence from Egypt

Abstract

BackgroundMany studies in high-income countries have investigated gender differences in the care and outcomes of patients hospitalized with acute myocardial infarction (AMI). However, little evidence exists on gender differences among patients with AMI in lower-middle-income countries, where the proportion deaths stemming from cardiovascular disease is projected to increase dramatically. This study examines gender differences in patients in the lower-middle-income country of Egypt to determine if female patients with AMI have a different presentation, management, or outcome compared with men.Methods and FindingsUsing registry data collected over 18 months from 5 Egyptian hospitals, we considered 1204 patients (253 females, 951 males) with a confirmed diagnosis of AMI. We examined gender differences in initial presentation, clinical management, and in-hospital outcomes using t-tests and χ2 tests. Additionally, we explored gender differences in in-hospital death using multivariate logistic regression to adjust for age and other differences in initial presentation.We found that women were older than men, had higher BMI, and were more likely to have hypertension, diabetes mellitus, dyslipidemia, heart failure, and atrial fibrillation. Women were less likely to receive aspirin upon admission (p<0.01) or aspirin or statins at discharge (p = 0.001 and p<0.05, respectively), although the magnitude of these differences was small. While unadjusted in-hospital mortality was significantly higher for women (OR: 2.10; 95% CI: 1.54 to 2.87), this difference did not persist in the fully adjusted model (OR: 1.18; 95% CI: 0.55 to 2.55).ConclusionsWe found that female patients had a different profile than men at the time of presentation. Clinical management of men and women with AMI was similar, though there are small but significant differences in some areas. These gender differences did not translate into differences in in-hospital outcome, but highlight differences in quality of care and represent important opportunities for improvement.

Gender Based Differences in Risk Factor Profile and Coronary Angiography of Patients Presenting with Acute Myocardial Infarction in North Indian Population

“…46% of our female patients were found to be hypertensive as compared to 28% of males which is similar to the studies from West where hypertension on an average was 25% more common in females [19,20]. The declining oestrogen levels increased plasma rennin activity due to up-regulated rennin-angiotensin system, increased salt sensitivity with sympathetic activity with menopause are few factors which lead to a steep rise in blood pressure in peri-menopausal and post menopausal women [21].…”

Effect of Self-Efficacy Enhancing Intervention Training on Clinical Health Status of Diabetic Patients at High-Risk for Leg Problems

“…The application of the randomization process in the current study was successful as shown by the absence of any significant differences in the socio-demographic and medical characteristics of the patients in the study and control groups. The percentage of women in both groups was slightly higher, which is in congruence with the known gender distribution, with higher prevalence among females [28]. There was also a high percentage of positive family history in the two groups, which goes in line with the findings of a recent study in Minia Governorate [29].…”

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) .…”

“…A study using data from the Global Registry for Acute Coronary Events (GRACE) that examined 43,393 patients (14,180 women and 29,213 men) with acute coronary syndromes from 14 countries observed similar patterns. In the GRACE study, women with ACS were more likely to be older, have higher rates of hypertension, diabetes, whereas men were more likely to smoke (16) . Limitations of our study were: a) retrospective b) nonrandomized c) conducted in a single center.…”

“…In one cohort study, women were found to be less likely to undergo diagnostic catheterization when present with AMI, less likely to receive thrombolytic therapy within 60 minutes and aspirin within 24 hours after arrival at the hospital and were less likely to be discharged on aspirin or beta-blockers when compared to men (17) . 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) .…”