Impact of Sex‐ and Gender‐Related Factors on Length of Stay Following Non–ST‐Segment–Elevation Myocardial Infarction: A Multicountry Analysis

Abstract

Background Gender‐related factors are psycho‐socio‐cultural characteristics and are associated with adverse clinical outcomes in acute myocardial infarction, independent of sex. Whether sex‐ and gender‐related factors contribute to the substantial heterogeneity in hospital length of stay (LOS) among patients with non–ST‐segment–elevation myocardial infarction remains unknown. Methods and Results This observational cohort study combined and analyzed data from the GENESIS‐PRAXY (Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome study), EVA (Endocrine Vascular Disease Approach study), and VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI [Acute Myocardial Infarction] Patients study) cohorts of adults hospitalized across Canada, the United States, Switzerland, Italy, Spain, and Australia for non–ST‐segment–elevation myocardial infarction. In total, 5219 participants were assessed for eligibility. Sixty‐three patients were excluded for missing LOS, and 2938 were excluded because of no non–ST‐segment–elevation myocardial infarction diagnosis. In total, 2218 participants were analyzed (66% women; mean±SD age, 48.5±7.9 years; 67.8% in the United States). Individuals with longer LOS (51%) were more likely to be White race, were more likely to have diabetes, hypertension, and a lower income, and were less likely to be employed and have completed secondary education. No univariate association between sex and LOS was observed. In the adjusted multivariable model, age (0.62 d/10 y; P <0.001), unemployment (0.63 days; P =0.01), and some of countries included relative to Canada (Italy, 4.1 days; Spain, 1.7 days; and the United States, −1.0 days; all P <0.001) were independently associated with longer LOS. Medical history mediated the effect of employment on LOS. No interaction between sex and employment was observed. Longer LOS was associated with increased 12‐month all‐cause mortality. Conclusions Older age, unemployment, and country of hospitalization were independent predictors of LOS, regardless of sex. Individuals employed with non–ST‐segment–elevation myocardial infarction were more likely to experience shorter LOS. Sociocultural factors represent a potential target for improvement in health care expenditure and resource allocation.

Risk Factors of Post-Partial Hepatectomy Acute Myocardial Infarction ： A Retrospective Nationwide Inpatient Sample Database Study

“…Clinical observations consistently indicated a higher percentage of elderly individuals in the AMI group. Logistic regression analysis in our study identi ed age over 80 as an independent risk factor for AMI, consistent with ndings from various studies that highlight advanced age as a wellestablished predictor of AMI (19,20,(23)(24)(25)(26). The complexity and uncertainty surrounding the mechanism by which advanced age contributes to AMI may be associated with endothelial dysfunction and atherosclerosis, increasing the risk of AMI (27,28).…”

“…The presence of in-hospital AMI following partial hepatectomy was linked with an extended length of stay, increased overall hospital expenses, and elevated in-hospital mortality. In addition to addressing AMI, post-operative factors, including pain management, complications, ambulatory ability, and family support, could contribute to prolonged hospitalization (11,15,23,33). Besides, AMI may be related to perioperative complications, including septicemia, respiratory failure, deep vein thrombosis, pulmonary embolism, gastrointestinal hemorrhage, pneumonia, stroke, acute renal failure, thrombocytopenia, blood transfusion, and ascites (Table 6).…”