Sex-based differences in quality of care and outcomes in a health system using a standardized STEMI protocol

Abstract

Aims Recent data from the National Cardiovascular Data Registry indicate that women with ST-segment-elevation myocardial infarction (STEMI) continue to have higher mortality and reported delays in treatment compared to men. We aimed to determine whether the sex difference in mortality exists when treatment disparities are reduced. Methods and Results Using a prospective regional percutaneous-coronary-intervention (PCI)-based STEMI system database with a standardized STEMI protocol, we evaluated baseline characteristics, treatment and clinical outcomes of STEMI patients stratified by sex. From March 2003 to January 2016, 4918 consecutive STEMI patients presented to the Minneapolis Heart Institute at Abbott Northwestern Hospital regional STEMI system including 1416 (28.8%) women. Compared to men, women were older (68.4 vs 60.9 years) with higher rates of hypertension (66.7 vs 55.7%), diabetes (21.7 vs 17.4%) and cardiogenic shock (11.5 vs 8.0%) (all P<0.001). Pre-revascularization medications and PCI were performed with same frequencies, but women were less likely to receive statin or anti-platelet therapy at discharge. After age-adjustment, women had similar in-hospital mortality to men (5.1% vs 4.8%, P=0.60), despite slightly longer door-to-balloon time (95 vs 92 mins, P=0.004). Five-year follow-up confirmed absence of a sex disparity in age-adjusted survival post-STEMI. Conclusions Previously reported treatment disparities between men and women are diminished in a regional PCI-based STEMI system using a standardized STEMI protocol. No sex differences in short-term or long-term age-adjusted mortality are present in this registry despite some treatment disparities. These results suggest that STEMI healthcare disparities and mortality in women can be improved using STEMI protocols and systems.

Gender-based difference in early mortality among patients with STsegment elevation myocardial infarction: insights from Kermanshah STEMI Registry

“…22 Likewise, Birkemeyer et al reported that women were significantly older, with a higher prevalence of HTN and DM, and men were more likely to be current smokers. 23 Also, consistent with some other reports, 24,25 this study found no significant differences in treatment with primary PCI for women and men; however, DTB and STB were delayed slightly in women compared to men. These results support the findings of previous studies that women typically experienced a delay in DTB and STB.…”

Biology and bias: do we have the will to improve cardiovascular disease outcomes for women?

“…We also demonstrated that prescriptions of guideline-based pharmacotherapies at discharge are equivalent in women and men with protocolised STEMI care 8. Protocolised care resulted in equivalent in-hospital and long-term (5 year) age-adjusted mortality (figure 1),8 suggesting that STEMI treatment disparities and mortality in women can be improved using protocols.…”

“…Five-year follow-up confirmed absence of a sex disparity in survival post-STEMI8 (reprinted with permission).…”

“…We have demonstrated that a network focused on improving emergency service recognition of STEMI and protocols to facilitate rapid transfer to a percutaneous coronary intervention (PCI)-capable centre maximised STEMI outcomes for both women and men 8. We also demonstrated that prescriptions of guideline-based pharmacotherapies at discharge are equivalent in women and men with protocolised STEMI care 8.…”

“…We have demonstrated that a network focused on improving emergency service recognition of STEMI and protocols to facilitate rapid transfer to a percutaneous coronary intervention (PCI)-capable centre maximised STEMI outcomes for both women and men 8. We also demonstrated that prescriptions of guideline-based pharmacotherapies at discharge are equivalent in women and men with protocolised STEMI care 8. Protocolised care resulted in equivalent in-hospital and long-term (5 year) age-adjusted mortality (figure 1),8 suggesting that STEMI treatment disparities and mortality in women can be improved using protocols.…”