Sex differences in quality indicator attainment for myocardial infarction: a nationwide cohort study

Chris Wilkinson, Owen Bebb, Tatendashe B Dondo, Theresa Munyombwe, Barbara Casadei, Sarah Clarke, François Schiele, Adam Timmis, Marlous Hall, Chris P Gale

Research output: Contribution to journalArticlepeer-review

Abstract

AIM: To investigate sex differences in acute myocardial infarction (AMI) guideline-indicated care as defined by the European Society of Cardiology (ESC) Acute Cardiovascular Care Association (ACCA) quality indicators.

METHODS: Nationwide cohort study comprising 691 290 AMI hospitalisations in England and Wales (n=233 hospitals) from the Myocardial Ischaemia National Audit Project between 1 January 2003 and 30 June 2013.

RESULTS: There were 34.5% (n=238 489) women (median age 76.7 (IQR 66.3-84.0) years; 33.9% (n=80 884) ST-elevation myocardial infarction (STEMI)) and 65.5% (n=452 801) men (median age 67.1 (IQR 56.9-77.2) years; 42.5% (n=192 229) STEMI). Women less frequently received 13 of the 16 quality indicators compared with men, including timely reperfusion therapy for STEMI (76.8% vs 78.9%; p<0.001), timely coronary angiography for non-STEMI (24.2% vs 36.7%; p<0.001), dual antiplatelet therapy (75.4% vs 78.7%) and secondary prevention therapies (87.2% vs 89.6% for statins, 82.5% vs 85.6% for ACE inhibitor/angiotensin receptor blockers and 62.6% vs 67.6% for beta-blockers; all p<0.001). Median 30-day Global Registry of Acute Coronary Events risk score adjusted mortality was higher for women than men (median: 5.2% (IQR 1.8%-13.1%) vs 2.3% (IQR 0.8%-7.1%), p<0.001). An estimated 8243 (95% CI 8111 to 8375) deaths among women could have been prevented over the study period if their quality indicator attainment had been equal to that attained by men.

CONCLUSION: According to the ESC ACCA AMI quality indicators, women in England and Wales less frequently received guideline-indicated care and had significantly higher mortality than men. Greater attention to the delivery of recommended AMI treatments for women has the potential to reduce the sex-AMI mortality gap.

Original languageEnglish
Pages (from-to)516-523
Number of pages8
JournalHeart
Volume105
Issue number7
Early online date23 Nov 2018
DOIs
Publication statusPublished - 19 Mar 2019

Bibliographical note

© Author(s) (or their employer(s)) 2019.

Keywords

  • Aged
  • Cohort Studies
  • Female
  • Guideline Adherence
  • Hospitalization/statistics & numerical data
  • Humans
  • Mortality
  • Myocardial Infarction/diagnosis
  • Needs Assessment
  • Outcome and Process Assessment, Health Care
  • Patient Care Management/methods
  • Practice Guidelines as Topic
  • Preventive Health Services/standards
  • Quality Indicators, Health Care/standards
  • Secondary Prevention/organization & administration
  • Sex Factors
  • United Kingdom/epidemiology

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