CLINICAL RESEARCH: ACUTE CORONARY SYNDROMES
Gender disparities in the diagnosis and treatment of non–ST-segment elevation acute coronary syndromes
Large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative
Andra L. Blomkalns, MD*,*,
Anita Y. Chen, MS ,
Judith S. Hochman, MD ,
Eric D. Peterson, MD, MPH,
Kelly Trynosky, RN ,
Deborah B. Diercks, MD||,
Gerard X. Brogan, Jr, MD¶,
William E. Boden, MD#,
Matthew T. Roe, MD, MHS,
E. Magnus Ohman, MD**,
W. Brian Gibler, MD*,
L. Kristin Newby, MD, MHS CRUSADE Investigators
* Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
Division of Cardiology, New York University School of Medicine, New York, New York
Ephrata Community Hospital, Ephrata, Pennsylvania
|| Department of Emergency Medicine, University of California-Davis, Sacramento, California
¶ Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
# Division of Cardiology, Hartford Hospital, Hartford, Connecticut
** Division of Cardiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
Manuscript received July 20, 2004;
revised manuscript received November 22, 2004,
accepted November 29, 2004.
* Reprint requests and correspondence: Dr. Andra L. Blomkalns, Assistant Professor, Department of Emergency Medicine, Mail Location 0769, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, Ohio 45267-0769
(Email: Andra.Blomkalns{at}uc.edu).
OBJECTIVES: We hypothesized that significant disparities in gender exist in the management of patients with non–ST-segment elevation (NSTE) acute coronary syndromes (ACS).
BACKGROUND: Gender-related differences in the diagnosis and treatment of ACS have important healthcare implications. No large-scale examination of these disparities has been completed since the publication of the revised American College of Cardiology/American Heart Association guidelines for management of patients with NSTE ACS.
METHODS: Using data from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative, we examined differences of gender in treatment and outcomes among patients with NSTE ACS.
RESULTS: Women (41% of 35,875 patients) were older (median age 73 vs. 65 years) and more often had diabetes and hypertension. Women were less likely to receive acute heparin, angiotensin-converting enzyme inhibitors, and glycoprotein IIb/IIIa inhibitors and less commonly received aspirin, angiotensin-converting enzyme inhibitors, and statins at discharge. The use of cardiac catheterization and revascularization was higher in men, but among patients with significant coronary disease, percutaneous revascularization was performed in a similar proportion of women and men. Women were at higher risk for unadjusted in-hospital death (5.6% vs. 4.3%), reinfarction (4.0% vs. 3.5%), heart failure (12.1% vs. 8.8%), stroke (1.1% vs. 0.8%), and red blood cell transfusion (17.2% vs. 13.2%), but after adjustment, only transfusion was higher in women.
CONCLUSIONS: Despite presenting with higher risk characteristics and having higher in-hospital risk, women with NSTE ACS are treated less aggressively than men.
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Abbreviations and Acronyms
| | ACC = American College of Cardiology | | ACS = acute coronary syndromes | | AHA = American Heart Association | | CRUSADE = Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines | | GP = glycoprotein | | MI = myocardial infarction | | NSTE = non–ST-segment elevation |
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