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Biology or bias: practice patterns and long-term outcomes for men and women with acute myocardial infarction

D. A. Alter, MD, PhD^*,*, C. D. Naylor, MD, Dphil^*||¶, P. C. Austin, PC, PhD^*|| and J. V. Tu, MD, PhD^*||

^* Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
University of Toronto Clinical Epidemiology and Health Care Research Program (Sunnybrook & Women’s College site), Toronto, Ontario, Canada
Division of Cardiology, Schulich Heart Centre, Sunnybrook & Women’s College Health Sciences Centre, Toronto, Ontario, Canada
Division of General Internal Medicine and the University of Toronto, Toronto, Ontario, Canada
^|| Department of Health Policy, Management and EvaluationToronto, Ontario, Canada
^¶ Dean’s Office, University of Toronto, Toronto, Ontario, Canada

View larger version (28K): [in a new window]   Figure 1 Adjusted rates of treatments and follow-up care according to age at acute myocardial infarction (AMI) presentation. (A) Adjusted risk ratios of coronary angiography by six months after AMI according to age. Adjusted risk ratios ± 95% confidence intervals for angiography by six months after myocardial infarction (MI) for a typical male and female patient (average median neighborhood income and predicted probability of 30-day mortality who is admitted to an internist at a non-tertiary hospital). P value for the age–gender interaction, p < 0.001. (B) Adjusted risk ratios of follow-up by a cardiologist by one-year after AMI according to age. Adjusted risk ratios ± 95% confidence intervals for cardiology follow-up care by one year after MI for a typical male and female patient (average median neighborhood income and predicted probability of 30-day mortality who is admitted to an internist at a non-tertiary hospital). P value for the age–gender interaction, p < 0.001. (C) Adjusted risk ratios of general practitioner-only or no physician follow-up by one year after AMI according to age. Adjusted risk ratios ± 95% confidence intervals for general practitioner-only or no physician follow-up care by one year after MI for a typical male and female patient (average median neighborhood income and predicted probability of 30-day mortality who is admitted to an internist at a non-tertiary hospital). P value for the age–gender interaction, p < 0.001. Solid diamond = men; open square = women.

View larger version (24K): [in a new window]   Figure 2 Adjusted five-year survival rates according to age at acute myocardial infarction (MI) presentation. Adjusted five-year hazards of death for a typical male and female patient (average median neighborhood income and predicted probability of 30-day mortality who is admitted to an internist at a non-tertiary hospital). P value for the age–gender interaction, p < 0.001. Solid diamond = men; open square = women.