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J Am Heart Assoc. 2016 Feb 22;5(2). pii: e002157. doi: 10.1161/JAHA.115.002157.

Sex Differences in Clinical Profiles and Quality of Care Among Patients With ST-Segment Elevation Myocardial Infarction From 2001 to 2011: Insights From the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE)-Retrospective Study.

Author information

1
National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
2
Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
3
Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
4
Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT.
5
Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO Colorado Cardiovascular Outcomes Research Consortium, Denver, CO.
6
University of Missouri-Kansas City, School of Medicine, Biomedical & Health Informatics, Kansas City, MO Saint Luke's Mid America Heart Institute, Kansas City, MO.
7
Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, FL Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL.
8
Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT Department of Internal Medicine, Yale School of Medicine, New Haven, CT Section of Cardiovascular Medicine, Robert Wood Johnson Clinical Scholars Program, Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.
9
National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China jiangl@fwoxford.org.

Abstract

BACKGROUND:

China is experiencing a marked increase in ST-segment elevation myocardial infarction hospitalizations, with 30% occurring among women and higher risk of in-hospital death in relatively younger age groups (<70). Yet, little is known about sex differences in ST-segment elevation myocardial infarction presentation and management.

METHODS AND RESULTS:

In a nationally representative sample of patients with ST-segment elevation myocardial infarction admitted to 162 Chinese hospitals in 2001, 2006, and 2011, we examined sex differences in hospitalization rates, clinical profiles, and quality of care. Among 11 986 patients, the proportion of women was unchanged between 2001 and 2011. The estimated national rates of hospital admission per 100 000 people increased from 4.6 in 2001 to 18.0 in 2011 among men (3.9-fold increase) and from 1.9 to 8.0 among women (4.2-fold increase) (Ptrend<0.0001). The median age of women increased from 68 years in 2001 to 72 years in 2011 (Ptrend<0.001); however, there was no age change in men (63 years in 2011) (Ptrend=0.48). After accounting for age, women had a higher frequency of comorbidities. Although there were significant sex differences in the time interval of >12 hours between symptom onset and admission time in 2001, since 2006 delays in presentation were comparable between women and men. Fewer women without contraindications received evidence-based therapies than men, including reperfusion (57.5% versus 44.2%), early aspirin (88.8% versus 85.9%), and clopidogrel (56.9% versus 52.5%, P<0.001 for all) and the differences were largely unchanged over time.

CONCLUSIONS:

Women experienced a higher increase in hospitalization rates for ST-segment elevation myocardial infarction in China between 2001 and 2011 and were less likely to receive evidence-based therapies, especially reperfusion. In addition to efforts to improve quality of care generally, understanding the reasons for this sex disparity and addressing these differences in care should be a priority.

CLINICAL TRIAL REGISTRATION:

URL: https://www.clinicaltrials.gov. Unique identifier: NCT01624883.

KEYWORDS:

acute myocardial infarction; epidemiology; health policy; quality of care; sex

PMID:
26903002
PMCID:
PMC4802449
DOI:
10.1161/JAHA.115.002157
[Indexed for MEDLINE]
Free PMC Article
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