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UNDERUTILIZATION INFLUENCING FACTORS OF EVIDENCE BASED THERAPIES IN WOMEN
A120.E1119 JACC March 9, 2010 Volume 55, issue 10A
MYOCARDIAL ISCHEMIA AND INFARCTION UNDERUTILIZATION INFLUENCING FACTORS OF EVIDENCE BASED THERAPIES IN WOMEN ACC Poster Contributions Georgia World Congress Center, Hall B5 Monday, March 15, 2010, 3:30 p.m.-4:30 p.m.
Session Title: Sex Differences in Evaluation, Treatment and Outcomes in Patients with Acute Coronary Syndromes Abstract Category: Unstable Ischemic Syndrome--Clinical Presentation Number: 1211-283 Authors: Raffaele Bugiardini, Andrew T. Yan, Raymond T. Yan, David Fitchett, Anatoly Langer, Shaun G. Goodman, Olivia Manfrini, on the behalf of the Canadian Acute Coronary Syndrome Registry I and II Investigators, University of Bologna, Bologna, Italy, University of Toronto, Toronto, ON, Canada Background: Previous studies have reported differences in the use of cardiovascular medications for acute coronary syndromes according to the sex of the patient. A deliberate act to deny women proven treatment by their physicians seems unlikely. In order to contribute to a better understanding of the clinical decision making process in women, we analyzed which factors are associated with underutilization of evidence based therapies. Methods: From the Canadian Registry of Acute Coronary Syndromes I and II, 6558 patients (4471 men and 2087 women) with a final diagnosis of acute coronary syndrome entered into the current analysis. Covariates were chosen using the approach described by Blackstone. The final selected model included 24 patient variables. Results: Women were less likely than men to receive beta-blockers (75.76% versus 79.24%; p<0.01), lipid-modifying agents (56.37% versus 65.44%; p<0.0001) and ACE inhibitors (55.52% versus 59.99%; p<0.01). Female sex and clinical decision not to investigate with cardiac catheterization were the strongest predictors (p<0.01) for not receiving lipid-modifying agents (OR 0.77, 95% CI 0.66 to 0.88; and OR 0.38, 95% CI 0.15 to 0.57, respectively) and ACEI (OR, 0.74; 95% CI, 0.65.to 0.83; and OR 0.81, 95% CI, 0.76.to 0.94, respectively) at discharge. Age (OR 0.83, 95% CI 0.78 to 0.88), Killip class 2 (OR 0.67, 95% CI 0.55 to 0.80) and Killip class 3/4 (OR 0.61, 95% CI 0.44 to 0.85) were significant (p<0.01) independent predictors of underutilization of beta-blocker use at discharge. Women were older (69±12 versus 64±12; p<0.01) with a higher prevalence of congestive heart failure (12.9% versus 8.9%; p<0.001), but they were less likely to be referred for cardiac catheterization (41.9% versus 49.6 %; p<0.001). Conclusions: The findings demonstrate a serious underutilization of evidence-based treatments in women with acute coronary syndromes. Disparity largely depends on factors related to the patient (age), on factors related to the disease (congestive heart failure), and on factors related to the physician’s assessment of patient risk (decision to catheterize).
MYOCARDIAL ISCHEMIA AND INFARCTION UNDERUTILIZATION INFLUENCING FACTORS OF EVIDENCE BASED THERAPIES IN WOMEN ACC Poster Contributions Georgia World Congress Center, Hall B5 Monday, March 15, 2010, 3:30 p.m.-4:30 p.m.
Session Title: Sex Differences in Evaluation, Treatment and Outcomes in Patients with Acute Coronary Syndromes Abstract Category: Unstable Ischemic Syndrome--Clinical Presentation Number: 1211-283 Authors: Raffaele Bugiardini, Andrew T. Yan, Raymond T. Yan, David Fitchett, Anatoly Langer, Shaun G. Goodman, Olivia Manfrini, on the behalf of the Canadian Acute Coronary Syndrome Registry I and II Investigators, University of Bologna, Bologna, Italy, University of Toronto, Toronto, ON, Canada Background: Previous studies have reported differences in the use of cardiovascular medications for acute coronary syndromes according to the sex of the patient. A deliberate act to deny women proven treatment by their physicians seems unlikely. In order to contribute to a better understanding of the clinical decision making process in women, we analyzed which factors are associated with underutilization of evidence based therapies. Methods: From the Canadian Registry of Acute Coronary Syndromes I and II, 6558 patients (4471 men and 2087 women) with a final diagnosis of acute coronary syndrome entered into the current analysis. Covariates were chosen using the approach described by Blackstone. The final selected model included 24 patient variables. Results: Women were less likely than men to receive beta-blockers (75.76% versus 79.24%; p<0.01), lipid-modifying agents (56.37% versus 65.44%; p<0.0001) and ACE inhibitors (55.52% versus 59.99%; p<0.01). Female sex and clinical decision not to investigate with cardiac catheterization were the strongest predictors (p<0.01) for not receiving lipid-modifying agents (OR 0.77, 95% CI 0.66 to 0.88; and OR 0.38, 95% CI 0.15 to 0.57, respectively) and ACEI (OR, 0.74; 95% CI, 0.65.to 0.83; and OR 0.81, 95% CI, 0.76.to 0.94, respectively) at discharge. Age (OR 0.83, 95% CI 0.78 to 0.88), Killip class 2 (OR 0.67, 95% CI 0.55 to 0.80) and Killip class 3/4 (OR 0.61, 95% CI 0.44 to 0.85) were significant (p<0.01) independent predictors of underutilization of beta-blocker use at discharge. Women were older (69±12 versus 64±12; p<0.01) with a higher prevalence of congestive heart failure (12.9% versus 8.9%; p<0.001), but they were less likely to be referred for cardiac catheterization (41.9% versus 49.6 %; p<0.001). Conclusions: The findings demonstrate a serious underutilization of evidence-based treatments in women with acute coronary syndromes. Disparity largely depends on factors related to the patient (age), on factors related to the disease (congestive heart failure), and on factors related to the physician’s assessment of patient risk (decision to catheterize).