Younger women (women between the ages of 18 and 55) have more adverse outcomes than men during the first year after treatment. acute myocardial infarction (AMI) and an increased risk of cardiac and non-cardiac readmission, a new analysis of the VIRGO study suggests.
The all-cause hospitalization rate within 1 year after discharge was 23% for men and 34.8% for women. Most of the women’s hospitalizations were coronary related.
women of myocardial infarction Women with non-occlusive coronary arteries (MINOCA) had lower readmission rates than women who experienced an obstructive myocardial infarction coronary artery disease (MI-CAD).
There was a more significant gender difference between women and men in noncardiac hospitalizations compared to all other hospitalizations (incidence, 145.8 [women] vs 69.6 [men] per 1000 person-years).
“Despite controlling for more than 30 variables, which are often influential variables such as belonging to the self-reported non-Hispanic black population and low socioeconomic status, there were no significant differences in gender differences in one-year outcomes. I was surprised to see the significance. [and] Mitsuaki Sawano, M.D., Ph.D., Yale University School of Medicine, New Haven, Connecticut, said: theheart.org| Medscape Cardiology“Our findings indicate that women may actually be at higher risk for one year of hospitalization.
In the United States, comprehensive data capturing healthcare utilization among young AMI patients is lacking, Sawano said. role), which is why the study began more than a decade ago.”
“We believe the VIRGO data are still relevant today, as there is no indication that the care provided to young patients has changed significantly in the last decade,” he added.
Result is publish online May 1st Journal of the American College of Cardiology.
clear gender gap
The VIRGO study enrolled men and women with AMI at 103 US hospitals. The average patient age was 47 years, and 70% identified as non-Hispanic Caucasian. A higher proportion of women self-identify as non-Hispanic Black compared to men.
Women also had a higher prevalence of comorbidities, including: obesity, congestive heart failureprevious stroke, and renal disease, and greater history depression at baseline (48.7% vs 24.2%).
Of the 2979 patients (67% female) included in the analysis, 905 (30.4%) had at least one hospitalization within 1 year after discharge.
The main cause of hospitalization was coronary artery-related (incidence [IR]171.8 in women vs. 117.8 in men), followed by noncardiac hospitalization (IR, 145.8 vs. 69.6) and dissection and vasospasm (1.4% vs. 0.2%).
Women with MINOCA had a lower 1-year incidence of all-cause, coronary-related, and stable or coronary artery disease. unstable angina Hospitalization compared with women with MI-CAD. Women with MINOCA also reported lower treatment satisfaction compared with men or women with MI-CAD.
At discharge, women had longer total hospital stays than men, and women were less likely to receive guideline-recommended medical treatment, including: aspirin (92.6% vs 95%), statins (67.5% vs 71.7%), beta blockers (89.6% vs 94.1%), and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (61.2% vs 70.6%).
“Increased risk factor burden, chest discomfort considered ‘non-cardiac’, delay in hospital admission, delay in post-hospital care, inequality in timely reperfusion therapy or revascularization, optimal Such as medical therapy prescribing and reduced continuation rates, all of which have been proposed as factors worsening clinical outcomes for young women,” Sawano said. I have not seen a full-fledged attempt to
To minimize the risk of avoidable hospitalization, a multidisciplinary team of cardiologists, psychiatrists, obstetricians and gynecologists, diabetes clinicians, and obesity specialists has developed a will be done,” he added.
“Clinicians need to understand their patients better.” This includes factors such as economic situation, insurance, access to health care, and constraints that may be related to family roles. “Everything is related to caring for young patients,” he said.
Beyond traditional risk factors
“Young women are the least aware of their heart attack risk, so we’re not surprised by the current findings,” says cardiologist Nieka Goldberg, M.D., clinical associate professor of medicine at New York University’s Grossman School of Medicine, Atria, NY. the medical director of the city, said theheart.org| Medscape Cardiology“The current healthcare system seems to be anchored in the image that men and older women are at risk for heart disease. A different analysis would likely yield the same results.” ”
Physicians need to look beyond traditional risk factors such as high blood pressure, high cholesterol, family history, smoking, physical inactivity and obesity, she said. is needed. preeclampsia, gestational diabetes, premature birth So are mental health issues such as depression, anxiety, and stress. These disorders can widen the net for women at risk for heart disease.”
Martha Gulati, MD, MS, Cedars-Sinai Smidt Heart Institute, Los Angeles, California and colleagues Related editorials The new analysis adds to decades of literature clearly showing that young women with AMI experience more adverse outcomes than men.
“The disparity is clear,” they conclude. “It’s time to stop adding stigma to infarction and resolve these persistent gender differences in cardiovascular care.”
The VIRGO study (NCT00597922) was supported by the National Heart, Lung, and Blood Institute. Although Sawano does not report any relevant financial ties, several co-authors do report industry ties. A full list can be found in the original article. Editors and Goldberg have not reported any related financial relationships.
J Am Call CardiolPublished online on May 1, 2023. overview, editorial
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