Age and Gender Differences in Quality of Care and Outcomes for Patients with ST-segment Elevation Myocardial Infarction

• Published in: The American journal of medicine Vol. 125; no. 10; pp. 1000 - 1009
• Main Authors: Bangalore, Sripal, MD, MHA, Fonarow, Gregg C., MD, Peterson, Eric D., MD, MPH, Hellkamp, Anne S., MS, Hernandez, Adrian F., MD, Laskey, Warren, MD, Peacock, W. Frank, MD, Cannon, Christopher P., MD, Schwamm, Lee H., MD, Bhatt, Deepak L., MD, MPH
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2012; Elsevier; Elsevier Sequoia S.A
• Subjects: Adult; Age differences; Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Clinical outcomes; Cohort Studies; Coronary heart disease; Female; Gender; Gender differences; General aspects; Guideline Adherence - statistics & numerical data; Healthcare Disparities - statistics & numerical data; Heart; Heart attacks; Hospital Mortality; Humans; Indexing in process; Internal Medicine; Male; Medical sciences; Middle Aged; Miscellaneous; Mortality; Multivariate Analysis; Myocardial infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - etiology; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Outcome and Process Assessment (Health Care); Practice Guidelines as Topic; Prognosis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality Indicators, Health Care; Quality of care; Registries; Risk Factors; Sex Factors; United States; Young; United States; Myocardial infarction; Young; Prognosis; Gender; Human; Sex; Cardiovascular disease; Patient; Coronary heart disease; Myocardial disease; Care; Medicine; ST elevation; Quality; Evolution; Age; Comparative study; Public health
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2011.11.016

Abstract Background Young patients (aged ≤ 45 years) presenting with ST-segment elevation myocardial infarction present unique challenges. The quality of care and in-hospital outcomes may differ from their older counterparts. Methods A total of 31,544 patients presenting with ST-segment elevation myocardial infarction and enrolled in the American Heart Association's Get With the Guidelines Coronary Artery Disease registry were analyzed. The cohort was divided into those aged 45 years or less and those aged more than 45 years. Results Young patients accounted for 10.3% of all ST-segment elevation myocardial infarction cases. Compared with older patients, younger patients were less likely to have traditional cardiovascular risk factors and had similar or better quality/performance measures with lower in-hospital mortality (unadjusted rate 1.6 vs 6.5%, P <.0001; adjusted odds ratio [OR], 0.37; 95% confidence interval [CI], 0.29-0.46). Time trend analysis (2002-2008) suggested an increase over time in the “all or none” composite performance measure in both the younger and older patients (68%-97% and 69%-96%, respectively). However, there was significantly lower quality of care and worse outcomes in women (vs men) and in the very young (≤35 vs 36-45 years). Significant interaction was seen between age and gender for in-hospital death, such that the gender difference was greater in the younger cohort. Similar interaction was seen for door-to-thrombolytic time such that the gender delay was greater in the younger cohort (women:men ratio of means = 1.73, 95% CI, 1.21-2.45 [younger] vs 1.08, 95% CI, 1.00-1.18 [older]; Pinteraction = .0031). Conclusion Young patients aged 45 years or less presenting with ST-segment elevation myocardial infarction overall had similar quality of care and in-hospital outcomes as older counterparts. However, quality of care was significantly lower and mortality was higher in young women (vs young men) and the very young (≤35 vs 36-45 years).