Abstract 16866: Sex Differences in Access to Care Before Acute Myocardial Infarction: Does the Health Care System Matter?

Abstract

Introduction: Access to high-quality health care for young women with acute myocardial infarction (AMI) lags behind that of men. Whether access to care varies based on the health care system remains unknown. We evaluated sex differences in pre-AMI access to care in young patients with AMI across countries. Methods: We utilized data from the GENESIS-PRAXY and VIRGO cohorts, which included young ( < 55 yrs) AMI patients hospitalized in countries with public (Canada, Spain, Australia) or private (United States [US], Switzerland) health care systems (2009-13). We collected data on demographics, CV risk, and psychosocial factors. Pre-AMI access to care was defined as: having a primary health care provider, difficulties in access to primary/specialist care, primary health care visits/diagnostic tests for cardiac symptoms (12 months prior to AMI). Sex-stratified analysis by health care system was performed. Results: Among 4,689 AMI patients (58% women, mean age 47±6 yrs), 64% were from the US and 22% from Canada. Compared with men, women had more CV risk factors, higher rates of depression/stress and lower socioeconomic status (SES) (Table); more strikingly in the US. Across countries, 70% of patients had a primary health care provider. However, women experienced more difficulties accessing primary (21% vs. 15%) or specialist care (27% vs. 20%, all p<.001) versus men. Women in the US reported cost barriers (47% vs. 5%), whereas women from other countries had difficulties in contacting primary health care providers (91% vs. 46%, all p<.001). Nevertheless, compared with men, women reported more primary health care provider visits (46% vs. 37%) and tests for cardiac symptoms (66% vs. 50%), regardless of health care system. Conclusions: In both public and privately funded health care systems, one-fifth of young AMI patients had poor pre-AMI access to care, despite a high-risk factor burden - especially among women in the US. Young women of low SES should be targeted for primary prevention.