Abstract 185: The Sex Gap among Cardiovascular Disease Encounters in India

Abstract

Background: Women have long been underrepresented in CV care studies. Studies examining this gap mainly focus on the U.S. and Europe. Investigating sex disparities in India could inform efforts to reduce gaps in access to treatment in a population phenotypically predisposed to cardiovascular conditions and metabolic syndrome. Methods: PINNACLE India is a cardiovascular data collection and reporting program. Data are collected for CV patients at hospital outpatient departments (OPDs) via scanning of paper records or electronic integration with hospital systems when available. Longitudinal and retrospective encounter data are collected if available. Results: From Jan 1, 2012 through Oct 29, 2013, 146,522 CV patient encounters were recorded, including retrospective encounters dating to Feb 1, 2007. Of these patient encounters, 71.6% (104,874) were males and 28.2% (41,285) were females (Table 1). A portion of this difference likely reflects a higher CV disease burden among Indian males, but the gap is wider than expected. The PINNACLE Registry in the U.S. collects data on a similar population of CV outpatients. Published PINNACLE U.S. data show 53.4% of encounters were male patients and 46.6% were female patients. The gender split appears least prevalent in Indian atrial fibrillation (AF) patients, where women represent 46.6% and males account for 52.6% of patient encounters. In contrast and across a much larger patient population, 86.9% of coronary artery disease (CAD) patients were male and 13.1% were female. Conclusion: Untreated or poorly managed AF and CAD can lead to myocardial infarction, stroke and death. A greater awareness of gender differences in AF and CAD, and the impact of factors that are unique to each gender, would contribute to more effective management and better long-term outcomes. Though genetic differences may contribute to greater cardiovascular disease prevalence in men, PINNACLE India’s sizable difference in male and female representation could be indicative of cultural or economic issues limiting access to specialty care for females. Implementing dedicated efforts to understand and reduce gaps in access could have far-reaching impacts on improving India’s overall population health. Factors limiting access for females should be investigated further.