Abstract
Background: Evaluation of functional status following myocardial infarction (MI) is essential for long-term prognosis and treatment. We hypothesized that functional status following hospitalized MI is lower among women as compared to men. Methods: Peer-reviewed articles that presented functional status stratified by gender were identified from MEDLINE, PsycInfo, CINAHL, Embase, and the Cochrane Database of Systematic Reviews (Jan. 1, 1991-May 20, 2011) using the terms: myocardial infarction, acute coronary syndrome, functional status, and quality of life. A priori exclusion criteria included: non-English language, review papers, expert opinions or discussions, case reports, studies without original data, samples without MI patients or measures of physical functioning; studies not on adults or studies restricted to all men or all women; and studies with outcomes not stratified by gender or MI status. Initial search identified 2102 articles/abstracts. Based on eligibility criteria, we excluded from initial review 1537 articles. Title and/or abstract review of remaining 565 studies led to further exclusion of 491, leaving 74 articles. A full-text review narrowed this to 30 articles which were then abstracted. Results: Average follow-up time after MI was 11.8 months (range: 0-89 months) with average number of study participants 879 (range: 60-2950). Majority of the studies (n=23, 77%) used generic, rather than disease-specific, health-related quality of life questionnaires (e.g. SF-36) to assess functional status. Of the 30 articles abstracted, 26 (87%) reported better functional status in men with MI as compared to women with MI. Effect of age, comorbidities, and clinical variables on association of gender with functional status following MI was assessed in 5 studies and found to attenuate gender differences to non-significant level in 2 studies. Increase in gender-related differences in functional status after MI was reported in 2 of 5 studies that evaluated change in functional status over time. Conclusions: Functional status of women with MI is on average worse than functional status of men with MI. Differences in clinical variables, age, and comorbidities may partly explain gender differences in post-MI functional status.
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