Patient sex and quality of emergency department care for patients with acute myocardial infarction

Abstract

Study objectives: Although previous studies have shown that women are less likely than men to undergo invasive procedures to treat coronary artery disease, less is known about sex differences in the medical treatment of acute myocardial infarction in the emergency department (ED). The objective of this study is to assess differences in rates of use of aspirin, β-blockers, and reperfusion therapy between male and female ED acute myocardial infarction (AMI) patients with no contraindications to these therapies. Methods: This was a cohort study of 2,216 consecutive, enzyme-confirmed AMI patients presenting to 1 of 5 community EDs in Colorado and California from July 2000 through June 2002. ED and inpatient records were abstracted to obtain information on the use of aspirin, β-blockers, reperfusion therapy, contraindications to these treatments, patient characteristics, and clinical factors. Hierarchical multivariable regression was used to evaluate the relationship between sex and the receipt of aspirin, β-blockers, and reperfusion therapy in ideal candidates while adjusting for patient and hospital characteristics, and inhospital clustering. Results: There were 849 women and 1,367 men in the study sample. Female patients were older than male patients (women, 73.4 years versus men, 66.1 years; P<.001). Women more often had a history of hypertension, congestive heart failure, and chronic obstructive pulmonary disease and less often had a history of smoking, hyperlipidemia, and previous cardiac disease. Compared with men, women were less likely to be administered aspirin (women 76.3 versus men 81.3, P<.01), β-blockers (women 51.7 versus men 61.4, P<.01), and reperfusion therapy (women 64.0 versus men 72.8, P<.05). However, after adjustment for age there was no longer a significant relationship between sex and the use of aspirin (relative risk [RR] 0.91, 95% confidence interval [CI] 0.73 to 1.14), β-blockers (RR 0.82, 95% CI 0.62 to 1.08), or reperfusion therapy (RR 0.99, 95% CI 0.63 to 1.54). In models that adjusted for additional demographic, clinical, and hospital characteristics, there remained no association between sex and process of care. Conclusion: Women with AMI cared for in the ED have a lower likelihood of receiving aspirin, β-blocker, and reperfusion therapy. However, this association appears to be explained by the difference in age between men and women who present to the ED with AMI. Study objectives: Although previous studies have shown that women are less likely than men to undergo invasive procedures to treat coronary artery disease, less is known about sex differences in the medical treatment of acute myocardial infarction in the emergency department (ED). The objective of this study is to assess differences in rates of use of aspirin, β-blockers, and reperfusion therapy between male and female ED acute myocardial infarction (AMI) patients with no contraindications to these therapies. Methods: This was a cohort study of 2,216 consecutive, enzyme-confirmed AMI patients presenting to 1 of 5 community EDs in Colorado and California from July 2000 through June 2002. ED and inpatient records were abstracted to obtain information on the use of aspirin, β-blockers, reperfusion therapy, contraindications to these treatments, patient characteristics, and clinical factors. Hierarchical multivariable regression was used to evaluate the relationship between sex and the receipt of aspirin, β-blockers, and reperfusion therapy in ideal candidates while adjusting for patient and hospital characteristics, and inhospital clustering. Results: There were 849 women and 1,367 men in the study sample. Female patients were older than male patients (women, 73.4 years versus men, 66.1 years; P<.001). Women more often had a history of hypertension, congestive heart failure, and chronic obstructive pulmonary disease and less often had a history of smoking, hyperlipidemia, and previous cardiac disease. Compared with men, women were less likely to be administered aspirin (women 76.3 versus men 81.3, P<.01), β-blockers (women 51.7 versus men 61.4, P<.01), and reperfusion therapy (women 64.0 versus men 72.8, P<.05). However, after adjustment for age there was no longer a significant relationship between sex and the use of aspirin (relative risk [RR] 0.91, 95% confidence interval [CI] 0.73 to 1.14), β-blockers (RR 0.82, 95% CI 0.62 to 1.08), or reperfusion therapy (RR 0.99, 95% CI 0.63 to 1.54). In models that adjusted for additional demographic, clinical, and hospital characteristics, there remained no association between sex and process of care. Conclusion: Women with AMI cared for in the ED have a lower likelihood of receiving aspirin, β-blocker, and reperfusion therapy. However, this association appears to be explained by the difference in age between men and women who present to the ED with AMI.