Narrowing gender differences in procedure use for acute myocardial infarction: insights from the Worcester heart attack study.
OBJECTIVE
To examine age-specific gender differences and trends over time in the management of patients with acute myocardial infarction (AMI).


METHODS
Cross-sectional study of patients admitted with AMI from a community-wide perspective over a 10-year period (1990-1999).


METHODS
All hospitals in the Worcester (Mass) metropolitan area (1990 census = 437000).


METHODS
We identified 2037 women and 2645 men who were hospitalized in the Worcester metropolitan area with confirmed AMI during six 1-year periods between 1990 and 1999. Four age groups (<55, 55 to 64, 65 to 74 and >or=75 years) of men and women were studied.


RESULTS
Use of echocardiography, exercise treadmill testing (ETT), cardiac catheterization, percutaneous coronary interventions (PCI), and coronary artery bypass grafting (CABG) during the index hospitalization was examined in relation to age and gender. Overall, women were less likely to undergo ETT, cardiac catheterization, and CABG than were men, and these trends remained after controlling for potentially confounding factors. Between 1990 and 1999, there was a dramatic decrease in ETT, whereas the use of echocardiography remained unchanged. There were marked increases over time in the use of cardiac catheterization and PCI in women and men. Use of cardiac catheterization and PCI increased to a greater extent in women as compared to men. In patients who underwent cardiac catheterization, rates of coronary revascularization were similar between men and women.


CONCLUSIONS
Our data suggest that women and men with AMI are treated differently with respect to use of diagnostic and revascularization procedures. However, gender differences in the use of these diagnostic and interventional approaches have narrowed over time.
Harrold
Leslie R
LR
Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA. HarroldL@ummhc.org
Esteban
Julian
J
Lessard
Darleen
D
Yarzebski
Jorge
J
Gurwitz
Jerry H
JH
Gore
Joel M
JM
Goldberg
Robert J
RJ
D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004452:Echocardiography / Q000706:statistics & numerical data; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D016017:Odds Ratio; D012107:Research Design; D017678:Sex Distribution; D016387:Women's Health