Women veterans and outcomes after acute myocardial infarction.
BACKGROUND
Previous studies have shown that women have decreased survival and receive fewer cardiac procedures after acute myocardial infarction (AMI) compared with men, raising concerns for sexual bias in provision of care. The objective of this study is to describe clinical characteristics, treatment, and survival in women veterans compared with men after admission to VA hospitals for AMI.


METHODS
This is a retrospective inception cohort study using data drawn from the VA Cardiac Care Follow-up Clinical Study, describing patients admitted for AMI to VA hospitals from October 1, 2003 to March 31, 2005. Subjects were followed for 1 year.


RESULTS
There were 236 women and 13,259 men admitted during the study period to VA hospitals with AMI. Women were less likely to have a history of heart failure compared with men (18.2% of women vs. 27.2% of men, p = 0.002) and previous coronary artery bypass grafting (CABG) (11.4% of women vs. 19.6% of men, p = 0.002). Diagnostic cardiac catheterization was similar in women and men (36.9% and 34.9%, p = 0.539). Crude in-hospital mortality was 4.2% for women and 7.6% for men (p = 0.051). After adjusting for comorbidities and treatment variables, in-hospital mortality was not significantly different for women compared with men (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.60-1.12).


CONCLUSIONS
Women veterans receive a level of care similar to men veterans for MI treated in VA hospitals. Differences in mortality between women and men were not significant and do not suggest that women fare worse.
Wheeler
Stephanie
S
VA Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, S-111-GIMC, 1660 South Columbian Way, Seattle, WA 98108, USA. stephanie.wheeler@med.va.gov
Bowen
Jennie D
JD
Maynard
Charles
C
Lowy
Elliot
E
Sun
Haili
H
Sales
Anne E
AE
Smith
Nicholas L
NL
Fihn
Stephan D
SD
D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006787:Hospitals, Veterans / Q000458:organization & administration; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D017678:Sex Distribution; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*; D016387:Women's Health