Gender differences in presentation, management, and in-hospital outcomes for patients with AMI in a lower-middle income country: evidence from Egypt.
BACKGROUND
Many studies in high-income countries have investigated gender differences in the care and outcomes of patients hospitalized with acute myocardial infarction (AMI). However, little evidence exists on gender differences among patients with AMI in lower-middle-income countries, where the proportion deaths stemming from cardiovascular disease is projected to increase dramatically. This study examines gender differences in patients in the lower-middle-income country of Egypt to determine if female patients with AMI have a different presentation, management, or outcome compared with men.


RESULTS
Using registry data collected over 18 months from 5 Egyptian hospitals, we considered 1204 patients (253 females, 951 males) with a confirmed diagnosis of AMI. We examined gender differences in initial presentation, clinical management, and in-hospital outcomes using t-tests and χ(2) tests. Additionally, we explored gender differences in in-hospital death using multivariate logistic regression to adjust for age and other differences in initial presentation. We found that women were older than men, had higher BMI, and were more likely to have hypertension, diabetes mellitus, dyslipidemia, heart failure, and atrial fibrillation. Women were less likely to receive aspirin upon admission (p<0.01) or aspirin or statins at discharge (p = 0.001 and p<0.05, respectively), although the magnitude of these differences was small. While unadjusted in-hospital mortality was significantly higher for women (OR: 2.10; 95% CI: 1.54 to 2.87), this difference did not persist in the fully adjusted model (OR: 1.18; 95% CI: 0.55 to 2.55).


CONCLUSIONS
We found that female patients had a different profile than men at the time of presentation. Clinical management of men and women with AMI was similar, though there are small but significant differences in some areas. These gender differences did not translate into differences in in-hospital outcome, but highlight differences in quality of care and represent important opportunities for improvement.
Yale School of Medicine, New Haven, Connecticut, United States of America. neel.butala@yale.edu
Neel M
NM
Butala
Mayur M
MM
Desai
Erika L
EL
Linnander
Y Rex
YR
Wong
Daoud G
DG
Mikhail
Lesli S
LS
Ott
John A
JA
Spertus
Elizabeth H
EH
Bradley
Ahmed Abdel
AA
Aaty
Alia
A
Abdelfattah
Ayman
A
Gamal
Hatem
H
Kholeif
Mohamed
M
el-Baz
A H
AH
Allam
Harlan M
HM
Krumholz
D004534:Egypt; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D012727:Sex Characteristics; D016896:Treatment Outcome