title: Association between gender, process of care measures, and outcomes in ACS in India: results from the detection and management of coronary heart disease (DEMAT) registry.
abstract: BACKGROUND
  Studies from high-income countries have shown that women receive less aggressive diagnostics and treatment than men in acute coronary syndromes (ACS), though their short-term mortality does not appear to differ from men. Data on gender differences in ACS presentation, management, and outcomes are sparse in India.
  
  
  RESULTS
  The Detection and Management of Coronary Heart Disease (DEMAT) Registry collected data from 1,565 suspected ACS patients (334 women; 1,231 men) from ten tertiary care centers throughout India between 2007-2008. We evaluated gender differences in presentation, in-hospital and discharge management, and 30-day death and major adverse cardiovascular event (MACE; death, re-hospitalization, and cardiac arrest) rates. Women were less likely to present with STEMI than men (38% vs. 55%, p<0.001). Overall inpatient diagnostics and treatment patterns were similar between men and women after adjustment for potential confounders. Optimal discharge management with aspirin, clopidogrel, beta-blockers, and statin therapy was lower for women than men, (58% vs. 65%, p = 0.03), but these differences were attenuated after adjustment (OR = 0.86 (0.62, 1.19)). Neither the outcome of 30-day mortality (OR = 1.40 (0.62, 3.16)) nor MACE (OR = 1.00 (0.67, 1.48)) differed significantly between men and women after adjustment.
  
  
  CONCLUSIONS
  ACS in-hospital management, discharge management, and 30-day outcomes did not significantly differ between genders in the DEMAT registry, though consistently higher treatment rates and lower event rates in men compared to women were seen. These findings underscore the importance of further investigation of gender differences in cardiovascular care in India.
authors: Centre for Chronic Disease Control, New Delhi, India. npagidipati@partners.org
authors: Neha J
authors: NJ
authors: Pagidipati
authors: Mark D
authors: MD
authors: Huffman
authors: Panniyammakal
authors: P
authors: Jeemon
authors: Rajeev
authors: R
authors: Gupta
authors: Prakash
authors: P
authors: Negi
authors: Thannikot M
authors: TM
authors: Jaison
authors: Satyavan
authors: S
authors: Sharma
authors: Nakul
authors: N
authors: Sinha
authors: Padinhare
authors: P
authors: Mohanan
authors: B G
authors: BG
authors: Muralidhara
authors: Sasidharan
authors: S
authors: Bijulal
authors: Sivasubramonian
authors: S
authors: Sivasankaran
authors: Vijay K
authors: VK
authors: Puri
authors: Jacob
authors: J
authors: Jose
authors: K Srinath
authors: KS
authors: Reddy
authors: Dorairaj
authors: D
authors: Prabhakaran
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D000553:Ambulatory Care; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007297:Inpatients; D008297:Male; D017063:Outcome Assessment, Health Care; D012042:Registries; D012737:Sex Factors; D012959:Socioeconomic Factors
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