title: Trends in Gender Differences in Cardiac Care and Outcome After Acute Myocardial Infarction in Western Sweden: A Report From the Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART).
abstract: BACKGROUND
  Cardiovascular disease is the most common cause of death for both genders. Debates are ongoing as to whether gender-specific differences in clinical course, diagnosis, and management of acute myocardial infarction (MI) exist.
  
  
  RESULTS
  We compared all men and women who were treated for acute MI at cardiac care units in Västra Götaland, Sweden, between January 1995 and October 2014 by obtaining data from the prospective SWEDEHEART (Swedish Web-System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. We performed unadjusted and adjusted Cox proportional hazards and logistic regression analyses on complete case data and on imputed data sets. Overall, 48 118 patients (35.4% women) were diagnosed with acute MI. Women as a group had better age-adjusted prognosis than men, but this survival benefit was absent for younger women (aged <60 years) and for women with ST-segment elevation MI. Compared with men, younger women and women with ST-segment elevation MI were more likely to develop prehospital cardiogenic shock (adjusted odds ratio 1.67, 95% CI 1.30 to 2.16, P<0.001 and adjusted odds ratio 1.31, 95% CI 1.16 to 1.48, P<0.001) and were less likely to be prescribed evidence-based treatment at discharge (P<0.001 for β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, statins, and P2Y12 antagonists). Differences in treatment between the genders did not decrease over the study period (P>0.1 for all treatments).
  
  
  CONCLUSIONS
  Women on average have better adjusted prognosis than men after acute MI; however, younger women and women with ST-segment elevation MI have disproportionately poor prognosis and are less likely to be prescribed evidence-based treatment.
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.).
authors.forename: Björn
authors.initials: B
authors.lastname: Redfors
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.).
authors.forename: Oskar
authors.initials: O
authors.lastname: Angerås
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.).
authors.forename: Truls
authors.initials: T
authors.lastname: Råmunddal
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.).
authors.forename: Petur
authors.initials: P
authors.lastname: Petursson
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.).
authors.forename: Inger
authors.initials: I
authors.lastname: Haraldsson
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.).
authors.forename: Christian
authors.initials: C
authors.lastname: Dworeck
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.).
authors.forename: Jacob
authors.initials: J
authors.lastname: Odenstedt
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.).
authors.forename: Dan
authors.initials: D
authors.lastname: Ioaness
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.).
authors.forename: Annika
authors.initials: A
authors.lastname: Ravn-Fischer
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.).
authors.forename: Peder
authors.initials: P
authors.lastname: Wellin
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.).
authors.forename: Helen
authors.initials: H
authors.lastname: Sjöland
authors.affiliation: Department of Cardiology, Hacettepe University Hospital, Ankara, Turkey (L.T.).
authors.forename: Lale
authors.initials: L
authors.lastname: Tokgozoglu
authors.affiliation: Department of Cardiology, Södra Älvsborgs Sjukhus, Borås, Sweden (H.T.).
authors.forename: Hans
authors.initials: H
authors.lastname: Tygesen
authors.affiliation: Department of Cardiology, Skaraborg Hospital, Skövde, Sweden (E.F.).
authors.forename: Erik
authors.initials: E
authors.lastname: Frick
authors.affiliation: Department of Cardiology, Allingsås Hospital, Allingsås, Sweden (R.R.).
authors.forename: Rickard
authors.initials: R
authors.lastname: Roupe
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.).
authors.forename: Per
authors.initials: P
authors.lastname: Albertsson
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.).
authors.forename: Elmir
authors.initials: E
authors.lastname: Omerovic
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019317:Evidence-Based Medicine / Q000639:trends*; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000639:trends*; D017052:Hospital Mortality; D006801:Humans; D020407:Internet; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D017064:Process Assessment, Health Care / Q000639:trends*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: ST‐segment elevation myocardial infarction; acute myocardial infarction; evidence‐based treatment; gender; non–ST‐segment elevation myocardial infarction