title: A higher burden of metabolic risk factors and underutilization of therapy among women compared to men might influence a poorer prognosis: a study among acute myocardial patients in Albania, a transitional country in Southeastern Europe.
abstract: OBJECTIVE
  To determine the clinical profile, burden of risk factors, and quality of care among patients hospitalized for an acute myocardial infarction (AMI) with special focus on gender differences.
  
  
  METHODS
  The study included 256 AMI patients admitted to the Coronary Care Unit of "Mother Teresa" hospital in Tirana during 2013-2014. We obtained information on patients' demographic data, AMI characteristics, complications (heart failure [HF] and ventricular fibrillation [VF]), risk factors and medication use prior and during the AMI hospitalization. Age-adjusted Poisson regression analyses were applied to explore gender differences (women vs men) with regard to clinical profile and quality of care and results are expressed as incidence rate ratios (IRR).
  
  
  RESULTS
  55.4% of patients had ≥3 risk factors, 44.5% developed HF, and 5.7% developed VF. Only 40.4% of patients received all 4 medication classes (beta-blockers, angiotensin-converting-enzyme inhibitor/angiotensin receptor blockers, statins, and aspirin) and 46.4% had revascularization. Significantly more women than men were obese, (P=0.042) had diabetes, (P=0.001) developed HF (P<0.001) or experienced a VF episode (P<0.001). After adjusting for age, differences with regard to obesity (IRR=.17; 95% confidence interval [CI] 1.15-4.09), diabetes (IRR=1.35; 95% CI 1.07-1.71), HF (IRR=1.32; 95% CI 1.02-1.74) and VF (IRR=2.82; 95% CI 1.07-7.43) remained significant. There were no differences with regard to individual drug classes taken. However, women had fewer revascularization procedures than men (IRR=0.65; 95% CI 0.43-0.98).
  
  
  CONCLUSIONS
  Women were found to have more unfavorable clinical profile, higher complication rates, and underutilization of therapy, which may be influenced by socioeconomic differences between genders and lead to a differential prognosis.
authors.forename: Sokol
authors.initials: S
authors.lastname: Myftiu
authors.forename: Enxhela
authors.initials: E
authors.lastname: Sulo
authors.forename: Genc
authors.initials: G
authors.lastname: Burazeri
authors.forename: Ilir
authors.initials: I
authors.lastname: Sharka
authors.forename: Artan
authors.initials: A
authors.lastname: Shkoza
authors.affiliation: Gerhard Sulo, Department of Global Public Health and Primary Care, Kalfarveien 31, N-5018 Bergen, Norway, gerhard.sulo@uib.no.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Sulo
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000415:Albania / Q000453:epidemiology; D002317:Cardiovascular Agents / Q000008:administration & dosage; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D009765:Obesity / Q000453:epidemiology; D011379:Prognosis; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D002317:Cardiovascular Agents