TY - JOUR
T1 - Sex disparity in secondary prevention pharmacotherapy and clinical outcomes following acute coronary syndrome
AU - Dagan, Misha
AU - Dinh, Diem T.
AU - Stehli, Julia
AU - Tan, Christianne
AU - Brennan, Angela
AU - Warren, Josephine
AU - Ajani, Andrew E.
AU - Freeman, Melanie
AU - Murphy, Alexandra
AU - Reid, Christopher M.
AU - Hiew, Chin
AU - Oqueli, Ernesto
AU - Clark, David J.
AU - Duffy, Stephen J.
N1 - Funding Information:
The Melbourne Interventional Group gratefully acknowledges funding from: Abbott Vascular, Astra-Zeneca, BMS and Pfizer. These companies do not have access to data and do not have the right to review manuscripts or abstracts before publication. C.M.R. is supported by a National Health and Medical Research Council of Australia Principal Research Fellowship (reference no. 11136372). S.J.D. work is supported by a National Health and Medical Research Council of grant (reference no. 1111170).
Publisher Copyright:
© 2021 Published on behalf of the European Society of Cardiology.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - Aims: We sought to investigate if sex disparity exists for secondary prevention pharmacotherapy following acute coronary syndrome (ACS) and impact on long-term clinical outcomes. Methods and results: We analysed data on medical management 30-day post-percutaneous coronary intervention (PCI) for ACS in 20 976 patients within the multicentre Melbourne Interventional Group registry (2005-2017). Optimal medical therapy (OMT) was defined as five guideline-recommended medications, near-optimal medical therapy (NMT) as four medications, sub-optimal medical therapy (SMT) as ≤3 medications. Overall, 65% of patients received OMT, 27% NMT and 8% SMT. Mean age was 64 ± 12 years; 24% (4931) were female. Women were older (68 ± 12 vs. 62 ± 12 years) and had more comorbidities. Women were less likely to receive OMT (61% vs. 66%) and more likely to receive SMT (10% vs. 8%) compared to men, P < 0.001. On long-term follow-up (median 5 years, interquartile range 2-8 years), women had higher unadjusted mortality (20% vs. 13%, P < 0.001). However, after adjusting for medical therapy and baseline risk, women had lower long-term mortality [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.79-0.98; P = 0.02]. NMT (HR 1.17, 95% CI 1.05-1.31; P = 0.004) and SMT (HR 1.79, 95% CI 1.55-2.07; P < 0.001) were found to be independent predictors of long-term mortality. Conclusion: Women are less likely to be prescribed optimal secondary prevention medications following PCI for ACS. Lower adjusted long-term mortality amongst women suggests that as well as baseline differences between gender, optimization of secondary prevention medical therapy amongst women can lead to improved outcomes. This highlights the need to focus on minimizing the gap in secondary prevention pharmacotherapy between sexes following ACS.
AB - Aims: We sought to investigate if sex disparity exists for secondary prevention pharmacotherapy following acute coronary syndrome (ACS) and impact on long-term clinical outcomes. Methods and results: We analysed data on medical management 30-day post-percutaneous coronary intervention (PCI) for ACS in 20 976 patients within the multicentre Melbourne Interventional Group registry (2005-2017). Optimal medical therapy (OMT) was defined as five guideline-recommended medications, near-optimal medical therapy (NMT) as four medications, sub-optimal medical therapy (SMT) as ≤3 medications. Overall, 65% of patients received OMT, 27% NMT and 8% SMT. Mean age was 64 ± 12 years; 24% (4931) were female. Women were older (68 ± 12 vs. 62 ± 12 years) and had more comorbidities. Women were less likely to receive OMT (61% vs. 66%) and more likely to receive SMT (10% vs. 8%) compared to men, P < 0.001. On long-term follow-up (median 5 years, interquartile range 2-8 years), women had higher unadjusted mortality (20% vs. 13%, P < 0.001). However, after adjusting for medical therapy and baseline risk, women had lower long-term mortality [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.79-0.98; P = 0.02]. NMT (HR 1.17, 95% CI 1.05-1.31; P = 0.004) and SMT (HR 1.79, 95% CI 1.55-2.07; P < 0.001) were found to be independent predictors of long-term mortality. Conclusion: Women are less likely to be prescribed optimal secondary prevention medications following PCI for ACS. Lower adjusted long-term mortality amongst women suggests that as well as baseline differences between gender, optimization of secondary prevention medical therapy amongst women can lead to improved outcomes. This highlights the need to focus on minimizing the gap in secondary prevention pharmacotherapy between sexes following ACS.
KW - Acute coronary syndrome
KW - Guideline-directed medical therapy
KW - Optimal medical therapy
KW - Secondary prevention
KW - Women
UR - http://www.scopus.com/inward/record.url?scp=85126007674&partnerID=8YFLogxK
U2 - 10.1093/ehjqcco/qcab007
DO - 10.1093/ehjqcco/qcab007
M3 - Article
C2 - 33537698
AN - SCOPUS:85126007674
SN - 2058-5225
VL - 8
SP - 420
EP - 428
JO - European Heart Journal - Quality of Care and Clinical Outcomes
JF - European Heart Journal - Quality of Care and Clinical Outcomes
IS - 4
ER -