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Sex-based analysis of NSTEMI processes of care and outcomes by hospital: a nationwide cohort study

Moledina, S; Weight, Nicholas; Dafaalla, Mohammed; Chen, Dennis; Rashid, Muhammad; Mohamed, Mohamed; Vanspall, Harriette; Iannaccone, Mario; Chieffo, Alaide; Mamas, Mamas

Authors

S Moledina

Nicholas Weight

Mohammed Dafaalla

Dennis Chen

Mohamed Mohamed

Harriette Vanspall

Mario Iannaccone

Alaide Chieffo



Abstract

Background Contemporary studies have demonstrated that in non-ST-segment elevation myocardial infarction (NSTEMI), processes of care vary significantly according to biological sex. Little is known regarding variation in practice between geographical areas and individual centers. Methods & Results We identified 305,014 admissions with NSTEMI in the United Kingdom (UK) Myocardial Infarction National Audit Project (MINAP), 2010-2017, including female sex (n = 110,209). Females presented significantly older (77y vs. 69y, P<0.001), were more likely to be Caucasian (93% vs. 91%, P<0.001) and less likely to be current smokers (18% vs. 24%, P<0.001). Females were less frequently treated with GDMT after NSTEMI, less frequently managed with an invasive coronary angiogram (ICA) (58% vs. 75%, P<0.001) during index admission and less frequently underwent PCI (35% vs. 49%, P<0.001) or CABG surgery (5% vs. 9%, P<0.001) compared to males. Structural process of care differed between the sexes, with a lower proportion of females being treated on a dedicated cardiology ward (48% vs. 56%, P<0.001) or admitted under a attending cardiologist (44% vs. 52%, P<0.001). In our hospital-clustered analysis, we show a positive correlation between the risk-standardized mortality rates (RSMR) and increasing proportion of women treated for NSTEMI (R2=0.17, P<0.001). There was a clear negative correlation between the proportion of females who had an optimum opportunity-based quality indicator score (surrogate for optimum process of care) during their admission and RSMR (R2 =0.22, P<0.001), with a far weaker correlation in males (R2 =0.08, P<0.001). Conclusion There was a significant in variation of the management of patients with NSTEMI according to sex, with widespread geographical variation. Structural changes are likely required to enable successful change for female patients.

Journal Article Type Meeting Abstract
Acceptance Date Nov 9, 2023
Online Publication Date Nov 9, 2023
Publication Date Nov 9, 2023
Deposit Date Nov 27, 2023
Journal European Heart Journal
Print ISSN 0195-668X
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 44
Issue Supplement_2
Article Number ehad655.3027
DOI https://doi.org/10.1093/eurheartj/ehad655.3027
Keywords Cardiology and Cardiovascular Medicine