Variation in cardiovascular disease care: an Australian cohort study on sex differences in receipt of coronary procedures
Objectives The aim of this study was to quantify sex differences in diagnostic and revascularisation coronary procedures within 1 year of hospitalisation for acute myocardial infarction (AMI) or angina.Design This is a prospective cohort study. Baseline questionnaire (January 2006–April 2009) data f...
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BMJ Publishing Group
2019-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/7/e026507.full |
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| author | Emily Banks Rosemary J Korda Jennifer Welsh Alexandra Jane Fogg Walter Abhayaratna |
| author_facet | Emily Banks Rosemary J Korda Jennifer Welsh Alexandra Jane Fogg Walter Abhayaratna |
| author_sort | Emily Banks |
| collection | DOAJ |
| description | Objectives The aim of this study was to quantify sex differences in diagnostic and revascularisation coronary procedures within 1 year of hospitalisation for acute myocardial infarction (AMI) or angina.Design This is a prospective cohort study. Baseline questionnaire (January 2006–April 2009) data from the Sax Institute’s 45 and Up Study were linked to hospitalisation and mortality data (to 30 June 2016) in a time-to-event analysis, treating death as a censoring event.Setting This was conducted in New South Wales, Australia.Participants The study included participants aged ≥45 years with no history of ischaemic heart disease (IHD) who were admitted to hospital with a primary diagnosis of AMI (n=4580) or a primary diagnosis of angina or chronic IHD with secondary diagnosis of angina (n=4457).Outcome measures The outcome of this study was coronary angiography and coronary revascularisation with percutaneous coronary intervention or coronary artery bypass graft (PCI/CABG) within 1 year of index admission. Cox regression models compared coronary procedure rates in men and women, adjusting sequentially for age, sociodemographic variables and health characteristics.Results Among patients with AMI, 71.6% of men (crude rate 3.45/person-year) and 64.7% of women (2.62/person-year) received angiography; 57.8% of men (1.73/person-year) and 37.4% of women (0.77/person-year) received PCI/CABG. Adjusted HRs for men versus women were 1.00 (0.92–1.08) for angiography and 1.51 (1.38–1.67) for PCI/CABG. In the angina group, 67.3% of men (crude rate 2.36/person-year) and 54.9% of women (1.32/person-year) received angiography; 44.6% of men (0.90/person-year) and 19.5% of women (0.26/person-year) received PCI/CABG. Adjusted HRs were 1.24 (1.14–1.34) and 2.44 (2.16–2.75), respectively.Conclusions Men are more likely than women to receive coronary procedures, particularly revascularisation. This difference is most evident among people with angina, where clinical guidelines are less prescriptive than for AMI. |
| format | Article |
| id | doaj-art-c326c6071eae4f8c96d0d9463057ffcd |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-07-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-c326c6071eae4f8c96d0d9463057ffcd2024-11-29T22:55:12ZengBMJ Publishing GroupBMJ Open2044-60552019-07-019710.1136/bmjopen-2018-026507Variation in cardiovascular disease care: an Australian cohort study on sex differences in receipt of coronary proceduresEmily Banks0Rosemary J Korda1Jennifer Welsh2Alexandra Jane Fogg3Walter Abhayaratna4National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, AustraliaNational Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, AustraliaNational Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia1 Australian National University Medical School, The Australian National University, Canberra, Australian Capital Territory, AustraliaSchool of Medicine and Psychology, Australian National University, Canberra, Australian Capital Territory, AustraliaObjectives The aim of this study was to quantify sex differences in diagnostic and revascularisation coronary procedures within 1 year of hospitalisation for acute myocardial infarction (AMI) or angina.Design This is a prospective cohort study. Baseline questionnaire (January 2006–April 2009) data from the Sax Institute’s 45 and Up Study were linked to hospitalisation and mortality data (to 30 June 2016) in a time-to-event analysis, treating death as a censoring event.Setting This was conducted in New South Wales, Australia.Participants The study included participants aged ≥45 years with no history of ischaemic heart disease (IHD) who were admitted to hospital with a primary diagnosis of AMI (n=4580) or a primary diagnosis of angina or chronic IHD with secondary diagnosis of angina (n=4457).Outcome measures The outcome of this study was coronary angiography and coronary revascularisation with percutaneous coronary intervention or coronary artery bypass graft (PCI/CABG) within 1 year of index admission. Cox regression models compared coronary procedure rates in men and women, adjusting sequentially for age, sociodemographic variables and health characteristics.Results Among patients with AMI, 71.6% of men (crude rate 3.45/person-year) and 64.7% of women (2.62/person-year) received angiography; 57.8% of men (1.73/person-year) and 37.4% of women (0.77/person-year) received PCI/CABG. Adjusted HRs for men versus women were 1.00 (0.92–1.08) for angiography and 1.51 (1.38–1.67) for PCI/CABG. In the angina group, 67.3% of men (crude rate 2.36/person-year) and 54.9% of women (1.32/person-year) received angiography; 44.6% of men (0.90/person-year) and 19.5% of women (0.26/person-year) received PCI/CABG. Adjusted HRs were 1.24 (1.14–1.34) and 2.44 (2.16–2.75), respectively.Conclusions Men are more likely than women to receive coronary procedures, particularly revascularisation. This difference is most evident among people with angina, where clinical guidelines are less prescriptive than for AMI.https://bmjopen.bmj.com/content/9/7/e026507.full |
| spellingShingle | Emily Banks Rosemary J Korda Jennifer Welsh Alexandra Jane Fogg Walter Abhayaratna Variation in cardiovascular disease care: an Australian cohort study on sex differences in receipt of coronary procedures BMJ Open |
| title | Variation in cardiovascular disease care: an Australian cohort study on sex differences in receipt of coronary procedures |
| title_full | Variation in cardiovascular disease care: an Australian cohort study on sex differences in receipt of coronary procedures |
| title_fullStr | Variation in cardiovascular disease care: an Australian cohort study on sex differences in receipt of coronary procedures |
| title_full_unstemmed | Variation in cardiovascular disease care: an Australian cohort study on sex differences in receipt of coronary procedures |
| title_short | Variation in cardiovascular disease care: an Australian cohort study on sex differences in receipt of coronary procedures |
| title_sort | variation in cardiovascular disease care an australian cohort study on sex differences in receipt of coronary procedures |
| url | https://bmjopen.bmj.com/content/9/7/e026507.full |
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