Sex-based analysis of NSTEMI processes of care and outcomes by hospital: a nationwide cohort study
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 &am...
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| Veröffentlicht in: | European heart journal 2023-11, Vol.44 (Supplement_2) |
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| creator | Moledina, S Nicholas Weight, N W Mohammed Dafaalla, M D Dennis Chen, D C Muhammad Rashid, M R Mohamed Mohamed, M M Harriette Vanspall, H V S Mario Iannaccone, M I Alaide Chieffo, A C Mamas Mamas, M M |
| description | 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 |
| doi_str_mv | 10.1093/eurheartj/ehad655.3027 |
| format | Article |
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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.]]></description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehad655.3027</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><ispartof>European heart journal, 2023-11, Vol.44 (Supplement_2)</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids></links><search><creatorcontrib>Moledina, S</creatorcontrib><creatorcontrib>Nicholas Weight, N W</creatorcontrib><creatorcontrib>Mohammed Dafaalla, M D</creatorcontrib><creatorcontrib>Dennis Chen, D C</creatorcontrib><creatorcontrib>Muhammad Rashid, M R</creatorcontrib><creatorcontrib>Mohamed Mohamed, M M</creatorcontrib><creatorcontrib>Harriette Vanspall, H V S</creatorcontrib><creatorcontrib>Mario Iannaccone, M I</creatorcontrib><creatorcontrib>Alaide Chieffo, A C</creatorcontrib><creatorcontrib>Mamas Mamas, M M</creatorcontrib><title>Sex-based analysis of NSTEMI processes of care and outcomes by hospital: a nationwide cohort study</title><title>European heart journal</title><description><![CDATA[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.]]></description><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNqNkM1Kw0AUhQdRsFZfQeYF0t7JZCYZd1KqFqouWsFduJkfktJ2wkyC5u1tbXHt6sDhfGfxEXLPYMJA8antQ20xdJuprdFIISYc0vyCjJhI00TJTFySETAlEimLz2tyE-MGAArJ5IhUK_udVBitobjH7RCbSL2jb6v1_HVB2-C1jdH-dhqDPYwM9X2n_e5QVgOtfWybDrcPFOkeu8bvvxpjqfa1Dx2NXW-GW3LlcBvt3TnH5ONpvp69JMv358XscZloxvM8yQTXzJkcpTNFliultOCyMgh5Bs6AUjkUiosq5S6rEKwSgGnhQEpMnTN8TOTpVwcfY7CubEOzwzCUDMqjqfLPVHk2VR5NHUB2An3f_pf5ARpTckk</recordid><startdate>20231109</startdate><enddate>20231109</enddate><creator>Moledina, S</creator><creator>Nicholas Weight, N W</creator><creator>Mohammed Dafaalla, M D</creator><creator>Dennis Chen, D C</creator><creator>Muhammad Rashid, M R</creator><creator>Mohamed Mohamed, M M</creator><creator>Harriette Vanspall, H V S</creator><creator>Mario Iannaccone, M I</creator><creator>Alaide Chieffo, A C</creator><creator>Mamas Mamas, M M</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20231109</creationdate><title>Sex-based analysis of NSTEMI processes of care and outcomes by hospital: a nationwide cohort study</title><author>Moledina, S ; Nicholas Weight, N W ; Mohammed Dafaalla, M D ; Dennis Chen, D C ; Muhammad Rashid, M R ; Mohamed Mohamed, M M ; Harriette Vanspall, H V S ; Mario Iannaccone, M I ; Alaide Chieffo, A C ; Mamas Mamas, M M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1377-453c1fd7a6fd847999c536bda0740fd099708935b23f4ba0e950a28f066a2ffd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Moledina, S</creatorcontrib><creatorcontrib>Nicholas Weight, N W</creatorcontrib><creatorcontrib>Mohammed Dafaalla, M D</creatorcontrib><creatorcontrib>Dennis Chen, D C</creatorcontrib><creatorcontrib>Muhammad Rashid, M R</creatorcontrib><creatorcontrib>Mohamed Mohamed, M M</creatorcontrib><creatorcontrib>Harriette Vanspall, H V S</creatorcontrib><creatorcontrib>Mario Iannaccone, M I</creatorcontrib><creatorcontrib>Alaide Chieffo, A C</creatorcontrib><creatorcontrib>Mamas Mamas, M M</creatorcontrib><collection>CrossRef</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moledina, S</au><au>Nicholas Weight, N W</au><au>Mohammed Dafaalla, M D</au><au>Dennis Chen, D C</au><au>Muhammad Rashid, M R</au><au>Mohamed Mohamed, M M</au><au>Harriette Vanspall, H V S</au><au>Mario Iannaccone, M I</au><au>Alaide Chieffo, A C</au><au>Mamas Mamas, M M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sex-based analysis of NSTEMI processes of care and outcomes by hospital: a nationwide cohort study</atitle><jtitle>European heart journal</jtitle><date>2023-11-09</date><risdate>2023</risdate><volume>44</volume><issue>Supplement_2</issue><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract><![CDATA[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.]]></abstract><cop>US</cop><pub>Oxford University Press</pub><doi>10.1093/eurheartj/ehad655.3027</doi><oa>free_for_read</oa></addata></record> |
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| title | Sex-based analysis of NSTEMI processes of care and outcomes by hospital: a nationwide cohort study |
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