Patient sex and quality of ED care for patients with myocardial infarction
Abstract Objective The aim of the study was to assess the quality of care between male and female emergency department (ED) patients with acute myocardial infarction (AMI). Methods A 2-year retrospective cohort study of 2215 patients with AMI presenting immediately to 5 EDs from July 1, 2000, throug...
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| Veröffentlicht in: | The American journal of emergency medicine 2007-11, Vol.25 (9), p.996-1003 |
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| creator | Vinson, David R., MD Magid, David J., MD, MPH Brand, David W., MSPH Masoudi, Frederick A., MD, MSPH Ho, P. Michael, MD, PhD Lyons, Ella E., MS Crounse, Laurie, MPH van der Vlugt, Theresa M., MD Padgett, Thomas G., MD Tricomi, Albert J., MD Go, Alan S., MD Rumsfeld, John S., MD, PhD |
| description | Abstract Objective The aim of the study was to assess the quality of care between male and female emergency department (ED) patients with acute myocardial infarction (AMI). Methods A 2-year retrospective cohort study of 2215 patients with AMI presenting immediately to 5 EDs from July 1, 2000, through June 30, 2002 was conducted. Data on patient characteristics, clinical presentation, and ED processes of care were obtained from chart and electrocardiogram reviews. Multivariable regression models were used to assess the independent association between sex and the ED administration of aspirin, β -blockers, and reperfusion therapy to eligible patients with AMI. Results There were 849 women and 1366 men in the study. Female patients were older than male patients (74.3 years for women vs 66.8 years for men, P < .001). Among ideal patients, women were less likely than men to receive aspirin (76.3% of women vs 81.3% of men, P < .01), β -blockers (51.7% of women vs 61.4% of men, P < .01), and reperfusion therapy (64.0% of women vs 72.8% of men, P < .05). However, after adjustment for age, there was no longer a significant relationship between sex and the use of aspirin (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.95-1.03), β -blockers (OR, 0.94; 95% CI, 0.82-1.04), or reperfusion therapy (OR, 1.01; 95% CI, 0.89-1.09). In models adjusting for additional demographic, clinical, and hospital characteristics, there remained no association between sex and the processes of care. Conclusion Women with AMI treated in the ED have a lower likelihood of receiving aspirin, β -blocker, and reperfusion therapy. However, this association appears to be explained by the age difference between men and women with AMI. Although there are no apparent sex disparities in care, ED AMI management remains suboptimal for both sexes. |
| doi_str_mv | 10.1016/j.ajem.2007.02.049 |
| format | Article |
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Michael, MD, PhD ; Lyons, Ella E., MS ; Crounse, Laurie, MPH ; van der Vlugt, Theresa M., MD ; Padgett, Thomas G., MD ; Tricomi, Albert J., MD ; Go, Alan S., MD ; Rumsfeld, John S., MD, PhD</creator><creatorcontrib>Vinson, David R., MD ; Magid, David J., MD, MPH ; Brand, David W., MSPH ; Masoudi, Frederick A., MD, MSPH ; Ho, P. Michael, MD, PhD ; Lyons, Ella E., MS ; Crounse, Laurie, MPH ; van der Vlugt, Theresa M., MD ; Padgett, Thomas G., MD ; Tricomi, Albert J., MD ; Go, Alan S., MD ; Rumsfeld, John S., MD, PhD</creatorcontrib><description>Abstract Objective The aim of the study was to assess the quality of care between male and female emergency department (ED) patients with acute myocardial infarction (AMI). Methods A 2-year retrospective cohort study of 2215 patients with AMI presenting immediately to 5 EDs from July 1, 2000, through June 30, 2002 was conducted. Data on patient characteristics, clinical presentation, and ED processes of care were obtained from chart and electrocardiogram reviews. Multivariable regression models were used to assess the independent association between sex and the ED administration of aspirin, β -blockers, and reperfusion therapy to eligible patients with AMI. Results There were 849 women and 1366 men in the study. Female patients were older than male patients (74.3 years for women vs 66.8 years for men, P < .001). Among ideal patients, women were less likely than men to receive aspirin (76.3% of women vs 81.3% of men, P < .01), β -blockers (51.7% of women vs 61.4% of men, P < .01), and reperfusion therapy (64.0% of women vs 72.8% of men, P < .05). However, after adjustment for age, there was no longer a significant relationship between sex and the use of aspirin (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.95-1.03), β -blockers (OR, 0.94; 95% CI, 0.82-1.04), or reperfusion therapy (OR, 1.01; 95% CI, 0.89-1.09). In models adjusting for additional demographic, clinical, and hospital characteristics, there remained no association between sex and the processes of care. Conclusion Women with AMI treated in the ED have a lower likelihood of receiving aspirin, β -blocker, and reperfusion therapy. However, this association appears to be explained by the age difference between men and women with AMI. Although there are no apparent sex disparities in care, ED AMI management remains suboptimal for both sexes.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2007.02.049</identifier><identifier>PMID: 18022492</identifier><identifier>CODEN: AJEMEN</identifier><language>eng</language><publisher>Philadelphia, PA: Elsevier Inc</publisher><subject>Acute coronary syndromes ; Adrenergic beta-Antagonists - administration & dosage ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Aspirin ; Aspirin - administration & dosage ; Biological and medical sciences ; Cardiology. Vascular system ; Clinical death. Palliative care. Organ gift and preservation ; Coronary heart disease ; Electrocardiography ; Emergency ; Emergency medical care ; Emergency Service, Hospital - standards ; Female ; Females ; Gender differences ; Heart ; Heart attacks ; Hospitals ; Humans ; Intensive care medicine ; Male ; Medical sciences ; Myocardial infarction ; Myocardial Infarction - therapy ; Myocardial Reperfusion ; Quality of Health Care ; Registries ; Regression Analysis ; Reproducibility of Results ; Retrospective Studies ; Sex Factors ; United States ; Women</subject><ispartof>The American journal of emergency medicine, 2007-11, Vol.25 (9), p.996-1003</ispartof><rights>Elsevier Inc.</rights><rights>2007 Elsevier Inc.</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c467t-54d15d9be4b2d1ecd766d5d39ec856ca4eea759a6f9fd9579b74fcceadbd52b03</citedby><cites>FETCH-LOGICAL-c467t-54d15d9be4b2d1ecd766d5d39ec856ca4eea759a6f9fd9579b74fcceadbd52b03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735675707001994$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19891207$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18022492$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vinson, David R., MD</creatorcontrib><creatorcontrib>Magid, David J., MD, MPH</creatorcontrib><creatorcontrib>Brand, David W., MSPH</creatorcontrib><creatorcontrib>Masoudi, Frederick A., MD, MSPH</creatorcontrib><creatorcontrib>Ho, P. Michael, MD, PhD</creatorcontrib><creatorcontrib>Lyons, Ella E., MS</creatorcontrib><creatorcontrib>Crounse, Laurie, MPH</creatorcontrib><creatorcontrib>van der Vlugt, Theresa M., MD</creatorcontrib><creatorcontrib>Padgett, Thomas G., MD</creatorcontrib><creatorcontrib>Tricomi, Albert J., MD</creatorcontrib><creatorcontrib>Go, Alan S., MD</creatorcontrib><creatorcontrib>Rumsfeld, John S., MD, PhD</creatorcontrib><title>Patient sex and quality of ED care for patients with myocardial infarction</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>Abstract Objective The aim of the study was to assess the quality of care between male and female emergency department (ED) patients with acute myocardial infarction (AMI). Methods A 2-year retrospective cohort study of 2215 patients with AMI presenting immediately to 5 EDs from July 1, 2000, through June 30, 2002 was conducted. Data on patient characteristics, clinical presentation, and ED processes of care were obtained from chart and electrocardiogram reviews. Multivariable regression models were used to assess the independent association between sex and the ED administration of aspirin, β -blockers, and reperfusion therapy to eligible patients with AMI. Results There were 849 women and 1366 men in the study. Female patients were older than male patients (74.3 years for women vs 66.8 years for men, P < .001). Among ideal patients, women were less likely than men to receive aspirin (76.3% of women vs 81.3% of men, P < .01), β -blockers (51.7% of women vs 61.4% of men, P < .01), and reperfusion therapy (64.0% of women vs 72.8% of men, P < .05). However, after adjustment for age, there was no longer a significant relationship between sex and the use of aspirin (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.95-1.03), β -blockers (OR, 0.94; 95% CI, 0.82-1.04), or reperfusion therapy (OR, 1.01; 95% CI, 0.89-1.09). In models adjusting for additional demographic, clinical, and hospital characteristics, there remained no association between sex and the processes of care. Conclusion Women with AMI treated in the ED have a lower likelihood of receiving aspirin, β -blocker, and reperfusion therapy. However, this association appears to be explained by the age difference between men and women with AMI. Although there are no apparent sex disparities in care, ED AMI management remains suboptimal for both sexes.</description><subject>Acute coronary syndromes</subject><subject>Adrenergic beta-Antagonists - administration & dosage</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Aspirin</subject><subject>Aspirin - administration & dosage</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Clinical death. Palliative care. Organ gift and preservation</subject><subject>Coronary heart disease</subject><subject>Electrocardiography</subject><subject>Emergency</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital - standards</subject><subject>Female</subject><subject>Females</subject><subject>Gender differences</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Myocardial infarction</subject><subject>Myocardial Infarction - therapy</subject><subject>Myocardial Reperfusion</subject><subject>Quality of Health Care</subject><subject>Registries</subject><subject>Regression Analysis</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Sex Factors</subject><subject>United States</subject><subject>Women</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kl1rFDEUhoNY7Lr6B7yQgNi7GZNMMpmACNJWaykoqNchk5xgxvnYJjPa_fdm2IWFXniVizzvyTlPDkKvKCkpofW7rjQdDCUjRJaElYSrJ2hDRcWKhkr6FG2IrERRSyHP0fOUOkIo5YI_Q-e0IYxxxTbo9puZA4wzTvCAzejw_WL6MO_x5PH1FbYmAvZTxLsDlvDfMP_Cw37KNy6YHofRm2jnMI0v0Jk3fYKXx3OLfn66_nF5U9x9_fzl8uNdYXkt50JwR4VTLfCWOQrWybp2wlUKbCNqaziAkUKZ2ivvlJCqldxbC8a1TrCWVFt0cai7i9P9AmnWQ0gW-t6MMC1J142gsm5UBt88ArtpiWPuTVNSkYYKRqpMsQNl45RSBK93MQwm7jOkV8-606tnvXrWhOnsOYdeH0sv7QDuFDmKzcDbI2CSNb2PZrQhnTjVKMry_2zR-wMH2difAFEnm0VbcCGCnbWbwv_7-PAobvswhvzib9hDOs2rUw7o7-tGrAtBZF4GpXj1D8FhsFg</recordid><startdate>20071101</startdate><enddate>20071101</enddate><creator>Vinson, David R., MD</creator><creator>Magid, David J., MD, MPH</creator><creator>Brand, David W., MSPH</creator><creator>Masoudi, Frederick A., MD, MSPH</creator><creator>Ho, P. Michael, MD, PhD</creator><creator>Lyons, Ella E., MS</creator><creator>Crounse, Laurie, MPH</creator><creator>van der Vlugt, Theresa M., MD</creator><creator>Padgett, Thomas G., MD</creator><creator>Tricomi, Albert J., MD</creator><creator>Go, Alan S., MD</creator><creator>Rumsfeld, John S., MD, PhD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20071101</creationdate><title>Patient sex and quality of ED care for patients with myocardial infarction</title><author>Vinson, David R., MD ; Magid, David J., MD, MPH ; Brand, David W., MSPH ; Masoudi, Frederick A., MD, MSPH ; Ho, P. Michael, MD, PhD ; Lyons, Ella E., MS ; Crounse, Laurie, MPH ; van der Vlugt, Theresa M., MD ; Padgett, Thomas G., MD ; Tricomi, Albert J., MD ; Go, Alan S., MD ; Rumsfeld, John S., MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c467t-54d15d9be4b2d1ecd766d5d39ec856ca4eea759a6f9fd9579b74fcceadbd52b03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Acute coronary syndromes</topic><topic>Adrenergic beta-Antagonists - administration & dosage</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Aspirin</topic><topic>Aspirin - administration & dosage</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Clinical death. Palliative care. Organ gift and preservation</topic><topic>Coronary heart disease</topic><topic>Electrocardiography</topic><topic>Emergency</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital - standards</topic><topic>Female</topic><topic>Females</topic><topic>Gender differences</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Myocardial infarction</topic><topic>Myocardial Infarction - therapy</topic><topic>Myocardial Reperfusion</topic><topic>Quality of Health Care</topic><topic>Registries</topic><topic>Regression Analysis</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Sex Factors</topic><topic>United States</topic><topic>Women</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vinson, David R., MD</creatorcontrib><creatorcontrib>Magid, David J., MD, MPH</creatorcontrib><creatorcontrib>Brand, David W., MSPH</creatorcontrib><creatorcontrib>Masoudi, Frederick A., MD, MSPH</creatorcontrib><creatorcontrib>Ho, P. Michael, MD, PhD</creatorcontrib><creatorcontrib>Lyons, Ella E., MS</creatorcontrib><creatorcontrib>Crounse, Laurie, MPH</creatorcontrib><creatorcontrib>van der Vlugt, Theresa M., MD</creatorcontrib><creatorcontrib>Padgett, Thomas G., MD</creatorcontrib><creatorcontrib>Tricomi, Albert J., MD</creatorcontrib><creatorcontrib>Go, Alan S., MD</creatorcontrib><creatorcontrib>Rumsfeld, John S., MD, PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vinson, David R., MD</au><au>Magid, David J., MD, MPH</au><au>Brand, David W., MSPH</au><au>Masoudi, Frederick A., MD, MSPH</au><au>Ho, P. Michael, MD, PhD</au><au>Lyons, Ella E., MS</au><au>Crounse, Laurie, MPH</au><au>van der Vlugt, Theresa M., MD</au><au>Padgett, Thomas G., MD</au><au>Tricomi, Albert J., MD</au><au>Go, Alan S., MD</au><au>Rumsfeld, John S., MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patient sex and quality of ED care for patients with myocardial infarction</atitle><jtitle>The American journal of emergency medicine</jtitle><addtitle>Am J Emerg Med</addtitle><date>2007-11-01</date><risdate>2007</risdate><volume>25</volume><issue>9</issue><spage>996</spage><epage>1003</epage><pages>996-1003</pages><issn>0735-6757</issn><eissn>1532-8171</eissn><coden>AJEMEN</coden><abstract>Abstract Objective The aim of the study was to assess the quality of care between male and female emergency department (ED) patients with acute myocardial infarction (AMI). Methods A 2-year retrospective cohort study of 2215 patients with AMI presenting immediately to 5 EDs from July 1, 2000, through June 30, 2002 was conducted. Data on patient characteristics, clinical presentation, and ED processes of care were obtained from chart and electrocardiogram reviews. Multivariable regression models were used to assess the independent association between sex and the ED administration of aspirin, β -blockers, and reperfusion therapy to eligible patients with AMI. Results There were 849 women and 1366 men in the study. Female patients were older than male patients (74.3 years for women vs 66.8 years for men, P < .001). Among ideal patients, women were less likely than men to receive aspirin (76.3% of women vs 81.3% of men, P < .01), β -blockers (51.7% of women vs 61.4% of men, P < .01), and reperfusion therapy (64.0% of women vs 72.8% of men, P < .05). However, after adjustment for age, there was no longer a significant relationship between sex and the use of aspirin (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.95-1.03), β -blockers (OR, 0.94; 95% CI, 0.82-1.04), or reperfusion therapy (OR, 1.01; 95% CI, 0.89-1.09). In models adjusting for additional demographic, clinical, and hospital characteristics, there remained no association between sex and the processes of care. Conclusion Women with AMI treated in the ED have a lower likelihood of receiving aspirin, β -blocker, and reperfusion therapy. However, this association appears to be explained by the age difference between men and women with AMI. Although there are no apparent sex disparities in care, ED AMI management remains suboptimal for both sexes.</abstract><cop>Philadelphia, PA</cop><pub>Elsevier Inc</pub><pmid>18022492</pmid><doi>10.1016/j.ajem.2007.02.049</doi><tpages>8</tpages></addata></record> |
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| subjects | Acute coronary syndromes Adrenergic beta-Antagonists - administration & dosage Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Aspirin Aspirin - administration & dosage Biological and medical sciences Cardiology. Vascular system Clinical death. Palliative care. Organ gift and preservation Coronary heart disease Electrocardiography Emergency Emergency medical care Emergency Service, Hospital - standards Female Females Gender differences Heart Heart attacks Hospitals Humans Intensive care medicine Male Medical sciences Myocardial infarction Myocardial Infarction - therapy Myocardial Reperfusion Quality of Health Care Registries Regression Analysis Reproducibility of Results Retrospective Studies Sex Factors United States Women |
| title | Patient sex and quality of ED care for patients with myocardial infarction |
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