Sex-related differences in access to care among patients with premature acute coronary syndrome
Access to care may be implicated in disparities between men and women in death after acute coronary syndrome, especially among younger adults. We aimed to assess sex-related differences in access to care among patients with premature acute coronary syndrome and to identify clinical and gender-relate...
Gespeichert in:
| Veröffentlicht in: | Canadian Medical Association journal (CMAJ) 2014-04, Vol.186 (7), p.497-504 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 504 |
|---|---|
| container_issue | 7 |
| container_start_page | 497 |
| container_title | Canadian Medical Association journal (CMAJ) |
| container_volume | 186 |
| creator | Pelletier, Roxanne Humphries, Karin H Shimony, Avi Bacon, Simon L Lavoie, Kim L Rabi, Doreen Karp, Igor Tsadok, Meytal Avgil Pilote, Louise |
| description | Access to care may be implicated in disparities between men and women in death after acute coronary syndrome, especially among younger adults. We aimed to assess sex-related differences in access to care among patients with premature acute coronary syndrome and to identify clinical and gender-related determinants of access to care.
We studied 1123 patients (18-55 yr) admitted to hospital for acute coronary syndrome and enrolled in the GENESIS-PRAXY cohort study. Outcome measures were door-to-electrocardiography, door-to-needle and door-to-balloon times, as well as proportions of patients undergoing cardiac catheterization, reperfusion or nonprimary percutaneous coronary intervention. We performed univariable and multivariable logistic regression analyses to identify clinical and gender-related determinants of timely procedures and use of invasive procedures.
Women were less likely than men to receive care within benchmark times for electrocardiography (≤ 10 min: 29% v. 38%, p = 0.02) or fibrinolysis (≤ 30 min: 32% v. 57%, p = 0.01). Women with ST-segment elevation myocardial infarction (MI) were less likely than men to undergo reperfusion therapy (primary percutaneous coronary intervention or fibrinolysis) (83% v. 91%, p = 0.01), and women with non-ST-segment elevation MI or unstable angina were less likely to undergo nonprimary percutaneous coronary intervention (48% v. 66%, p < 0.001). Clinical determinants of poorer access to care included anxiety, increased number of risk factors and absence of chest pain. Gender-related determinants included feminine traits of personality and responsibility for housework.
Among younger adults with acute coronary syndrome, women and men had different access to care. Moreover, fewer than half of men and women with ST-segment elevation MI received timely primary coronary intervention. Our results also highlight that men and women with no chest pain and those with anxiety, several traditional risk factors and feminine personality traits were at particularly increased risk of poorer access to care. |
| doi_str_mv | 10.1503/cmaj.131450 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3986312</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A366082859</galeid><sourcerecordid>A366082859</sourcerecordid><originalsourceid>FETCH-LOGICAL-c640t-63b80cc408ab5e843394d7cf0d4b91be42cb94df4f7f8468b25072288a073d563</originalsourceid><addsrcrecordid>eNqVktFr1TAUxoso7jp98l2CA1Gk1zRJ2_RFGMPpYCg4fQ5petqbS5t0Sarbf2_K3eat3BeTh4RzfvnOF85JkpcZXmc5ph_UILfrjGYsx4-SVcY4Twkl1eNkhTnBKa1YcZQ8836L46KkfJocEVZQjkmxSsQV3KQOehmgQY1uW3BgFHikDZIqXjwKFinpAMnBmg6NMmgwwaPfOmzQ6GCQYZqzagqAlHXWSHeL_K1pnB3gefKklb2HF3fncfLz_NOPsy_p5bfPF2enl6kqGA5pQWuOlWKYyzoHzmh03ZSqxQ2rq6wGRlQdIy1ry5azgtckxyUhnEtc0iYv6HHycac7TvUAjYoWnezF6PQQ7QgrtVhmjN6Izv4StOIFzUgUeHsn4Oz1BD6IQXsFfS8N2MmLLM9KhjGp5lon_6BbOzkTvxcpQsq4SP6X6mQPQpvWxrpqFhWntChib3heRSo9QHVgIJq0Blodwwv-9QFejfpa7EPrA1DcDQxaHVR9t3gQmQA3oZOT9-Li6vt_sF-X7Js9dgOyDxtv-yloa_wSfL8DlbPeO2gfOpdhMU-5mKdc7KY80q_2m_3A3o81_QN46POY</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1522777725</pqid></control><display><type>article</type><title>Sex-related differences in access to care among patients with premature acute coronary syndrome</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><source>Journals@Ovid Complete</source><creator>Pelletier, Roxanne ; Humphries, Karin H ; Shimony, Avi ; Bacon, Simon L ; Lavoie, Kim L ; Rabi, Doreen ; Karp, Igor ; Tsadok, Meytal Avgil ; Pilote, Louise</creator><creatorcontrib>Pelletier, Roxanne ; Humphries, Karin H ; Shimony, Avi ; Bacon, Simon L ; Lavoie, Kim L ; Rabi, Doreen ; Karp, Igor ; Tsadok, Meytal Avgil ; Pilote, Louise ; GENESIS-PRAXY Investigators</creatorcontrib><description>Access to care may be implicated in disparities between men and women in death after acute coronary syndrome, especially among younger adults. We aimed to assess sex-related differences in access to care among patients with premature acute coronary syndrome and to identify clinical and gender-related determinants of access to care.
We studied 1123 patients (18-55 yr) admitted to hospital for acute coronary syndrome and enrolled in the GENESIS-PRAXY cohort study. Outcome measures were door-to-electrocardiography, door-to-needle and door-to-balloon times, as well as proportions of patients undergoing cardiac catheterization, reperfusion or nonprimary percutaneous coronary intervention. We performed univariable and multivariable logistic regression analyses to identify clinical and gender-related determinants of timely procedures and use of invasive procedures.
Women were less likely than men to receive care within benchmark times for electrocardiography (≤ 10 min: 29% v. 38%, p = 0.02) or fibrinolysis (≤ 30 min: 32% v. 57%, p = 0.01). Women with ST-segment elevation myocardial infarction (MI) were less likely than men to undergo reperfusion therapy (primary percutaneous coronary intervention or fibrinolysis) (83% v. 91%, p = 0.01), and women with non-ST-segment elevation MI or unstable angina were less likely to undergo nonprimary percutaneous coronary intervention (48% v. 66%, p < 0.001). Clinical determinants of poorer access to care included anxiety, increased number of risk factors and absence of chest pain. Gender-related determinants included feminine traits of personality and responsibility for housework.
Among younger adults with acute coronary syndrome, women and men had different access to care. Moreover, fewer than half of men and women with ST-segment elevation MI received timely primary coronary intervention. Our results also highlight that men and women with no chest pain and those with anxiety, several traditional risk factors and feminine personality traits were at particularly increased risk of poorer access to care.</description><identifier>ISSN: 0820-3946</identifier><identifier>EISSN: 1488-2329</identifier><identifier>DOI: 10.1503/cmaj.131450</identifier><identifier>PMID: 24638026</identifier><identifier>CODEN: CMAJAX</identifier><language>eng</language><publisher>Canada: Joule Inc</publisher><subject>Acute Coronary Syndrome - epidemiology ; Acute Coronary Syndrome - therapy ; Adolescent ; Adult ; Canada - epidemiology ; Cardiovascular disease ; Care and treatment ; Coronary heart disease ; Diagnosis ; Discrimination in medical care ; Electrocardiography ; Female ; Follow-Up Studies ; Gender differences ; Health care access ; Health Services Accessibility - statistics & numerical data ; Humans ; Incidence ; Male ; Medical research ; Medicine, Experimental ; Middle Aged ; Myocardial Revascularization - methods ; Prevalence ; Prognosis ; Prospective Studies ; Risk Factors ; Sex Factors ; Studies ; Surveys and Questionnaires ; Survival Rate - trends ; Switzerland - epidemiology ; Thrombolytic Therapy - methods ; United States - epidemiology ; Young Adult</subject><ispartof>Canadian Medical Association journal (CMAJ), 2014-04, Vol.186 (7), p.497-504</ispartof><rights>COPYRIGHT 2014 Joule Inc.</rights><rights>Copyright Canadian Medical Association Apr 15, 2014</rights><rights>1995-2014, Canadian Medical Association 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c640t-63b80cc408ab5e843394d7cf0d4b91be42cb94df4f7f8468b25072288a073d563</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986312/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986312/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24638026$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pelletier, Roxanne</creatorcontrib><creatorcontrib>Humphries, Karin H</creatorcontrib><creatorcontrib>Shimony, Avi</creatorcontrib><creatorcontrib>Bacon, Simon L</creatorcontrib><creatorcontrib>Lavoie, Kim L</creatorcontrib><creatorcontrib>Rabi, Doreen</creatorcontrib><creatorcontrib>Karp, Igor</creatorcontrib><creatorcontrib>Tsadok, Meytal Avgil</creatorcontrib><creatorcontrib>Pilote, Louise</creatorcontrib><creatorcontrib>GENESIS-PRAXY Investigators</creatorcontrib><title>Sex-related differences in access to care among patients with premature acute coronary syndrome</title><title>Canadian Medical Association journal (CMAJ)</title><addtitle>CMAJ</addtitle><description>Access to care may be implicated in disparities between men and women in death after acute coronary syndrome, especially among younger adults. We aimed to assess sex-related differences in access to care among patients with premature acute coronary syndrome and to identify clinical and gender-related determinants of access to care.
We studied 1123 patients (18-55 yr) admitted to hospital for acute coronary syndrome and enrolled in the GENESIS-PRAXY cohort study. Outcome measures were door-to-electrocardiography, door-to-needle and door-to-balloon times, as well as proportions of patients undergoing cardiac catheterization, reperfusion or nonprimary percutaneous coronary intervention. We performed univariable and multivariable logistic regression analyses to identify clinical and gender-related determinants of timely procedures and use of invasive procedures.
Women were less likely than men to receive care within benchmark times for electrocardiography (≤ 10 min: 29% v. 38%, p = 0.02) or fibrinolysis (≤ 30 min: 32% v. 57%, p = 0.01). Women with ST-segment elevation myocardial infarction (MI) were less likely than men to undergo reperfusion therapy (primary percutaneous coronary intervention or fibrinolysis) (83% v. 91%, p = 0.01), and women with non-ST-segment elevation MI or unstable angina were less likely to undergo nonprimary percutaneous coronary intervention (48% v. 66%, p < 0.001). Clinical determinants of poorer access to care included anxiety, increased number of risk factors and absence of chest pain. Gender-related determinants included feminine traits of personality and responsibility for housework.
Among younger adults with acute coronary syndrome, women and men had different access to care. Moreover, fewer than half of men and women with ST-segment elevation MI received timely primary coronary intervention. Our results also highlight that men and women with no chest pain and those with anxiety, several traditional risk factors and feminine personality traits were at particularly increased risk of poorer access to care.</description><subject>Acute Coronary Syndrome - epidemiology</subject><subject>Acute Coronary Syndrome - therapy</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Canada - epidemiology</subject><subject>Cardiovascular disease</subject><subject>Care and treatment</subject><subject>Coronary heart disease</subject><subject>Diagnosis</subject><subject>Discrimination in medical care</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gender differences</subject><subject>Health care access</subject><subject>Health Services Accessibility - statistics & numerical data</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine, Experimental</subject><subject>Middle Aged</subject><subject>Myocardial Revascularization - methods</subject><subject>Prevalence</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Sex Factors</subject><subject>Studies</subject><subject>Surveys and Questionnaires</subject><subject>Survival Rate - trends</subject><subject>Switzerland - epidemiology</subject><subject>Thrombolytic Therapy - methods</subject><subject>United States - epidemiology</subject><subject>Young Adult</subject><issn>0820-3946</issn><issn>1488-2329</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqVktFr1TAUxoso7jp98l2CA1Gk1zRJ2_RFGMPpYCg4fQ5petqbS5t0Sarbf2_K3eat3BeTh4RzfvnOF85JkpcZXmc5ph_UILfrjGYsx4-SVcY4Twkl1eNkhTnBKa1YcZQ8836L46KkfJocEVZQjkmxSsQV3KQOehmgQY1uW3BgFHikDZIqXjwKFinpAMnBmg6NMmgwwaPfOmzQ6GCQYZqzagqAlHXWSHeL_K1pnB3gefKklb2HF3fncfLz_NOPsy_p5bfPF2enl6kqGA5pQWuOlWKYyzoHzmh03ZSqxQ2rq6wGRlQdIy1ry5azgtckxyUhnEtc0iYv6HHycac7TvUAjYoWnezF6PQQ7QgrtVhmjN6Izv4StOIFzUgUeHsn4Oz1BD6IQXsFfS8N2MmLLM9KhjGp5lon_6BbOzkTvxcpQsq4SP6X6mQPQpvWxrpqFhWntChib3heRSo9QHVgIJq0Blodwwv-9QFejfpa7EPrA1DcDQxaHVR9t3gQmQA3oZOT9-Li6vt_sF-X7Js9dgOyDxtv-yloa_wSfL8DlbPeO2gfOpdhMU-5mKdc7KY80q_2m_3A3o81_QN46POY</recordid><startdate>20140415</startdate><enddate>20140415</enddate><creator>Pelletier, Roxanne</creator><creator>Humphries, Karin H</creator><creator>Shimony, Avi</creator><creator>Bacon, Simon L</creator><creator>Lavoie, Kim L</creator><creator>Rabi, Doreen</creator><creator>Karp, Igor</creator><creator>Tsadok, Meytal Avgil</creator><creator>Pilote, Louise</creator><general>Joule Inc</general><general>CMA Impact, Inc</general><general>Canadian Medical Association</general><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>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FQ</scope><scope>8FV</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M3G</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20140415</creationdate><title>Sex-related differences in access to care among patients with premature acute coronary syndrome</title><author>Pelletier, Roxanne ; Humphries, Karin H ; Shimony, Avi ; Bacon, Simon L ; Lavoie, Kim L ; Rabi, Doreen ; Karp, Igor ; Tsadok, Meytal Avgil ; Pilote, Louise</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c640t-63b80cc408ab5e843394d7cf0d4b91be42cb94df4f7f8468b25072288a073d563</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Acute Coronary Syndrome - epidemiology</topic><topic>Acute Coronary Syndrome - therapy</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Canada - epidemiology</topic><topic>Cardiovascular disease</topic><topic>Care and treatment</topic><topic>Coronary heart disease</topic><topic>Diagnosis</topic><topic>Discrimination in medical care</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gender differences</topic><topic>Health care access</topic><topic>Health Services Accessibility - statistics & numerical data</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Medical research</topic><topic>Medicine, Experimental</topic><topic>Middle Aged</topic><topic>Myocardial Revascularization - methods</topic><topic>Prevalence</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Sex Factors</topic><topic>Studies</topic><topic>Surveys and Questionnaires</topic><topic>Survival Rate - trends</topic><topic>Switzerland - epidemiology</topic><topic>Thrombolytic Therapy - methods</topic><topic>United States - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pelletier, Roxanne</creatorcontrib><creatorcontrib>Humphries, Karin H</creatorcontrib><creatorcontrib>Shimony, Avi</creatorcontrib><creatorcontrib>Bacon, Simon L</creatorcontrib><creatorcontrib>Lavoie, Kim L</creatorcontrib><creatorcontrib>Rabi, Doreen</creatorcontrib><creatorcontrib>Karp, Igor</creatorcontrib><creatorcontrib>Tsadok, Meytal Avgil</creatorcontrib><creatorcontrib>Pilote, Louise</creatorcontrib><creatorcontrib>GENESIS-PRAXY Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Canadian Business & Current Affairs Database</collection><collection>Canadian Business & Current Affairs Database (Alumni Edition)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</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>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Research Library</collection><collection>Science Database</collection><collection>CBCA Reference & Current Events</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 China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Canadian Medical Association journal (CMAJ)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pelletier, Roxanne</au><au>Humphries, Karin H</au><au>Shimony, Avi</au><au>Bacon, Simon L</au><au>Lavoie, Kim L</au><au>Rabi, Doreen</au><au>Karp, Igor</au><au>Tsadok, Meytal Avgil</au><au>Pilote, Louise</au><aucorp>GENESIS-PRAXY Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sex-related differences in access to care among patients with premature acute coronary syndrome</atitle><jtitle>Canadian Medical Association journal (CMAJ)</jtitle><addtitle>CMAJ</addtitle><date>2014-04-15</date><risdate>2014</risdate><volume>186</volume><issue>7</issue><spage>497</spage><epage>504</epage><pages>497-504</pages><issn>0820-3946</issn><eissn>1488-2329</eissn><coden>CMAJAX</coden><abstract>Access to care may be implicated in disparities between men and women in death after acute coronary syndrome, especially among younger adults. We aimed to assess sex-related differences in access to care among patients with premature acute coronary syndrome and to identify clinical and gender-related determinants of access to care.
We studied 1123 patients (18-55 yr) admitted to hospital for acute coronary syndrome and enrolled in the GENESIS-PRAXY cohort study. Outcome measures were door-to-electrocardiography, door-to-needle and door-to-balloon times, as well as proportions of patients undergoing cardiac catheterization, reperfusion or nonprimary percutaneous coronary intervention. We performed univariable and multivariable logistic regression analyses to identify clinical and gender-related determinants of timely procedures and use of invasive procedures.
Women were less likely than men to receive care within benchmark times for electrocardiography (≤ 10 min: 29% v. 38%, p = 0.02) or fibrinolysis (≤ 30 min: 32% v. 57%, p = 0.01). Women with ST-segment elevation myocardial infarction (MI) were less likely than men to undergo reperfusion therapy (primary percutaneous coronary intervention or fibrinolysis) (83% v. 91%, p = 0.01), and women with non-ST-segment elevation MI or unstable angina were less likely to undergo nonprimary percutaneous coronary intervention (48% v. 66%, p < 0.001). Clinical determinants of poorer access to care included anxiety, increased number of risk factors and absence of chest pain. Gender-related determinants included feminine traits of personality and responsibility for housework.
Among younger adults with acute coronary syndrome, women and men had different access to care. Moreover, fewer than half of men and women with ST-segment elevation MI received timely primary coronary intervention. Our results also highlight that men and women with no chest pain and those with anxiety, several traditional risk factors and feminine personality traits were at particularly increased risk of poorer access to care.</abstract><cop>Canada</cop><pub>Joule Inc</pub><pmid>24638026</pmid><doi>10.1503/cmaj.131450</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0820-3946 |
| ispartof | Canadian Medical Association journal (CMAJ), 2014-04, Vol.186 (7), p.497-504 |
| issn | 0820-3946 1488-2329 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3986312 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; PubMed Central; Alma/SFX Local Collection; Journals@Ovid Complete |
| subjects | Acute Coronary Syndrome - epidemiology Acute Coronary Syndrome - therapy Adolescent Adult Canada - epidemiology Cardiovascular disease Care and treatment Coronary heart disease Diagnosis Discrimination in medical care Electrocardiography Female Follow-Up Studies Gender differences Health care access Health Services Accessibility - statistics & numerical data Humans Incidence Male Medical research Medicine, Experimental Middle Aged Myocardial Revascularization - methods Prevalence Prognosis Prospective Studies Risk Factors Sex Factors Studies Surveys and Questionnaires Survival Rate - trends Switzerland - epidemiology Thrombolytic Therapy - methods United States - epidemiology Young Adult |
| title | Sex-related differences in access to care among patients with premature acute coronary syndrome |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-07T21%3A18%3A39IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Sex-related%20differences%20in%20access%20to%20care%20among%20patients%20with%20premature%20acute%20coronary%20syndrome&rft.jtitle=Canadian%20Medical%20Association%20journal%20(CMAJ)&rft.au=Pelletier,%20Roxanne&rft.aucorp=GENESIS-PRAXY%20Investigators&rft.date=2014-04-15&rft.volume=186&rft.issue=7&rft.spage=497&rft.epage=504&rft.pages=497-504&rft.issn=0820-3946&rft.eissn=1488-2329&rft.coden=CMAJAX&rft_id=info:doi/10.1503/cmaj.131450&rft_dat=%3Cgale_pubme%3EA366082859%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1522777725&rft_id=info:pmid/24638026&rft_galeid=A366082859&rfr_iscdi=true |