@article{0d69fbf39d9b4a46870c43b7b4725bb6,
title = "Sustained sex-based treatment differences in acute coronary syndrome care: Insights from the American Heart Association Get With The Guidelines Coronary Artery Disease Registry",
abstract = "Background: Sex-based differences in acute coronary syndrome (ACS) mortality may attenuate with age due to better symptom recognition and prompt care. Hypothesis: Age is a modifier of temporal trends in sex-based differences in ACS care. Methods: Among 104 817 eligible patients with ACS enrolled in the AHA Get With the Guidelines–Coronary Artery Disease registry between 2003 and 2008, care and in-hospital mortality were evaluated stratified by sex and age. Temporal trends within sex and age groups were assessed for 2 care processes: percentage of STEMI patients presenting to PCI-capable hospitals with a DTB time ≤ 90 minutes (DTB90) and proportion of eligible ACS patients receiving aspirin within 24 hours. Results: After adjustment for clinical risk factors and sociodemographic and hospital characteristics, 2276 (51.7%) women and 6276 (56.9%) men with STEMI were treated with DTB90 (adjusted OR: 0.85, 95% CI: 0.80–0.91, P < 0.0001 for women vs men). Time trend analysis showed an absolute increase ranging from 24% to 35% in DTB90 rates among both men and women (P for trend <0.0001 for each group), with consistent differences over time across the 4 age/sex groups (3-way P-interaction = 0.93). Despite high rate of baseline aspirin use (87%–91%), there was a 9% to 11% absolute increase in aspirin use over time, also with consistent differences across the 4 age/sex groups (all 3-way P-interaction ≥0.15). Conclusions: Substantial gains of generally similar magnitude existed in ACS performance measures over 6 years of study across sex and age groups; areas for improvement remain, particularly among younger women.",
keywords = "Acute Coronary Syndrome, Epidemiology, Quality of Care, Women",
author = "{for the Get With The Guidelines Steering Committee and Investigators} and Udell, {Jacob A.} and Fonarow, {Gregg C.} and Maddox, {Thomas M.} and Cannon, {Christopher P.} and {Frank Peacock}, W. and Laskey, {Warren K.} and Grau-Sepulveda, {Maria V.} and Smith, {Eric E.} and Hernandez, {Adrian F.} and Peterson, {Eric D.} and Bhatt, {Deepak L.}",
note = "Funding Information: American Heart Association Get With The Guidelines; The study was supported by an American Heart Association Get With the Guidelines Young Investigator grant. The funding sources were not involved in data collection, data analysis, manuscript writing, or publication. The Get With the Guidelines– Coronary Artery Disease (GWTG-CAD) program was provided by the American Heart Association and supported in part through the American Heart Association Pharmaceutical Roundtable and an unrestricted educational grant from Merck. Funding Information: Dr. Udell has served on advisory boards for Boehringer-Ingelheim, Janssen, Merck, and Sanofi Pasteur; received research funding from AstraZeneca and Novartis; and has received honoraria for sponsored symposia from Boehringer-Ingelheim and Janssen. Dr. Peacock has served on advisory boards for Abbott, AstraZeneca, Bayer, Beckman, Boehringer-Ingelheim, Ischemia Care, Dx, ImmunArray, Instrument Labs, Janssen, Ortho Clinical Diagnostics, Relypsa, Roche, and Siemens; received research funding from Abbott, Braincheck, ImmunArray, Janssen, Roche, and ZS Pharma; has provided expert testimony for Johnson & Johnson; and has ownership interests in Comprehensive Research Associates LLC, Emergencies In Medicine LLC, and Ischemia DX LLC. Dr. Bhatt has served on advisory board for Car-dax, Elsevier PracticeUpdate Cardiology, Medscape Cardiology, and Regado Biosciences; has served on board of directors of Boston VA Research Institute and the Society of Cardiovascular Patient Care; has been chair of the American Heart Association Quality Oversight Committee; has served on data monitoring committees for Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, and Population Health Research Institute; has received honoraria from American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor, Associate Editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), and WebMD (CME steering committees); has served as deputy editor for Clinical Cardiology, chair of the NCDR-ACTION Registry Steering Committee, and chair of the VA CART Research and Publications Committee; has received research funding from Abbott, Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Regeneron, Roche, Sanofi Aventis, and The Medicines Company; has received royalties from Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald's Heart Disease); has served as site co-investigator for Biotronik, Boston Scientific, and St. Jude Medical (now Abbott); has served as a trustee of the American College of Cardiology; and reports unfunded research for FlowCo, Merck, PLx Pharma, and Takeda. The authors declare no other potential conflicts of interest. Publisher Copyright: {\textcopyright} 2018 Wiley Periodicals, Inc.",
year = "2018",
month = jun,
doi = "10.1002/clc.22938",
language = "English (US)",
volume = "41",
pages = "758--768",
journal = "Clinical Cardiology",
issn = "0160-9289",
publisher = "John Wiley and Sons Inc.",
number = "6",
}