Men and Women Veterans Receive Equal Care for AMI in VA Hospitals
Previous studies have shown that women are less likely to undergo cardiac catheterization and generally received evidence-based therapy less often than men in the treatment of acute myocardial infarction (AMI), raising concerns of bias in the provision of care. However, no studies have described whether or not women Veterans experience similar differences in treatment or survival. This study sought to describe the clinical characteristics, treatment, and survival in women Veterans (n=236) compared with men (13,259) admitted to VA hospitals for AMI between 10/03 and 3/05. Using data from the VA Cardiac Care Follow-up Clinical Study, investigators assessed patient demographics, symptoms, comorbidities, medications, revascularizations, and other cardiac procedures.
Findings show that after adjusting for clinical characteristics, men and women Veterans treated for AMI in VA hospitals had similar levels of care and survival. There were no significant differences in the treatment provided to men and women Veterans, and cardiac catheterization was provided at equal rates (34.9% for men vs. 36.9% for women). Men did have higher mortality rates, but after adjusting for clinical characteristics this difference was no longer significant. Results also show that women were less likely than men to have a history of heart failure (18.2% vs. 27.2%) and previous coronary artery bypass grafting (11.4% vs. 19.6%). In addition, significantly more men were prescribed aspirin and angiotensin-converting enzyme inhibitors, but there were no differences with regard to other platelet inhibitors, beta-blockers, or lipid-lowering medications.
Wheeler S, Bowen J, Maynard C, Lowy E, Sun H, Sales A, Smith N, and Fihn S. Women Veterans and outcomes after acute myocardial infarction. Journal of Women’s Health May 2009;18(5):613-18.
All authors but Dr. Smith are part of the VA Puget Sound Health Care System; Drs. Maynard, Sales, and Fihn also are part of HSR&D's Northwest Center for Outcomes Research in Older Adults in Seattle.