Variation in cardiovascular disease care: an Australian cohort study on sex differences in receipt of coronary procedures

Alexandra Jane Fogg; Jennifer Welsh; Emily Banks; Walter Abhayaratna; Rosemary J Korda

doi:10.1136/bmjopen-2018-026507

Variation in cardiovascular disease care: an Australian cohort study on sex differences in receipt of coronary procedures

BMJ Open. 2019 Jul 23;9(7):e026507. doi: 10.1136/bmjopen-2018-026507.

Authors

Alexandra Jane Fogg¹, Jennifer Welsh², Emily Banks^{2

3}, Walter Abhayaratna^{1

4}, Rosemary J Korda²

Affiliations

¹ Australian National University Medical School, The Australian National University, Canberra, Australian Capital Territory, Australia.
² National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia.
³ The Sax Institute, Sydney, New South Wales, Australia.
⁴ Division of Medicine, Canberra Hospital, Canberra, Australian Capital Territory, Australia.

Abstract

Objectives: The aim of this study was to quantify sex differences in diagnostic and revascularisation coronary procedures within 1 year of hospitalisation for acute myocardial infarction (AMI) or angina.

Design: This is a prospective cohort study. Baseline questionnaire (January 2006-April 2009) data from the Sax Institute's 45 and Up Study were linked to hospitalisation and mortality data (to 30 June 2016) in a time-to-event analysis, treating death as a censoring event.

Setting: This was conducted in New South Wales, Australia.

Participants: The study included participants aged ≥45 years with no history of ischaemic heart disease (IHD) who were admitted to hospital with a primary diagnosis of AMI (n=4580) or a primary diagnosis of angina or chronic IHD with secondary diagnosis of angina (n=4457).

Outcome measures: The outcome of this study was coronary angiography and coronary revascularisation with percutaneous coronary intervention or coronary artery bypass graft (PCI/CABG) within 1 year of index admission. Cox regression models compared coronary procedure rates in men and women, adjusting sequentially for age, sociodemographic variables and health characteristics.

Results: Among patients with AMI, 71.6% of men (crude rate 3.45/person-year) and 64.7% of women (2.62/person-year) received angiography; 57.8% of men (1.73/person-year) and 37.4% of women (0.77/person-year) received PCI/CABG. Adjusted HRs for men versus women were 1.00 (0.92-1.08) for angiography and 1.51 (1.38-1.67) for PCI/CABG. In the angina group, 67.3% of men (crude rate 2.36/person-year) and 54.9% of women (1.32/person-year) received angiography; 44.6% of men (0.90/person-year) and 19.5% of women (0.26/person-year) received PCI/CABG. Adjusted HRs were 1.24 (1.14-1.34) and 2.44 (2.16-2.75), respectively.

Conclusions: Men are more likely than women to receive coronary procedures, particularly revascularisation. This difference is most evident among people with angina, where clinical guidelines are less prescriptive than for AMI.

Keywords: 45 and Up study; cardiovascular disease; coronary procedure; health inequality; linked data.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Angina Pectoris / diagnostic imaging*
Angina Pectoris / mortality
Angina Pectoris / therapy*
Coronary Angiography / statistics & numerical data
Coronary Artery Bypass / statistics & numerical data
Female
Follow-Up Studies
Health Care Surveys
Healthcare Disparities / statistics & numerical data*
Hospitalization / statistics & numerical data
Humans
Male
Middle Aged
Myocardial Infarction / diagnostic imaging*
Myocardial Infarction / mortality
Myocardial Infarction / therapy*
New South Wales
Percutaneous Coronary Intervention / statistics & numerical data
Practice Patterns, Physicians' / statistics & numerical data*
Procedures and Techniques Utilization / statistics & numerical data*
Proportional Hazards Models
Prospective Studies
Sex Factors
Treatment Outcome