BACKGROUND: Women with ST-segment elevation myocardial infarction (STEMI) receive suboptimal care and have worse outcomes than men. Whether strategies to reduce STEMI care variability impact disparities in the care and outcomes of women with STEMI is unknown. OBJECTIVES: The study assessed the care and outcomes of men versus women with STEMI before and after implementation of a comprehensive STEMI protocol. METHODS: On July 15, 2014, the authors implemented: 1) emergency department catheterization lab activation; 2) STEMI Safe Handoff Checklist; 3) immediate transfer to an immediately available catheterization lab; and 4) radial first approach to percutaneous coronary intervention (PCI). The authors prospectively studied consecutive patients with STEMI and assessed guideline-directed medical therapy (GDMT) before PCI, median door-to-balloon time (D2BT), in-hospital adverse events, and 30-day mortality stratified by sex before (January 1, 2011 to July 14, 2014; control group) and after (July 15, 2014 to December 31, 2016) implementation of the STEMI protocol. RESULTS: Of 1,272 participants (68% men, 32% women), women were older with more comorbidities than men. In the control group, women had less GDMT (77% vs. 69%; p = 0.019) and longer D2BT (median 104 min; [interquartile range (IQR): 79 to 133] min vs. 112 [IQR: 85 to 147] min; p = 0.023). Women had more in-hospital stroke, vascular complications, bleeding, transfusion, and death. In the comprehensive 4-step STEMI protocol, sex disparities in GDMT (84% vs. 80%; p = 0.32), D2BT (89 [IQR: 68 to 106] min vs. 91 [IQR: 68 to 114] min; p = 0.15), and in-hospital adverse events resolved. The absolute sex difference in 30-day mortality decreased from the control group (6.1% higher in women; p = 0.002) to the comprehensive 4-step STEMI protocol (3.2% higher in women; p = 0.090). CONCLUSIONS: A systems-based approach to STEMI care reduces sex disparities and improves STEMI care and outcomes in women.
BACKGROUND:Women with ST-segment elevation myocardial infarction (STEMI) receive suboptimal care and have worse outcomes than men. Whether strategies to reduce STEMI care variability impact disparities in the care and outcomes of women with STEMI is unknown. OBJECTIVES: The study assessed the care and outcomes of men versus women with STEMI before and after implementation of a comprehensive STEMI protocol. METHODS: On July 15, 2014, the authors implemented: 1) emergency department catheterization lab activation; 2) STEMI Safe Handoff Checklist; 3) immediate transfer to an immediately available catheterization lab; and 4) radial first approach to percutaneous coronary intervention (PCI). The authors prospectively studied consecutive patients with STEMI and assessed guideline-directed medical therapy (GDMT) before PCI, median door-to-balloon time (D2BT), in-hospital adverse events, and 30-day mortality stratified by sex before (January 1, 2011 to July 14, 2014; control group) and after (July 15, 2014 to December 31, 2016) implementation of the STEMI protocol. RESULTS: Of 1,272 participants (68% men, 32% women), women were older with more comorbidities than men. In the control group, women had less GDMT (77% vs. 69%; p = 0.019) and longer D2BT (median 104 min; [interquartile range (IQR): 79 to 133] min vs. 112 [IQR: 85 to 147] min; p = 0.023). Women had more in-hospital stroke, vascular complications, bleeding, transfusion, and death. In the comprehensive 4-step STEMI protocol, sex disparities in GDMT (84% vs. 80%; p = 0.32), D2BT (89 [IQR: 68 to 106] min vs. 91 [IQR: 68 to 114] min; p = 0.15), and in-hospital adverse events resolved. The absolute sex difference in 30-day mortality decreased from the control group (6.1% higher in women; p = 0.002) to the comprehensive 4-step STEMI protocol (3.2% higher in women; p = 0.090). CONCLUSIONS: A systems-based approach to STEMI care reduces sex disparities and improves STEMI care and outcomes in women.
Authors: Harmony R Reynolds; C Noel Bairey Merz; Colin Berry; Rohit Samuel; Jacqueline Saw; Nathaniel R Smilowitz; Ana Carolina do A H de Souza; Robert Sykes; Viviany R Taqueti; Janet Wei Journal: Circ Res Date: 2022-02-17 Impact factor: 17.367
Authors: Chetan P Huded; Anirudh Kumar; Nicholas Kassis; Michael J Johnson; Kathleen Kravitz; Abigail Brown; Marguerite Shanahan; Karen Trentanelli; Grant W Reed; Venu Menon; Amar Krishnaswamy; Stephen G Ellis; Damon M Kralovic; Stephen W Meldon; Samir R Kapadia; Umesh N Khot Journal: Eur Heart J Open Date: 2021-08-20
Authors: Patrick M Hyland; Jiaman Xu; Changyu Shen; Lawrence J Markson; Warren J Manning; Jordan B Strom Journal: Heart Date: 2022-05-25 Impact factor: 7.365
Authors: Merry L Lindsey; Keith R Brunt; Jonathan A Kirk; Petra Kleinbongard; John W Calvert; Lisandra E de Castro Brás; Kristine Y DeLeon-Pennell; Dominic P Del Re; Nikolaos G Frangogiannis; Stefan Frantz; Richard J Gumina; Ganesh V Halade; Steven P Jones; Rebecca H Ritchie; Francis G Spinale; Edward B Thorp; Crystal M Ripplinger; Zamaneh Kassiri Journal: Am J Physiol Heart Circ Physiol Date: 2021-10-08 Impact factor: 5.125
Authors: Tina E Brinkley; Shana D Stites; Holly C Hunsberger; Carrie A Karvonen-Gutierrez; Mengting Li; C Elizabeth Shaaban; Roland J Thorpe; Stephen B Kritchevsky Journal: Innov Aging Date: 2022-08-21
Authors: Christine Pacheco; Laurie-Anne Boivin-Proulx; Alexandra Bastiany; Alexis Matteau; Samer Mansour; François Gobeil; Oana-Maria Simion; André Kokis; C Noel Bairey Merz; Brian J Potter Journal: CJC Open Date: 2021-01-23