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

BackgroundSex‐based differences in acute coronary syndrome (ACS) mortality may attenuate with age due to better symptom recognition and prompt care.HypothesisAge is a modifier of temporal trends in sex‐based differences in ACS care.MethodsAmong 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.ResultsAfter 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).ConclusionsSubstantial 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.