What does this research mean for the field?

Younger men were 38% more likely than younger women to initiate appropriate treatment after acute myocardial infarction, with no significant difference in adherence. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

The aim is to investigate sex and age differences in the treatment initiation and adherence among acute myocardial infarction survivors.

October 14, 2015Circulation Cardiovascular Quality and Outcomes

Sex Disparities in Post-Acute Myocardial Infarction Pharmacologic Treatment Initiation and Adherence

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Key result

Younger men initiate post-AMI therapies ~38% more often than younger women, despite similar adherence.

Why the study?

Does sex disparity exist in the initiation and adherence to secondary prevention cardiovascular medications in survivors of acute myocardial infarction?

Population

12,261 adults admitted to hospital for incident acute myocardial infarction in 2007-2009 who survived for 1…

Comparison

Initiation and adherence to secondary prevention… vs Comparison between men and women across…

Design

Cohort

Follow-up

1 year after discharge

Authors

KSKate SmolinaUniversity of British Columbia Hospital LBLaura BallWestern University KHKarin H. HumphriesPreventive Cardiology

Discussion

Member takes

Implication

Younger women may face initiation barriers after AMI; this cohort study leaves open whether targeted interventions can improve equity.

Key Points

The aim is to investigate sex and age differences in the treatment initiation and adherence among acute myocardial infarction survivors.
Retrospective population-based cohort study using linked administrative data sets in British Columbia.
Included individuals hospitalized for acute myocardial infarction in 2007-2009 who survived for at least one year.
Evaluated medication initiation and refill rates for angiotensin-converting enzyme inhibitors, beta-blockers, and statins.
Over two-thirds of AMI survivors initiated treatment within 2 months of discharge.
Younger men were significantly more likely to initiate treatment than younger women.
One-third of AMI survivors filled prescriptions for at least 80% of the year after discharge, with no significant adherence difference between sexes.
Women under 55 years were less likely to be on optimal therapy by the end of the year due to lower initiation rates.

Structured PICO

Does sex disparity exist in the initiation and adherence to secondary prevention cardiovascular medications in survivors of acute myocardial infarction?

Population

12,261 adults (aged 20-99 years) admitted to hospital for incident acute myocardial infarction (AMI) in 2007-2009 who survived for 1 year after hospital discharge, mean age 71.5 (women) and 64.9 (men), 31% female, British Columbia, Canada.

Intervention

Initiation and adherence to secondary prevention cardiovascular medications (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, and statins) post-AMI.

Comparator

Comparison between men and women across different age groups.

Outcome

Initiation of appropriate pharmacotherapy (filling prescriptions for all appropriate medications within 2 months of discharge) and adherence (proportion of days covered ≥0.8 for all medications during 1 year after discharge).

Women under 55 years are significantly less likely to be on optimal secondary prevention therapy 1 year post-AMI, driven by disparities in treatment initiation rather than adherence.

Limitations

Unable to determine whether sex-based differences in treatment initiation were driven by physician prescribing practices or patient behavior
Measure of adherence is indirect and overestimates adherence in those who fill prescriptions but do not take them
Possible misclassification of patients with relative contraindications
Inability to examine the use of aspirin
Unable to ascertain blood pressure values and lipid levels
Results only apply to 1-year survivors of AMI

Coverage & sources

Journal, society, and media accounts. Useful signal, not independent expert judgment.

Cite This Study

Smolina et al. (2015) studied this question. Younger men were 38% more likely than younger women to initiate appropriate treatment after AMI, with no significant difference in adherence.

synapsesocial.com/papers/696a9ced50a360e9ca119855 https://doi.org/10.1161/circoutcomes.115.001987

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Sex Disparities in Post-Acute Myocardial Infarction Pharmacologic Treatment Initiation and Adherence

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Coverage & sources

Cite This Study

Sex Disparities in Post-Acute Myocardial Infarction Pharmacologic Treatment Initiation and Adherence

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Coverage & sources

Cite This Study

Also Consider

Also Consider