Key result
Female patients with acute myocardial infarction were significantly less likely to be prescribed optimal medical therapy at discharge compared to men (51% vs 60%, OR 0.90).
Why the study?
Does female sex reduce the likelihood of being prescribed optimal medical therapy at discharge in patients with acute myocardial infarction?
Observational (n=34,612)
Yes
Does female sex reduce the likelihood of being prescribed optimal medical therapy at discharge in patients with acute myocardial infarction?
Odds Ratio: 0.9 (95% CI 0.85–0.95)
Absolute Event Rate: 51% vs 60%
p-value: p=<0.001
Despite temporal improvements in secondary prevention prescribing after acute myocardial infarction, significant sex disparities persist, with women being less likely to receive optimal medical therapy at discharge.
Sex disparities in post-AMI secondary prevention prescribing persist; leaves open whether targeted interventions can achieve equitable guideline adherence.
AIMS: Recent studies have demonstrated sex-related differences in secondary prevention pharmacotherapy in patients with acute myocardial infarction, although guidelines recommend the same preventive approach in both women and men. This study builds upon previous research by examining temporal trends in prescribing patterns of secondary prevention medications using contemporary, long-term data from Switzerland, with particular focus on sex-related disparities. METHODS: Acute myocardial infarction patients enrolled in the AMIS (Acute Myocardial Infarction in Switzerland) Plus project between 2003 and 2022 were included. For this retrospective analysis, optimal medical therapy was defined as the combination of all five guideline-recommended medications at discharge: aspirin; P2Y12 inhibitor; lipid-lowering drug; beta-blocker; angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Uni- and multivariable logistic regression analyses were performed. RESULTS: Among 34,612 patients (75% men, n=25,913), women were older and had more comorbidities but were less frequently prescribed optimal medical therapy than men (51% vs 60%) across all age groups (all p <0.001), with the greatest gap occurring in patients <50 years of age. A marked increase in optimal medical therapy prescription (36% to 60%) was detected irrespective of age and sex, mainly due to greater prescription of dual antiplatelet therapy (71% to 91%) and lipid-lowering drugs (69% to 93%). The sex-related gap in optimal medical therapy prescription disfavouring women showed a fluctuating trend (0.7–14%) whereas there was a progressive and sustained reduction regarding the combination of dual antiplatelet therapy plus lipid-lowering drug, from 18% to 10% at the beginning and the end of the observation period, respectively. Multivariable analysis showed greater frequency of optimal medical therapy prescription in patients with STEMI (OR: 1.65, 95% CI: 1.57–1.73) and those treated with PCI (OR: 4.85, 95% CI: 4.49–5.24), whereas lower prescription frequencies were observed among female patients (OR: 0.90, 95% CI: 0.85–0.95) and older individuals (OR per additional year: 0.99, 95% CI: 0.98–0.99). CONCLUSIONS: Although optimal medical therapy prescription increased gradually over time among both women and men, concerning sex disparities disfavouring women, particularly young women, remained. Targeted programmes to reduce sex-related differences in secondary prevention care are warranted.
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Berther et al. (2026) conducted an observational in Acute myocardial infarction (n=34,612). Female sex vs. Male sex was evaluated on Optimal medical therapy prescription at discharge (combination of 5 guideline-recommended medications) (OR 0.90, 95% CI 0.85-0.95, p=<0.001). Female patients with acute myocardial infarction were significantly less likely to be prescribed optimal medical therapy at discharge compared to men (51% vs 60%, OR 0.90).
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