Cardiology Resident University of Alberta University of Alberta
Background: Acute coronary syndrome (ACS) is the greatest cause of mortality (approximately 7 million deaths annually) and loss of disability adjusted life years1 . Men often receive earlier diagnosis, and more aggressive treatment then women when hospitalized for ACS2-4. This variability in initial management is well documented, however, it is unclear if differences persist during follow up. We aimed to evaluate sex differences and outcomes in the outpatient management strategies post ACS in Alberta, Canada.
METHODS AND RESULTS: This study used linked administrative datasets to establish a cohort of all incident ACS patients in the province of Alberta from 2010 to 2022. Patients residing out of the province and those with previously established cardiovascular disease (CVD) were excluded. The primary endpoint was time to and frequency of follow up by sex at 30 days, 60 days, 90 days and yearly (up to 10 years). Mean comparison t-test and Wilcoxon rank-sum median comparison test between unstable angina, non-ST elevation myocardial infarction (NSTEMI), ST elevation myocardial infarction (STEMI) were used to determine statistical differences between sexes. A Cox proportional hazard was used to determine death within one year of ACS events.
Of 60 448 patients without prior CVD diagnosed with ACS, 41 799 (69.2%) were men and 18 649 (30.8%) were women with a mean age of 61.7 years and 66.2 years in men and women, respectively. Men were more likely to be current smokers whereas hypertension and diabetes were more common in women. Women with NSTEMI were less likely to receive early primary care physician and specialist follow up than men, and had fewer total follow up visits. There was a significant decrease of missed/loss to follow up post ACS in the post pandemic period for both men and women in all three ACS pathologies (table 1). Lastly, death (5.9% vs 4.7%) and heart failure events (2.3% vs 1.5%) at one year were more common in women than men (p < 0.001).
Conclusion: Our findings suggest that there are sex differences in follow up after an ACS event which may contribute to differences in outcomes. Further research is required to determine whether these process of care differences lead to differences in guideline directed medical therapy. Finally, we have identified a large increase in post pandemic follow up that may affect future outcomes in both sexes.
