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dc.contributor.authorDagan, M.
dc.contributor.authorDinh, D.T.
dc.contributor.authorStehli, J.
dc.contributor.authorTan, C.
dc.contributor.authorBrennan, A.
dc.contributor.authorWarren, J.
dc.contributor.authorAjani, A.E.
dc.contributor.authorFreeman, M.
dc.contributor.authorMurphy, A.
dc.contributor.authorReid, Christopher
dc.contributor.authorHiew, C.
dc.contributor.authorOqueli, E.
dc.contributor.authorClark, D.J.
dc.contributor.authorDuffy, S.J.
dc.date.accessioned2023-08-31T00:48:06Z
dc.date.available2023-08-31T00:48:06Z
dc.date.issued2022
dc.identifier.citationDagan, M. and Dinh, D.T. and Stehli, J. and Tan, C. and Brennan, A. and Warren, J. and Ajani, A.E. et al. 2022. Sex disparity in secondary prevention pharmacotherapy and clinical outcomes following acute coronary syndrome. European Heart Journal - Quality of Care and Clinical Outcomes. 8 (4): pp. 420-428.
dc.identifier.urihttp://hdl.handle.net/20.500.11937/93092
dc.identifier.doi10.1093/ehjqcco/qcab007
dc.description.abstract

Aims: We sought to investigate if sex disparity exists for secondary prevention pharmacotherapy following acute coronary syndrome (ACS) and impact on long-term clinical outcomes. Methods and results: We analysed data on medical management 30-day post-percutaneous coronary intervention (PCI) for ACS in 20 976 patients within the multicentre Melbourne Interventional Group registry (2005-2017). Optimal medical therapy (OMT) was defined as five guideline-recommended medications, near-optimal medical therapy (NMT) as four medications, sub-optimal medical therapy (SMT) as ≤3 medications. Overall, 65% of patients received OMT, 27% NMT and 8% SMT. Mean age was 64 ± 12 years; 24% (4931) were female. Women were older (68 ± 12 vs. 62 ± 12 years) and had more comorbidities. Women were less likely to receive OMT (61% vs. 66%) and more likely to receive SMT (10% vs. 8%) compared to men, P < 0.001. On long-term follow-up (median 5 years, interquartile range 2-8 years), women had higher unadjusted mortality (20% vs. 13%, P < 0.001). However, after adjusting for medical therapy and baseline risk, women had lower long-term mortality [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.79-0.98; P = 0.02]. NMT (HR 1.17, 95% CI 1.05-1.31; P = 0.004) and SMT (HR 1.79, 95% CI 1.55-2.07; P < 0.001) were found to be independent predictors of long-term mortality. Conclusion: Women are less likely to be prescribed optimal secondary prevention medications following PCI for ACS. Lower adjusted long-term mortality amongst women suggests that as well as baseline differences between gender, optimization of secondary prevention medical therapy amongst women can lead to improved outcomes. This highlights the need to focus on minimizing the gap in secondary prevention pharmacotherapy between sexes following ACS.

dc.languageEnglish
dc.publisherOXFORD UNIV PRESS
dc.relation.sponsoredbyhttp://purl.org/au-research/grants/nhmrc/1111170
dc.subjectScience & Technology
dc.subjectLife Sciences & Biomedicine
dc.subjectCardiac & Cardiovascular Systems
dc.subjectCardiovascular System & Cardiology
dc.subjectWomen
dc.subjectOptimal medical therapy
dc.subjectGuideline-directed medical therapy
dc.subjectAcute coronary syndrome
dc.subjectSecondary prevention
dc.subjectACUTE MYOCARDIAL-INFARCTION
dc.subjectAMERICAN-HEART-ASSOCIATION
dc.subjectDISEASE
dc.subjectWOMEN
dc.subjectCARE
dc.subjectMANAGEMENT
dc.subjectINITIATION
dc.subjectSTATEMENT
dc.subjectFAILURE
dc.subjectCOLLEGE
dc.subjectAcute coronary syndrome
dc.subjectGuideline-directed medical therapy
dc.subjectOptimal medical therapy
dc.subjectSecondary prevention
dc.subjectWomen
dc.subjectAcute Coronary Syndrome
dc.subjectAged
dc.subjectFemale
dc.subjectHumans
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectPercutaneous Coronary Intervention
dc.subjectRegistries
dc.subjectSecondary Prevention
dc.subjectTreatment Outcome
dc.subjectHumans
dc.subjectTreatment Outcome
dc.subjectRegistries
dc.subjectAged
dc.subjectMiddle Aged
dc.subjectFemale
dc.subjectMale
dc.subjectAcute Coronary Syndrome
dc.subjectSecondary Prevention
dc.subjectPercutaneous Coronary Intervention
dc.titleSex disparity in secondary prevention pharmacotherapy and clinical outcomes following acute coronary syndrome
dc.typeJournal Article
dcterms.source.volume8
dcterms.source.number4
dcterms.source.startPage420
dcterms.source.endPage428
dcterms.source.issn2058-5225
dcterms.source.titleEuropean Heart Journal - Quality of Care and Clinical Outcomes
dc.date.updated2023-08-31T00:48:05Z
curtin.departmentCurtin School of Population Health
curtin.accessStatusOpen access via publisher
curtin.facultyFaculty of Health Sciences
curtin.contributor.orcidReid, Christopher [0000-0001-9173-3944]
dcterms.source.eissn2058-1742
curtin.repositoryagreementV3


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