Gender Differences in Management After Acute Myocardial Infarction: Not 'sexism' but a Reflection of Age at Presentation

Objective: To test whether women receive less intensive treatment and fewer risk stratification tests following acute myocardial infarction (MI), than men.

Methods: A retrospective study of medical records in all district general hospitals and tertiary referral centres for cardiology in Wales was performed. Patients (n = 1595, of which 989 were men) admitted to hospital over 4 months with a diagnosis of acute MI had their case notes reviewed for treatment, stratification of risk factors and secondary prevention. Data were analysed for differences in treatment between men and women and whether these could be attributed to age at presentation.

Results: Women were older than men at presentation [mean age 75 (SD 11) versus 66 (12) years, p < 0.01]; fewer women received thrombolysis (34 versus 44 per cent) and low molecular weight heparin (63 versus 71 per cent) (both p < 0.001); and women had higher 30 day mortality (28 versus 17 per cent, p < 0.001). Fewer women received cardiac catheterization, investigations to identify high risk, drugs for secondary prevention on discharge and referral to cardiac rehabilitation. However, intensities of treatment, investigation and secondary prevention were strongly related to age and, after adjusting for age, gender differences remained only for thrombolysis and exercise testing.

Conclusion: Although women receive fewer investigations and treatments than men, this potential gender bias can be explained by age. The lower use of treatment and investigation among older patients draws attention to the lack of direct evidence of effectiveness for these patients. Further studies are needed to confirm effectiveness of investigations and treatments in older patients.