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Treatment and Health Outcomes of Women and Men in a Cohort With Coronary Artery Disease
Lisa M. Schwartz, MD, MS;
Elliott S. Fisher, MD, MPH;
Anna N. A. Tosteson, ScD;
Steven Woloshin, MD, MS;
Chiang-Hua Chang, MS;
Beth A. Virnig, PhD;
Joy Plohman, RN, MBA;
Brock Wright, MD, MBA
Arch Intern Med. 1997;157(14):1545-1551.
Abstract
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Background
Women with coronary artery disease are treated differently than men. Although mortality has been studied, functional outcomes for women and men have not been prospectively compared.
Methods
The Manitoba Health Reform Impact Study used hospital databases to identify all residents aged 45 years and older in Manitoba who were hospitalized for a myocardial infarction between October 1, 1991, and September 30, 1992. Cohort members were interviewed twice, an average of 16 and 25 months after hospitalization. Baseline and follow-up measures included treatments (eg, physician visits, diagnostic testing, revascularization, and cardiac medications), physical health status (physical component summary [PCS] score derived from the Medical Outcomes Study Short Form 36), reinfarction, and mortality.
Results
Of the 820 patients who completed the initial survey, 31 died during the follow-up period, and 734 completed the follow-up survey. Data were complete for the primary outcome (PCS score) and all relevant covariates for the 677 patients who were included in this study. Women constituted 34% of this cohort. Although women had more physician visits during follow-up, they were less likely to have undergone treadmill testing or angiography (odds ratio, 0.68; 95% confidence interval, 0.46-0.99). Women were equally likely to report taking β-adrenergic blocking agents, but were less likely than men to report the use of aspirin (odds ratio, 0.69; 95% confidence interval, 0.48-0.98). After adjusting for baseline differences in PCS scores, age, income, social supports, and the levels of angina and dyspnea, the PCS score for women declined by 1.4 points, while the score for men improved by 0.2 points (P=.03). During the follow-up period, reinfarction and mortality rates were low overall, but were not different in men and women.
Conclusions
In this cohort of patients with known coronary artery disease, we found less aggressive treatment of coronary artery disease and less use of aspirin among women than among men during 1 year of observation. After controlling for baseline differences, women with coronary artery disease experienced a more rapid decline in physical health status than did men during 1 year of follow-up.
Arch Intern Med. 1997;157:1545-1551
Author Affiliations
From the Department of Veterans Affairs Medical Center, White River Junction, Vt (Drs Schwartz, Fisher, and Woloshin); the Center for the Evaluative Clinical Sciences (Drs Fisher and Tosteson and Ms Chang) and the Department of Medicine (Drs Fisher and Tosteson), Dartmouth Medical School, Hanover, NH; the Department of Family Medicine, University of Miami, Miami, Fla (Dr Virnig); and the Department of Community Health Sciences, University of Manitoba, Winnipeg (Ms Plohman and Dr Wright).
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