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Sex Differences in the Application of Evidence-Based Therapies for the Treatment of Acute Myocardial Infarction
The American College of Cardiology's Guidelines Applied in Practice Projects in Michigan
Sandeep M. Jani, MPH;
Cecelia Montoye, RN, MSN;
Rajendra Mehta, MD;
Arthur L. Riba, MD;
Anthony C. DeFranco, MD;
Robert Parrish, MM;
Stephen Skorcz, MPH;
Patricia L. Baker, MS;
Jessica Faul, MPH;
Benrong Chen, PhD;
Canopy Roychoudhury, PhD;
Mary Anne C. Elma, BA;
Kristi R. Mitchell, MPH;
Kim A. Eagle, MD; for the American College of Cardiology Foundation Guidelines Applied in Practice Steering Committee
Arch Intern Med. 2006;166:1164-1170.
Background Studies have shown that women with acute myocardial infarction (AMI) are less likely to receive evidence-based care compared with men. The American College of Cardiology's AMI Guidelines Applied in Practice (GAP) program has been shown to increase the rates of evidence-based medicine use and reduce mortality in patients with AMI. The objective of this study was to investigate the relative benefits of the GAP program in men and women.
Methods By using a predesign-postdesign, standard orders, and a discharge tool to improve evidence-based indicator rates and long-term mortality in patients with AMI in Michigan, this study compared the success of GAP in men vs women. Logistic regression was used to develop predictive models for death at 30 days and 1 year in men and women.
Results Use of evidence-based care, including use of  -blockers and aspirin in men and women at hospital discharge and lipid-lowering agent use in men, was higher in the post-GAP sample (P<.01 for all). Use of the discharge tool promoted by the GAP program was independently protective against death at 1 year in women (adjusted odds ratio, 0.46; 95% confidence interval, 0.27-0.79), and a trend existed for similar results in men (adjusted odds ratio, 0.62; 95% confidence interval, 0.36-1.06). However, the tool was used slightly less often with women (27.9% vs 33.96%; P=.003).
Conclusions The GAP program increased the use of evidence-based therapies in male and female patients. In addition, the GAP discharge tool may decrease mortality rates at 1 year in patients with AMI; however, the tool was used less often with women. Greater use of the GAP discharge tool in women might narrow the post-MI sex mortality gap.
Author Affiliations: Department of Cardiology, University of Michigan Health System, Ann Arbor (Mr Jani and Drs Mehta and Eagle); American College of Cardiology, Bethesda, Md (Mss Montoye, Elma, and Mitchell); Division of Cardiology, Oakwood Hospital, Dearborn, Mich (Dr Riba); Division of Cardiology, McLaren Regional Medical Center, Flint, Mich (Dr DeFranco); Greater Detroit Area Health Council, Detroit, Mich (Mr Parrish); Greater Flint Health Coalition, Flint (Mr Skorcz); MPRO, Farmington Hills, Mich (Ms Baker and Drs Chen and Roychoudhury); and Institute for Social Research, University of Michigan (Ms Faul). Ms Montoye is now with Michigan Heart and Vascular Institute, St Joseph Mercy Hospital, Ann Arbor; Dr Mehta is now with the Division of Cardiology, Duke University, Durham, NC; and Dr DeFranco is now with Cardiology Associates, PSC, Edgewood, Ky.
RELATED LETTERS
Sex Differences in the Benefits of the Guidelines Applied in Practice Project: Are They Due to Sex?
Andrew T. Yan, Raymond T. Yan, and Shaun G. Goodman
Arch Intern Med. 2006;166(21):2405-2406.
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Sex Differences in the Benefits of the Guidelines Applied in Practice Project: Are They Due to Sex?—Reply
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Arch Intern Med. 2006;166(21):2406.
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Arch Intern Med. 2006;166(11):1162-1163.
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