Sex Differences in Health Status After Acute Myocardial Infarction
University of Kansas
Preventive Medicine and Public Health
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Background: Past research suggests that women, as compared with men, have worse survival after an acute myocardial infarction (AMI). However, little is known about whether women also have worse health status (symptoms, function, and quality of life [QOL]) after an AMI. Methods: Across two multi-centered AMI registries (PREMIER and TRIUMPH), we examined whether there were sex differences in health status recovery among 4,555 AMI patients using the validated disease-specific Seattle Angina Questionnaire (SAQ). We compared 1-year change in SAQ angina frequency and QOL scores for men and women with hierarchical linear regression models that adjusted for demographics, clinical comorbidities, socio-economic factors, and medication treatment. To facilitate interpretability, we also compared the presence of any angina as a dichotomous variable at 1 year (SAQ angina frequency score <100 vs. 100). Results: Of 4,555 AMI patients, 1,481(32.5%) were women. Women were older, more frequently of black race and widowed, and were more likely to have economic barriers to care, including financial difficulty affording medications and be unemployed. Compared with men, women had lower mean baseline (61.3±23.4 vs. 64.9±22.7) and 1-year (80.3±21.5 vs. 84.2±19.0) QOL scores, and less model-adjusted improvement in QOL at 1-year (-2.60 SAQ points; 95% CI: -1.31, -3.90; P<0.001). Although women and men had similar baseline SAQ angina scores (85.0±20.7 vs. 85.8±20.4), women had more frequent angina at 1-year (91.6±17.6 vs. 94.1±14.9), which resulted in less model-adjusted improvement in angina frequency scores after adjustment for all covariates (-2.85 SAQ points; 95% CI: -1.34, -4.36; P<0.001). This also translated to a 28% increased odds of any angina at 1-year (adjusted OR=1.28; 95% CI = 1.07, 1.52; P=0.01). Conclusion: Compared with men, women have worse health status recovery after AMI than men, with smaller improvements in QOL and angina symptoms at 1 year.
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