Gender bias in treatment of cardiovascular disease in Newfoundland and Labrador

• Main Author: Griffiths-Beresford, Sheila
• Format: Thesis
• Language: English
• Published: Memorial University of Newfoundland 2003
• Subjects: Newfoundland; Canada
• Online Access: https://research.library.mun.ca/10585/; https://research.library.mun.ca/10585/1/GriffithsBeresford_Sheila.pdf

Rationale: Cardiovascular disease (CDV) is the leading cause of mortality and morbidity in Canada. Mortality from cardiovascular disease is higher in Newfoundland and Labrador (NL) than other Canadian provinces. Gender differences in the treatment of and assessment of CVD have been repeatedly demonstrated in clinical trials. -- Objective: 1) To determine the existence and impact of gender bias in the treatment of Acute Myocardial Infarction (AMI) in NL. 2) To determine if male gender is associated with inappropriate use of surgical revascularization in NL. -- Design: Two observational studies: 1) Prospective cohort study; 2) Cohort study with retrospective data collection. -- Setting: University based tertiary referral center in St. John's, NL. -- Participants: 1) AMI patients admitted between May 24, 1990 and June 30, 1993 and followed for 3 years. -- 2) Patients referred for Coronary Angiography (CA) between April!, 1994 and March 31, 1995 who subsequently underwent Coronary Artery Bypass Grafting (CABO). -- Measurements: 1) The gender rates of risk factors, post-MI complications, CA, pharmacologic interventions, CABO, Percutaneous Transluminal Coronary Angioplasty (PTCA), functional class assessment using Goldman scales and mortality for three years following AMI were compared. -- 2) CAD risk factors, angina severity, coronary anatomy, medical therapy, CABO indication, appropriateness and necessity of CABO and operative risk and post operative complications were compared by gender. -- Results: 1) During the AMI admission 9.4% of women compared to 3.9% of men had recurrent MI (p=0.04), 12.6% of women and 7.4% of men died (p=0.03). With the exception of heparin (67% male vs. 58% female p = 0.02), pharmacologic intervention was comparable in men and women. CA was performed in 31 % of women and 41.9% of men (p = 0.007). Men were more likely to be revascularized during the AMI admission (19.3 vs. 12.2, p= 0.02) but there was no gender difference in revascularization up to three years post-MI. Multiple logistic ...