The rehospitalization rate of young women is higher than that of young men after a heart attack

In a new study of young heart attack victims in Ontario, Canada, researchers found that the health care system provides high quality care for young people who have had a heart attack; however, there are still differences between men and women. Cardiovascular and all-cause readmission rates are higher in young women than in young men. This underscores the need for continued efforts to improve prevention strategies as risk factors for heart disease in young women continue to rise. Their results appear in Canadian Journal of Cardiology.

Despite improvements in the management and outcomes of patients with ischemic heart disease, every year a large number of women are hospitalized with acute myocardial infarction (AMI). Several previous studies have shown that heart attack outcomes in women are worse than in men. Young women have been found to be at particularly high risk, with significantly higher mortality rates than young men and worse outcomes even compared to older women. As a result, vigorous efforts to address these disparities in treatment have been directed at the public and health professionals.

“Many of the gaps in care for young women with AMI in Ontario are closing, but readmission rates remain higher than for young men,” explained lead researcher Meena Madan, MD, MHS, Schulich Cardiology Center, Sunnybrook Health Sciences Center and Department of Medicine University of Toronto, Toronto, Ontario, Canada.

Using data from ICES, researchers examined clinical outcomes in 38,071 heart attack survivors aged 18 to 55 years who were hospitalized in Ontario, Canada, between April 1, 2009 and March 31, 2019, with a diagnosis of GIM. Of them, 8,077 (21.2%) are women. They compared trends in cardiology risk factorsangiographic outcomes and revascularization rates in men and women and studied their outcomes during the first year after a heart attack.

The researchers found that young women hospitalized with AMI had significantly more cardiac risk factors and comorbidities compared to young men with AMI. It is noteworthy that over time there is a steady increase in the prevalence of diabetes in women. About 25% had diabetes in 2009, compared to almost 35% in 2018, which was significantly higher than among men, whose diabetes rate increased by just 4%, from 18% to 22%, over the same period. time. By 2018, more than one in three young women with AMI had diabetes, nearly half had hypertension and dyslipidemia, and more than two in five were smokers.

Although previous studies have shown that women are less likely to be referred for coronary angiography to screen for coronary artery disease, by 2018 the use of coronagraphy was basically universal for both sexes. Young women were less likely to be referred for angioplasty or bypass compared with young men, which may be explained by the higher prevalence of normal coronary arteries and non-obstructive coronary artery disease seen at angiography in women.

During the study period, adjusted mortality rates for young men and women after hospitalization for a heart attack were similar. However, the rate of readmissions for adverse cardiovascular events and the rate of all-cause readmissions were significantly higher in women (25.8% for women vs. 21.1% for men).

“This may reflect the higher risk profile among young women we observed in our study compared to young men, or support the notion that young women may benefit from follow-up and improved support networks that may reduce the need for readmission soon after after discharge,” said Dr. Madan.

In an accompanying editoriallead author Karin H. Humphreys, MBA, DSc, University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada, comments, “This important analysis gives us both good and bad news. Although it provides evidence that sex differences in AMI are diminishing, there is also a pressing need to understand what accounts for the higher readmission rates in women. Is this due to unrecognized depression, less medication use after AMI, or delays in accessing care? an investigation in these areas is clearly necessary.”

“There is certainly room to do better,” agrees Dr. Madan, “by taking measures that could reduce early readmission rates for young women and renewed public education initiatives to raise awareness of the importance of diet, exercise, and healthy lifestyle choices to avoid developing cardiovascular disease.”