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. 1996 Oct 5;313(7061):853–855. doi: 10.1136/bmj.313.7061.853

Sex differences in case fatality before and after admission to hospital after acute cardiac events: analysis of community based coronary heart disease register.

G S Sonke 1, R Beaglehole 1, A W Stewart 1, R Jackson 1, F M Stewart 1
PMCID: PMC2359036  PMID: 8870571

Abstract

OBJECTIVE: To determine whether the reported higher case fatality in hospital after an acute cardiac event in women can be explained by sex differences in mortality before admission and in baseline risk factors. DESIGN: Analyses of data from a community based coronary heart disease register. SETTING: Auckland region, New Zealand. SUBJECTS: 5106 patients aged 25-64 years with an acute cardiac event leading to coronary death or definite myocardial infarction within 28 days of onset, occurring between 1986 and 1992. MAIN OUTCOME MEASURES: Case fatality before admission, 28 day case fatality for patients in hospital, and total case fatality after an acute cardiac event. RESULTS: Despite a more unfavourable risk profile women tended to have lower case fatality before admission than men (crude odds ratio 0.88; 95% confidence interval 0.77 to 1.02). Adjustment for age, living arrangements, smoking, medical history, and treatment increased the effect of sex (0.72; 0.60 to 0.86). After admission to hospital, women had a higher case fatality than men (1.76; 1.43 to 2.17), but after adjustment for confounders this was reduced to 1.18 (0.89 to 1.58). Total case fatality 28 days after an acute cardiac event showed no significant difference between men and women (0.85; 0.70 to 1.02) CONCLUSIONS: The higher case fatality after an acute cardiac event in women admitted to hospital is largely explained by differences in living status, history, and medical treatment and is balanced by a lower case fatality before admission.

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Selected References

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  1. Brett K. M., Madans J. H. Long-term survival after coronary heart disease. Comparisons between men and women in a national sample. Ann Epidemiol. 1995 Jan;5(1):25–32. doi: 10.1016/1047-2797(94)00037-t. [DOI] [PubMed] [Google Scholar]
  2. Brunham R. C., Paavonen J., Stevens C. E., Kiviat N., Kuo C. C., Critchlow C. W., Holmes K. K. Mucopurulent cervicitis--the ignored counterpart in women of urethritis in men. N Engl J Med. 1984 Jul 5;311(1):1–6. doi: 10.1056/NEJM198407053110101. [DOI] [PubMed] [Google Scholar]
  3. Case R. B., Moss A. J., Case N., McDermott M., Eberly S. Living alone after myocardial infarction. Impact on prognosis. JAMA. 1992 Jan 22;267(4):515–519. [PubMed] [Google Scholar]
  4. Demirovic J., Blackburn H., McGovern P. G., Luepker R., Sprafka J. M., Gilbertson D. Sex differences in early mortality after acute myocardial infarction (the Minnesota Heart Survey). Am J Cardiol. 1995 Jun 1;75(16):1096–1101. doi: 10.1016/s0002-9149(99)80737-1. [DOI] [PubMed] [Google Scholar]
  5. Jackson R., Stewart A., Beaglehole R. Trends in coronary heart disease mortality and morbidity in Auckland, New Zealand, 1974-1986. Int J Epidemiol. 1990 Jun;19(2):279–283. doi: 10.1093/ije/19.2.279. [DOI] [PubMed] [Google Scholar]
  6. Karlson B. W., Herlitz J., Hartford M. Prognosis in myocardial infarction in relation to gender. Am Heart J. 1994 Sep;128(3):477–483. doi: 10.1016/0002-8703(94)90620-3. [DOI] [PubMed] [Google Scholar]
  7. Löwel H., Dobson A., Keil U., Herman B., Hobbs M. S., Stewart A., Arstila M., Miettinen H., Mustaniemi H., Tuomilehto J. Coronary heart disease case fatality in four countries. A community study. The Acute Myocardial Infarction Register Teams of Auckland, Augsburg, Bremen, FINMONICA, Newcastle, and Perth. Circulation. 1993 Dec;88(6):2524–2531. doi: 10.1161/01.cir.88.6.2524. [DOI] [PubMed] [Google Scholar]
  8. Marrugat J., Antó J. M., Sala J., Masiá R. Influence of gender in acute and long-term cardiac mortality after a first myocardial infarction. REGICOR Investigators. J Clin Epidemiol. 1994 Feb;47(2):111–118. doi: 10.1016/0895-4356(94)90016-7. [DOI] [PubMed] [Google Scholar]
  9. Moser D. K., Dracup K. Gender differences in treatment-seeking delay in acute myocardial infarction. Prog Cardiovasc Nurs. 1993 Summer;8(1):6–12. [PubMed] [Google Scholar]
  10. Tunstall-Pedoe H., Kuulasmaa K., Amouyel P., Arveiler D., Rajakangas A. M., Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation. 1994 Jul;90(1):583–612. doi: 10.1161/01.cir.90.1.583. [DOI] [PubMed] [Google Scholar]
  11. Vaccarino V., Krumholz H. M., Berkman L. F., Horwitz R. I. Sex differences in mortality after myocardial infarction. Is there evidence for an increased risk for women? Circulation. 1995 Mar 15;91(6):1861–1871. doi: 10.1161/01.cir.91.6.1861. [DOI] [PubMed] [Google Scholar]

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