Women Veterans and Outcomes after Acute Myocardial Infarction

Background: Previous studies have shown that women have decreased survival and receive fewer cardiac procedures after acute myocardial infarction (AMI) compared with men, raising concerns for sexual bias in provision of care. The objective of this study is to describe clinical characteristics, treatment, and survival in women veterans compared with men after admission to VA hospitals for AMI. Methods: This is a retrospective inception cohort study using data drawn from the VA Cardiac Care Follow-up Clinical Study, describing patients admitted for AMI to VA hospitals from October 1, 2003 to March 31, 2005. Subjects were followed for 1 year. Results: There were 236 women and 13,259 men admitted during the study period to VA hospitals with AMI. Women were less likely to have a history of heart failure compared with men (18.2% of women vs. 27.2% of men, p = 0.002) and previous coronary artery bypass grafting (CABG) (11.4% of women vs. 19.6% of men, p=0.002). Diagnostic cardiac catheterization was similar in women and men (36.9% and 34.9%, p = 0.539). Crude in-hospital mortality was 4.2% for women and 7.6% for men (p=0.051). After adjusting for comorbidities and treatment variables, in-hospital mortality was not significantly different for women compared with men (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.60-1.12). Conclusions: Women veterans receive a level of care similar to men veterans for MI treated in VA hospitals. Differences in mortality between women and men were not significant and do not suggest that women fare worse.