Abstract
Background
Recent research has demonstrated discrepancies in care post-ST-elevation myocardial infarction (STEMI), showing that women often have delays in time to percutaneous coronary intervention (PCI) and are less often prescribed evidence-based medications for secondary prevention. This single-centre study evaluated gender differences in management and local prescribing patterns of STEMI patients on discharge consistent with implicit bias, benchmarked against Australian clinical guidelines.
Method and Result
A retrospective, consecutive study of 318 patients admitted with a STEMI was conducted at a large tertiary hospital from January 2018 until October 2019. Data was collected from medical records including patient demographics, door-to-balloon (DTB) time, and pharmacological management. The mean age of women with a STEMI was higher (67.90 years in women; 64.17 in men, p = 0.013). DTB times were unaffected by gender with 88% of both men and women receiving PCI in less than 90 min (1.04 95% CI (0.44-2.46). Women were less likely to be prescribed an angiotensin-converting enzyme (ACE)-inhibitor/angiotensin receptor blocker (ARB) on discharge (p = 0.003). However, all other medications prescribed were appropriate between genders based on recommended guidelines.
Conclusions
Our study identified excellent adherence with recommended guidelines, challenging recent data both internationally and from the Victorian Cardiac Outcomes Registry (VCOR). Pharmacological and revascularisation management post-STEMI for both male and female patients was equal, suggesting implicit bias is not universal and may be institutional. Health services should evaluate their practices to identify sources of implicit bias, which may influence their management of women presenting with a STEMI.
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Data Availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Contributions
All authors contributed to study conception and design. Material preparation, data collection, and analysis were performed by Dr Stephanie Whittle, Ms Helene Angerer and Ms Viviane Khalil. The first draft and revision of the manuscript were written by Dr Stephanie Whittle and Ms Viviane Khalil. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Ethics approval
The study was approved by the Hospital Human Research Ethics Committee (Reference QA/54253/PH-2019).
Conflict of interest
The authors declare that they have no conflict of interest.
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Whittle, S., Angerer, H., Premaratne, M. et al. Discrepancies in post-ST-elevation myocardial infarction care in women compared with men: evaluating for implicit bias—a single-centre study. Ir J Med Sci 191, 169–173 (2022). https://doi.org/10.1007/s11845-021-02528-z
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DOI: https://doi.org/10.1007/s11845-021-02528-z