{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:46:43Z","timestamp":1789624003731,"version":"build-2803163510"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2019,7,25]],"date-time":"2019-07-25T00:00:00Z","timestamp":1564012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Joint Working Agreement"},{"name":"AstraZeneca UK Ltd"},{"DOI":"10.13039\/100010526","name":"NHS Greater Glasgow and Clyde","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010526","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Golden Jubilee Foundation"},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Centre of Research Excellence Award","award":["RE\/186134217"],"award-info":[{"award-number":["RE\/186134217"]}]},{"name":"Clinical Training Fellowship","award":["FS\/15\/54\/31639"],"award-info":[{"award-number":["FS\/15\/54\/31639"]}]},{"name":"Clinical Training Fellowship","award":["FS\/18\/14\/33330"],"award-info":[{"award-number":["FS\/18\/14\/33330"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Ischaemic heart disease persists as the leading cause of death in both men and women in most countries and sex disparities, defined as differences in health outcomes and their determinants, may be relevant. We examined sex disparities in presenting characteristics, treatment and all-cause mortality in patients hospitalized with myocardial infarction (MI) or angina.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>We conducted a cohort study of all patients admitted with MI or angina (01 October 2013 to 30 June 2016) from a secondary care acute coronary syndrome e-Registry in NHS Scotland linked with national registers of community drug dispensation and mortality data. A total of 7878 patients hospitalized for MI or angina were prospectively included; 3161 (40%) were women. Women were older, more deprived, had a greater burden of comorbidity, were more often treated with guideline-recommended therapy preadmission and less frequently received immediate invasive management. Men were more likely to receive coronary angiography [adjusted odds ratio (OR) 1.52, confidence interval (CI) 1.37\u20131.68] and percutaneous coronary intervention (adjusted OR 1.68, CI 1.52\u20131.86). Women were less comprehensively treated with evidence-based therapies post-MI. Women had worse crude survival, primarily those with ST-elevation myocardial infarction (14.3% vs. 8.0% at 1 year, P\u2009&amp;lt;\u20090.001), but this finding was explained by differences in baseline factors. Men with non-ST-elevation myocardial infarction had a higher risk of all-cause death at 30 days [adjusted hazard ratio (HR) 1.72, CI 1.16\u20132.56] and 1 year (adjusted HR 1.38, CI 1.12\u20131.69).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>After taking account of baseline risk factors, sex differences in treatment pathway, use of invasive management, and secondary prevention therapies indicate disparities in guideline-directed management of women hospitalized with MI or angina.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcz040","type":"journal-article","created":{"date-parts":[[2019,7,24]],"date-time":"2019-07-24T11:16:49Z","timestamp":1563967009000},"page":"156-165","source":"Crossref","is-referenced-by-count":31,"title":["Healthcare disparities for women hospitalized with myocardial infarction and angina"],"prefix":"10.1093","volume":"6","author":[{"given":"Alice M","family":"Jackson","sequence":"first","affiliation":[{"name":"British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3475-7557","authenticated-orcid":false,"given":"Ruiqi","family":"Zhang","sequence":"first","affiliation":[{"name":"Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iain","family":"Findlay","sequence":"first","affiliation":[{"name":"Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Corsebar Road, Paisley PA2 9PN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6557-8298","authenticated-orcid":false,"given":"Keith","family":"Robertson","sequence":"first","affiliation":[{"name":"Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Corsebar Road, Paisley PA2 9PN, UK"},{"name":"Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell","family":"Lindsay","sequence":"first","affiliation":[{"name":"Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK"},{"name":"Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4475-5483","authenticated-orcid":false,"given":"Tamsin","family":"Morris","sequence":"first","affiliation":[{"name":"AstraZeneca UK, Capability Green, Luton LU1 3LU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8345-4002","authenticated-orcid":false,"given":"Brian","family":"Forbes","sequence":"first","affiliation":[{"name":"AstraZeneca UK, Capability Green, Luton LU1 3LU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7095-4844","authenticated-orcid":false,"given":"Richard","family":"Papworth","sequence":"first","affiliation":[{"name":"Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7262-7000","authenticated-orcid":false,"given":"Alex","family":"McConnachie","sequence":"first","affiliation":[{"name":"Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3505-7440","authenticated-orcid":false,"given":"Kenneth","family":"Mangion","sequence":"first","affiliation":[{"name":"British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4306-5317","authenticated-orcid":false,"given":"Pardeep S","family":"Jhund","sequence":"first","affiliation":[{"name":"British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9466-833X","authenticated-orcid":false,"given":"Colin","family":"McCowan","sequence":"first","affiliation":[{"name":"School of Medicine, Medical and Biological Sciences Building, University of St Andrews, North Haugh, St Andrews KY16 9TF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4547-8636","authenticated-orcid":false,"given":"Colin","family":"Berry","sequence":"first","affiliation":[{"name":"British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK"},{"name":"Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK"},{"name":"Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,7,25]]},"reference":[{"key":"2020040606452756400_qcz040-B1","first-page":"1736","article-title":". Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"392","year":"2017","journal-title":"Lancet"},{"key":"2020040606452756400_qcz040-B2"},{"key":"2020040606452756400_qcz040-B3","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/j.ijcard.2010.10.047","article-title":"Long-term prognosis after hospital admission for acute myocardial infarction from 1987 to 2006","volume":"155","author":"Dudas","year":"2012","journal-title":"Int J Cardiol"},{"key":"2020040606452756400_qcz040-B4","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1056\/NEJMoa0908610","article-title":"Population trends in the incidence and outcomes of acute myocardial infarction","volume":"362","author":"Yeh","year":"2010","journal-title":"N Engl J Med"},{"key":"2020040606452756400_qcz040-B5","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1136\/heartjnl-2018-313959","article-title":"Sex differences in quality indicator attainment for myocardial infarction: a nationwide cohort study","volume":"105","author":"Wilkinson","year":"2019","journal-title":"Heart"},{"key":"2020040606452756400_qcz040-B6","doi-asserted-by":"crossref","first-page":"g7873.","DOI":"10.1136\/bmj.g7873","article-title":"High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study","volume":"350","author":"Shah","year":"2015","journal-title":"BMJ"},{"key":"2020040606452756400_qcz040-B7","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1093\/eurheartj\/ehp493","article-title":"Women with acute coronary syndrome are less invasively examined and subsequently less treated than men","volume":"31","author":"Hvelplund","year":"2010","journal-title":"Eur Heart J"},{"key":"2020040606452756400_qcz040-B8","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1093\/eurheartj\/ehr027","article-title":"Factors influencing underutilization of evidence-based therapies in women","volume":"32","author":"Bugiardini","year":"2011","journal-title":"Eur Heart J"},{"key":"2020040606452756400_qcz040-B9","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1016\/S0735-1097(02)01835-1","article-title":"Improved outcomes for women undergoing contemporary percutaneous coronary intervention: a report from the National Heart, Lung, and Blood Institute Dynamic registry","volume":"39","author":"Jacobs","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"2020040606452756400_qcz040-B10","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.amjcard.2012.10.007","article-title":"Influence of gender on ischemic times and outcomes after ST-elevation myocardial infarction","volume":"111","author":"Velders","year":"2013","journal-title":"Am J Cardiol"},{"key":"2020040606452756400_qcz040-B11","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1002\/ejhf.238","article-title":"Sex differences in clinical characteristics and outcomes after myocardial infarction: insights from the Valsartan in Acute Myocardial Infarction Trial (VALIANT)","volume":"17","author":"Lam","year":"2015","journal-title":"Eur J Heart Fail"},{"key":"2020040606452756400_qcz040-B12","first-page":"155","article-title":"Linking hospital patient records for suspected or established acute coronary syndrome in a complex secondary care system: a proof-of-concept e-registry in National Health Service Scotland","volume":"4","author":"Findlay","year":"2018","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2020040606452756400_qcz040-B13"},{"key":"2020040606452756400_qcz040-B14"},{"key":"2020040606452756400_qcz040-B15"},{"key":"2020040606452756400_qcz040-B16","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1016\/j.jclinepi.2004.03.012","article-title":"New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality","volume":"57","author":"Sundararajan","year":"2004","journal-title":"J Clin Epidemiol"},{"key":"2020040606452756400_qcz040-B17","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1136\/bmj.322.7295.1152","article-title":"Relation between socioeconomic deprivation and death from a first myocardial infarction in Scotland: population based analysis","volume":"322","author":"Macintyre","year":"2001","journal-title":"BMJ"},{"key":"2020040606452756400_qcz040-B18","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/S0140-6736(04)17018-9","article-title":"Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study","volume":"364","author":"Yusuf","year":"2004","journal-title":"Lancet"},{"key":"2020040606452756400_qcz040-B19","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1161\/CIRCULATIONAHA.111.044784","article-title":"Associations of pregnancy complications with calculated cardiovascular disease risk and cardiovascular risk factors in middle age: the Avon Longitudinal Study of Parents and Children","volume":"125","author":"Fraser","year":"2012","journal-title":"Circulation"},{"key":"2020040606452756400_qcz040-B20"},{"key":"2020040606452756400_qcz040-B21"},{"key":"2020040606452756400_qcz040-B22"},{"key":"2020040606452756400_qcz040-B23"},{"key":"2020040606452756400_qcz040-B24","doi-asserted-by":"crossref","first-page":"1845","DOI":"10.1016\/j.jacc.2005.05.091","article-title":"Differences in the management and prognosis of women and men who suffer from acute coronary syndromes","volume":"46","author":"Anand","year":"2005","journal-title":"J Am Coll Cardiol"},{"key":"2020040606452756400_qcz040-B25","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1161\/01.CIR.0000155337.50423.C9","article-title":"Percutaneous coronary intervention and adjunctive pharmacotherapy in women: a statement for healthcare professionals from the American Heart Association","volume":"111","author":"Lansky","year":"2005","journal-title":"Circulation"},{"key":"2020040606452756400_qcz040-B26","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1001\/jama.2012.199","article-title":"Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality","volume":"307","author":"Canto","year":"2012","journal-title":"JAMA"},{"key":"2020040606452756400_qcz040-B27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1161\/JAHA.113.000523","article-title":"Sex-based differences in outcomes after percutaneous coronary intervention for acute myocardial infarction: a report from TRANSLATE-ACS","volume":"3","author":"Hess","year":"2014","journal-title":"J Am Heart Assoc"},{"key":"2020040606452756400_qcz040-B28","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1001\/jama.2009.1227","article-title":"Sex differences in mortality following acute coronary syndromes","volume":"302","author":"Berger","year":"2009","journal-title":"J Am Med Assoc"},{"key":"2020040606452756400_qcz040-B29","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1136\/hrt.2008.155804","article-title":"The joint contribution of sex, age and type of myocardial infarction on hospital mortality following acute myocardial infarction","volume":"95","author":"Champney","year":"2009","journal-title":"Heart"},{"key":"2020040606452756400_qcz040-B30","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1093\/cvr\/cvq394","article-title":"Ischaemic heart disease in women: are there sex differences in pathophysiology and risk factors?: position Paper from the Working Group on Coronary Pathophysiology and Microcirculation of the European Society of Cardiology","volume":"90","author":"Vaccarino","year":"2011","journal-title":"Cardiovasc Res"},{"key":"2020040606452756400_qcz040-B31","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1016\/j.jacc.2003.12.047","article-title":"The pathophysiology of cigarette smoking and cardiovascular disease: an update","volume":"43","author":"Ambrose","year":"2004","journal-title":"J Am Coll Cardiol"},{"key":"2020040606452756400_qcz040-B32","first-page":"399","article-title":"Patient-physician gender concordance and increased mortality among female heart attack patients","volume":"91","author":"Greenwood","year":"2017","journal-title":"Proc Natl Acad Sci USA"}],"container-title":["European Heart Journal - Quality of Care and Clinical Outcomes"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ehjqcco\/advance-article-pdf\/doi\/10.1093\/ehjqcco\/qcz040\/29200917\/qcz040.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ehjqcco\/article-pdf\/6\/2\/156\/33015372\/qcz040.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ehjqcco\/article-pdf\/6\/2\/156\/33015372\/qcz040.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,4,6]],"date-time":"2020-04-06T10:46:11Z","timestamp":1586169971000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article\/6\/2\/156\/5538976"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,25]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,7,25]]},"published-print":{"date-parts":[[2020,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjqcco\/qcz040","relation":{},"ISSN":["2058-5225","2058-1742"],"issn-type":[{"value":"2058-5225","type":"print"},{"value":"2058-1742","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,4]]},"published":{"date-parts":[[2019,7,25]]}}}