Gender differences and factors associated with the receipt of thrombolytic therapy in patients with acute myocardial infarction: a community-wide perspective

Jorge L. Yarzebski, University of Massachusetts Medical School
Nananda F. Col, University of Massachusetts Medical School
Paul Pagley, University of Massachusetts Medical School
Judith A. Savageau, University of Massachusetts Medical School
Joel M. Gore, University of Massachusetts Medical School
Robert J. Goldberg, University of Massachusetts Medical School

Abstract

In spite of national interest in gender differences in the presentation and management of chronic disease, limited information is available about possible gender differences in the receipt of thrombolytic therapy after acute myocardial infarction (AMI). As part of an ongoing community-based study of AMI, we examined gender differences in the receipt of thrombolytic therapy among 2885 patients with confirmed AMI. The study sample consisted of 1680 males and 1205 females with validated AMI who were admitted to 16 hospitals in the Worcester, Massachusetts, metropolitan area in four study periods between 1986 and 1991. During the years under study, 24.4% of men and 14.4% of women received thrombolytic therapy. Increases over time in the use of thrombolytic therapy were seen in both men (13.9% in 1986; 31.6% in 1991) and women (3.2% in 1986; and 19.0% in 1991). After controlling for a variety of factors that might affect use of thrombolytic agents, younger age, absence of a history of either congestive heart failure or stroke, and experiencing a Q-wave AMI were associated with receipt of thrombolytic therapy in both men and women; having an anterior AMI also was associated with use of thrombolytic agents in men. Women without as compared with those with a history of angina pectoris were significantly more likely to receive thrombolytics. Men who had Medicare insurance were significantly less likely to receive thrombolytics than were men with other types of health insurance. When this analysis was restricted to patients who were seen in area-wide hospitals within 6 hours of the onset of symptoms suggestive of AMI, similar factors were associated with the receipt of thrombolytic agents in men and women. The results of this community-wide study suggest a marked increase over the 5-year study period in the use of thrombolytic therapy in both men and women, with a greater relative increase observed in women. A relatively similar profile of patients likely to receive thrombolytic therapy was seen in both men and women.