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. 2023 Apr 19;12(8):2972.
doi: 10.3390/jcm12082972.

Sex-Related Differences in Outpatient Healthcare of Acute Coronary Syndrome: Evidence from an Italian Real-World Investigation

Raffaella Ronco  1   2 , Federico Rea  1   2 , Amelia Filippelli  1   3 , Aldo Pietro Maggioni  4 , Giovanni Corrao  1   2
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Sex-Related Differences in Outpatient Healthcare of Acute Coronary Syndrome: Evidence from an Italian Real-World Investigation

Raffaella Ronco et al. J Clin Med. .

Abstract

At the time of first acute coronary syndrome (ACS) hospital admission, women are generally older and have more comorbidities than men, which may explain differences in their short-term prognosis. However, few studies have focused on differences in the out-of-hospital management of men and women. This study investigated (i) the risk of clinical outcomes, (ii) the use of out-of-hospital healthcare and (iii) the effects of clinical recommendations on outcomes in men vs. women. A total of 90,779 residents of the Lombardy Region (Italy) were hospitalized for ACS from 2011 to 2015. Exposure to prescribed drugs, diagnostic procedures, laboratory tests, and cardiac rehabilitation in the first year after ACS hospitalization were recorded. To evaluate whether sex can modify the relationship between clinical recommendations and outcomes, adjusted Cox models were separately fitted for men and women. Women were exposed to fewer treatments, required fewer outpatient services than men and had a lower risk of long-term clinical events. The stratified analysis showed an association between adherence to clinical recommendations and a lower risk of clinical outcomes in both sexes. Since improved adherence to clinical recommendations seems to be beneficial for both sexes, tight out-of-hospital healthcare control should be recommended to achieve favourable clinical benefits.

Keywords: acute coronary syndrome; healthcare; public health; real-world; sex-differences.

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Conflict of interest statement

Giovanni Corrao received research support from the European Community (EC), the Italian Medicines Agency (AIFA), and the Italian Ministry of Education, University and Research (MIUR). He took part in a variety of projects that were funded by pharmaceutical companies (i.e., Novartis, GSK, Roche, AMGEN and BMS). He also received honoraria from Roche as a member of its Advisory Board. Other authors declare that they have no conflict of interest to disclose.

Figures

Figure 1
Figure 1
Flowchart of selection of the cohorts.
Figure 2
Figure 2
Cumulative incidences of health-related outcomes (ACS hospitalization, cardiovascular hospitalization, and all-cause mortality) among Propensity Score 1:1 matched and non-matched cohorts, according to sex.
See this image and copyright information in PMC

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