TREATMENT AND HEALTH OUTCOMES OF WOMEN AND MEN IN A COHORT WITH CORONARY-ARTERY DISEASE

Background: Women with coronary artery disease are treated differently than men. Although mortality has been studied, functional outcomes fo r women and men have not been prospectively compared. Methods: The Man itoba Health Reform Impact Study used hospital databases to identify a ll residents aged 45 years and older in Manitoba who were hospitalized for a myocardial infarction between October 1, 1991, and September 30 , 1992. Cohort members were interviewed twice, an average of 16 and 25 months after hospitalization. Baseline and follow-up measures include d treatments (eg, physician visits, diagnostic testing, revascularizat ion, and cardiac medications), physical health status (physical compon ent summary [PCS] score derived from the Medical Outcomes Study Short Form 36), reinfarction, and mortality. Results: Of the 820 patients wh o completed the initial survey, 31 died during the follow-up period, a nd 734 completed the follow-up survey. Data were complete for the prim ary outcome (PCS score) and all relevant covariates for the 677 patien ts who were included in this study. Women constituted 34% of this coho rt. Although women had more physician visits during follow-up, they we re less likely to have undergone treadmill testing or angiography (odd s ratio, 0.68; 95% confidence interval, 0.46-0.99). Women were equally likely to report taking beta-adrenergic blocking agents, but were les s likely than men to report the use of aspirin (odds ratio, 0.69; 95% confidence interval, 0.48-0.98). After adjusting for baseline differen ces in PCS scores, age, income, social supports, and the levels of ang ina and dyspnea, the PCS score for women declined by 1.4 points, while the score for men improved by 0.2 points (P=.03). During the follow-u p period, reinfarction and mortality rates were low overall, but were not different in men and women. Conclusions: In this cohort of patient s with known coronary artery disease, we found less aggressive treatme nt of coronary artery disease and less use of aspirin among women than among men during I year of observation. After controlling for baselin e differences, women with coronary artery disease experienced a more r apid decline in physical health status than did men during 1 year of f ollow-up.