Author + information
- Received February 22, 2018
- Accepted February 25, 2018
- Published online March 10, 2018.
- Chetan P. Huded, MD MSca,b,
- Michael Johnson, MDa,b,
- Kathleen Kravitz, MBA RNb,
- Venu Menon, MDb,
- Mouin Abdallah, MDa,b,
- Travis C. Gullett, MDc,
- Scott Hantz, RNb,
- Stephen G. Ellis, MDb,
- Seth R. Podolsky, MDc,
- Stephen W. Meldon, MDc,
- Damon M. Kralovic, DOc,
- Deborah Brosovich, RNb,
- Elizabeth Smith, MPHc,
- Samir R. Kapadia, MDb and
- Umesh N. Khot, MDa,b,∗ ()
- aHeart and Vascular Institute Center for Healthcare Delivery Innovation, Cleveland, Ohio
- bHeart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- cEmergency Services Institute of the Cleveland Clinic, Cleveland, Ohio
- ↵∗Address for correspondence: Umesh N. Khot, MD Cleveland Clinic Heart and Vascular Institute Center for Healthcare Delivery Innovation 9500 Euclid Avenue, Desk J2-4 Cleveland, Ohio 44195 Telephone: 216-445-4440 Fax: 216-636-6973.
Background Women with STEMI receive suboptimal care and have worse outcomes than men. Whether strategies to reduce STEMI care variability impact disparities in the care and outcomes of women with STEMI is unknown.
Objectives We assessed the care and outcomes of men vs. women with STEMI before and after implementation of a comprehensive STEMI protocol.
Methods On 7/15/14 we implemented: (1) emergency department catheterization lab activation, (2) STEMI Safe Handoff Checklist, (3) immediate transfer to an immediately available catheterization lab, and (4) radial first approach to percutaneous coronary intervention (PCI). We prospectively studied consecutive patients with STEMI and assessed guideline-directed medical therapy (GDMT) prior to PCI, median door to balloon time (D2BT), in-hospital adverse events, and 30-day mortality stratified by gender before (1/1/11-7/14/14; control group) and after (7/15/14-12/31/16) implementation of the STEMI protocol.
Results Of 1272 participants (68% men, 32% women), women were older with more comorbidities than men. In the control group, women had less GDMT (77% vs. 69%, P=0.019) and longer D2BT (104min [79, 133] vs. 112min [85, 147], P=0.023). Women had more in-hospital stroke, vascular complications, bleeding, transfusion, and death. In the comprehensive four-step STEMI protocol, gender disparities in GDMT (84% vs. 80%, P=0.320), D2BT (89min [68, 106] vs. 91min [68, 114], P=0.150), and in-hospital adverse events resolved. The absolute gender difference in 30-day mortality decreased from the control group (6.1% higher in women, P=0.002) to the comprehensive four-step STEMI protocol (3.2% higher in women, P=0.090).
Conclusions A systems-based approach to STEMI care reduces gender disparities and improves STEMI care and outcomes in women.
- Gender disparity
- acute myocardial infarction
- door to balloon time
- percutaneous coronary intervention
Funding: The funding source was unrestricted philanthropic support to the Heart and Vascular Institute Center for Healthcare Delivery Innovation, Cleveland Clinic. The funding source had no role in the design or conduct of the study; collection, management, analyses, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Disclosures: Stephen Ellis has served as a consultant for Abbott Vascular, Boston Scientific, and Medtronic. Umesh Khot has served as a consultant for AstraZeneca. The remaining authors have no conflicts of interest to disclose.
- Received February 22, 2018.
- Accepted February 25, 2018.