Sex differences in prescription patterns of secondary prevention pharmacotherapy in patients with acute myocardial infarction: a 20-year insight from the AMIS Plus registry.
Recent studies have demonstrated sex-related differences in secondary prevention pharmacotherapy in patients with acute myocardial infarction, although guidelines recommend the same preventive approach in both women and men. This study builds upon previous research by examining temporal trends in prescribing patterns of secondary prevention medications using contemporary, long-term data from Switzerland, with particular focus on sex-related disparities.
Acute myocardial infarction patients enrolled in the AMIS (Acute Myocardial Infarction in Switzerland) Plus project between 2003 and 2022 were included. For this retrospective analysis, optimal medical therapy was defined as the combination of all five guideline-recommended medications at discharge: aspirin; P2Y12 inhibitor; lipid-lowering drug; beta-blocker; angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Uni- and multivariable logistic regression analyses were performed.
Among 34,612 patients (75% men, n=25,913), women were older and had more comorbidities but were less frequently prescribed optimal medical therapy than men (51% vs 60%) across all age groups (all p <0.001), with the greatest gap occurring in patients <50 years of age. A marked increase in optimal medical therapy prescription (36% to 60%) was detected irrespective of age and sex, mainly due to greater prescription of dual antiplatelet therapy (71% to 91%) and lipid-lowering drugs (69% to 93%). The sex-related gap in optimal medical therapy prescription disfavouring women showed a fluctuating trend (0.7-14%) whereas there was a progressive and sustained reduction regarding the combination of dual antiplatelet therapy plus lipid-lowering drug, from 18% to 10% at the beginning and the end of the observation period, respectively. Multivariable analysis showed greater frequency of optimal medical therapy prescription in patients with STEMI (OR: 1.65, 95% CI: 1.57-1.73) and those treated with PCI (OR: 4.85, 95% CI: 4.49-5.24), whereas lower prescription frequencies were observed among female patients (OR: 0.90, 95% CI: 0.85-0.95) and older individuals (OR per additional year: 0.99, 95% CI: 0.98-0.99).
Although optimal medical therapy prescription increased gradually over time among both women and men, concerning sex disparities disfavouring women, particularly young women, remained. Targeted programmes to reduce sex-related differences in secondary prevention care are warranted.
Acute myocardial infarction patients enrolled in the AMIS (Acute Myocardial Infarction in Switzerland) Plus project between 2003 and 2022 were included. For this retrospective analysis, optimal medical therapy was defined as the combination of all five guideline-recommended medications at discharge: aspirin; P2Y12 inhibitor; lipid-lowering drug; beta-blocker; angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Uni- and multivariable logistic regression analyses were performed.
Among 34,612 patients (75% men, n=25,913), women were older and had more comorbidities but were less frequently prescribed optimal medical therapy than men (51% vs 60%) across all age groups (all p <0.001), with the greatest gap occurring in patients <50 years of age. A marked increase in optimal medical therapy prescription (36% to 60%) was detected irrespective of age and sex, mainly due to greater prescription of dual antiplatelet therapy (71% to 91%) and lipid-lowering drugs (69% to 93%). The sex-related gap in optimal medical therapy prescription disfavouring women showed a fluctuating trend (0.7-14%) whereas there was a progressive and sustained reduction regarding the combination of dual antiplatelet therapy plus lipid-lowering drug, from 18% to 10% at the beginning and the end of the observation period, respectively. Multivariable analysis showed greater frequency of optimal medical therapy prescription in patients with STEMI (OR: 1.65, 95% CI: 1.57-1.73) and those treated with PCI (OR: 4.85, 95% CI: 4.49-5.24), whereas lower prescription frequencies were observed among female patients (OR: 0.90, 95% CI: 0.85-0.95) and older individuals (OR per additional year: 0.99, 95% CI: 0.98-0.99).
Although optimal medical therapy prescription increased gradually over time among both women and men, concerning sex disparities disfavouring women, particularly young women, remained. Targeted programmes to reduce sex-related differences in secondary prevention care are warranted.
Authors
Berther Berther, Radovanovic Radovanovic, Roffi Roffi, Stähli Stähli, Pedrazzini Pedrazzini, Rickli Rickli, On Behalf Of The Amis Plus Investigators On Behalf Of The Amis Plus Investigators
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