4-Step Protocol for Disparities in STEMI Care and Outcomes in Women

Chetan P. Huded, Michael Johnson, Kathleen Kravitz, Venu Menon, Mouin Abdallah, Travis C. Gullett, Scott Hantz, Stephen Ellis, Seth Podolsky, Stephen Meldon, Damon M. Kralovic, Deborah Brosovich, Elizabeth Smith, Samir R. Kapadia, Umesh N. Khot

Research output: Contribution to journalArticle

  • 3 Citations

Abstract

Background: Women with ST-segment elevation myocardial infarction (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: The study assessed the care and outcomes of men versus women with STEMI before and after implementation of a comprehensive STEMI protocol. Methods: On July 15, 2014, the authors 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). The authors prospectively studied consecutive patients with STEMI and assessed guideline-directed medical therapy (GDMT) before PCI, median door-to-balloon time (D2BT), in-hospital adverse events, and 30-day mortality stratified by sex before (January 1, 2011 to July 14, 2014; control group) and after (July 15, 2014 to December 31, 2016) implementation of the STEMI protocol. Results: Of 1,272 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 (median 104 min; [interquartile range (IQR): 79 to 133] min vs. 112 [IQR: 85 to 147] min; p = 0.023). Women had more in-hospital stroke, vascular complications, bleeding, transfusion, and death. In the comprehensive 4-step STEMI protocol, sex disparities in GDMT (84% vs. 80%; p = 0.32), D2BT (89 [IQR: 68 to 106] min vs. 91 [IQR: 68 to 114] min; p = 0.15), and in-hospital adverse events resolved. The absolute sex difference in 30-day mortality decreased from the control group (6.1% higher in women; p = 0.002) to the comprehensive 4-step STEMI protocol (3.2% higher in women; p = 0.090). Conclusions: A systems-based approach to STEMI care reduces sex disparities and improves STEMI care and outcomes in women.

LanguageEnglish (US)
Pages2122-2132
Number of pages11
JournalJournal of the American College of Cardiology
Volume71
Issue number19
DOIs
StatePublished - May 15 2018

Fingerprint

Myocardial Infarction
Guidelines
Percutaneous Coronary Intervention
Catheterization
Control Groups
Mortality
Checklist
Sex Characteristics
Blood Vessels
Hospital Emergency Service
Comorbidity
Therapeutics
Stroke
Hemorrhage

Keywords

  • acute myocardial infarction
  • door-to-balloon time
  • percutaneous coronary intervention
  • sex disparity
  • STEMI
  • women

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Huded, C. P., Johnson, M., Kravitz, K., Menon, V., Abdallah, M., Gullett, T. C., ... Khot, U. N. (2018). 4-Step Protocol for Disparities in STEMI Care and Outcomes in Women. Journal of the American College of Cardiology, 71(19), 2122-2132. https://doi.org/10.1016/j.jacc.2018.02.039

4-Step Protocol for Disparities in STEMI Care and Outcomes in Women. / Huded, Chetan P.; Johnson, Michael; Kravitz, Kathleen; Menon, Venu; Abdallah, Mouin; Gullett, Travis C.; Hantz, Scott; Ellis, Stephen; Podolsky, Seth; Meldon, Stephen; Kralovic, Damon M.; Brosovich, Deborah; Smith, Elizabeth; Kapadia, Samir R.; Khot, Umesh N.

In: Journal of the American College of Cardiology, Vol. 71, No. 19, 15.05.2018, p. 2122-2132.

Research output: Contribution to journalArticle

Huded, CP, Johnson, M, Kravitz, K, Menon, V, Abdallah, M, Gullett, TC, Hantz, S, Ellis, S, Podolsky, S, Meldon, S, Kralovic, DM, Brosovich, D, Smith, E, Kapadia, SR & Khot, UN 2018, '4-Step Protocol for Disparities in STEMI Care and Outcomes in Women' Journal of the American College of Cardiology, vol. 71, no. 19, pp. 2122-2132. https://doi.org/10.1016/j.jacc.2018.02.039
Huded CP, Johnson M, Kravitz K, Menon V, Abdallah M, Gullett TC et al. 4-Step Protocol for Disparities in STEMI Care and Outcomes in Women. Journal of the American College of Cardiology. 2018 May 15;71(19):2122-2132. https://doi.org/10.1016/j.jacc.2018.02.039
Huded, Chetan P. ; Johnson, Michael ; Kravitz, Kathleen ; Menon, Venu ; Abdallah, Mouin ; Gullett, Travis C. ; Hantz, Scott ; Ellis, Stephen ; Podolsky, Seth ; Meldon, Stephen ; Kralovic, Damon M. ; Brosovich, Deborah ; Smith, Elizabeth ; Kapadia, Samir R. ; Khot, Umesh N. / 4-Step Protocol for Disparities in STEMI Care and Outcomes in Women. In: Journal of the American College of Cardiology. 2018 ; Vol. 71, No. 19. pp. 2122-2132.
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abstract = "Background: Women with ST-segment elevation myocardial infarction (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: The study assessed the care and outcomes of men versus women with STEMI before and after implementation of a comprehensive STEMI protocol. Methods: On July 15, 2014, the authors 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). The authors prospectively studied consecutive patients with STEMI and assessed guideline-directed medical therapy (GDMT) before PCI, median door-to-balloon time (D2BT), in-hospital adverse events, and 30-day mortality stratified by sex before (January 1, 2011 to July 14, 2014; control group) and after (July 15, 2014 to December 31, 2016) implementation of the STEMI protocol. Results: Of 1,272 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 (median 104 min; [interquartile range (IQR): 79 to 133] min vs. 112 [IQR: 85 to 147] min; p = 0.023). Women had more in-hospital stroke, vascular complications, bleeding, transfusion, and death. In the comprehensive 4-step STEMI protocol, sex disparities in GDMT (84{\%} vs. 80{\%}; p = 0.32), D2BT (89 [IQR: 68 to 106] min vs. 91 [IQR: 68 to 114] min; p = 0.15), and in-hospital adverse events resolved. The absolute sex difference in 30-day mortality decreased from the control group (6.1{\%} higher in women; p = 0.002) to the comprehensive 4-step STEMI protocol (3.2{\%} higher in women; p = 0.090). Conclusions: A systems-based approach to STEMI care reduces sex disparities and improves STEMI care and outcomes in women.",
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AU - Huded, Chetan P.

AU - Johnson, Michael

AU - Kravitz, Kathleen

AU - Menon, Venu

AU - Abdallah, Mouin

AU - Gullett, Travis C.

AU - Hantz, Scott

AU - Ellis, Stephen

AU - Podolsky, Seth

AU - Meldon, Stephen

AU - Kralovic, Damon M.

AU - Brosovich, Deborah

AU - Smith, Elizabeth

AU - Kapadia, Samir R.

AU - Khot, Umesh N.

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N2 - Background: Women with ST-segment elevation myocardial infarction (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: The study assessed the care and outcomes of men versus women with STEMI before and after implementation of a comprehensive STEMI protocol. Methods: On July 15, 2014, the authors 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). The authors prospectively studied consecutive patients with STEMI and assessed guideline-directed medical therapy (GDMT) before PCI, median door-to-balloon time (D2BT), in-hospital adverse events, and 30-day mortality stratified by sex before (January 1, 2011 to July 14, 2014; control group) and after (July 15, 2014 to December 31, 2016) implementation of the STEMI protocol. Results: Of 1,272 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 (median 104 min; [interquartile range (IQR): 79 to 133] min vs. 112 [IQR: 85 to 147] min; p = 0.023). Women had more in-hospital stroke, vascular complications, bleeding, transfusion, and death. In the comprehensive 4-step STEMI protocol, sex disparities in GDMT (84% vs. 80%; p = 0.32), D2BT (89 [IQR: 68 to 106] min vs. 91 [IQR: 68 to 114] min; p = 0.15), and in-hospital adverse events resolved. The absolute sex difference in 30-day mortality decreased from the control group (6.1% higher in women; p = 0.002) to the comprehensive 4-step STEMI protocol (3.2% higher in women; p = 0.090). Conclusions: A systems-based approach to STEMI care reduces sex disparities and improves STEMI care and outcomes in women.

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