Failure to Close the Age and Sex Gap in the Use of Evidence-Based Therapies in Acute Coronary Syndromes: Perspectives from a Multinational Registry

Background: Despite evidence from clinical trials suggesting that elderly patients and women with acute coronary syndromes (ACS) benefit from evidence-based therapies, in clinical practice these groups are less aggressively treated than other groups. The purpose of this study was to describe age and sex differences, changing trends (1999-2007), in the hospital use of evidence-based therapies in patients with an ACS.

Methods: The study sample consisted of 50,096 patients hospitalized with an ACS in 14 countries participating in the Global Registry of Acute Coronary Events.

Results: Increasing trends in the use of evidence-based medications and interventional cardiac procedures were observed over time. Overall, after adjustment for potential confounders, older patients (≥ 65 years) were significantly less likely to have received aspirin, beta blockers, statins and CABG surgery or PCI during hospitalization compared with younger patients; men were significantly more likely to have received aspirin, ACE-inhibitors/ARBs, beta blockers, statins , and CABG surgery or PCI, compared with women. While differences in the receipt of evidence -based therapies in patient's of different ages, and, between men and women, have narrowed over time, during our recent study years the prescribing of these therapies remained lower in older as compared to younger patients, as did the utilization of several therapies and CABG surgery or PCI in women compared with men.

Conclusions: The use of effective therapies for patients with an ACS is increasing in clinical practice; however, important gaps in their use persist in elderly patients, and to a definite but lesser extent, in women.