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Identification of Women’s coronary heart disease and risk factors prior to first myocardial infarction

Identification of Women’s coronary heart disease and risk factors prior to first myocardial infarction. Barbara P. Yawn, MD, MSc Peter L. Wollan, PhD Steven J. Jacobsen, MD, PhD George E. Fryer, PhD Veronique L. Roger, MD, MPH Funded by R01 HS10239 and AR30582. Purpose:.

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Identification of Women’s coronary heart disease and risk factors prior to first myocardial infarction

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  1. Identification of Women’s coronary heart disease and risk factors prior to first myocardial infarction Barbara P. Yawn, MD, MSc Peter L. Wollan, PhD Steven J. Jacobsen, MD, PhD George E. Fryer, PhD Veronique L. Roger, MD, MPH Funded by R01 HS10239 and AR30582

  2. Purpose: To understand when women’s coronary heart disease (CHD) and CHD risk factors are recognized prior to first myocardial infarction (MI). Different than previous studies because we looked at the initial primary care diagnosis of CHD before any event.

  3. Methods: • Retrospective cohort study. • Medical record review of all of the care 10 years prior to MI. • Women with a confirmed incident MI. • January 1, 1996 through December 31, 2001.

  4. Objectives: • Determine the timing of CHD diagnosis • Determine the likelihood and timing of assessment for risk factors • Determine the likelihood of treatment for identified risk factors

  5. Ability to do this project: The Rochester Epidemiology Project (REP) • Database that links all care • All health care facilities in Olmsted County • Over 97% of care to Olmsted County residents

  6. Population: • Over 95% white non-Hispanic • Over 90% with a high school education • About 20% with a graduate level degree • Average income about same as that for all Minnesotans • All with confirmed MI

  7. AMI Algorithm Reproduced from McGovern, et al. Trends in survival of hospitalized myocardial infarction patients between 1970 and 1985, Circ 1992;85:172-179.

  8. ECG Classification by Minnesota Code Chest pain Present Chest Pain Absent Abnormal Enzymes Equivocal Enzymes Missing enzymes Normal Enzymes Abnormal Enzymes Equivocal Enzymes Missing enzymes Normal Enzymes Evolving Diagnostic Definite AMI Definite AMI Definite AMI Definite AMI Definite AMI Definite AMI Definite AMI Definite AMI Diagnostic Definite AMI Possible AMI Possible AMI No AMI Definite AMI Possible AMI No AMI No AMI Equivocal Definite AMI Possible AMI Possible AMI No AMI Possible AMI Possible AMI No AMI No AMI Other Definite AMI Possible AMI Possible AMI No AMI Possible AMI No AMI No AMI No AMI

  9. Definitions of Risk Factors

  10. Results: • 150 women had incident MIs during the study period • 8,732 ambulatory visits and 457 hospitalizations • A mean of 9.1 years, follow up; range 6.2 to 10 years • Mean age at incident MI was 74.7 years; range 38.9 to 99.8 years

  11. Results continued: • CHD diagnosis prior to first MI was present in 52% (n=78) • Less common in those <70 (p=.001) • 98% had 1 or more modifiable risk factors prior to their first MI

  12. CHD diagnosis prior to AMI by age group

  13. Age (in years) at incident MI <50 n (%)* 50-55 n (%) 55-60 n (%) 60-65 n (%) 65-70 n (%) 70-75 n (%) 75-80 n (%) 80+ n (%) Received CHD diagnosis Prior to AMI 0 (0) 2 (20) 3 (21) 4 (27) 8 (80) 10 (48) 13 (59) 36 (67) No CHD diagnosis prior to AMI 4 (100) 8 (80) 11 (79) 11 (63) 2 (20) 11 (52) 9 (41) 18 (33) * percents are columnar percents

  14. Results continued: • Treatment of recognized risk factors • 81% anti-hypertension medications • 28% drug therapy for abnormal lipid levels • CHD diagnosis was associated with an increased likelihood of risk factors and drug treatment for identified risk factors

  15. Risk factors evaluation and treatment before incident MI in those women with and without a pre-MI diagnosis of CHD.

  16. Modifiable risk factors identified prior to first MI N=150 women

  17. Figure 1. Timing of diagnosis of CHD prior to incident MI.

  18. Figure 2. Timing of documentation of risk factor presence prior to incident MI.

  19. Risk factor ecology

  20. Conclusions: • Missed opportunities: • 48% without CHD diagnosis prior to MI • Women <70 years of age not diagnosed • Failed prevention in women--? Gender bias?

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