Utilization of Sex-Specific Reporting to Assess Disparities in Percutaneous Coronary Intervention Related Process Measures
Julia L. Berkowitz, M.D., Lifespan Cardiovascular Institute, Providence, RI
Julia L. Berkowitz, M.D.1, Deborah L. Nadler, M.D.1, Kevin F Kennedy2, Herb D. Aronow, MD, MPH, FSCAI3 and J. Dawn Abbott, M.D., FSCAI4, (1)Lifespan Cardiovascular Institute, Providence, RI, (2)St. Luke's Hospital, Kansas City, MO, (3)Henry Ford Health, Detroit, MI, (4)Rhode Island Hospital, Barrington, RI
Keywords: Acute Coronary Syndromes (ACS), Coronary, Diversity Equity and Inclusion (DEI) and Quality
Background:
Sex-based disparities in use of guideline directed medical therapy (GDMT) post percutaneous coronary intervention (PCI) and STEMI care are well described. This study aimed to assess trends over time in PCI related process measures and to compare quality of care in women and men who underwent PCI at two tertiary care centers in Rhode Island.
Methods:
Our institutional data, collected for the NCDR Cath PCI Registry, from patients who underwent PCI from 7/2009-3/2018 were analyzed. Process measures of interest included discharge on GDMT (composite aspirin, P2Y12 inhibitor, statin), door to balloon time (D2B) <90 minutes and median D2B time for STEMI, and positive stress test before elective PCI. For each metric, eligibility was based on NCDR-defined inclusion criteria. Crude rates were calculated for all process measures according to sex and trend analysis was performed using logistic regression including the interaction between sex and time.
Results:
Rates of GDMT were high, but statistically lower in women (n = 5216) vs. men (n = 12,588) (93.7% vs. 95.2%, p< 0.001) with no interaction between sex and trends over time (p=0.32). For D2B, 1935 patients were eligible (n=511 women; 1424 men) and no differences by sex were identified (D2B < 90 93.9% vs 94.5%, p=0.62) with no interaction between sex and trends over time (p=0.99); and similar median DTB in women and men (60 vs 58 minutes, p = 0.07). For presence of positive stress test, 2092 patients were eligible (n=516 women; n=1579 men) and women had lower rates (54.8% vs 60.9%, p=0.02) and there was no interaction between sex and trends over time (p=0.90).
Conclusions:
Using sex-specific reporting of PCI related process measures can identify disparities and areas to focus local quality improvement. While we observed no sex-based disparities in STEMI performance metrics, women were less likely to meet goals for GDMT use and pre-procedure testing than men. These observed disparities did not improve over time.