Dreyer Rachel P, Wang Yongfei, Strait Kelly M, Lorenze Nancy P, D'Onofrio Gail, Bueno Héctor, Lichtman Judith H, Spertus John A, Krumholz Harlan M
From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (R.P.D., Y.W., K.M.S., N.P.L., J.H.L., H.M.K.); Section of Cardiovascular Medicine (R.P.D., Y.W., H.M.K.) and the Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), and Department of Emergency Medicine (G.D.), Yale School of Medicine, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Spain (H.B.); Departments of Chronic Disease Epidemiology (J.H.L.) and Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; University of Missouri, Kansas City, School of Medicine, Biomedical & Health Informatics (J.A.S.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.).
Circulation. 2015 Jun 2;131(22):1971-80. doi: 10.1161/CIRCULATIONAHA.114.014503. Epub 2015 Apr 10.
Despite the excess risk of mortality in young women (≤55 years of age) after acute myocardial infarction (AMI), little is known about young women's health status (symptoms, functioning, quality of life) during the first year of recovery after an AMI. We examined gender differences in health status over time from baseline to 12 months after AMI.
A total of 3501 AMI patients (67% women) 18 to 55 years of age were enrolled from 103 US and 24 Spanish hospitals. Data were obtained by medical record abstraction and patient interviews at baseline hospitalization and 1 and 12 months after AMI. Health status was measured by generic (Short Form-12) and disease-specific (Seattle Angina Questionnaire) measures. We compared health status scores at all 3 time points and used longitudinal linear mixed-effects analyses to examine the independent effect of gender, adjusting for time and selected covariates. Women had significantly lower health status scores than men at each assessment (all P values <0.0001). After adjustment for time and all covariates, women had Short Form-12 physical/mental summary scores that were -0.96 (95% confidence interval [CI], -1.59 to -0.32) and -2.36 points (95% CI, -2.99 to -1.73) lower than those of men, as well as worse Seattle Angina Questionnaire physical limitations (-2.44 points lower; 95% CI, -3.53 to -1.34), more angina (-1.03 points lower; 95% CI, -1.98 to -0.07), and poorer quality of life (-3.51 points lower; 95% CI, -4.80 to -2.22).
Although both genders recover similarly after AMI, women have poorer scores than men on all health status measures, a difference that persisted throughout the entire year after discharge.
尽管年轻女性(≤55岁)急性心肌梗死(AMI)后死亡风险较高,但对于年轻女性在AMI后第一年恢复期间的健康状况(症状、功能、生活质量)却知之甚少。我们研究了从基线到AMI后12个月期间健康状况随时间的性别差异。
从美国103家医院和西班牙24家医院招募了3501例18至55岁的AMI患者(67%为女性)。通过病历摘要以及在基线住院时、AMI后1个月和12个月时对患者进行访谈来获取数据。健康状况通过通用量表(简短健康调查问卷-12)和疾病特异性量表(西雅图心绞痛问卷)进行测量。我们比较了所有3个时间点的健康状况评分,并使用纵向线性混合效应分析来检验性别在调整时间和选定协变量后的独立影响。在每次评估中,女性的健康状况评分均显著低于男性(所有P值<0.0001)。在调整时间和所有协变量后,女性的简短健康调查问卷身体/心理综合评分比男性低- 0.96(95%置信区间[CI],-1.59至-0.32)和-2.36分(95%CI,-2.99至-1.73),西雅图心绞痛问卷身体限制方面也更差(低-2.44分;95%CI,-3.53至-1.34),心绞痛更多(低-1.03分;95%CI,-1.98至-0.07),生活质量更差(低-3.51分;95%CI,-4.80至-2.22)。
尽管AMI后男女恢复情况相似,但在所有健康状况指标上女性得分均低于男性,这种差异在出院后的一整年中持续存在。