Young Women More Likely to be Rehospitalized after Acute Myocardial Infarction than Men

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Women aged ≤55 years who survived an acute myocardial infarction (AMI) may have nearly double the risk of rehospitalization in the year after discharge compared to men of a similar age, according to new research.

In an analysis of data from the prospective Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study, the common causes of hospital readmission did not differ by sex, however, higher risks were consistently observed for all-cause, coronary-related, and noncardiac rehospitalizations among young women than men.

The study was funded by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health (NIH), and was published online May 1, 2023, in the Journal of the American College of Cardiology.

“We have shown for the first time that rehospitalizations following heart attacks in women aged 55 and younger are accompanied by certain non-cardiac factors, such as depression and low-income, that appear more common in women than men and are associated with more adverse outcomes,” said corresponding author Harlan M. Krumholz, MD, cardiologist, professor of medicine, Yale School of Medicine, New Haven, Connecticut, in an NIH press release. “The study reveals a need for paying greater attention to these noncardiac risk factors in younger women in order help design better clinical interventions and improve outcomes after discharge for a heart attack.”

To determine sex differences in causes and timing of 1-year outcomes after AMI in persons aged 18-55 years, Krumholz and colleagues analyzed data from 2979 participants (2007 women, 972 men) from the VIRGO study, which enrolled young adults with acute MI across 103 US hospitals. Researchers assessed sex differences in all-cause and cause-specific hospitalizations by calculating incidence rates ([IRs] per 1000 person-years) and IR ratios (IRR).

FINDINGS

Among the cohort, the mean age was 47.1 years and at least 1 hospitalization occurred among 905 patients (30.4%) in the year after discharge.

The leading causes of hospitalization were coronary related for both sexes but incidence rates for women were higher than for men (IR 171.8, 95% CI 153.6-192.2 among women vs 117.8, 95% CI 97.3-142.6 among men), followed by noncardiac hospitalization (IR 145.8, 95% CI 129.2-164.5 among women vs 69.6, 95% CI 54.5-88.9 among men).

Investigators also observed sex-based differences for coronary-related hospitalizations (subdistribution HR [SHR] 1.33, 95% CI 1.04-1.70; P=.02) and noncardiac hospitalizations (SHR 1.51, 95% CI 1.13-2.07; P=.01).

“Further studies to better understand the underlying mechanisms of noncardiac hospitalizations are warranted,” concluded Krumholz et al.

Reference: Krumholz HM, Sawano M, Lu Y, et al. Sex difference in outcomes of acute myocardial infarction in young patients. JACC. 2023;18:1797-1806.