Gender inequalities in prescribing and initiation patterns of guideline-recommended drugs after acute myocardial infarction

Abstract

Background

European guidelines recommend the prescription of certain drugs after acute myocardial infarction (AMI). The existence of gender differences in pharmacological treatment after an AMI has been described. This study aims to describe and analyse, using real-world data (RWD), whether there are gender differences in the prescribing patterns and initiation of treatment in secondary prevention after a first AMI, and which are the factors that explain these differences.

Methods

A population-based observational study of RWD was conducted in the CARhES (CArdiovascular Risk factors for hEalth Services research) cohort. The study included subjects who had experienced a first episode of AMI between 2017 and 2022, had survived the event, and had a minimum follow-up of 180 days.

Results

3,975 subjects were followed 180 days after a first AMI. Women (27.8% of the study population) were older and had more comorbidities. Of the main guideline-recommended drugs, antiplatelets, lipid modifying agents and beta-blockers, were prescribed less often in women. Comedications such as rivaroxaban and calcium channel blockers were more likely to be prescribed in women. The proportion of subjects initiating treatment was similar in both genders.

Overall, age and morbidity burden were the main contributors to differences in the prescribing patterns. Living in an urban area seemed to be a protective or mitigating factor. There were controversial results regarding socioeconomic level.

Conclusion

In our study population, women are older, have greater comorbidities and lower socioeconomic status. Despite this, gender inequalities in the prescribing patterns after a first AMI remains, as women appear to experience less therapeutic effort. It is crucial to analyse them from an intersectional perspective, considering the influence of multiple axes of inequality on health, in order to develop gender-sensitive strategies with a multidisciplinary approach.