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Systematic review and meta-analyses investigating whether risk stratification explains lower rates of coronary angiography among women with Non-ST-Segment Elevation Acute Coronary Syndrome

Worrall-Carter, Linda, McEvedy, Samantha, Kuhn, Lisa, Scruth, Elizabeth, MacIsaac, Andrew and Rahman, Muhammad Aziz 2017, Systematic review and meta-analyses investigating whether risk stratification explains lower rates of coronary angiography among women with Non-ST-Segment Elevation Acute Coronary Syndrome, Journal of cardiovascular nursing, vol. 32, no. 2, pp. 112-124, doi: 10.1097/JCN.0000000000000300.

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Title Systematic review and meta-analyses investigating whether risk stratification explains lower rates of coronary angiography among women with Non-ST-Segment Elevation Acute Coronary Syndrome
Author(s) Worrall-Carter, Linda
McEvedy, Samantha
Kuhn, Lisa
Scruth, Elizabeth
MacIsaac, Andrew
Rahman, Muhammad Aziz
Journal name Journal of cardiovascular nursing
Volume number 32
Issue number 2
Start page 112
End page 124
Total pages 13
Publisher Lippincott Williams & Wilkins
Place of publication Philadelphia, Pa.
Publication date 2017-03
ISSN 0889-4655
1550-5049
Keyword(s) acute coronary syndrome
angiogram
meta-analyses
risk stratification
women
Summary BACKGROUND: Guidelines recommend that all non-ST-segment elevation acute coronary syndrome (NSTEACS) patients with high-risk features receive a coronary angiogram. We hypothesised that the widely reported gender disparity in the use of angiography might be the result of women more frequently being stratified into the lower-risk category.

OBJECTIVES: The aim of the study was to review studies reporting risk stratification of NSTEACS patients by gender, compare risk profiles, and assess impact on use of coronary angiography.

METHODS: PubMed, Scopus, and EMBASE databases were searched on June 17, 2014, using MeSH terms/subheadings and/or key words with no further limits. The search revealed 1230 articles, of which 25 met our objective.

RESULTS: Among the 28 risk-stratified populations described in the 25 articles, women were more likely to be stratified as high-risk in 13 studies; men were more likely to be stratified as high-risk in 3 studies. After meta-analyses, women had a 23% higher odds of being stratified as high-risk than did men (P = .001). Lower-risk patients were more likely to receive an angiogram in 15 study populations.

CONCLUSIONS: Contrary to our hypothesis, this review showed that women with NSTEACS are more likely than men to be considered high-risk when stratified using a range of risk assessment methods. Lower rates of angiography in women form part of a broader treatment-risk paradox, which may involve gender bias in the selection of patients for invasive therapy.
Language eng
DOI 10.1097/JCN.0000000000000300
Field of Research 1102 Cardiovascular Medicine And Haematology
1110 Nursing
111099 Nursing not elsewhere classified
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2017, Wolters Kluwer Health
Persistent URL http://hdl.handle.net/10536/DRO/DU:30080190

Document type: Journal Article
Collection: School of Nursing and Midwifery
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