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Tuesday, 14 July 2009
Learning Objective 1: discuss factors influencing mortality among females who experienced a myocardial infarction
Learning Objective 2: Identify coronary heart disease risk factors associated with increased mortality among females.
Purpose: The purpose was to determine what factors contributed to increased mortality after an acute myocardial infarction (MI) in females. Methods: The design was a secondary analysis of a retrospective, comparative study. Two hundred seventy-three randomly selected patient charts with a discharge diagnosis of acute MI were included, 109 females and 164 males. Results: There were three research questions. First, what was the proportion of deaths in females compared to males? The proportion of deaths among females was almost twice that of males: 13 females (12%) and 11 males (7%) died in the hospital. Second, what cardiovascular risk factors (family history of coronary heart disease (CHD), history of CHD, diabetes, hypercholesterolemia, smoking history, and hypertension) were associated with an increased death rate among females? Of the females who died the only risk factor which differed significantly from males was the females were more likely to have hypertension (p=0.043). All the females who died had a family history of CHD. Third, among the female group only, what characteristics differed between those who died and those who survived the MI? There was no difference in CHD risk factors between the females who died and those who survived. The females that died differed on MI type, p<0.001, and the type of MI presenting symptoms, p=0.02. Those females who survived were more likely to have presenting MI symptoms of chest pain and shortness of breath. In addition, those females who survived were more likely to have a non ST elevation MI; whereas, those who died had more ST elevation MIs. Conclusion: In conclusion, there was a higher mortality rate among females. These results show an important contribution of CHD family history and hypertension. Those females that died differed in presenting MI symptoms and MI type suggesting more investigation in how these factors influenced mortality.