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 article


Worrall-Carter, Linda, McEvedy, Sam, Kuhn, Lisa, Scruth, Elizabeth, MacIsaac, Andrew and Rahman, 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. 32(2), pp. 112 - 124. https://doi.org/10.1097/JCN.0000000000000300
AuthorsWorrall-Carter, Linda, McEvedy, Sam, Kuhn, Lisa, Scruth, Elizabeth, MacIsaac, Andrew and Rahman, Aziz
Abstract

Background: Guidelines recommend that all nonYST-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.

Keywordsacute coronary syndrome; angiogram; meta-analyses; risk stratification; women
Year2017
JournalJournal of Cardiovascular Nursing
Journal citation32 (2), pp. 112 - 124
PublisherLippincott Williams & Wilkins
ISSN0889-4655
Digital Object Identifier (DOI)https://doi.org/10.1097/JCN.0000000000000300
Scopus EID2-s2.0-84946599895
Page range112 - 124
Research GroupMary MacKillop Institute for Health Research
Publisher's version
File Access Level
Controlled
Place of publicationUnited States
EditorsB. Riegel and D. K. Moser
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Symptom recognition in elders with heart failure
Riegel, Barbara, Dickson, Victoria, Cameron, Jan, Johnson, Jerry, Bunker, Stephen, Page, Karen and Worrall-Carter, Linda. (2010). Symptom recognition in elders with heart failure. Journal of Nursing Scholarship. 42(1), pp. 92 - 100. https://doi.org/10.1111/j.1547-5069.2010.01333.x
Self-Care Behaviours and Heart Failure: Does Experience with Symptoms Really Make a Difference?
Cameron, Janette, Worrall-Carter, Linda, Page, Karen and Stewart, Simon. (2010). Self-Care Behaviours and Heart Failure: Does Experience with Symptoms Really Make a Difference? European Journal of Cardiovascular Nursing. 9(2), pp. 92 - 100. https://doi.org/10.1016/j.ejcnurse.2009.10.004
The information and support needs of Faroese women hospitalised with an acute coronary syndrome
Askham, Jorun, Kuhn, Lisa, Frederiksen, Kirsten, Davidson, Patricia, Edward, Karen-Leigh and Worrall-Carter, Linda. (2010). The information and support needs of Faroese women hospitalised with an acute coronary syndrome. Journal of Clinical Nursing. 19(October), pp. 1352 - 1361. https://doi.org/10.1111/j.1365-2702.2009.03013.x
A naturalistic inquiry of registered nurses' perspectives and expectations of psychodynamic therapeutic care in acute psychiatric inpatient facilities
Awty, Patricia, Welch, Anthony and Kuhn, Lisa. (2010). A naturalistic inquiry of registered nurses' perspectives and expectations of psychodynamic therapeutic care in acute psychiatric inpatient facilities. Archives of Psychiatric Nursing. 24(2), pp. 104 - 113. https://doi.org/10.1016/j.apnu.2009.05.001
Does cognitive impairment predict poor self-care in patients with chronic heart failure?
Cameron, Janette, Worrall-Carter, Linda, Page, Karen, Riegel, Barbara, Lo, Sing Kai and Stewart, Simon. (2010). Does cognitive impairment predict poor self-care in patients with chronic heart failure? European Journal of Heart Failure. 12(5), pp. 508 - 515. https://doi.org/10.1093/eurjhf/hfq042
Theoretical considerations in reducing risk for cardiovascular diseases : Implications for nursing practice
Gholizadeh, Leila, Davidson, Patricia, Salamonson, Yenna and Worrall-Carter, Linda. (2010). Theoretical considerations in reducing risk for cardiovascular diseases : Implications for nursing practice. Journal of Clinical Nursing. 19(15-16), pp. 2137-2145. https://doi.org/10.1111/j.1365-2702.2009.03189.x
Gender-specific barriers and facilitators to heart failure self-care: A mixed methods study
Riegel, Barbara, Dickson, Victoria, Lisa, Kuhn,, Page, Karen and Worrall-Carter, Linda. (2010). Gender-specific barriers and facilitators to heart failure self-care: A mixed methods study. International Journal of Nursing Studies. 47(7), pp. 888 - 895. https://doi.org/10.1016/j.ijnurstu.2009.12.011
Recovering from an acute cardiac event- the relationship between the depression and life satisfaction.
Page, Karen, Davidson, Patricia, Edward, Karen-Leigh, Allen, Josh, Cummins, Robert, Thompson, David and Worrall-Carter, Linda. (2010). Recovering from an acute cardiac event- the relationship between the depression and life satisfaction. Journal of Clinical Nursing. 19(June), pp. 736 - 743. https://doi.org/10.1111/j.1365-2702.2009.03106.x
Awareness and causal attributions of risk factors for heart disease among immigrant women living in Australia
Gholizadeh, Leila, Salamonson, Yenna, Worrall-Carter, Linda, DiGiacomo, Michelle and Davidson, Patricia M.. (2009). Awareness and causal attributions of risk factors for heart disease among immigrant women living in Australia. Journal of Women's Health. 18(9), pp. 1385 - 1393. https://doi.org/10.1089/jwh.2008.0956
Gender differences in heart failure self-care : A multinational cross-sectional study
Lee, Christopher S., Reigel, Barbara, Driscoll, Andrea, Suwanno, Jom, Moser, Debra K., Lennie, Terry A., Dickson, Victoria V., Cameron, Jan and Worrall-Carter, Linda. (2009). Gender differences in heart failure self-care : A multinational cross-sectional study. International Journal of Nursing Studies. 46(11), pp. 1485-1495. https://doi.org/10.1016/j.ijnurstu.2009.04.004
ECG interpretation Part 2: Determination of bundle branch and fascicular blocks
Rose, Louise and Kuhn, Lisa. (2009). ECG interpretation Part 2: Determination of bundle branch and fascicular blocks. Journal of Emergency Nursing. 35(2), pp. 123 - 126. https://doi.org/10.1016/j.jen.2008.03.009
Testing a model of patient characteristics, psychologic status, and cognitive function as predictors of self-care in persons with chronic heart failure
Cameron, Janette, Worrall-Carter, Linda, Riegel, Barbara, Lo, Sing Kai and Stewart, Simon. (2009). Testing a model of patient characteristics, psychologic status, and cognitive function as predictors of self-care in persons with chronic heart failure. Heart & Lung: the journal of acute and critical care. 38(5), pp. 410 - 418. https://doi.org/10.1016/j.hrtlng.2008.11.004
Evidence-based chronic heart failure management programs: Reality or myth?
Driscoll, Andrea, Worrall-Carter, Linda, Hare, David, Davidson, Patricia, Riegel, Barbara, Tonkin, Andrew and Stewart, Simon. (2009). Evidence-based chronic heart failure management programs: Reality or myth? BMJ Quality and Safety. 18(6), pp. 450 - 455. https://doi.org/10.1136/qshc.2008.028035
Measuring self-care in chronic heart failure: A review of the psychometric properties of clinical instruments
Cameron, Janette, Worrall-Carter, Linda, Driscoll, Andrea and Stewart, Simon. (2009). Measuring self-care in chronic heart failure: A review of the psychometric properties of clinical instruments. The Journal of Cardiovascular Nursing. 24(6), pp. E10 - E22. https://doi.org/10.1097/JCN.0b013e3181b5660f
Opting in and opting out: A grounded theory of nursing's contribution to inpatient rehabilitation
Pryor, Julie, Walker, Annette, O'Connell, Beverley and Worrall-Carter, Linda. (2009). Opting in and opting out: A grounded theory of nursing's contribution to inpatient rehabilitation. Clinical Rehabilitation. 23(12), pp. 1124 - 1135. https://doi.org/10.1177/0269215509343233
Relationship of heart failure patients' knowledge, perceived barriers, and attitudes regarding low-sodium diet recommendations to adherence
Lennie, Terry, Worrall-Carter, Linda, Hammash, M., Odom-Forren, J., Roser, L. P., Smith, C. S., Trupp, T., Chung, Misook and Moser, Debra. (2008). Relationship of heart failure patients' knowledge, perceived barriers, and attitudes regarding low-sodium diet recommendations to adherence. Progress in Cardiovascular Nursing. 23(1), pp. 6 - 11. https://doi.org/10.1111/j.1751-7117.2008.tb00525.x
Improving depression and anxiety screening of patients with heart disease: implementing a multidisciplinary Clinical Pathway
Rahman, Aziz and Worrall-Carter, Linda. (2008). Improving depression and anxiety screening of patients with heart disease: implementing a multidisciplinary Clinical Pathway [Dataset]. Australian Catholic University. https://doi.org/10.26199/acu.89yv4
The impact of an ICU liaison nurse service on patient outcomes
Elliott, Suzanne, Ernest, David, Doric, Andrea, Page, Karen, Worrall-Carter, Linda, Thalib, Lukman and Chaboyer, Wendy. (2008). The impact of an ICU liaison nurse service on patient outcomes. Critical Care and Resuscitation. 10(4), pp. 296 - 300.
Smoking and smokeless tobacco consumption: Possible risk factors for coronary heart disease among young patients attending a tertiary care cardiac hospital in bangladesh
Rahman, Aziz and Zaman, Mostafa. (2008). Smoking and smokeless tobacco consumption: Possible risk factors for coronary heart disease among young patients attending a tertiary care cardiac hospital in bangladesh. Public Health. 122(12), pp. 1331 - 1338. https://doi.org/10.1016/j.puhe.2008.05.015
ECG interpretation part 1: Understanding mean electrical axis
Kuhn, Lisa and Rose, Louise. (2008). ECG interpretation part 1: Understanding mean electrical axis. Journal of Emergency Nursing. 34(6), pp. 530 - 534. https://doi.org/10.1016/j.jen.2008.01.007
Ethical dilemmas of a large national multi-centre study in Australia: Time for some consistency
Driscoll, Andrea, Currey, Judy, Worrall-Carter, Linda and Stewart, Simon. (2008). Ethical dilemmas of a large national multi-centre study in Australia: Time for some consistency. Journal of Clinical Nursing. 17(16), pp. 2212 - 2220. https://doi.org/10.1111/j.1365-2702.2007.02219.x
Returning to work: Exploring the experiences of women with acute coronary syndromes
Parry, A., Worrall-Carter, Linda, Page, Karen, Kuhn, Lisa, DiGiacomo, Michelle and Davidson, Patricia. (2007). Returning to work: Exploring the experiences of women with acute coronary syndromes. British Journal of Cardiac Nursing. 2(6), pp. 292 - 301.
Depression, anxiety and stress in women following acute coronary syndrome: Implications for secondary prevention
DiGiacomo, Michelle, Davidson, Patricia, Vanderpluym, A., Snell, R. and Worrall-Carter, Linda. (2007). Depression, anxiety and stress in women following acute coronary syndrome: Implications for secondary prevention. Australian Critical Care. 20(2), pp. 69 - 76. https://doi.org/10.1016/j.aucc.2007.03.002
Extent of heart failure self-care as an endpoint to patient education: A review of the literature
Cameron, Jan, Worrall-Carter, Linda, Driscoll, Andrea, New, G. and Stewart, Simon. (2007). Extent of heart failure self-care as an endpoint to patient education: A review of the literature. British Journal of Cardiac Nursing. 2(4), pp. 188 - 197.
Gender differences in adherence to the sodium-restricted diet in patients with heart failure
Chung, Misook, Moser, Debra, Lennie, Terry, Worrall-Carter, Linda, Bentley, B., Trupp, T. and Armentano, D.. (2006). Gender differences in adherence to the sodium-restricted diet in patients with heart failure. Journal of Cardiac Failure. 12(8), pp. 628 - 634. https://doi.org/10.1016/j.cardfail.2006.07.007
Assessment of cognitive function in heart failure patients
Wolfe, R, Worrall-Carter, Linda, Foister, K., Keks, N. and Howe, V.. (2006). Assessment of cognitive function in heart failure patients. European Journal of Cardiovascular Nursing. 5(2), pp. 158 - 164. https://doi.org/10.1016/j.ejcnurse.2005.10.005
Heterogeneity of heart failure management programs in Australia
Driscoll, Andrea, Worrall-Carter, Linda, McLennan, Skye, Dawson, Anna, O'Reilly, J. and Stewart, Simon. (2006). Heterogeneity of heart failure management programs in Australia. European Journal of Cardiovascular Nursing. 5(1), pp. 75 - 82. https://doi.org/10.1016/j.ejcnurse.2005.08.001
Rationale and design of the national benchmarking and evidence-based national clinical guidelines for chronic heart failure management programs study
Driscoll, Andrea, Worrall-Carter, Linda and Stewart, Simon. (2006). Rationale and design of the national benchmarking and evidence-based national clinical guidelines for chronic heart failure management programs study. Journal of Cardiovascular Nursing. 21(4), pp. 276 - 282. https://doi.org/10.1097/00005082-200607000-00007
The experiences and adjustments of women following their first acute myocardial infarction
Worrall-Carter, Linda, Jones, T. and Driscoll, Andrea. (2005). The experiences and adjustments of women following their first acute myocardial infarction. Contemporary Nurse. 19(February), pp. 211 - 221.
Psychosocial issues facilitating recovery post-CABG surgery
Theobald, K, Worrall-Carter, Linda and McMurray, Anne. (2005). Psychosocial issues facilitating recovery post-CABG surgery. Australian Critical Care. 18(2), pp. 76 - 85. https://doi.org/10.1016/S1036-7314(05)80006-2
A historical review of the nurse practitioner role in Australia
Driscoll, Andrea, Worrall-Carter, Linda, O'Reilly, J. and Stewart, Simon. (2005). A historical review of the nurse practitioner role in Australia. Clinical Excellence for Nurse Practitioners. 9(3), pp. 141 - 152.
Nurse academics meeting the challenges of scholarship and research
Worrall-Carter, Linda and Snell, R.. (2003). Nurse academics meeting the challenges of scholarship and research. Contemporary Nurse. 16(February), pp. 40 - 50.