Prognostic value of noninvasive risk stratification in younger and older patients referred for evaluation of suspected coronary artery disease

Leslee J. Shaw, Donald D Miller, James C. Romeis, Liwa T. Younis, Kathleen N. Gillespie, James R. Kimmey, Bernard R. Chaitman

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: The purpose of this investigation is to explore the relationship of patient gender and age on coronary artery disease diagnostic evaluation and to assess the impact of noninvasive testing results on coronary revascularization rates and cardiac event-free survival. STUDY DESIGN: Retrospective observational cohort. PARTICIPANTS: From a series of 5322 consecutively tested patients from a Midwestern university tertiary medical center, a hospital cohort of 1345 patients with clinically suspected coronary artery disease was enrolled from 1988 through 1989. MEASUREMENTS AND RESULTS: Cardiac risk factor and symptom profiles were worse in women, whereas rates of positive test results were similar in both sexes. Multivariable-adjusted risk for follow-up diagnostic testing was 1.8 and 1.9 times greater, respectively, for men ≤ and > 65 years of age than for women (P < .01). Younger women were 4.9 times (P = .001) more likely to experience a cardiac event than younger men, with no differences between younger and older women (relative risk = 1.1; P > .20). Overall cardiac event rates were 2.3, 7.4, 16.7, and 20.2% for young men, young women, older women, and older men, respectively. Initial screening was delayed 2 to 7 times longer for older and younger women compared with men (P < .001); the greatest delays were observed for younger women. Diagnostic follow-up and subsequent cost of total care from initial evaluation through 2 years of follow-up were higher for men than for women (P < .0001), with older women having the lowest rate of subsequent diagnostic and interventional follow-up. In the highest risk patients, subsequent utilization rates were 40 and 20% higher for younger and older men than for similarly aged women. In particular, diabetics were less likely to undergo follow-up diagnostic testing and revascularization (67% younger women). CONCLUSIONS: Age appears to significantly and differently influence decisions regarding noninvasive and invasive medical service utilization in men and women and may partially account for variable outcomes in this and previous gender based comparisons.

Original languageEnglish (US)
Pages (from-to)1190-1197
Number of pages8
JournalJournal of the American Geriatrics Society
Volume44
Issue number10
DOIs
StatePublished - Jan 1 1996
Externally publishedYes

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Coronary Artery Disease
Disease-Free Survival
Costs and Cost Analysis

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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Prognostic value of noninvasive risk stratification in younger and older patients referred for evaluation of suspected coronary artery disease. / Shaw, Leslee J.; Miller, Donald D; Romeis, James C.; Younis, Liwa T.; Gillespie, Kathleen N.; Kimmey, James R.; Chaitman, Bernard R.

In: Journal of the American Geriatrics Society, Vol. 44, No. 10, 01.01.1996, p. 1190-1197.

Research output: Contribution to journalArticle

Shaw, Leslee J. ; Miller, Donald D ; Romeis, James C. ; Younis, Liwa T. ; Gillespie, Kathleen N. ; Kimmey, James R. ; Chaitman, Bernard R. / Prognostic value of noninvasive risk stratification in younger and older patients referred for evaluation of suspected coronary artery disease. In: Journal of the American Geriatrics Society. 1996 ; Vol. 44, No. 10. pp. 1190-1197.
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abstract = "OBJECTIVES: The purpose of this investigation is to explore the relationship of patient gender and age on coronary artery disease diagnostic evaluation and to assess the impact of noninvasive testing results on coronary revascularization rates and cardiac event-free survival. STUDY DESIGN: Retrospective observational cohort. PARTICIPANTS: From a series of 5322 consecutively tested patients from a Midwestern university tertiary medical center, a hospital cohort of 1345 patients with clinically suspected coronary artery disease was enrolled from 1988 through 1989. MEASUREMENTS AND RESULTS: Cardiac risk factor and symptom profiles were worse in women, whereas rates of positive test results were similar in both sexes. Multivariable-adjusted risk for follow-up diagnostic testing was 1.8 and 1.9 times greater, respectively, for men ≤ and > 65 years of age than for women (P < .01). Younger women were 4.9 times (P = .001) more likely to experience a cardiac event than younger men, with no differences between younger and older women (relative risk = 1.1; P > .20). Overall cardiac event rates were 2.3, 7.4, 16.7, and 20.2{\%} for young men, young women, older women, and older men, respectively. Initial screening was delayed 2 to 7 times longer for older and younger women compared with men (P < .001); the greatest delays were observed for younger women. Diagnostic follow-up and subsequent cost of total care from initial evaluation through 2 years of follow-up were higher for men than for women (P < .0001), with older women having the lowest rate of subsequent diagnostic and interventional follow-up. In the highest risk patients, subsequent utilization rates were 40 and 20{\%} higher for younger and older men than for similarly aged women. In particular, diabetics were less likely to undergo follow-up diagnostic testing and revascularization (67{\%} younger women). CONCLUSIONS: Age appears to significantly and differently influence decisions regarding noninvasive and invasive medical service utilization in men and women and may partially account for variable outcomes in this and previous gender based comparisons.",
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T1 - Prognostic value of noninvasive risk stratification in younger and older patients referred for evaluation of suspected coronary artery disease

AU - Shaw, Leslee J.

AU - Miller, Donald D

AU - Romeis, James C.

AU - Younis, Liwa T.

AU - Gillespie, Kathleen N.

AU - Kimmey, James R.

AU - Chaitman, Bernard R.

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Y1 - 1996/1/1

N2 - OBJECTIVES: The purpose of this investigation is to explore the relationship of patient gender and age on coronary artery disease diagnostic evaluation and to assess the impact of noninvasive testing results on coronary revascularization rates and cardiac event-free survival. STUDY DESIGN: Retrospective observational cohort. PARTICIPANTS: From a series of 5322 consecutively tested patients from a Midwestern university tertiary medical center, a hospital cohort of 1345 patients with clinically suspected coronary artery disease was enrolled from 1988 through 1989. MEASUREMENTS AND RESULTS: Cardiac risk factor and symptom profiles were worse in women, whereas rates of positive test results were similar in both sexes. Multivariable-adjusted risk for follow-up diagnostic testing was 1.8 and 1.9 times greater, respectively, for men ≤ and > 65 years of age than for women (P < .01). Younger women were 4.9 times (P = .001) more likely to experience a cardiac event than younger men, with no differences between younger and older women (relative risk = 1.1; P > .20). Overall cardiac event rates were 2.3, 7.4, 16.7, and 20.2% for young men, young women, older women, and older men, respectively. Initial screening was delayed 2 to 7 times longer for older and younger women compared with men (P < .001); the greatest delays were observed for younger women. Diagnostic follow-up and subsequent cost of total care from initial evaluation through 2 years of follow-up were higher for men than for women (P < .0001), with older women having the lowest rate of subsequent diagnostic and interventional follow-up. In the highest risk patients, subsequent utilization rates were 40 and 20% higher for younger and older men than for similarly aged women. In particular, diabetics were less likely to undergo follow-up diagnostic testing and revascularization (67% younger women). CONCLUSIONS: Age appears to significantly and differently influence decisions regarding noninvasive and invasive medical service utilization in men and women and may partially account for variable outcomes in this and previous gender based comparisons.

AB - OBJECTIVES: The purpose of this investigation is to explore the relationship of patient gender and age on coronary artery disease diagnostic evaluation and to assess the impact of noninvasive testing results on coronary revascularization rates and cardiac event-free survival. STUDY DESIGN: Retrospective observational cohort. PARTICIPANTS: From a series of 5322 consecutively tested patients from a Midwestern university tertiary medical center, a hospital cohort of 1345 patients with clinically suspected coronary artery disease was enrolled from 1988 through 1989. MEASUREMENTS AND RESULTS: Cardiac risk factor and symptom profiles were worse in women, whereas rates of positive test results were similar in both sexes. Multivariable-adjusted risk for follow-up diagnostic testing was 1.8 and 1.9 times greater, respectively, for men ≤ and > 65 years of age than for women (P < .01). Younger women were 4.9 times (P = .001) more likely to experience a cardiac event than younger men, with no differences between younger and older women (relative risk = 1.1; P > .20). Overall cardiac event rates were 2.3, 7.4, 16.7, and 20.2% for young men, young women, older women, and older men, respectively. Initial screening was delayed 2 to 7 times longer for older and younger women compared with men (P < .001); the greatest delays were observed for younger women. Diagnostic follow-up and subsequent cost of total care from initial evaluation through 2 years of follow-up were higher for men than for women (P < .0001), with older women having the lowest rate of subsequent diagnostic and interventional follow-up. In the highest risk patients, subsequent utilization rates were 40 and 20% higher for younger and older men than for similarly aged women. In particular, diabetics were less likely to undergo follow-up diagnostic testing and revascularization (67% younger women). CONCLUSIONS: Age appears to significantly and differently influence decisions regarding noninvasive and invasive medical service utilization in men and women and may partially account for variable outcomes in this and previous gender based comparisons.

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