1. The identification of risk factors and diagnosis of coronary heart disease in men and women prior to their first acute myocardial infarction. Barbara P. Yawn, MD, MSc Olmsted Medical Center Rochester, MN March, 2004 Funding R 01HS 10239 AHRQ

2. Coronary Heart Disease Under-recognized and under-treated in women, what about men? Most CHD diagnoses are initiated in primary care offices Little is known about initial CHD diagnosis – Most studies of the diagnosis of CHD begin with referral or first procedure

3. Improving Care and Prevention of CHD Requires knowledge of current practice Identification of missed opportunities Changing practice behavior – CME of little value – Feedback – Systems to make prevention easy

4. Knowledge acquisition is the prerequisite to behavior change* - Dr. Claude Lenfant June 20, 2003

5. Study Design: Retrospective medical record review observational Based on cohort of men and women with known CHD--had incident AMI. – Review of all care of the subjects from the 10 years prior to first AMI

6. Main Outcomes: (in relation to timing of first AMI) Time of first CHD diagnosis Time of first notation of each risk factor being assessment Presence of treatment of noted risk factors

7. Results: 148 women and 150 men with first AMI between 1996 and 2001 Over 16,000 visits reviewed Average time of follow up 9.1 years (range 6.2 to 10 years) Average age at first AMI – women 73.4 years (range 37.6 to 87.3 years) – men ?? Years (range……..)

8. First CHD Diagnosis:

9. Risk Factors: Assessed: Blood pressure 100% Lipids 92% Blood glucose 87% Family history 72%

10. Risk Factors: Treated: Diagnosed hypertension 87% BP >140/90 x 3 80% Total cholesterol >240mg/dl 37% Not improved by previous CHD diagnosis

11. Discussion: ~ 50% noted CHD prior to AMI – CHD is a chronic condition Risk factors assessed but not always treated – Assessed late Women presented often for care

12. Reasons for delay? Normal sizing Competing demands Mens disease

13. Conclusions: Missed opportunities for risk factor Rx – Not better with CHD diagnosis Missed opportunities to identify CHD???? – Need to know more about presenting complaints in women – Need to compare with men