Perl L, Peiffer V, Fuhrer A, D’Ascenzo F, Pietzsch JB. Sex differences in discharge destination following acute myocardial infarction. Coron Artery Dis. 2018;29(6):502–510; doi: 10.1097/mca.0000000000000643.

Objectives. Despite advances in treatment, acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality in the elderly population. Previous research has highlighted long-standing sex disparities in the care of such patients. However, differences in the patterns of discharge have not been well described. One key parameter is the destination of discharge and, in particular, discharge to skilled nursing facilities (SNFs)—a factor associated with worse prognosis and greater costs to the healthcare system. Our aim was to observe destination differences after AMI on the basis of sex and other baseline characteristics.

Methods. From a cohort of 143,180 claims, we carried out an observational analysis of 6,123 Medicare beneficiaries discharged following AMI during the first quarter of 2016.

Results. For patients who were referred from SNFs, the rates of in-hospital death were higher, even after adjustment for baseline characteristics (odds ratio, 1.78; 95% confidence interval, 1.17–2.70). Of those discharged to SNF or home, 36.33% of the female patients were discharged to an SNF versus 25.12% (P <0.01) of the male patients. After adjusting for baseline characteristics, discharge to SNF remained significantly higher among female patients (odds ratio, 1.57; 95% confidence interval, 1.27–1.94).

Conclusions. Discharge to SNF following AMI is more frequent for female patients, even after adjustment for risk factors. Our findings highlight the need to better characterize this unique patient population and understand the cycle of care that they receive following AMI.