Abstract 2416: Gender Disparities In Treatment After Coronary Artery Bypass: A New Twist On An Old Problem
Background: Treatment disparities that disadvantage women following coronary artery bypass graft (CABG) surgery have been reported. However, postoperative treatment of depression has not been assessed in this population. The purpose of this study was to evaluate treatment rates for depression and routine postoperative therapies in men and women after CABG.
Methods: Within the first month after post-CABG hospital discharge, 206 patients (age 66 ± 11 years, 99 [48%] men) from three cardiac surgery centers were evaluated for the presence of major depression using structured clinical interviews (Structured Clinical Interview for DSM [SCID] or Diagnostic Interview and Structured Hamilton [DISH]). Medical records were reviewed and patients were queried to identify postoperative use of antidepressants, aspirin, statins, beta blockers and angiotensin converting enzyme inhibitors. Gender comparisons were conducted by t-tests and chi-square. Odds ratios (OR) and confidence intervals (CI) for treatments by gender were generated by multivariate logistic regression.
Results: Rates of major depression were similar in men and women (19 [19%] vs. 18 [17%], p = .66), but men were less likely than women to receive antidepressants (3 [3%] vs. 12 [11%], p = .03). Even when antidepressant use was considered together with age, depression status, and other medications, the disparity favoring its use in women remained (OR = 5.87, CI = 1.2 – 29.1, p =.03). Women were less likely than men to receive statins (OR = 0.3, CI = 0.14 – 0.92, p =.03) and aspirin (OR = 0.3, CI = 0.14 – 0.67, p =.003).
Conclusion: For both men and women, major depression after CABG is undertreated. While women remain less likely than men to receive standard therapies for coronary artery disease after CABG, men are less likely than women to receive antidepressants. Because depression is associated with increased cardiac mortality and morbidity, these findings emphasize the importance of its identification and treatment in all CABG patients. Clinicians should guard against gender bias in assessing the need for antidepressant treatment, as well as in the application of more routine therapies.