Abstract Body (Do not enter title and authors here): Background: Anxiety, depression, and cognitive changes are common adverse outcomes after acute coronary syndromes (ACS). These challenges also predict increased risk of adverse cardiac outcomes. While it is known that females have higher rates of psychological symptoms generally, data on sex differences in onset following an acute cardiac event are scarce, especially among older adults.

Goal: Our goal was to determine if sex differences exist in mental health and cognitive outcomes after acute coronary syndrome in older adults.

Hypothesis: Females are more likely to have new psychological and cognitive issues within one year of ACS compared to male patients.

Methods: We conducted a retrospective analysis using Texas Medicare claims data from 2017-2020. The study population consisted of those 65 and older, diagnosed with ACS (either STEMI or NSTEMI). Eligible participants had continuous enrollment in Medicare Part A and B for at least one year before and after the index event, were not part of any Health Maintenance Organization, and had no prior diagnosis of the outcomes of interest (anxiety, depression, amnesia, and dementia). Data were extracted on demographic characteristics, clinical variables, and intervention (i.e. PCI/CABG). Descriptive statistics were used to summarize the data.

Results: Our study included 56,325 patients (23,911, 42.4% female), 13,078 with STEMI and 43,247 with NSTEMI. In STEMI and NSTEMI patients respectively, the prevalence of onset of the following outcomes was significantly higher among females compared to males: anxiety (14.8% vs. 9.3%; 16.2% vs. 11.3%), depression (11.5% vs. 7.9%; 14.1% vs. 9.9%), and dementia/Alzheimer's (2.5% vs. 1.7%; 3.5% vs. 2.5%). No differences were observed in amnesia by sex. Differences by sex persisted by treatment type for anxiety and depression (Table). Additionally, rates of new diagnoses were higher across sexes for CABG compared to PCI.

Conclusion: Significant sex differences exist in cognitive and mental health outcomes after ACS. Females are more likely to have worse outcomes following ACS as compared to men. Additionally, across sexes, psychological outcomes are worse following CABG as compared to PCI.