101
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Gender differences in short- and long-term mortality in the Vienna STEMI registry. Int J Cardiol 2017; 244:303-308. [DOI: 10.1016/j.ijcard.2017.05.068] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 04/24/2017] [Accepted: 05/16/2017] [Indexed: 01/15/2023]
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102
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Dong L, Fakeye OA, Graham G, Gaskin DJ. Racial/Ethnic Disparities in Quality of Care for Cardiovascular Disease in Ambulatory Settings: A Review. Med Care Res Rev 2017; 75:263-291. [DOI: 10.1177/1077558717725884] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Racial and ethnic disparities in cardiovascular disease (CVD) outcomes are widely reported, but research has largely focused on differences in quality of inpatient and urgent care to explain these disparate outcomes. The objective of this review is to synthesize recent evidence on racial and ethnic disparities in management of CVD in the ambulatory setting. Database searches yielded 550 articles of which 25 studies met the inclusion criteria. Reviewed studies were categorized into non-interventional studies examining the association between race and receipt of ambulatory CVD services with observational designs, and interventional studies evaluating specific clinical courses of action intended to ameliorate disparities. Based on the Donabedian framework, this review demonstrates that significant racial/ethnic disparities persist in process and outcome measures of quality of ambulatory CVD care. Multimodal interventions were most effective in reducing disparities in CVD outcomes.
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Affiliation(s)
- Liming Dong
- University of Michigan School of Public Health, Ann Arbor, MI, USA
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103
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Soma-Pillay P, Louw MC, Adeyemo AO, Makin J, Pattinson RC. Cardiac diastolic function after recovery from pre-eclampsia. Cardiovasc J Afr 2017; 29:26-31. [PMID: 28906533 PMCID: PMC6002791 DOI: 10.5830/cvja-2017-031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/10/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pre-eclampsia is associated with significant changes to the cardiovascular system during pregnancy. Eccentric and concentric remodelling of the left ventricle occurs, resulting in impaired contractility and diastolic dysfunction. It is unclear whether these structural and functional changes resolve completely after delivery. AIMS The objective of the study was to determine cardiac diastolic function at delivery and one year post-partum in women with severe pre-eclampsia, and to determine possible future cardiovascular risk. METHODS This was a descriptive study performed at Steve Biko Academic Hospital, a tertiary referral hospital in Pretoria, South Africa. Ninety-six women with severe preeclampsia and 45 normotensive women with uncomplicated pregnancies were recruited during the delivery admission. Seventy-four (77.1%) women in the pre-eclamptic group were classified as a maternal near miss. Transthoracic Doppler echocardiography was performed at delivery and one year post-partum. RESULTS At one year post-partum, women with pre-eclampsia had a higher diastolic blood pressure (p = 0.001) and body mass index (p = 0.02) than women in the normotensive control group. Women with early onset pre-eclampsia requiring delivery prior to 34 weeks' gestation had an increased risk of diastolic dysfunction at one year post-partum (RR 3.41, 95% CI: 1.11-10.5, p = 0.04) and this was irrespective of whether the patient had chronic hypertension or not. CONCLUSION Women who develop early-onset pre-eclampsia requiring delivery before 34 weeks are at a significant risk of developing cardiac diastolic dysfunction one year after delivery compared to normotensive women with a history of a low-risk pregnancy.
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Affiliation(s)
- P Soma-Pillay
- Cardiac Obstetric Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa; South African Medical Research Council; Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa.
| | - M C Louw
- Department of Cardiology, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - A O Adeyemo
- MediClinic Heart Hospital, Pretoria, South Africa
| | - J Makin
- South African Medical Research Council; Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - R C Pattinson
- South African Medical Research Council; Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
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104
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Colantonio LD, Gamboa CM, Richman JS, Levitan EB, Soliman EZ, Howard G, Safford MM. Black-White Differences in Incident Fatal, Nonfatal, and Total Coronary Heart Disease. Circulation 2017; 136:152-166. [PMID: 28696265 DOI: 10.1161/circulationaha.116.025848] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 05/08/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Blacks have higher coronary heart disease (CHD) mortality compared with whites. However, a previous study suggests that nonfatal CHD risk may be lower for black versus white men. METHODS We compared fatal and nonfatal CHD incidence and CHD case-fatality among blacks and whites in the Atherosclerosis Risk in Communities study (ARIC), the Cardiovascular Health Study (CHS), and the Reasons for Geographic and Racial Differences in Stroke study (REGARDS) by sex. Participants 45 to 64 years of age in ARIC (men=6479, women=8488) and REGARDS (men=5296, women=7822), and ≥65 years of age in CHS (men=1836, women=2790) and REGARDS (men=3381, women=4112), all without a history of CHD, were analyzed. Fatal and nonfatal CHD incidence was assessed from baseline (ARIC=1987-1989, CHS=1989-1990, REGARDS=2003-2007) through up to 11 years of follow-up. RESULTS Age-adjusted hazard ratios comparing black versus white men 45 to 64 years of age in ARIC and REGARDS were 2.09 (95% confidence interval, 1.42-3.06) and 2.11 (1.32-3.38), respectively, for fatal CHD, and 0.82 (0.64-1.05) and 0.94 (0.69-1.28), respectively, for nonfatal CHD. After adjustment for social determinants of health and cardiovascular risk factors, hazard ratios in ARIC and REGARDS were 1.19 (95% confidence interval, 0.74-1.92) and 1.09 (0.62-1.93), respectively, for fatal CHD, and 0.64 (0.47-0.86) and 0.67 (0.48-0.95), respectively, for nonfatal CHD. Similar patterns were present among men ≥65 years of age in CHS and REGARDS. Among women 45 to 64 years of age in ARIC and REGARDS, age-adjusted hazard ratios comparing blacks versus whites were 2.61 (95% confidence interval, 1.57-4.34) and 1.79 (1.06-3.03), respectively, for fatal CHD, and 1.47 (1.13-1.91) and 1.29 (0.91-1.83), respectively, for nonfatal CHD. After multivariable adjustment, hazard ratios in ARIC and REGARDS were 0.67 (95% confidence interval, 0.36-1.24) and 1.00 (0.54-1.85), respectively, for fatal CHD, and 0.70 (0.51-0.97) and 0.70 (0.46-1.06), respectively, for nonfatal CHD. Racial differences in CHD incidence were attenuated among older women. CHD case fatality was higher among black versus white men and women, and the difference remained similar after multivariable adjustment. CONCLUSIONS After accounting for social determinants of health and risk factors, black men and women have similar risk for fatal CHD compared with white men and women, respectively. However, the risk for nonfatal CHD is consistently lower for black versus white men and women.
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Affiliation(s)
- Lisandro D Colantonio
- From Department of Epidemiology, School of Public Health (L.D.C., E.B.L.), Department of Medicine, School of Medicine (C.M.G.), Department of Surgery, School of Medicine (J.S.R.), Department of Biostatistics, School of Public Health (G.H.), University of Alabama at Birmingham; Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); and Department of Medicine, Weill Cornell Medical College, New York (M.M.S.)
| | - Christopher M Gamboa
- From Department of Epidemiology, School of Public Health (L.D.C., E.B.L.), Department of Medicine, School of Medicine (C.M.G.), Department of Surgery, School of Medicine (J.S.R.), Department of Biostatistics, School of Public Health (G.H.), University of Alabama at Birmingham; Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); and Department of Medicine, Weill Cornell Medical College, New York (M.M.S.)
| | - Joshua S Richman
- From Department of Epidemiology, School of Public Health (L.D.C., E.B.L.), Department of Medicine, School of Medicine (C.M.G.), Department of Surgery, School of Medicine (J.S.R.), Department of Biostatistics, School of Public Health (G.H.), University of Alabama at Birmingham; Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); and Department of Medicine, Weill Cornell Medical College, New York (M.M.S.)
| | - Emily B Levitan
- From Department of Epidemiology, School of Public Health (L.D.C., E.B.L.), Department of Medicine, School of Medicine (C.M.G.), Department of Surgery, School of Medicine (J.S.R.), Department of Biostatistics, School of Public Health (G.H.), University of Alabama at Birmingham; Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); and Department of Medicine, Weill Cornell Medical College, New York (M.M.S.)
| | - Elsayed Z Soliman
- From Department of Epidemiology, School of Public Health (L.D.C., E.B.L.), Department of Medicine, School of Medicine (C.M.G.), Department of Surgery, School of Medicine (J.S.R.), Department of Biostatistics, School of Public Health (G.H.), University of Alabama at Birmingham; Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); and Department of Medicine, Weill Cornell Medical College, New York (M.M.S.)
| | - George Howard
- From Department of Epidemiology, School of Public Health (L.D.C., E.B.L.), Department of Medicine, School of Medicine (C.M.G.), Department of Surgery, School of Medicine (J.S.R.), Department of Biostatistics, School of Public Health (G.H.), University of Alabama at Birmingham; Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); and Department of Medicine, Weill Cornell Medical College, New York (M.M.S.)
| | - Monika M Safford
- From Department of Epidemiology, School of Public Health (L.D.C., E.B.L.), Department of Medicine, School of Medicine (C.M.G.), Department of Surgery, School of Medicine (J.S.R.), Department of Biostatistics, School of Public Health (G.H.), University of Alabama at Birmingham; Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); and Department of Medicine, Weill Cornell Medical College, New York (M.M.S.).
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105
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Mrsic Z, Hulten E. Toward Gender Equality in Outcomes After Percutaneous Coronary Intervention. J Womens Health (Larchmt) 2017; 26:1043-1044. [PMID: 28745548 DOI: 10.1089/jwh.2017.6508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zorana Mrsic
- Cardiology Service, Department of Medicine, Walter Reed National Military Medical Center , Bethesda, Maryland
| | - Edward Hulten
- Cardiology Service, Department of Medicine, Walter Reed National Military Medical Center , Bethesda, Maryland
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106
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Emokpae MA, Nwagbara GONA. Serum Creatine Kinase-MB Isoenzyme Activity among Subjects with Uncomplicated Essential Hypertension: Any Sex Differences. Med Sci (Basel) 2017; 5:E8. [PMID: 29099024 PMCID: PMC5635785 DOI: 10.3390/medsci5020008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/05/2017] [Accepted: 04/21/2017] [Indexed: 12/16/2022] Open
Abstract
Hypertension (high blood pressure) is a major health challenge and more women than men are affected by the condition. Complications as a result of this condition often lead to disabilities and premature death. The objective of this study was to evaluate creatine kinase-MB (CK-MB) activity in uncomplicated hypertension and to know whether sex differences exist in the activity of the enzyme. Serum creatine kinase-MB isoenzyme activity, troponin I, and lipid profile were evaluated in 140 male and 100 female Nigerians with hypertension. The control group was comprised of 100 (50 males and 50 females) normotensive subjects. Measured parameters were assayed using Selectra Pros chemistry analyzer. The means were compared between males and females using Students't-test. The mean CK-MB activity of the female hypertensive subjects was significantly higher (p < 0.001) than the males. Similarly, the mean cardiac troponin I (cTnI) of the female hypertensive subjects was significantly higher (p < 0.001) than the males. Conversely, the mean CK-MB activity of the female normotensive subjects was significantly lower (p < 0.001) than the male counterparts. There was no difference in the levels of cTnI between male and female normotensive subjects. Serum CK-MB activity was higher in female than male hypertensive subjects. In the light of these results, cardiac markers should be routinely done in the evaluation of hypertensive subjects and sex-specific consideration may be recognized in the management of these patients.
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Affiliation(s)
| | - Goodluck O N A Nwagbara
- Department of Medical Laboratory Science, University of Benin, Benin City 300283, Nigeria.
- Defence Reference Laboratory, Health institution, Abuja-Nigeria, FCT-Abuja 900211, Nigeria.
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107
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Miller AL, Simon D, Roe MT, Kontos MC, Diercks D, Amsterdam E, Bhatt DL. Comparison of Delay Times from Symptom Onset to Medical Contact in Blacks Versus Whites With Acute Myocardial Infarction. Am J Cardiol 2017; 119:1127-1134. [PMID: 28237284 DOI: 10.1016/j.amjcard.2016.12.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 12/13/2022]
Abstract
Clinical outcomes in acute myocardial infarction (AMI) worsen with increasing delay between symptom onset and clinical presentation. Previous studies have shown that black patients with AMI have longer presentation delays. The objective of this analysis is to explore the potential contribution of community factors to presentation delays in black patients with AMI. We linked clinical data for 346,499 consecutive patients with AMI from Acute Coronary Treatment Intervention Outcomes Network Registry-Get With the Guidelines™ (2007-2014) to socioeconomic and community information from the American Community Survey. Black patients with AMI had longer symptom onset to first medical contact times than white patients (114 vs 101 minutes, p <0.0001) regardless of ambulance versus self-transport. Compared with white patients, black patients were younger and more likely to have clinical co-morbidities such as hypertension, diabetes, previous heart failure, and stroke. They were also more likely to live in urban communities with lower socioeconomic status, lower rates of long-term residence, and higher proportion of single-person households than white patients. In sequential linear regression models adjusting for patient demographic and clinical characteristics, logistic barriers to prompt presentation, and community socioeconomic and composition factors, black patients had a persistent 9% greater time from symptom onset to presentation compared with white patients (95% CI 8% to 11%, p <0.0001). In conclusion, the longer delay in time to presentation in black patients with AMI compared with white patients persists after accounting for a number of both patient and community factors.
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108
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109
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Kentner AC, Grace SL. Between mind and heart: Sex-based cognitive bias in cardiovascular disease treatment. Front Neuroendocrinol 2017; 45:18-24. [PMID: 28232227 DOI: 10.1016/j.yfrne.2017.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 01/01/2023]
Abstract
Given that both men and women experience cardiovascular disease (CVD), a common misconception is that they have similar risk factors and clinical presentation, receive comparable treatment, and have equivalent clinical outcomes; in reality differences are observed between men and women for each of these endpoints. Moreover, these differences occur as a function of both gender and sex. A review of the literature reveals widespread bias in the selection of research subjects based on these factors, in addition to implicit patient and provider biases that impede the access of women to recommended primary and secondary CVD management. In this perspective, we identify strategies to eliminate such biases and improve women's access to CVD treatments to ensure their care is consistent with current guidelines.
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Affiliation(s)
- Amanda C Kentner
- Massachusetts College of Pharmacy and Health Sciences, Health Psychology Program, Boston, MA, United States.
| | - Sherry L Grace
- York University, School of Kinesiology and Health Science, Toronto, Ontario, Canada; University Health Network, Toronto General Hospital Research Institute, Peter Munk Cardiac Centre, Toronto, Ontario, Canada; University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
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110
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Du X, Patel A, Li X, Wu Y, Turnbull F, Gao R. Treatment and outcomes of acute coronary syndromes in women: An analysis of a multicenter quality improvement Chinese study. Int J Cardiol 2017; 241:19-24. [PMID: 28363686 DOI: 10.1016/j.ijcard.2017.03.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/05/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Variations in care and outcomes by sex in patients with acute coronary syndrome (ACS) have been reported worldwide. The aims of this study are to describe ACS management according to sex in China and the effects of a quality improvement program in Chinese male and female ACS patients. METHODS AND RESULTS Clinical Pathways for Acute Coronary Syndromes - Phase 2 (CPACS-2) was a cluster randomized trial to test whether a clinical pathways-based intervention would improve ACS management in China. The study enrolled 15,141 hospitalized patients [4631 (30.6%) were women] from 75 hospitals throughout China between October 2007 and August 2010. The intervention included clinical pathway implementation and performance measurement using standardized indicators with 6 monthly audit-feedback cycles. Eight key performance indicators reflecting in hospital management of ACS were measured. After adjustment for differences in patient characteristics and comorbidities at presentation, women were significantly less likely to undergo coronary angiography when indicated (RR 0.88 [0.85 to 0.92], P<0.001), less likely to receive guideline recommended medical therapies at discharge (RR 0.94 [0.91 to 0.98], P=0.003) and more likely to be hospitalized for shorter (mean difference -0.42 [-0.73 to -0.12] days, P=0.007). However, in-hospital clinical outcomes did not differ by sex. There was no evidence of heterogeneity in the relative effects of the quality improvement initiative by sex. CONCLUSIONS Sex disparities were apparent in some key quality of care indicators for patients with suspected with ACS presenting to hospitals in China. The beneficial effect of the quality improvement program was consistent in women and men. CLINICAL TRIAL REGISTRATION http://www.anzctr.org.au/default.aspx. Unique identifier: ACTRN12609000491268.
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Affiliation(s)
- Xin Du
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China; The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
| | - Anushka Patel
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Beijing, China; Peking University School of Public Health, Beijing, China; Peking University People's Hospital, Beijing, China
| | - Fiona Turnbull
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Runlin Gao
- The Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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111
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Goldberg RJ, Gore JM, McManus DD, McManus R, Tisminetzky M, Lessard D, Gurwitz JH, Parish DC, Allison J, Hess CN, Wang T, Kiefe C. Race and place differences in patients hospitalized with an acute coronary syndrome: Is there double jeopardy? Findings from TRACE-CORE. Prev Med Rep 2017; 6:1-8. [PMID: 28210536 PMCID: PMC5300696 DOI: 10.1016/j.pmedr.2017.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/18/2017] [Accepted: 01/22/2017] [Indexed: 11/10/2022] Open
Abstract
The objectives of this longitudinal study were to examine differences between whites and blacks, and across two geographical regions, in the socio-demographic, clinical, and psychosocial characteristics, hospital treatment practices, and post-discharge mortality for hospital survivors of an acute coronary syndrome (ACS). In this prospective cohort study, we performed in-person interviews and medical record abstractions for patients discharged from the hospital after an ACS at participating sites in Central Massachusetts and Central Georgia during 2011–2013. Among the 1143 whites in Central Massachusetts, 514 whites in Central Georgia, and 277 blacks in Central Georgia, we observed a gradient of socioeconomic position with whites in Central Massachusetts being the most privileged, followed by whites and then blacks from Central Georgia; similar gradients pertained to psychosocial vulnerability (e.g., 10.7%, 25.1%, and 49.1% had cognitive impairment, respectively) and to the hospital receipt of all 4 evidence-based cardiac medications (35.5%, 18.1%, and 14.4%, respectively) used in the acute management of patients hospitalized with an ACS. Multivariable adjusted odds ratios (95% confidence intervals) for the receipt of a percutaneous coronary intervention for whites and blacks in Georgia vs. whites in Massachusetts were 0.57 (0.46–0.71) and 0.40(0.30–0.52), respectively. Thirty-day and one-year mortality risks exhibited a similar gradient. The results of this contemporary clinical/epidemiologic study in a diverse patient cohort suggest that racial and geographic disparities continue to exist for patients hospitalized with an ACS. We observed a gradient of socio-economic position, treatment practices, and dying. Interplay of race and place with treatment practices and post discharge outcomes. Racial and geographic disparities continue to exist for patients after an ACS.
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Affiliation(s)
- Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Joel M Gore
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - David D McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Richard McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Mayra Tisminetzky
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jerry H Gurwitz
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - David C Parish
- Department of Community Medicine, Mercer University School of Medicine, Macon, GA, United States
| | - Jeroan Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Connie Ng Hess
- University of Colorado Denver - Anschutz Medical Campus, Denver, CO, United States
| | - Tracy Wang
- Duke Clinical Research Institute, Durham, NC, United States
| | - Catarina Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
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112
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Udell JA, Koh M, Qiu F, Austin PC, Wijeysundera HC, Bagai A, Yan AT, Goodman SG, Tu JV, Ko DT. Outcomes of Women and Men With Acute Coronary Syndrome Treated With and Without Percutaneous Coronary Revascularization. J Am Heart Assoc 2017; 6:JAHA.116.004319. [PMID: 28108465 PMCID: PMC5523628 DOI: 10.1161/jaha.116.004319] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Women hospitalized with a non‐ST segment elevation acute coronary syndrome (ACS) have worse clinical outcomes compared with men. An early invasive strategy with prompt coronary revascularization may mitigate sex differences in outcomes. However, few contemporary studies have evaluated whether clinical outcomes differ between women and men presenting with ACS treated with an early invasive strategy. Methods and Results A population‐based cohort of hospitalized ACS patients who received prompt cardiac catheterization from 2008 to 2011 in Ontario, Canada and followed for up to 2 years was studied. Clinical outcomes were compared between men and women, stratified by the use of coronary revascularization. Inverse probability weighting using the propensity score accounted for measured differences in baseline characteristics between men and women. Among the 23 473 ACS patients who received cardiac catheterization during an index hospitalization, 66.1% of men and 51.8% of women received coronary revascularization during the same hospitalization. In the propensity‐weighted cohort of patients who received coronary revascularization, the 1‐year rate of death or recurrent ACS was 10.6% for men (referent) compared with 13.1% for women (hazard ratio 1.24; 95% CI 1.16–1.33). In contrast, outcomes for patients who did not receive coronary revascularization did not differ significantly between women and men at 1 year (17.8% versus 16.9%; hazard ratio 1.06; 95% CI 0.99–1.14) or at longer follow‐up. Conclusions An increased risk of adverse clinical outcomes was observed for women with ACS undergoing an early invasive strategy and coronary revascularization compared with men.
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Affiliation(s)
- Jacob A Udell
- Women's College Research Institute and Cardiovascular Division, Department of Medicine, Women's College Hospital, University of Toronto, Ontario, Canada .,Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada
| | - Maria Koh
- Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada
| | - Feng Qiu
- Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada.,Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Akshay Bagai
- Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Andrew T Yan
- Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Shaun G Goodman
- Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Jack V Tu
- Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada.,Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Dennis T Ko
- Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada.,Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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113
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Worrall-Carter L, MacIsaac A, Scruth E, Rahman MA. Gender difference in the use of coronary interventions for patients with acute coronary syndrome: Experience from a major metropolitan hospital in Melbourne, Australia. Aust Crit Care 2017; 30:3-10. [DOI: 10.1016/j.aucc.2016.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 03/20/2016] [Accepted: 03/28/2016] [Indexed: 01/11/2023] Open
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114
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Sanguineti F, Garcia-Alonso C, Benamer H, Karrillon GJ. [Chronic total occlusions: Is there a woman specificity?]. Ann Cardiol Angeiol (Paris) 2016; 65:420-424. [PMID: 27817847 DOI: 10.1016/j.ancard.2016.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many differences have been reported regarding gender in angioplasty procedures (PCI), but their potential influence on clinical outcomes after CTO PCI has not been elucidated. Aim of this paper is to analyse these potential differences starting from 2 clinical cases. The basic features found in the two clinical cases presented here, older age and presence of diabetes (that are more frequent in women), are in line with the differences identified in non-CTO studies on angioplasty. Furthermore, CTO in women are generally under-diagnosed and less frequently treated by angioplasty than in men. These features combined to the often atypical clinical presentation could explain why women are generally less frequently enrolled in CTO registries than men. Although data on the impact of gender on this topic are scarce, it appears that, despite a clear outcome difference in patients who have a successful CTO angioplasty and similar success rates, women are still under-referred for a CTO angioplasty. Indeed, CTO angioplasty seems a valid therapeutic option, in women as in men.
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Affiliation(s)
- F Sanguineti
- Centre hospitalier Simone-Veil, 14, rue de Saint-Prix, 95600 Eaubonne, France.
| | - C Garcia-Alonso
- Centre chirurgical Marie-Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis-Robbinson, France
| | - H Benamer
- Institut cardiovasculaire Paris Sud, hôpital privé Jacques-Cartier, générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - G J Karrillon
- Centre hospitalier Simone-Veil, 14, rue de Saint-Prix, 95600 Eaubonne, France
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115
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Laugsand LE, Janszky I, Vatten LJ, Dalen H, Midthjell K, Grill V, Carlsson S. Autoimmune diabetes in adults and risk of myocardial infarction: the HUNT study in Norway. J Intern Med 2016; 280:518-531. [PMID: 27445256 DOI: 10.1111/joim.12530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The long-term consequences of autoimmune diabetes in adults (AIDA) are largely unexplored. OBJECTIVE To investigate the risk of myocardial infarction (MI) in AIDA compared to type 2 diabetes, taking into consideration the effects of socio-economic and lifestyle factors, the metabolic syndrome and glycaemic control. METHODS A total of 62 995 participants including 207 individuals with AIDA (onset ≥35 years and anti-GAD positive) and 2322 individuals with type 2 diabetes (onset ≥35 years and anti-GAD negative), from the population-based Norwegian HUNT study, were followed for a first MI during the period 1995-2008. We identified 2614 MIs by hospital records or the National Cause of Death Registry. Cox proportional hazard models were used to estimate the risk of MI by diabetes subgroups after adjustment for age and socio-economic and lifestyle factors. RESULTS AIDA amongst women was associated with a nearly fourfold increased risk of MI [hazard ratio (HR) 3.63, 95% confidence interval (CI) 2.21-5.96) compared to nondiabetic participants, whereas no excess risk was found in men with AIDA (HR 1.30, 95% CI 0.70-2.52). By contrast, type 2 diabetes was associated with an increased MI risk in both men (HR 1.92, 95% CI 1.62-2.26) and women (HR 2.39, 95% CI 1.98-2.89). The metabolic profile was more favourable in patients with AIDA than in those with type 2 diabetes, but glycaemic control was worse. Multivariable models and sensitivity analyses suggest that these results were robust. CONCLUSIONS Women with AIDA were more likely to develop MI, compared to men with AIDA and both men and women with type 2 diabetes. Further investigations are warranted to confirm this gender difference.
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Affiliation(s)
- L E Laugsand
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. .,Department of Cardiology, St. Olavs Hospital, Trondheim, Norway.
| | - I Janszky
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - L J Vatten
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - H Dalen
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Midthjell
- HUNT Research Centre, Department of Community Medicine and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Levanger, Norway
| | - V Grill
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - S Carlsson
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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116
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Foussas S. Differences in men and women in acute coronary syndromes. Hellenic J Cardiol 2016; 57:S1109-9666(16)30231-7. [PMID: 27780665 DOI: 10.1016/j.hjc.2016.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Abstract
Although research suggests why disability may cause poverty, it is not well understood why poverty may cause disability. This article presents the Poverty Disability Model, which includes four groups of factors that increase the risk that poverty will cause disability and chronic health problems. Rehabilitation interventions and counselor implications derived from the model are presented in addition to research.
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118
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Edmund Anstey D, Li S, Thomas L, Wang TY, Wiviott SD. Race and Sex Differences in Management and Outcomes of Patients After ST-Elevation and Non-ST-Elevation Myocardial Infarct: Results From the NCDR. Clin Cardiol 2016; 39:585-595. [PMID: 27468142 DOI: 10.1002/clc.22570] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/03/2016] [Accepted: 06/06/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Race and sex have been shown to affect management of myocardial infarction (MI); however, it is unclear if such disparities exist in contemporary care of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). HYPOTHESIS Disparities in care will be less prevalent in more heavily protocol-driven management of STEMI than the less algorithmic care of NSTEMI. METHODS Data were collected from the ACTION Registry-GWTG database to assess care differences related to race and sex of patients presenting with NSTEMI or STEMI. For key treatments and outcomes, adjustments were made including patient demographics, baseline comorbidities, and markers of socioeconomic status. RESULTS Key demographic variables demonstrate significant differences in baseline comorbidities; black patients had higher incidences of hypertension and diabetes, and women more frequently had diabetes. With few exceptions, rates of acute and discharge medical therapy were similar by race in any sex category in both STEMI and NSTEMI populations. Rates of catheterization were similar by race for STEMI but not for NSTEMI, where both black men and women had lower rates of invasive therapy. Rates of revascularization were significantly lower for black patients in both the STEMI and NSTEMI groups regardless of sex. Rates of adverse events differed by sex, with disparities for death and major bleeding; after adjustment, rates were similar by race within sex comparisons. CONCLUSIONS In this contemporary cohort, although there are differences by race in presentation and management of MI, heavily protocol-driven processes seem to show fewer racial disparities.
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Affiliation(s)
- D Edmund Anstey
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Shuang Li
- Cardiovascular Division, Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Laine Thomas
- Cardiovascular Division, Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Tracy Y Wang
- Cardiovascular Division, Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Stephen D Wiviott
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts.
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Galli C, Lippi G. High-sensitivity cardiac troponin testing in routine practice: economic and organizational advantages. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:257. [PMID: 27500158 PMCID: PMC4958731 DOI: 10.21037/atm.2016.07.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 06/23/2016] [Indexed: 12/21/2022]
Abstract
Very seldom, if ever, a single laboratory test has provided such a paradigm shift in the managed care as cardiac troponin (cTn) testing. More than twenty years of improvements in test design and analytical features have contributed to revolutionize the clinical recommendations and guidelines, and the diagnosis of myocardial infarction (MI) is now highly dependent upon the kinetics of cTn within a suggestive clinical setting. Despite the advent of high-sensitivity cTn (HS-cTn) immunoassays has allowed a more accurate and timely diagnosis as well as a higher prognostic accuracy, the focus is now shifting on the most suitable algorithms and on a comprehensive approach to the clinical management of acute coronary syndrome (ACS). In this article we aim to discuss the implications of HS-cTn testing for ruling out and ruling in ACS. In the latter instance, main improvements are related to ACS diagnosis in women, in whom this pathology is still often underdiagnosed or misdiagnosed. A quick and accurate rule out will also regarded as a great advantage from both an organizational and economic standpoint. The advantages that will stem from this new approach have been recently assessed, and shortening of repeated testing 1 or 2 h from conventional algorithms entailing blood sampling at 3 and 6 h seems attainable. The larger benefits will definitely occur in clinical settings where the actual diagnosis rate of MI among patients with suspect ACS is lower and, consequently, the negative predictive value (NPV) of HS-cTn is the highest.
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Affiliation(s)
- Claudio Galli
- Medical Scientific Liaison Europe, Abbott Diagnostics, Roma, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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120
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Convergence in male and female life expectancy: Direction, age pattern, and causes. DEMOGRAPHIC RESEARCH 2016. [DOI: 10.4054/demres.2016.34.38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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121
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Use of diagnostic coronary angiography in women and men presenting with acute myocardial infarction: a matched cohort study. BMC Cardiovasc Disord 2016; 16:120. [PMID: 27250115 PMCID: PMC4888313 DOI: 10.1186/s12872-016-0248-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 04/15/2016] [Indexed: 01/27/2023] Open
Abstract
Background Based on evident sex-related differences in the invasive management of patients presenting with acute myocardial infarction (AMI), we sought to identify predictors of diagnostic coronary angiography (DCA) and to investigate reasons for opting out an invasive strategy in women and men. Methods The study was designed as a matched cohort study. We randomly selected 250 female cases from a source population of 4000 patients hospitalized with a first AMI in a geographically confined region of Denmark from January 2010 to November 2011. Each case was matched to a male control on age and availability of cardiac invasive facilities at the index hospital. We systematically reviewed medical records for risk factors, comorbid conditions, clinical presentation, and receipt of DCA. Clinical justifications, as stated by the treating physician, were noted for the subset of patients who did not receive a DCA. Results Overall, 187 women and 198 men received DCA within 60 days (75 % vs. 79 %, hazard ratio: 0.82 [0.67-1.00], p = 0.047).In the subset of patients who did not receive a DCA (n = 114), clinical justifications for opting out an invasive strategy was not documented for 21 patients (18.4 %). Type 2 myocardial infarction was noted in 11 patients (women versus men; 14.5 % vs. 3.8 %, p = 0.06) and identified as a potential confounder of the sex-DCA relationship. Receipt of DCA was predicted by traditional risk factors for ischaemic heart disease (family history of cardiovascular disease, hypercholesterolemia, and smoking) and clinical presentation (chest pain, ST-segment elevations). Although prevalent in both women and men, the presence of relative contraindications did not prohibit the use of DCA. Conclusion In this matched cohort of patients with a first AMI, women and men had different clinical presentations despite similar age. However, no differences in the distribution of relative contraindications for DCA were found between the sexes. Type 2 MI posed a potentiel confounder for the sex-related differences in the use of DCA. Importantly,clinical justification for opting out an invasive strategy was not documented in almost one fifth of patients not receiving a DCA. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0248-9) contains supplementary material, which is available to authorized users.
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Naito R, Miyauchi K, Konishi H, Tsuboi S, Ogita M, Dohi T, Kasai T, Tamura H, Okazaki S, Isoda K, Daida H. Gender difference in long-term clinical outcomes following percutaneous coronary intervention during 1984-2008. Atherosclerosis 2016; 247:105-110. [PMID: 26896722 DOI: 10.1016/j.atherosclerosis.2015.10.088] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 10/07/2015] [Accepted: 10/20/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Female has been demonstrated to be at higher risk following percutaneous coronary intervention (PCI) compared with male in unadjusted analyses. However, conflicting results were observed after adjustment of confounding factors. Particularly, more recent studies reported that gender differences have diminished possibly by evolution of PCI-related devices and evidence-based medical therapy. We aimed to examine gender differences in long-term clinical outcomes following PCI during time period of 25 years. METHODS This was a single center retrospective study in which consecutive patients who received the first PCI in our institution between January 1984 and December 2008 were analyzed. A composite of all-cause death and acute coronary syndrome (ACS) at 5-year after the index PCI was compared between genders. The endpoint was also examined in plain-old balloon angioplasty (POBA)-, bare metal stent (BMS)- and drug-eluting stent (DES)-eras separately. RESULTS A total of 3531 patients (female; 605, male; 2926) were analyzed. The female patients had higher risk profiles than the male in terms of age, comorbid diseases, a prevalence of ACS, while male patients had a higher percentage of smoking, lower left ventricular ejection fraction (LVEF) and lower percentages of secondary prevention drugs. Gender difference was not observed in 5-year all-cause death and ACS in multivariable Cox regression analysis. After controlling variables, age, body mass index, hemoglobin value and LVEF were associated with the clinical outcomes in both genders. CONCLUSION Gender difference was not observed in the long-term all-cause death and ACS in patients following PCI.
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Affiliation(s)
- Ryo Naito
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Japan.
| | - Hirokazu Konishi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Shuta Tsuboi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Manabu Ogita
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Hiroshi Tamura
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Kikuo Isoda
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Japan
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McSweeney JC, Rosenfeld AG, Abel WM, Braun LT, Burke LE, Daugherty SL, Fletcher GF, Gulati M, Mehta LS, Pettey C, Reckelhoff JF. Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science: A Scientific Statement From the American Heart Association. Circulation 2016; 133:1302-31. [PMID: 26927362 PMCID: PMC5154387 DOI: 10.1161/cir.0000000000000381] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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124
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Li S, Fonarow GC, Mukamal KJ, Liang L, Schulte PJ, Smith EE, DeVore A, Hernandez AF, Peterson ED, Bhatt DL. Sex and Race/Ethnicity–Related Disparities in Care and Outcomes After Hospitalization for Coronary Artery Disease Among Older Adults. Circ Cardiovasc Qual Outcomes 2016; 9:S36-44. [DOI: 10.1161/circoutcomes.115.002621] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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125
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Izadnegahdar M, Mackay M, Lee MK, Sedlak TL, Gao M, Bairey Merz CN, Humphries KH. Sex and Ethnic Differences in Outcomes of Acute Coronary Syndrome and Stable Angina Patients With Obstructive Coronary Artery Disease. Circ Cardiovasc Qual Outcomes 2016; 9:S26-35. [DOI: 10.1161/circoutcomes.115.002483] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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126
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Smilowitz NR, Maduro GA, Lobach IV, Chen Y, Reynolds HR. Adverse Trends in Ischemic Heart Disease Mortality among Young New Yorkers, Particularly Young Black Women. PLoS One 2016; 11:e0149015. [PMID: 26882207 PMCID: PMC4755569 DOI: 10.1371/journal.pone.0149015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/25/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Ischemic heart disease (IHD) mortality has been on the decline in the United States for decades. However, declines in IHD mortality have been slower in certain groups, including young women and black individuals. HYPOTHESIS Trends in IHD vary by age, sex, and race in New York City (NYC). Young female minorities are a vulnerable group that may warrant renewed efforts to reduce IHD. METHODS IHD mortality trends were assessed in NYC 1980-2008. NYC Vital Statistics data were obtained for analysis. Age-specific IHD mortality rates and confidence bounds were estimated. Trends in IHD mortality were compared by age and race/ethnicity using linear regression of log-transformed mortality rates. Rates and trends in IHD mortality rates were compared between subgroups defined by age, sex and race/ethnicity. RESULTS The decline in IHD mortality rates slowed in 1999 among individuals aged 35-54 years but not ≥55. IHD mortality rates were higher among young men than women age 35-54, but annual declines in IHD mortality were slower for women. Black women age 35-54 had higher IHD mortality rates and slower declines in IHD mortality than women of other race/ethnicity groups. IHD mortality trends were similar in black and white men age 35-54. CONCLUSIONS The decline in IHD mortality rates has slowed in recent years among younger, but not older, individuals in NYC. There was an association between sex and race/ethnicity on IHD mortality rates and trends. Young black women may benefit from targeted medical and public health interventions to reduce IHD mortality.
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Affiliation(s)
- Nathaniel R. Smilowitz
- Cardiovascular Clinical Research Center, NYU School of Medicine, New York, NY, United States of America
| | - Gil A. Maduro
- New York City Department of Health and Mental Health, New York, NY, United States of America
| | - Iryna V. Lobach
- Department of Biostatistics, NYU School of Medicine, New York, NY, United States of America
| | - Yu Chen
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
| | - Harmony R. Reynolds
- Cardiovascular Clinical Research Center, NYU School of Medicine, New York, NY, United States of America
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127
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Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN, Lindley KJ, Vaccarino V, Wang TY, Watson KE, Wenger NK. Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation 2016; 133:916-47. [PMID: 26811316 DOI: 10.1161/cir.0000000000000351] [Citation(s) in RCA: 752] [Impact Index Per Article: 94.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction.
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128
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Hussain MA, Lindsay TF, Mamdani M, Wang X, Verma S, Al-Omran M. Sex differences in the outcomes of peripheral arterial disease: a population-based cohort study. CMAJ Open 2016; 4:E124-31. [PMID: 27280110 PMCID: PMC4866931 DOI: 10.9778/cmajo.20150107] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The role of sex in the outcomes of patients with peripheral arterial disease (PAD) has been poorly studied. We sought to investigate differences in the long-term adverse cardiovascular and limb outcomes between men and women with PAD. METHODS We conducted a population-based cohort study with up to 7 years of follow-up using linked administrative databases in Ontario, Canada. Patients aged 40 years or older who visited a vascular surgeon between Apr. 1, 2004, and Mar. 31, 2007 (index date), and carried a diagnosis of PAD comprised the study cohort. The primary outcome was a composite of death or hospital admission for stroke or myocardial infarction. Secondary outcomes included lower limb amputation or revascularization. We used Cox proportional hazards modelling to compute unadjusted hazard ratios (HRs) and HRs adjusted for baseline covariates. RESULTS A total of 6915 patients were studied, of whom 2461 (35.6%) were women. No significant differences in the risk of the primary outcome were observed between men and women (adjusted HR 0.99 [95% confidence interval (CI) 0.92-1.05]). Women were less likely than men to undergo minor amputation (adjusted HR 0.73 [95% CI 0.62-0.85]) and arterial bypass surgery (adjusted HR 0.82 [95% CI 0.71-0.94]) but were more likely to be admitted to hospital for acute myocardial infarction (adjusted HR 1.15 [95% CI 1.00-1.31]). There were no sex differences in the rates of major amputation or transluminal percutaneous angioplasty. INTERPRETATION We identified no significant differences in the composite risk of major adverse cardiovascular events between women and men with PAD, although our findings suggest men may be at increased risk for adverse limb events compared with women. Cardiovascular health campaigns should focus on both women and men to promote early diagnosis and management of PAD.
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Affiliation(s)
- Mohamad A Hussain
- Divisions of Vascular Surgery (Hussain, Al-Omran) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Mamdani, Verma, Al-Omran); Department of Surgery (Hussain, Lindsay, Verma, Al-Omran), University of Toronto; Division of Vascular Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network; Institute of Health Policy, Management, and Evaluation, and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Applied Health Research Centre (Mamdani), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program and Department of Surgery (Mamdani, Verma, Al-Omran), King Saud University, Riyadh, Kingdom of Saudi Arabia; Institute for Clinical Evaluative Sciences (Mamdani, Wang), Toronto, Ont
| | - Thomas F Lindsay
- Divisions of Vascular Surgery (Hussain, Al-Omran) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Mamdani, Verma, Al-Omran); Department of Surgery (Hussain, Lindsay, Verma, Al-Omran), University of Toronto; Division of Vascular Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network; Institute of Health Policy, Management, and Evaluation, and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Applied Health Research Centre (Mamdani), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program and Department of Surgery (Mamdani, Verma, Al-Omran), King Saud University, Riyadh, Kingdom of Saudi Arabia; Institute for Clinical Evaluative Sciences (Mamdani, Wang), Toronto, Ont
| | - Muhammad Mamdani
- Divisions of Vascular Surgery (Hussain, Al-Omran) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Mamdani, Verma, Al-Omran); Department of Surgery (Hussain, Lindsay, Verma, Al-Omran), University of Toronto; Division of Vascular Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network; Institute of Health Policy, Management, and Evaluation, and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Applied Health Research Centre (Mamdani), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program and Department of Surgery (Mamdani, Verma, Al-Omran), King Saud University, Riyadh, Kingdom of Saudi Arabia; Institute for Clinical Evaluative Sciences (Mamdani, Wang), Toronto, Ont
| | - Xuesong Wang
- Divisions of Vascular Surgery (Hussain, Al-Omran) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Mamdani, Verma, Al-Omran); Department of Surgery (Hussain, Lindsay, Verma, Al-Omran), University of Toronto; Division of Vascular Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network; Institute of Health Policy, Management, and Evaluation, and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Applied Health Research Centre (Mamdani), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program and Department of Surgery (Mamdani, Verma, Al-Omran), King Saud University, Riyadh, Kingdom of Saudi Arabia; Institute for Clinical Evaluative Sciences (Mamdani, Wang), Toronto, Ont
| | - Subodh Verma
- Divisions of Vascular Surgery (Hussain, Al-Omran) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Mamdani, Verma, Al-Omran); Department of Surgery (Hussain, Lindsay, Verma, Al-Omran), University of Toronto; Division of Vascular Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network; Institute of Health Policy, Management, and Evaluation, and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Applied Health Research Centre (Mamdani), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program and Department of Surgery (Mamdani, Verma, Al-Omran), King Saud University, Riyadh, Kingdom of Saudi Arabia; Institute for Clinical Evaluative Sciences (Mamdani, Wang), Toronto, Ont
| | - Mohammed Al-Omran
- Divisions of Vascular Surgery (Hussain, Al-Omran) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Mamdani, Verma, Al-Omran); Department of Surgery (Hussain, Lindsay, Verma, Al-Omran), University of Toronto; Division of Vascular Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network; Institute of Health Policy, Management, and Evaluation, and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Applied Health Research Centre (Mamdani), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program and Department of Surgery (Mamdani, Verma, Al-Omran), King Saud University, Riyadh, Kingdom of Saudi Arabia; Institute for Clinical Evaluative Sciences (Mamdani, Wang), Toronto, Ont
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Rashid S, Simms A, Batin P, Kurian J, Gale CP. Inequalities in care in patients with acute myocardial infarction. World J Cardiol 2015; 7:895-901. [PMID: 26730295 PMCID: PMC4691816 DOI: 10.4330/wjc.v7.i12.895] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/24/2015] [Accepted: 10/12/2015] [Indexed: 02/06/2023] Open
Abstract
Coronary heart disease is the single largest cause of death in developed countries. Guidelines exist for the management of acute myocardial infarction (AMI), yet despite these, significant inequalities exist in the care of these patients. The elderly, deprived socioeconomic groups, females and non-caucasians are the patient populations where practice tends to deviate more frequently from the evidence base. Elderly patients often had higher mortality rates after having an AMI compared to younger patients. They also tended to present with symptoms that were not entirely consistent with an AMI, thus partially contributing to the inequalities in care that is seen between younger and older patients. Furthermore the lack of guidelines in the elderly age group presenting with AMI can often make decision making challenging and may account for the discrepancies in care that are prevalent between younger and older patients. Other patients such as those from a lower socioeconomic group, i.e., low income and less than high school education often had poorer health and reduced life expectancy compared to patients from a higher socioeconomic group after an AMI. Lower socioeconomic status was also seen to be contributing to racial and geographical variation is the care in AMI patients. Females with an AMI were treated less aggressively and had poorer outcomes when compared to males. However even when females were treated in the same way they continued to have higher in hospital mortality which suggests that gender may well account for differences in outcomes. The purpose of this review is to identify the inequalities in care for patients who present with an AMI and explore potential reasons for why these occur. Greater attention to the management and a better understanding of the root causes of these inequalities in care may help to reduce morbidity and mortality rates associated with AMI.
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Affiliation(s)
- Shabnam Rashid
- Shabnam Rashid, Alexander Simms, Department of Cardiology, Leeds General Infirmary, West Yorkshire LS1 3EX, United Kingdom
| | - Alexander Simms
- Shabnam Rashid, Alexander Simms, Department of Cardiology, Leeds General Infirmary, West Yorkshire LS1 3EX, United Kingdom
| | - Phillip Batin
- Shabnam Rashid, Alexander Simms, Department of Cardiology, Leeds General Infirmary, West Yorkshire LS1 3EX, United Kingdom
| | - John Kurian
- Shabnam Rashid, Alexander Simms, Department of Cardiology, Leeds General Infirmary, West Yorkshire LS1 3EX, United Kingdom
| | - Chris P Gale
- Shabnam Rashid, Alexander Simms, Department of Cardiology, Leeds General Infirmary, West Yorkshire LS1 3EX, United Kingdom
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Regensteiner JG, Golden S, Huebschmann AG, Barrett-Connor E, Chang AY, Chyun D, Fox CS, Kim C, Mehta N, Reckelhoff JF, Reusch JEB, Rexrode KM, Sumner AE, Welty FK, Wenger NK, Anton B. Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus: A Scientific Statement From the American Heart Association. Circulation 2015; 132:2424-47. [PMID: 26644329 DOI: 10.1161/cir.0000000000000343] [Citation(s) in RCA: 214] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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131
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Benamer H, Motreff P, Jessen P, Piquet M, Haziza F, Chevalier B. [Women and acute coronary syndrome with ST elevation: Excess mortality related to longer delays and spontaneous coronary dissection]. Ann Cardiol Angeiol (Paris) 2015; 64:460-466. [PMID: 26514723 DOI: 10.1016/j.ancard.2015.09.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The outcome of patients with ST elevation acute coronary syndrome (ACS) has been increasingly improving in the general population over the past few decades. However, detailed analysis of the results show that the reduction in mortality rates is higher in males compared to their female counterparts. The excess mortality rate observed in women, though sometimes questioned, has been widely reported in the literature. The higher mortality rate observed in women with ST elevation ACS can be explained by the presence of aggravating clinical factors such as older age, a higher percentage of diabetics, and a higher frequency of cardiogenic shock. Other factors pertaining to patient management seem to negatively impact the outcome. These factors include a lower use of reperfusion strategies, longer time to treatment mainly as a result of diagnostic uncertainty with respect to a disease, which is believed to affect principally the male gender. The doubts that female patients themselves and their families have about the nature of their symptoms are also present in the medical environment but cease to exist in the catheterization laboratory. This is illustrated in the first clinical case that we present here. Coronary reperfusion is the cornerstone of the therapeutic management of MI. In this context, bleeding complications associated with the implemented treatments can also result in an increased mortality rate in this more vulnerable population. When all the factors likely to influence the prognosis are taken into account, excess mortality seems to persist in women, especially in younger patients. As described in the second clinical case, a distinct physio-pathological factor, more frequent in women, could account for this higher mortality rate. Indeed, spontaneous coronary dissection and intramural hematoma are not always easy to diagnose and may not be adequately managed by reperfusion treatments. In addition, these coronary reperfusion strategies are probably not adapted to this type of ACS. It is, therefore, very important to identify them by angiography coupled with intra-coronary imaging examination when necessary and to carry out further research to adjust our PCI techniques to this pathology.
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Affiliation(s)
- H Benamer
- ICPS, 6, avenue du Noyer-Lambert-à-Massy, 91300 Massy, France; IVC-GVM la Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - P Motreff
- CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - P Jessen
- IVC-GVM la Roseraie, 120, avenue de la République, 93300 Aubervilliers, France
| | - M Piquet
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - F Haziza
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - B Chevalier
- ICPS, 6, avenue du Noyer-Lambert-à-Massy, 91300 Massy, France
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132
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Donataccio MP, Puymirat E, Parapid B, Steg PG, Eltchaninoff H, Weber S, Ferrari E, Vilarem D, Charpentier S, Manzo-Silberman S, Ferrières J, Danchin N, Simon T. In-hospital outcomes and long-term mortality according to sex and management strategy in acute myocardial infarction. Insights from the French ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2005 Registry. Int J Cardiol 2015; 201:265-70. [DOI: 10.1016/j.ijcard.2015.08.065] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
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133
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Seeleman C, Essink-Bot ML, Stronks K, Ingleby D. How should health service organizations respond to diversity? A content analysis of six approaches. BMC Health Serv Res 2015; 15:510. [PMID: 26573437 PMCID: PMC4647506 DOI: 10.1186/s12913-015-1159-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 10/30/2015] [Indexed: 12/02/2022] Open
Abstract
Background Health care organizations need to be responsive to the needs of increasingly diverse patient populations. We compared the contents of six publicly available approaches to organizational responsiveness to diversity. The central questions addressed in this paper are: what are the most consistently recommended issues for health care organizations to address in order to be responsive to the needs of diverse groups that differ from the majority population? How much consensus is there between various approaches? Methods We purposively sampled six approaches from the US, Australia and Europe and used qualitative textual analysis to categorize the content of each approach into domains (conceptually distinct topic areas) and, within each domain, into dimensions (operationalizations). The resulting classification framework was used for comparative analysis of the content of the six approaches. Results We identified seven domains that were represented in most or all approaches: organizational commitment, empirical evidence on inequalities and needs, a competent and diverse workforce, ensuring access for all users, ensuring responsiveness in care provision, fostering patient and community participation, and actively promoting responsiveness. Variations in the operationalization of these domains related to different scopes, contexts and types of diversity. For example, approaches that focus on ethnic diversity mostly provide recommendations to handle cultural and language differences; approaches that take an intersectional approach and broaden their target population to vulnerable groups in a more general sense also pay attention to factors such as socio-economic status and gender. Conclusions Despite differences in labeling, there is a broad consensus about what health care organizations need to do in order to be responsive to patient diversity. This opens the way to full scale implementation of organizational responsiveness in healthcare and structured evaluation of its effectiveness in improving patient outcomes.
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Affiliation(s)
- Conny Seeleman
- Department of Public Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.
| | - Marie-Louise Essink-Bot
- Department of Public Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.
| | - David Ingleby
- Centre for Social Science and Global Health (SSGH), University of Amsterdam, Amsterdam, The Netherlands.
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134
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Bullock-Palmer RP. Prevention, Detection and Management of Coronary Artery Disease in Minority Females. Ethn Dis 2015; 25:499-506. [PMID: 26674268 PMCID: PMC4671445 DOI: 10.18865/ed.25.4.499] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND SIGNIFICANCE Heart disease is the leading cause of death for women living in the United States; this disease claims more female lives than all cancers combined. Additionally, according to the Centers of Disease Control data between the years 1979 and 2006, while cardiac-related mortality among men decreased significantly, only a modest decline was found among women. This disparity is greatest among minority females including Blacks and Hispanics who have an even greater prevalence of CVD and its risk factors. PREVENTION There are several risk factors for coronary artery disease (CAD). Modifiable risk factors include: tobacco smoking, hypertension, diabetes, hyperlipidemia, obesity and physical inactivity. The prevention of CAD is grounded in decreasing or removing these modifiable risk factors. DETECTION Accurately diagnosing CAD is dependent on an accurate assessment of the patient's pre-test probability to determine the best diagnostic approach to pursue. The patient's functional status, resting EKG and cardiac risk factors also assist in determining the best non-invasive cardiac test to pursue. MANAGEMENT The goals and mainstay in the management of minority females with stable CAD includes surveillance for CAD symptoms, management of hypertension, diabetes mellitus and hyperlipidemia, as well as encouraging healthy habits. CONCLUSION Heart disease remains the leading cause of death in minority females. Providers must be diligent to aggressively decrease patients' cardiovascular risk and, when patients do present with cardiovascular symptoms, providers must be aggressive in accurately diagnosing and treating these patients to decrease cardiac morbidity and mortality.
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135
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Kuhn L, Page K, Rahman MA, Worrall-Carter L. Gender difference in treatment and mortality of patients with ST-segment elevation myocardial infarction admitted to Victorian public hospitals: A retrospective database study. Aust Crit Care 2015; 28:196-202. [DOI: 10.1016/j.aucc.2015.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 12/03/2014] [Accepted: 01/21/2015] [Indexed: 01/05/2023] Open
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de-Miguel-Balsa E, Latour-Pérez J, Baeza-Román A, Llamas-Álvarez A, Ruiz-Ruiz J, Fuset-Cabanes MP. Accessibility to Reperfusion Therapy Among Women with Acute Myocardial Infarction: Impact on Hospital Mortality. J Womens Health (Larchmt) 2015; 24:882-8. [DOI: 10.1089/jwh.2014.5011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Eva de-Miguel-Balsa
- Intensive Care and Coronary Unit, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Jaime Latour-Pérez
- Intensive Care and Coronary Unit, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Anna Baeza-Román
- Intensive Care and Coronary Unit, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Ana Llamas-Álvarez
- Intensive Care and Coronary Unit, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Javier Ruiz-Ruiz
- Intensive Care and Coronary Unit, Hospital General de Castelló, Castelló, Castelló, Spain
| | - M Paz Fuset-Cabanes
- Intensive Care and Coronary Unit, Hospital Universitario y Politécnico la Fe, Valencia, Spain
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137
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Temporal Trends and Sex Differences in Revascularization and Outcomes of ST-Segment Elevation Myocardial Infarction in Younger Adults in the United States. J Am Coll Cardiol 2015; 66:1961-1972. [PMID: 26515998 DOI: 10.1016/j.jacc.2015.08.865] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 11/20/2022]
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138
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Sex Differences in the Presentation, Diagnosis, and Management of Acute Coronary Syndromes: Findings From the Kerala-India ACS Registry. Glob Heart 2015; 10:273-80. [PMID: 26410401 DOI: 10.1016/j.gheart.2015.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/29/2015] [Accepted: 06/08/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Previous literature from high-income countries has repeatedly shown sex differences in the presentation, diagnosis, and management of acute coronary syndromes (ACS), with women having atypical presentations and undergoing less aggressive diagnostic and therapeutic measures. However, much less data exist evaluating sex differences in ACS in India. OBJECTIVES This study sought to evaluate sex differences in the diagnosis, management, and treatment of patients with ACS in Kerala, India. METHODS The Kerala ACS Registry collected data from 25,748 consecutive ACS admissions (19,923 men and 5,825 women) from 125 hospitals in the Indian state of Kerala from 2007 to 2009. This study evaluated the association between sex differences in presentation, in-hospital management, and discharge care with in-hospital mortality and in-hospital major adverse cardiovascular events (defined as death, reinfarction, stroke, heart failure, or cardiogenic shock). RESULTS Women with ACS were older than men with ACS (64 vs. 59, p < 0.001) and were more likely to have a history of previous myocardial infarction (16% vs. 14%, p < 0.001). Inpatient diagnostics and management and discharge care were similar between sexes. No significant differences between men and women in the outcome of death (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 0.80 to 1.38) or in the composite outcome of death, reinfarction, stroke, heart failure, or cardiogenic shock (OR: 0.99, 95% CI: 0.79 to 1.25) were seen after adjustment for possible confounding factors. CONCLUSIONS In Kerala, even though women with ACS were older and more likely to have previous myocardial infarction, there were no significant differences in in-hospital and discharge management, in-hospital mortality, or major adverse cardiovascular events between sexes. Whether these results apply to other parts of India or acute presentations of other chronic diseases in low- and middle-income countries warrants further study.
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139
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Rodriguez F, Foody JM, Wang Y, López L. Young Hispanic Women Experience Higher In-Hospital Mortality Following an Acute Myocardial Infarction. J Am Heart Assoc 2015; 4:e002089. [PMID: 26353998 PMCID: PMC4599495 DOI: 10.1161/jaha.115.002089] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Although mortality rates for acute myocardial infarction (AMI) have declined for men and women, prior studies have reported a sex gap in mortality such that younger women were most likely to die after an AMI. Methods and Results We sought to explore the impact of race and ethnicity on the sex gap in AMI patterns of care and mortality for younger women in a contemporary patient cohort. We constructed multivariable hierarchical logistic regression models to examine trends in AMI hospitalizations, procedures, and in-hospital mortality by sex, age (<65 and ≥65 years), and race/ethnicity (white, black, and Hispanic). Analyses were derived from 194 071 patients who were hospitalized for an AMI with available race and ethnicity data from the 2009–2010 National Inpatient Sample. Hospitalization rates, procedures (coronary angiography, percutaneous coronary interventions, and cardiac bypass surgery), and inpatient mortality were analyzed across age, sex, and race/ethnic groups. There was significant variation in hospitalization rates by age and race/ethnicity. All racial/ethnic groups were less likely to undergo invasive procedures compared with white men (P<0.001). After adjustment for comorbidities, younger Hispanic women experienced higher in-hospital mortality compared with younger white men, with an odds ratio of 1.5 (95% CI 1.2 to 1.9), adjusted for age and comorbidities. Conclusion We found significant racial and sex disparities in AMI hospitalizations, care patterns, and mortality, with higher in-hospital mortality experienced by younger Hispanic women. Future studies are necessary to explore determinants of these significant racial and sex disparities in outcomes for AMI.
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Affiliation(s)
- Fátima Rodriguez
- Division of Cardiovascular Medicine, Stanford UniversityStanford, CA
| | - JoAnne M Foody
- Harvard Medical School, Massachusetts General HospitalBoston, MA
- Division of Cardiovascular Medicine, Brigham and Women’s HospitalBoston, MA
| | - Yun Wang
- Department of Biostatistics, Harvard School of Public HealthBoston, MA
| | - Lenny López
- Harvard Medical School, Massachusetts General HospitalBoston, MA
- Mongan Institute for Health Policy, Massachusetts General HospitalBoston, MA
- Disparities Solutions Center, Massachusetts General HospitalBoston, MA
- Division of General Internal Medicine, Brigham and Women’s HospitalBoston, MA
- Correspondence to: Lenny López, MD, MPH, MDiv, Mongan Institute of Health Policy, Massachusetts General Hospital, 50 Staniford St., 9th Floor, Boston, MA 02114. E-mail:
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Kramer MR, Valderrama AL, Casper ML. Decomposing Black-White Disparities in Heart Disease Mortality in the United States, 1973-2010: An Age-Period-Cohort Analysis. Am J Epidemiol 2015. [PMID: 26199382 DOI: 10.1093/aje/kwv050] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Against the backdrop of late 20th century declines in heart disease mortality in the United States, race-specific rates diverged because of slower declines among blacks compared with whites. To characterize the temporal dynamics of emerging black-white racial disparities in heart disease mortality, we decomposed race-sex-specific trends in an age-period-cohort (APC) analysis of US mortality data for all diseases of the heart among adults aged ≥35 years from 1973 to 2010. The black-white gap was largest among adults aged 35-59 years (rate ratios ranged from 1.2 to 2.7 for men and from 2.3 to 4.0 for women) and widened with successive birth cohorts, particularly for men. APC model estimates suggested strong independent trends across generations ("cohort effects") but only modest period changes. Among men, cohort-specific black-white racial differences emerged in the 1920-1960 birth cohorts. The apparent strength of the cohort trends raises questions about life-course inequalities in the social and health environments experienced by blacks and whites which could have affected their biomedical and behavioral risk factors for heart disease. The APC results suggest that the genesis of racial disparities is neither static nor restricted to a single time scale such as age or period, and they support the importance of equity in life-course exposures for reducing racial disparities in heart disease.
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141
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Hsia RY, Shen YC. Percutaneous Coronary Intervention in the United States: Risk Factors for Untimely Access. Health Serv Res 2015; 51:592-609. [PMID: 26174998 DOI: 10.1111/1475-6773.12335] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine how access to percutaneous coronary intervention (PCI) is distributed across demographics. DATA SOURCES Secondary data from the 2011 American Hospital Association (AHA) survey data combined with 2010 Census. STUDY DESIGN We calculated prehospital times from 32,370 ZIP codes to the nearest PCI center. We used a multivariate logit model to determine the odds of untimely access by the ZIP code's concentration of vulnerable populations. DATA COLLECTION We used ZIP code-level data on community characteristics from the 2010 Census and supplemented it with 2011 AHA survey data on service-line availability of PCI for responding hospitals. PRINCIPAL FINDINGS For approximately 306 million Americans, the median prehospital time to the nearest PCI center is 33 minutes. While 84 percent of Americans live within one hour of a PCI center, the odds of untimely access are higher in low-income (OR: 3.00; 95 percent CI: 2.39, 3.77), rural (8.10; 95 percent CI: 6.84, 9.59), and highly Hispanic communities (2.55; 95 percent CI: 1.86, 3.49). CONCLUSIONS While the majority of Americans live within 60 minutes of a PCI center, rural, low-income, and highly Hispanic communities have worse PCI access. This may translate into worse outcomes for patients with acute myocardial infarction.
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Affiliation(s)
- Renee Y Hsia
- Department of Emergency Medicine and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
| | - Yu-Chu Shen
- Naval Postgraduate School, Monterey, CA.,National Bureau of Economic Research, Cambridge, MA
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142
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Crea F, Battipaglia I, Andreotti F. Sex differences in mechanisms, presentation and management of ischaemic heart disease. Atherosclerosis 2015; 241:157-68. [DOI: 10.1016/j.atherosclerosis.2015.04.802] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 04/10/2015] [Accepted: 04/21/2015] [Indexed: 01/24/2023]
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143
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Hansen KW, Soerensen R, Madsen M, Madsen JK, Jensen JS, von Kappelgaard LM, Mortensen PE, Galatius S. Developments in the invasive diagnostic-therapeutic cascade of women and men with acute coronary syndromes from 2005 to 2011: a nationwide cohort study. BMJ Open 2015; 5:e007785. [PMID: 26063568 PMCID: PMC4466619 DOI: 10.1136/bmjopen-2015-007785] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To investigate for trends in sex-related differences in the invasive diagnostic-therapeutic cascade in a population of patients with acute coronary syndromes (ACS). DESIGN A nationwide cohort study. SETTING Administrative and clinical registries covering all hospitalisations, invasive cardiac procedures and deaths in the Danish population of 5.6 million inhabitants. PARTICIPANTS We included 52,565 patients aged 30-90 years who were hospitalised with a first ACS from January 2005 to November 2011. Follow-up was 60 days from the day of index admission. MAIN OUTCOME MEASURES Diagnostic coronary angiography, percutaneous coronary intervention or coronary artery bypass within 60 days of index admission. RESULTS Women constituted 36%, were older, had more comorbidity and were less likely to be admitted to a hospital with cardiac catheterisation facilities than men. Mortality rates were similar for both sexes. Diagnostic coronary angiography was performed less frequently on women compared with men, both within 1 day (31% vs 42%; p<0.001) and within 60 days (67% vs 80%; p<0.001), yielding adjusted female-male HRs of 0.83 (0.79-0.87) and 0.86 (0.84-0.89), respectively.Among the 39,677 patients undergoing coronary angiography, non-obstructive coronary artery disease was more frequent among women than men (22% vs 9%; p<0.001). Women were less likely to undergo percutaneous coronary intervention (58% vs 72%; p<0.001) and coronary artery bypass (6% vs 11%, p<0.001) within 60 days than men, yielding adjusted HRs of 0.96 (0.92-0.99) and 0.81 (0.74-0.89), respectively. The sex-related differences were not attenuated over time for any of the invasive cardiac procedures (p values for trend >0.05). CONCLUSIONS In this nationwide study, men were more likely to undergo an invasive approach than women when hospitalised with a first ACS--a difference persisting from 2005 to 2011. Future studies should focus on the potential mechanisms behind this differential treatment.
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Affiliation(s)
- Kim Wadt Hansen
- Department of Cardiology, University Hospital Bispebjerg, Bispebjerg, Denmark
| | - R Soerensen
- Department of Cardiology, University Hospital Gentofte, Hellerup, Denmark
| | - M Madsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J K Madsen
- Emergency Department, Holbaek University Hospital, Holbaek, Denmark
| | - J S Jensen
- Department of Cardiology, University Hospital Gentofte, Hellerup, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - L M von Kappelgaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- The Danish Heart Registry, Denmark
| | - P E Mortensen
- The Danish Heart Registry, Denmark
- Department of Thoracic Surgery, Odense University Hospital, Denmark
| | - S Galatius
- Department of Cardiology, University Hospital Bispebjerg, Bispebjerg, Denmark
- The Danish Heart Registry, Denmark
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Paulus JK, Shah ND, Kent DM. All else being equal, men and women are still not the same: using risk models to understand gender disparities in care. Circ Cardiovasc Qual Outcomes 2015; 8:317-20. [PMID: 25901046 PMCID: PMC4440837 DOI: 10.1161/circoutcomes.115.001842] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 03/23/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Jessica K Paulus
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA (J.K.P., D.M.K.); and Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN (N.D.S.).
| | - Nilay D Shah
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA (J.K.P., D.M.K.); and Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN (N.D.S.)
| | - David M Kent
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA (J.K.P., D.M.K.); and Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN (N.D.S.)
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145
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The current state of ethnic and racial disparities in cardiovascular care: lessons from the past and opportunities for the future. Curr Cardiol Rep 2015; 16:530. [PMID: 25135343 DOI: 10.1007/s11886-014-0530-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Significant racial/ethnic disparities have been documented in cardiovascular care. Although health care quality is improving for many Americans, differences in clinical outcomes have persisted between racial/ethnic minority patients and non-minorities, even when income, education level, and site of care are taken into consideration. Potential causes of disparities are complex and are related to differences in risk factor prevalence and control, use of evidence-based procedures and medications, and social and environmental factors. Minority patients are more likely to receive care from lower-quality health care providers and institutions and experience more barriers to accessing care. Factors such as stereotyping and bias in medicine are hard to quantify, but likely contribute to differences in treatment. Recent trends suggest that some disparities are decreasing. Opportunities for change and improvement exist for patients, providers, and health care systems. Promising interventions, such as health policy changes, quality improvement programs, and culturally targeted community and clinic-based interventions offer hope that high-quality health care in the USA can be provided to all patients.
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Yang D, James S, De Faire U, Alfredsson L, Jernberg T, Moradi T. Differences in undergoing cardiac procedures within three months after first myocardial infarction by country of birth in women and men: a Swedish national cohort study. ACUTE CARDIAC CARE 2015; 17:5-13. [PMID: 25806974 DOI: 10.3109/17482941.2015.1005101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the relationship between country of birth and the utilization of coronary angiography, percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) after a first-time myocardial infarction (MI). DESIGN, SETTING AND PATIENTS 117,494 MI patients of all ages who were admitted to coronary care units between 2001 and 2009 in Sweden were followed-up for three months after admission. MAIN OUTCOME MEASURES Undergoing coronary angiography, PCI or CABG after first-time MI. RESULTS proportion of patients undergoing angiography and PCI increased whereas proportion of patients undergoing CABG also delay time for all three procedures decreased over the study period. The proportion of women undergoing any of the three procedures was markedly lower and delay time longer than those of men regardless of study period and migration background. Overall foreign-born first MI patients had higher rate of angiography (HR = 1.30, 95% CI: 1.27-1.33), PCI (HR = 1.27, 95% CI: 1.24-1.30) and CABG (HR = 1.21, 95% CI: 1.15-1.28) compared with Sweden born first MI patients. After controlling for potential confounding factors in multivariable models, the overall differences vanished for angiography and reduced markedly for PCI and CABG. However, multivariable stratified analysis by specific country of birth yielded higher rate of angiography among men born in Uganda (HR = 2.11, 95% CI: 1.00-4.43) and Peru (HR = 1.98, 95% CI: 1.07-3.68) and lower rate among men born in Croatia (HR = 0.71, 95% CI: 0.52-0.99) and women born in Thailand (HR = 0.49, 95% CI: 0.35-0.94). PCI adjusted rates were higher among women born in Palestine state (HR = 2.44, 95% CI: 1.15-5.16), Iraq (HR = 1.34, 95% CI: 1.04-1.74) and Poland (HR = 1.21, 95% CI: 1.02-1.44) and rate of CABG was higher among immigrants from some parts of Asia, including men born in Sri Lanka (HR = 3.19, 95% CI: 1.43-7.12), India (HR = 1.95, 95% CI: 1.21-3.14), Vietnam (HR = 2.65, 95% CI: 1.32-5.33), Palestine State (HR = 2.11, 95% CI: 1.06-4.24), and women born in Syria (HR = 2.36, 95% CI: 1.25-4.45), Iraq (HR = 1.74, 95% CI: 1.02-2.94), and Turkey (HR = 1.70, 95% CI: 1.03-2.79). CONCLUSIONS The observed high rate of CABG for immigrants and particularly those born in some Asian countries was not explained by the potential confounding factors. A more severe coronary disease in this population might explain this high rate but needs further research. Awareness and subsequent intervention at earlier stage of coronary disease among immigrants could prolong their life and reduce the healthcare costs.
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Affiliation(s)
- Dong Yang
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet , Stockholm , Sweden
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147
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Isorni MA, Blanchard D, Teixeira N, le Breton H, Renault N, Gilard M, Lefèvre T, Mulak G, Danchin N, Spaulding C, Puymirat E. Impact of gender on use of revascularization in acute coronary syndromes: The national observational study of diagnostic and interventional cardiac catheterization (ONACI). Catheter Cardiovasc Interv 2015; 86:E58-65. [DOI: 10.1002/ccd.25921] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 03/08/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Marc-Antoine Isorni
- Department of Cardiology; Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes; Paris France
| | - Didier Blanchard
- Department of Cardiology; Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes; Paris France
| | - Nelson Teixeira
- Department of Cardiology; Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes; Paris France
| | - Hervé le Breton
- Department of Cardiology; University Hospital of Rennes; Rennes France
| | - Nisa Renault
- Paris Cardiovascular Research Center PARCC; INSERM U970; Paris France
| | - Martine Gilard
- Department of Cardiology; University Hospital of Brest; Brest France
| | - Thierry Lefèvre
- Department of Cardiology; Institut Hospitalier Jacques Cartier; Massy France
| | | | - Nicolas Danchin
- Department of Cardiology; Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes; Paris France
| | - Christian Spaulding
- Department of Cardiology; Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes; Paris France
- Paris Cardiovascular Research Center PARCC; INSERM U970; Paris France
| | - Etienne Puymirat
- Paris Cardiovascular Research Center PARCC; INSERM U970; Paris France
- Department of Cardiology; Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes; Paris France
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148
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Lam CSP, McEntegart M, Claggett B, Liu J, Skali H, Lewis E, Køber L, Rouleau J, Velazquez E, Califf R, McMurray JJ, Pfeffer M, Solomon S. Sex differences in clinical characteristics and outcomes after myocardial infarction: insights from the Valsartan in Acute Myocardial Infarction Trial (VALIANT). Eur J Heart Fail 2015; 17:301-12. [DOI: 10.1002/ejhf.238] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/11/2014] [Accepted: 11/14/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Carolyn S. P. Lam
- National University Health System; Tower Block Level 9, 1E Kent Ridge Road Singapore 119228
| | | | | | | | | | | | | | | | | | - Rob Califf
- Duke University Medical Center; Durham NC USA
| | - John J. McMurray
- Department of Cardiology; Western Infirmary; Glasgow Scotland UK
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149
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Tomey MI, Mehran R, Brener SJ, Maehara A, Witzenbichler B, Dizon JM, El-Omar M, Xu K, Gibson CM, Stone GW. Sex, adverse cardiac events, and infarct size in anterior myocardial infarction: an analysis of intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction (INFUSE-AMI). Am Heart J 2015; 169:86-93. [PMID: 25497252 DOI: 10.1016/j.ahj.2014.06.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 06/23/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women are more likely than men to experience adverse cardiac events after ST-elevation myocardial (STEMI). Whether differences in infarct size or reperfusion contribute to sex differences in outcomes is unknown. METHODS We compared baseline and procedural characteristics, angiographic and electrocardiographic indices of reperfusion, microvascular obstruction, infarct size, and clinical outcomes in 118 women and 334 men with anterior STEMI enrolled in the INFUSE-AMI randomized trial of intralesion abciximab and aspiration thrombectomy (NCT00976521). Infarct size was assessed by cardiac magnetic resonance imaging at 30 days, and clinical end points were adjudicated by an independent committee. RESULTS Women were older, were more commonly affected by hypertension and renal impairment, and had a 50.5-minute longer delay to reperfusion. There were no differences in infarct size, microvascular obstruction, or reperfusion success. At 30 days, major adverse cardiac events (MACE), defined as death, reinfarction, new-onset severe heart failure, or rehospitalization for heart failure, were more common in women (11.1% vs 5.4%, hazard ratio 2.09, 95% CI 1.03-4.27, P = .04). After multivariable adjustment, age, but not sex or time to reperfusion, was an independent predictor of MACE. CONCLUSIONS In the INFUSE-AMI randomized trial, women with anterior STEMI experienced a higher rate of MACE, attributable to older age. Despite longer delay from symptom onset to reperfusion therapy, there was no difference between women and men in infarct size or reperfusion success.
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Affiliation(s)
| | - Roxana Mehran
- The Icahn School of Medicine at Mount Sinai, New York, NY; Cardiovascular Research Foundation, New York, NY.
| | - Sorin J Brener
- Cardiovascular Research Foundation, New York, NY; New York Methodist Hospital, Brooklyn, NY
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY; Columbia University Medical Center, New York, NY
| | | | - José M Dizon
- Columbia University Medical Center, New York, NY
| | | | - Ke Xu
- Cardiovascular Research Foundation, New York, NY
| | - C Michael Gibson
- Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, MA
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, NY; Columbia University Medical Center, New York, NY
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150
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Sex and acute coronary syndrome-related outcomes - adjusting away the differences. Coron Artery Dis 2014; 26:3-4. [PMID: 25489861 DOI: 10.1097/mca.0000000000000182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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