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Haskiah F, Abdelhai K, Hilu R, Khaskia A. Sex Differences in Low-Density Lipoprotein Cholesterol Treatment Among Young Israeli Patients Following Premature Acute Coronary Syndrome. Metab Syndr Relat Disord 2024; 22:439-446. [PMID: 38546443 DOI: 10.1089/met.2023.0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024] Open
Abstract
Introduction: Effective management of dyslipidemias is crucial for reducing morbidity and mortality among patients after acute coronary syndrome (ACS). Sex differences in dyslipidemia management after premature ACS in Israeli patients have not been extensively studied. This study aimed to investigate potential disparities between men and women in managing dyslipidemia, considering current guidelines. Methods: This retrospective cohort study examined patients who were 55 years old or younger and admitted to Meir Medical Center for ACS from January 2018 to February 2019. The study aimed to evaluate the use of lipid-lowering therapy (LLT), measure the achievement of target low-density lipoprotein cholesterol (LDL-C) levels, and analyze the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) in both male and female patients. Results: The study included a total of 687 participants, of which 23.3% were identified as females. Upon discharge, ∼80% of the patients were prescribed high-intensity statins. After 1 year, it was observed that females had higher levels of LDL-C and lower rates of achieving target LDL-C levels (<70 and 55 mg/dL) as compared with males (45% vs. 54.6% and 30% vs. 42.2%, respectively). The use of non-statin LLT at the 1-year mark was minimal in both groups. Finally, it was found that the occurrence of MACCE was similar between males and females. Conclusion: Sex disparities in dyslipidemia management after a premature ACS were apparent, with females having higher LDL-C levels and lower rates of target achievement. Intervention is necessary to address these disparities and encourage greater use of non-statin LLT.
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Affiliation(s)
- Feras Haskiah
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karam Abdelhai
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel
| | - Ranin Hilu
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
| | - Abid Khaskia
- Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
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2
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Hoshi T, Sawano M, Kohsaka S, Ishii H, Amano T, Takeuchi T, Takahashi J, Hiraya D, Watabe H, Ishizu T, Kozuma K. Impact of Sex Differences on Clinical Outcomes in Patients Following Primary Revascularization for Acute Myocardial Infarction - Insights From the Japanese Nationwide Registry. Circ J 2024; 88:1211-1222. [PMID: 38684394 DOI: 10.1253/circj.cj-23-0966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Women with acute myocardial infarction (AMI) often present a worse risk profile and experience a higher rate of in-hospital mortality than men. However, sex differences in post-discharge prognoses remain inadequately investigated. We examined the impact of sex on 1-year post-discharge outcomes in patients with AMI undergoing percutaneous coronary intervention.Methods and Results: We extracted patient-level data for the period January 2017-December 2018 from the J-PCI OUTCOME Registry, endorsed by the Japanese Association of Cardiovascular Intervention and Therapeutics. One-year all-cause and cardiovascular mortality and major adverse cardiovascular events were compared between men and women. In all, 29,856 AMI patients were studied, with 6,996 (23.4%) being women. Women were significantly older and had a higher prevalence of comorbidities than men. Crude all-cause mortality was significantly higher among women than men (7.5% vs. 5.4% [P<0.001] for ST-elevation myocardial infarction [STEMI]; 7.0% vs. 5.2% [P=0.006] for non-STEMI). These sex-related differences in post-discharge outcomes were attenuated after stratification by age. Multivariate analysis demonstrated an increase in all-cause mortality in both sexes with increasing age and advanced-stage chronic kidney disease (CKD). CONCLUSIONS Within this nationwide cohort, women had worse clinical outcomes following AMI than men. However, these sex-related differences in outcomes diminished after adjusting for age. In addition, CKD was significantly associated with all-cause mortality in both sexes.
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Affiliation(s)
- Tomoya Hoshi
- Department of Cardiology, Institute of Medicine, University of Tsukuba
| | - Mitsuaki Sawano
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | | | - Toshiharu Takeuchi
- Division of Cardiology, Department of Internal Medicine, Asahikawa Medical University
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Daigo Hiraya
- Department of Cardiology, Institute of Medicine, University of Tsukuba
| | - Hiroaki Watabe
- Department of Cardiology, Institute of Medicine, University of Tsukuba
| | - Tomoko Ishizu
- Department of Cardiology, Institute of Medicine, University of Tsukuba
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital
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3
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Miyawaki A, Jena AB, Rotenstein LS, Tsugawa Y. Comparison of Hospital Mortality and Readmission Rates by Physician and Patient Sex. Ann Intern Med 2024; 177:598-608. [PMID: 38648639 DOI: 10.7326/m23-3163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Little is known as to whether the effects of physician sex on patients' clinical outcomes vary by patient sex. OBJECTIVE To examine whether the association between physician sex and hospital outcomes varied between female and male patients hospitalized with medical conditions. DESIGN Retrospective observational study. SETTING Medicare claims data. PATIENTS 20% random sample of Medicare fee-for-service beneficiaries hospitalized with medical conditions during 2016 to 2019 and treated by hospitalists. MEASUREMENTS The primary outcomes were patients' 30-day mortality and readmission rates, adjusted for patient and physician characteristics and hospital-level averages of exposures (effectively comparing physicians within the same hospital). RESULTS Of 458 108 female and 318 819 male patients, 142 465 (31.1%) and 97 500 (30.6%) were treated by female physicians, respectively. Both female and male patients had a lower patient mortality when treated by female physicians; however, the benefit of receiving care from female physicians was larger for female patients than for male patients (difference-in-differences, -0.16 percentage points [pp] [95% CI, -0.42 to 0.10 pp]). For female patients, the difference between female and male physicians was large and clinically meaningful (adjusted mortality rates, 8.15% vs. 8.38%; average marginal effect [AME], -0.24 pp [CI, -0.41 to -0.07 pp]). For male patients, an important difference between female and male physicians could be ruled out (10.15% vs. 10.23%; AME, -0.08 pp [CI, -0.29 to 0.14 pp]). The pattern was similar for patients' readmission rates. LIMITATION The findings may not be generalizable to younger populations. CONCLUSION The findings indicate that patients have lower mortality and readmission rates when treated by female physicians, and the benefit of receiving treatments from female physicians is larger for female patients than for male patients. PRIMARY FUNDING SOURCE Gregory Annenberg Weingarten, GRoW @ Annenberg.
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Affiliation(s)
- Atsushi Miyawaki
- Department of Health Services Research and Department of Public Health, Graduate School of Medicine, and Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan (A.M.)
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Department of Medicine, Massachusetts General Hospital, Boston, and National Bureau of Economic Research, Cambridge, Massachusetts (A.B.J.)
| | - Lisa S Rotenstein
- Divisions of General Internal Medicine and Clinical Informatics, University of California at San Francisco, San Francisco, California, and Center for Physician Experience and Practice Excellence, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts (L.S.R.)
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California (Y.T.)
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4
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Meccanici F, Thijssen CGE, Heijmen RH, Geuzebroek GSC, ter Woorst JF, Gökalp AL, de Bruin JL, Gratama DN, Bekkers JA, van Kimmenade RRJ, Poyck P, Peels K, Post MC, Mokhles MM, Takkenberg JJM, Roos‐Hesselink JW, Verhagen HJM. Male-Female Differences in Acute Type B Aortic Dissection. J Am Heart Assoc 2024; 13:e029258. [PMID: 38156593 PMCID: PMC10863826 DOI: 10.1161/jaha.122.029258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/31/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Acute type B aortic dissection is a cardiovascular emergency with considerable mortality and morbidity risk. Male-female differences have been observed in cardiovascular disease; however, literature on type B aortic dissection is scarce. METHODS AND RESULTS A retrospective cohort study was conducted including all consecutive patients with acute type B aortic dissection between 2007 and 2017 in 4 tertiary hospitals using patient files and questionnaires for late morbidity. In total, 384 patients were included with a follow-up of 6.1 (range, 0.02-14.8) years, of which 41% (n=156) were female. Women presented at an older age than men (67 [interquartile range (IQR), 57-73] versus 62 [IQR, 52-71]; P=0.015). Prior abdominal aortic aneurysm (6% versus 15%; P=0.009), distally extending dissections (71 versus 85%; P=0.001), and clinical malperfusion (18% versus 32%; P=0.002) were less frequently observed in women. Absolute maximal descending aortic diameters were smaller in women (36 [IQR: 33-40] mm versus 39 [IQR, 36-43] mm; P<0.001), while indexed for body surface area diameters were larger in women (20 [IQR, 18-23] mm/m2 versus 19 [IQR, 17-21] mm/m2). No male-female differences were found in treatment choice; however, indications for invasive treatment were different (P<0.001). Early mortality rate was 9.6% in women and 11.8% in men (P=0.60). The 5-year survival was 83% (95% CI, 77-89) for women and 84% (95% CI, 79-89) for men (P=0.90). No male-female differences were observed in late (re)interventions. CONCLUSIONS No male-female differences were found in management, early or late death, and morbidity in patients presenting with acute type B aortic dissection, despite distinct clinical profiles at presentation. More details on the impact of age and type of intervention are warranted in future studies.
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Affiliation(s)
- Frederike Meccanici
- Department of CardiologyErasmus University Medical CenterRotterdamNetherlands
| | - Carlijn G. E. Thijssen
- Department of CardiologyErasmus University Medical CenterRotterdamNetherlands
- Department of CardiologyRadboud University Medical CenterNijmegenNetherlands
| | - Robin H. Heijmen
- Department of Cardiothoracic SurgerySt. Antonius HospitalNieuwegeinNetherlands
| | | | | | - Arjen L. Gökalp
- Department of Cardiothoracic SurgeryErasmus University Medical CenterRotterdamNetherlands
| | - Jorg L. de Bruin
- Department of Vascular SurgeryErasmus University Medical CenterRotterdamNetherlands
| | - Daantje N. Gratama
- Department of Vascular SurgeryErasmus University Medical CenterRotterdamNetherlands
| | - Jos A. Bekkers
- Department of Cardiothoracic SurgeryErasmus University Medical CenterRotterdamNetherlands
| | - Roland R. J. van Kimmenade
- Department of CardiologyErasmus University Medical CenterRotterdamNetherlands
- Department of CardiologyRadboud University Medical CenterNijmegenNetherlands
| | - Paul Poyck
- Department of Vascular SurgeryRadboud University Medical CenterNijmegenNetherlands
| | - Kathinka Peels
- Department of CardiologyCatharina HospitalEindhovenNetherlands
| | - Marco C. Post
- Department of CardiologySt. Antonius HospitalNieuwegeinNetherlands
- Department of CardiologyUniversity Medical Center UtrechtUtrechtNetherlands
| | - Mostafa M. Mokhles
- Department of Cardiothoracic SurgeryErasmus University Medical CenterRotterdamNetherlands
- Department of Cardiothoracic SurgeryUniversity Medical Center UtrechtUtrechtNetherlands
| | | | | | - Hence J. M. Verhagen
- Department of Vascular SurgeryErasmus University Medical CenterRotterdamNetherlands
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5
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Xu M, Yang F, Shen B, Wang J, Niu W, Chen H, Li N, Chen W, Wang Q, HE Z, Ding R. A bibliometric analysis of acute myocardial infarction in women from 2000 to 2022. Front Cardiovasc Med 2023; 10:1090220. [PMID: 37576112 PMCID: PMC10416645 DOI: 10.3389/fcvm.2023.1090220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/01/2023] [Indexed: 08/15/2023] Open
Abstract
Background Plenty of publications had been written in the last several decades on acute myocardial infarction (AMI) in women. However, there are few bibliometric analyses in such field. In order to solve this problem, we attempted to examine the knowledge structure and development of research about AMI in women based on analysis of related publications. Method The Web of Science Core Collection was used to extract all publications regarding AMI in women, ranging from January 2000 to August 2022. Bibliometric analysis was performed using VOSviewer, Cite Space, and an online bibliometric analysis platform. Results A total of 14,853 publications related to AMI in women were identified from 2000 to 2022. Over the past 20 years, the United States had published the most articles in international research and participated in international cooperation the most frequently. The primary research institutions were Harvard University and University of Toronto. Circulation was the most cited journal and had an incontrovertible academic impact. 67,848 authors were identified, among which Harlan M Krumholz had the most significant number of articles and Thygesen K was co-cited most often. And the most common keywords included risk factors, disease, prognosis, mortality, criteria and algorithm. Conclusion The research hotspots and trends of AMI in women were identified and explored using bibliometric and visual methods. Researches about AMI in women are flourishing. Criteria and algorithms might be the focus of research in the near future, which deserved great attentions.
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Affiliation(s)
- Ming Xu
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
- Department of Cardiology, Shanghai Navy Feature Medical Center, Naval Medical University, Shanghai, China
| | - Fupeng Yang
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Bin Shen
- Department of Cardiology, Shanghai Navy Feature Medical Center, Naval Medical University, Shanghai, China
| | - Jiamei Wang
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Wenhao Niu
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Hui Chen
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Na Li
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Wei Chen
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Qinqin Wang
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Zhiqing HE
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Ru Ding
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
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6
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Behrouzi B, Sivaswamy A, Chu A, Ferreira-Legere LE, Abdel-Qadir H, Atzema CL, Jackevicius C, Kapral MK, Wijeysundera HC, Farkouh ME, Ross HJ, Ha ACT, Tadrous M, Paterson M, Gershon AS, Džavík V, Fang J, Kaul P, van Diepen S, Goodman SG, Ezekowitz JA, Bainey KR, Ko DT, Austin PC, McAlister FA, Lee DS, Udell JA. Sex-Based Differences in Severe Outcomes, Including Cardiovascular Hospitalization, in Adults With COVID-19 in Ontario, Canada. JACC. ADVANCES 2023; 2:100307. [PMID: 37250382 PMCID: PMC10171238 DOI: 10.1016/j.jacadv.2023.100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/30/2022] [Accepted: 02/08/2023] [Indexed: 05/31/2023]
Abstract
Background While men have experienced higher risks of SARS-CoV-2 infection compared to women, an analysis of sex differences by age in severe outcomes during the acute phase of infection is lacking. Objectives The purpose of this study was to assess heterogeneity in severe outcome risks by age and sex by conducting a retrospective cohort study of community-dwelling adults in Ontario who tested positive for SARS-CoV-2 infection during the first 3 waves. Methods Adjusted odds ratios were estimated using multilevel multivariable logistic regression models including an interaction term for age and sex. The primary outcome was a composite of severe outcomes (hospitalization for a cardiovascular (CV) event, intensive care unit admission, mechanical ventilation, or death) within 30 days. Results Among 30,736, 199,132, and 186,131 adults who tested positive during the first 3 waves, 1,908 (6.2%), 5,437 (2.7%), and 5,653 (3.0%) experienced a severe outcome within 30 days. For all outcomes, the sex-specific risk depended on age (all P for interaction <0.05). Men with SARS-CoV-2 infection experienced a higher risk of outcomes than infected women of the same age, except for the risk of all-cause hospitalization being higher for young women than men (ages 18-45 years) during waves 2 and 3. The sex disparity in CV hospitalization across all ages either persisted or increased with each subsequent wave. Conclusions To mitigate risks in subsequent waves, it is helpful to further understand the factors that contribute to the generally higher risks faced by men across all ages, and the persistent or increasing sex disparity in the risk of CV hospitalization.
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Affiliation(s)
- Bahar Behrouzi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Canada
| | | | | | | | - Husam Abdel-Qadir
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Clare L Atzema
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Cynthia Jackevicius
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- College of Pharmacy, Western University of Health Sciences, Pomona, California, USA
| | - Moira K Kapral
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada
- Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Canada
| | - Heather J Ross
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada
| | - Andrew C T Ha
- Department of Medicine, University of Toronto, Toronto, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada
| | - Mina Tadrous
- ICES, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Women's College Research Institute, Toronto, Canada
| | - Michael Paterson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - Andrea S Gershon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Vladimír Džavík
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada
| | | | - Padma Kaul
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Sean van Diepen
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Shaun G Goodman
- Department of Medicine, University of Toronto, Toronto, Canada
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
- Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | - Justin A Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Kevin R Bainey
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Dennis T Ko
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Peter C Austin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - Finlay A McAlister
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Douglas S Lee
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada
| | - Jacob A Udell
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada
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7
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Gnesin F, Mills EHA, Jensen B, Møller AL, Zylyftari N, Bøggild H, Ringgren KB, Kragholm K, Blomberg SNF, Christensen HC, Lippert F, Køber L, Folke F, Torp-Pedersen C. Symptoms reported in calls to emergency medical services within 24 hours prior to out-of-hospital cardiac arrest. Resuscitation 2022; 181:86-96. [PMID: 36334842 DOI: 10.1016/j.resuscitation.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022]
Abstract
AIM There is limited evidence regarding prodromal symptoms of out-of-hospital cardiac arrest (OHCA). We aimed to describe patient characteristics, prodromal symptoms, and prognosis of patients contacting emergency medical services (EMS) within 24 hours before OHCA. METHODS We identified all OHCA treated by Copenhagen EMS from 2016 through 2018 using the Danish Cardiac Arrest Registry and linked them to emergency calls. We included all pre-arrest calls by patients or bystanders if they were performed 1) within 24 hours before the OHCA call or 2) during the OHCA event for EMS-witnessed OHCA. Calls were reviewed by healthcare professionals using a survey guide. RESULTS Among 4,071 patients, 481 patients (12 %) had 539 calls within 24 hours prior to OHCA (60 % male, median age 74 years of age). The patient spoke on the phone in 25 % of calls. The most common symptoms were breathing problems (59 %), confusion (23 %), unconsciousness (20 %), chest pain (20 %), and paleness (19 %). Patients with breathing problems compared to chest pain were more likely to be ≤ 75 years of age (55 % versus 35 %), less likely to be male (52 % versus 73 %), have shockable rhythm (10 % versus 38 %), receive bystander defibrillation (6 % versus 19 %) or EMS defibrillation (15 % versus 65 %), achieve return of spontaneous circulation (37 % versus 68 %) and survive 30 days following OHCA (10 % versus 50 %). CONCLUSION More than 10% of patients with OHCA had a call to EMS within 24 hours before OHCA. The most common symptom was breathing problems which compared to chest pain had lower 30-day survival.
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Affiliation(s)
- Filip Gnesin
- Department of Cardiology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark.
| | | | - Britta Jensen
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg E, Denmark
| | | | - Nertila Zylyftari
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 2900 Hellerup, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg E, Denmark
| | | | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | | | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark; Danish Clinical Quality Program (RKKP), National Clinical Registries, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Freddy Lippert
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Lars Køber
- Department of Cardiology, Heart Center, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 2900 Hellerup, Denmark; Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark; Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 København K, Denmark
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8
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Gaine SP, Sharma G, Tower-Rader A, Botros M, Kovell L, Parakh A, Wood MJ, Harrington CM. Multimodality Imaging in the Detection of Ischemic Heart Disease in Women. J Cardiovasc Dev Dis 2022; 9:350. [PMID: 36286302 PMCID: PMC9604786 DOI: 10.3390/jcdd9100350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
Women with coronary artery disease tend to have a worse short and long-term prognosis relative to men and the incidence of atherosclerotic cardiovascular disease is increasing. Women are less likely to present with classic anginal symptoms when compared with men and more likely to be misdiagnosed. Several non-invasive imaging modalities are available for diagnosing ischemic heart disease in women and many of these modalities can also assist with prognostication and help to guide management. Selection of the optimal imaging modality to evaluate women with possible ischemic heart disease is a scenario which clinicians often encounter. Earlier modalities such as exercise treadmill testing demonstrate significant performance variation in men and women, while newer modalities such as coronary CT angiography, myocardial perfusion imaging and cardiac magnetic resonance imaging are highly specific and sensitive for the detection of ischemia and coronary artery disease with greater parity between sexes. Individual factors, availability, diagnostic performance, and female-specific considerations such as pregnancy status may influence the decision to select one modality over another. Emerging techniques such as strain rate imaging, CT-myocardial perfusion imaging and cardiac magnetic resonance imaging present additional options for diagnosing ischemia and coronary microvascular dysfunction.
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Affiliation(s)
- Sean Paul Gaine
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Garima Sharma
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Albree Tower-Rader
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
- Division of Cardiology, Massachusetts General Hospital, Boston, MA 02214, USA
| | - Mina Botros
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Lara Kovell
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Anushri Parakh
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Malissa J. Wood
- Division of Cardiology, Massachusetts General Hospital, Boston, MA 02214, USA
| | - Colleen M. Harrington
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
- Corrigan Women’s Heart Health Program, Massachusetts General Hospital, Boston, MA 02214, USA
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9
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Sex Differences in Acute Coronary Syndromes: A Global Perspective. J Cardiovasc Dev Dis 2022; 9:jcdd9080239. [PMID: 36005403 PMCID: PMC9409655 DOI: 10.3390/jcdd9080239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 02/06/2023] Open
Abstract
Despite increasing evidence and improvements in the care of acute coronary syndromes (ACS), sex disparities in presentation, comorbidities, access to care and invasive therapies remain, even in the most developed countries. Much of the currently available data are derived from more developed regions of the world, particularly Europe and the Americas. In contrast, in more resource-constrained settings, especially in Sub-Saharan Africa and some parts of Asia, more data are needed to identify the prevalence of sex disparities in ACS, as well as factors responsible for these disparities, particularly cultural, socioeconomic, educational and psychosocial. This review summarizes the available evidence of sex differences in ACS, including risk factors, pathophysiology and biases in care from a global perspective, with a focus on each of the six different World Health Organization (WHO) regions of the world. Regional trends and disparities, gaps in evidence and solutions to mitigate these disparities are also discussed.
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10
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Nyström A, Strömberg S, Jansson K, Faresjö ÅO, Faresjö T. Cardiovascular risks before myocardial infarction differences between men and women. BMC Cardiovasc Disord 2022; 22:110. [PMID: 35300605 PMCID: PMC8928675 DOI: 10.1186/s12872-022-02555-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background Prodromal cardiac symptoms are warning signals preceding cardiac disease. Previous studies have shown some gender differences in prodromal symptoms as well as established risk factors for MI. This study aims to map possible gender differences in social factors and established risk factors preceding myocardial infarction (MI).
Methods The study includes data of N = 213 middle-aged men and women, all diagnosed with myocardial infarction (ICD-10 I21.9) from the region of south-east Sweden. They answered a questionnaire at discharge from the cardiologic clinic and additional clinical data from medical records were merged from the National Swedeheart Register.
Results The dominant prodromal symptom for both sexes were experience of chest pain at the onset of MI. The major gender differences were that significantly more females (p = 0.015) had a hyperlipidemia diagnose. Females also reported to have experienced higher stress load the year preceding myocardial infarction with serious life events (p = 0.019), strained economy (p = 0.003), and reports of sadness/depression (p < 0.001). Females reported higher perceived stress load than men (p = 0.006). Men had higher systolic blood pressure than women at hospital admission and a higher systolic- and diastolic blood pressure at discharge. Conclusions Influences of the social environment, such as serious life events, strained economy, depression, stress, and sleep deprivation were stronger as potential risk factors for myocardial infarction in women than among men. Of the traditional risk factors only, hyperlipidemia was more frequent among women. These findings could contribute to a deeper understanding of diagnostic differences between gender, as well as a more gender-oriented cardiovascular preventive work.
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Affiliation(s)
- Alice Nyström
- Department of Health, Medicine and Care, General Practice, Linköping University, 581 83, Linkoping, Sweden
| | - Susanne Strömberg
- Department of Health, Medicine and Care, General Practice, Linköping University, 581 83, Linkoping, Sweden
| | - Karin Jansson
- Department of Cardiology, Vrinnevi Hospital, Norrköping, Region of Ostergotland, Sweden
| | - Åshild Olsen Faresjö
- Department of Health, Medicine and Care, General Practice, Linköping University, 581 83, Linkoping, Sweden
| | - Tomas Faresjö
- Department of Health, Medicine and Care, General Practice, Linköping University, 581 83, Linkoping, Sweden.
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11
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Xi Z, Qiu H, Guo T, Wang Y, Li J, Li Y, Zheng J, Gao R. Contemporary sex differences in mortality among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis. BMJ Open 2022; 12:e053379. [PMID: 35264344 PMCID: PMC8915368 DOI: 10.1136/bmjopen-2021-053379] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess the effect of sex differences on short-term and long-term mortality among patients with ST-segment elevation myocardial infarction (STEMI). DESIGN Systematic review and meta-analysis of contemporary available evidence. SETTING PubMed, Embase and Cochrane Library were searched for relevant studies reporting sex-specific outcomes among patients with STEMI published between 1 January 2010 and 1 August 2020. Risk ratios (RRs) and 95% CIs were measured using DerSimonian and Laird random-effects model. Sensitivity analyses were performed and publication bias was also checked. All statistical analyses were performed using STATA V.15.0. PARTICIPANTS Studies providing data about short-term or long-term mortality stratified by sex in patients with STEMI were included. Only study conducted in last 10 years were included. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was all-cause death at short-term (in-hospital or 30 days) and long-term (at least 12 months) follow-up. RESULTS A total of 15 studies involving 128 585 patients (31 706 (24.7%) female and 96 879 (75.3%) male) were included. In the unadjusted analyses, female were at a higher risk of short-term mortality (RR, 1.73; 95% CI 1.53 to 1.96, p<0.001, I2=77%) but not long-term mortality (RR, 1.23; 95% CI 0.89 to 1.69, p=0.206, I2=77.5%). When adjusted effect estimates from individual studies were used in meta-analysis, the association between female and higher risk of short-term mortality remained significant (RR, 1.24; 95% CI 1.11 to 1.38, p<0.001, I2=39.6%). And adjusted long-term mortality was also similar between female and male (RR, 1.11; 95% CI 0.42 to 1.80, p=0.670, I2=74.5%). CONCLUSIONS An increased short-term but not long-term mortality was found in female with STEMI. After adjustment for baseline cardiovascular risk factors and clinical profiles, short-term mortality remains higher in female with STEMI compared with male, indicating the need for further improvements in management in female patients.
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Affiliation(s)
- Ziwei Xi
- Department of Cardiology, Coronary artery disease center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Qiu
- Department of Cardiology, Coronary artery disease center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tingting Guo
- Thrombosis Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Wang
- Department of Cardiology, Coronary artery disease center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianan Li
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Beijing, China
| | - Yang Li
- Department of Cardiology, Coronary artery disease center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianfeng Zheng
- Department of Cardiology, Coronary artery disease center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - R Gao
- Department of Cardiology, Coronary artery disease center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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12
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Sella YO, Manistamara H, Apriliawan S, Lukitasari M, Rohman MS. Characteristic differences of chest pain in male and female patients with acute coronary syndrome: A pilot study. J Public Health Res 2021; 10. [PMID: 33855424 PMCID: PMC8129765 DOI: 10.4081/jphr.2021.2242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The typical sign or main symptom in acute coronary syndrome (ACS) patients is chest pain, which is an initial benchmark or early sign for diagnosis. Certain factors, such as gender differences, the presence of diabetes mellitus or other clinical conditions, may make the patient not realize they have ACS. Therefore, this study aims to identify the characteristics of chest pain symptoms in male and female patients with ACS. Design and Methods: This is a non-experimental quantitative study, namely analytical observation using a cross-sectional approach within 4 months (January-April 2019). Furthermore, the samples were 53 ACS patients (28 male and 25 female). Results: The chest pain characteristics that have a significant relationship with gender differences in ACS patients are shown based on the aspects of location, pain duration and quality. Male patients are more likely to feel pain at the left or middle chest, the duration is between <20 to >20 min with moderate pain quality, which tends to become severe, while females are more likely to feel pain at the chest which radiates to the neck and chin, the duration is usually >20 min, with mild to moderate pain quality. Conclusions: The result showed a significant difference in chest pain characteristics in male and female patients with ACS. Regarding location, duration and quality of chest pain, male ACS patients mostly have more typical symptoms, while females’ symptoms are atypical. Significance for public health There are various characteristics of chest pain differences between male and female patients with Acute Coronary Syndrome. The findings of this study showed that it is important to provide optimal nursing care and also educate patients and families about the signs, or symptoms that often occur, especially atypical symptoms. This will reduce the tendency to delay in seeking treatment, which will affect prehospital delay time.
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Affiliation(s)
| | | | - Sony Apriliawan
- Department of Nursing, Faculty of Medicine, Universitas Brawijaya, Malang.
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13
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Colella TJ, Hardy M, Hart D, Price JA, Sarfi H, Mullen KA, Mulvagh S, Norris CM. The Canadian Women's Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women-Chapter 3: Patient Perspectives. CJC Open 2021; 3:229-235. [PMID: 33778439 PMCID: PMC7985007 DOI: 10.1016/j.cjco.2020.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/23/2020] [Indexed: 11/21/2022] Open
Abstract
In recent years, public awareness campaigns have targeted knowledge gaps and inequities in care while focusing on the unique female experience and heightened cardiovascular disease (CVD) risk profile. Recognizing and understanding the sex and gender constructs, barriers, facilitators, and factors that affect access, treatment, and recovery after an acute cardiac event from the unique patient perspective is a key step in transforming clinical practice and care patterns. The aim of this atlas chapter is to provide a knowledge review and to identify gaps regarding the experience of living with CVD from the perspective of the female survivor. The sections are as follows: (1) experiencing and living with CVD as a woman; (2) "stopped at the gate": barriers to accessing acute cardiovascular care; and (3) action items to "open the gate" to women: what our patients want and need. The final section culminates with targeted recommendations stemming from recent literature and most importantly, from women with the lived experience of CVD.
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Affiliation(s)
- Tracey J.F. Colella
- Toronto Rehab Cardiovascular Prevention and Rehabilitation Program, University Health Network, Toronto, Ontario, Canada
| | - Marsha Hardy
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | - Donna Hart
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | - Jennifer A.D. Price
- Women’s College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Hope Sarfi
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | - Kerri-Anne Mullen
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sharon Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
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14
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Ahearn P, Johansen KL, Tan JC, McCulloch CE, Grimes BA, Ku E. Sex Disparity in Deceased-Donor Kidney Transplant Access by Cause of Kidney Disease. Clin J Am Soc Nephrol 2021; 16:241-250. [PMID: 33500250 PMCID: PMC7863650 DOI: 10.2215/cjn.09140620] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 12/14/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Women with kidney failure have lower access to kidney transplantation compared with men, but the magnitude of this disparity may not be uniform across all kidney diseases. We hypothesized that the attributed cause of kidney failure may modify the magnitude of the disparities in transplant access by sex. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a retrospective cohort study of adults who developed kidney failure between 2005 and 2017 according to the United States Renal Data System. We used adjusted Cox models to examine the association between sex and either access to waitlist registration or deceased-donor kidney transplantation, and tested for interaction between sex and the attributed cause of kidney failure using adjusted models. RESULTS Among a total of 1,478,037 patients, 271,111 were registered on the waitlist and 89,574 underwent deceased-donor transplantation. The rate of waitlisting was 6.5 per 100 person-years in women and 8.3 per 100 person-years for men. In adjusted analysis, women had lower access to the waitlist (hazard ratio, 0.89; 95% confidence interval, 0.89 to 0.90) and to deceased-donor transplantation after waitlisting (hazard ratio, 0.96; 95% confidence interval, 0.94 to 0.98). However, there was an interaction between sex and attributed cause of kidney disease in adjusted models (P<0.001). Women with kidney failure due to type 2 diabetes had 27% lower access to the kidney transplant waitlist (hazard ratio, 0.73; 95% confidence interval, 0.72 to 0.74) and 11% lower access to deceased-donor transplantation after waitlisting compared with men (hazard ratio, 0.89; 95% confidence interval, 0.86 to 0.92). In contrast, sex disparities in access to either the waitlist or transplantation were not observed in kidney failure secondary to cystic disease. CONCLUSIONS The disparity in transplant access by sex is not consistent across all causes of kidney failure. Lower deceased-donor transplantation rates in women compared with men are especially notable among patients with kidney failure attributed to diabetes.
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Affiliation(s)
- Patrick Ahearn
- Division of Nephrology, Stanford University, Palo Alto, California
| | - Kirsten L. Johansen
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota,Division of Nephrology, University of Minnesota, Minneapolis, Minnesota
| | - Jane C. Tan
- Division of Nephrology, Stanford University, Palo Alto, California
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Barbara A. Grimes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Elaine Ku
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California,Division of Nephrology, University of California, San Francisco, California,Division of Pediatric Nephrology, University of California, San Francisco, California
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15
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Snavely AC, Hendley N, Stopyra JP, Lenoir KM, Wells BJ, Herrington DM, Hiestand BC, Miller CD, Mahler SA. Sex and race differences in safety and effectiveness of the HEART pathway accelerated diagnostic protocol for acute chest pain. Am Heart J 2021; 232:125-136. [PMID: 33160945 DOI: 10.1016/j.ahj.2020.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/01/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND The HEART Pathway is an accelerated diagnostic protocol for Emergency Department patients with possible acute coronary syndrome. The objective was to compare the safety and effectiveness of the HEART Pathway among women vs men and whites vs non-whites. METHODS A subgroup analysis of the HEART Pathway Implementation Study was conducted. Adults with chest pain were accrued from November 2013 to January 2016 from 3 Emergency Departments in North Carolina. The primary outcomes were death and myocardial infarction (MI) and hospitalization rates at 30 days. Logistic regression evaluated for interactions of accelerated diagnostic protocol implementation with sex or race and changes in outcomes within subgroups. RESULTS A total of 8,474 patients were accrued, of which 53.6% were female and 34.0% were non-white. The HEART Pathway identified 32.6% of females as low-risk vs 28.5% of males (P = 002) and 35.6% of non-whites as low-risk vs 28.0% of whites (P < .0001). Among low-risk patients, death or MI at 30 days occurred in 0.4% of females vs 0.5% of males (P = .70) and 0.5% of non-whites vs 0.3% of whites (P = .69). Hospitalization at 30 days was reduced by 6.6% in females (aOR: 0.74, 95% CI: 0.64-0.85), 5.1% in males (aOR: 0.87, 95% CI: 0.75-1.02), 8.6% in non-whites (aOR: 0.72, 95% CI: 0.60-0.86), and 4.5% in whites (aOR: 0.83, 95% CI: 0.73-0.94). Interactions were not significant. CONCLUSION Women and non-whites are more likely to be classified as low-risk by the HEART Pathway. HEART Pathway implementation is associated with decreased hospitalizations and a very low death and MI rate among low-risk patients regardless of sex or race.
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16
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Impact of STEMI Diagnosis and Catheterization Laboratory Activation Systems on Sex- and Age-Based Differences in Treatment Delay. CJC Open 2021; 3:723-732. [PMID: 34169251 PMCID: PMC8209393 DOI: 10.1016/j.cjco.2021.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Women and the elderly with ST-elevation myocardial infarction (STEMI) experience longer treatment delays despite prehospital STEMI diagnosis and catheterization laboratory activation systems. It is not known what role specific STEMI referral systems might play in mediating this gap in care. We therefore examined sex- and age-based differences in STEMI treatment delay (TD) in different STEMI activation systems. Methods This observational comparative effectiveness study comprised 3 retrospective STEMI cohorts: a traditional hospital-based activation cohort (Cohort 1), an automated “physician-blind” prehospital activation cohort (Cohort 2), and a prehospital activation with real-time physician oversight cohort (Cohort 3). Outcomes of interest included sex and age group (< or ≥ 75 years) differences in suboptimal (> 90 minutes) first medical contact-to-device time (FMC-to-device) within each cohort, as well as independent predictors of suboptimal FMC-to-device and in-hospital mortality across cohorts. Results Five hundred-sixty STEMI activations were analyzed. In Cohort 1 (n = 179), women and those ≥ 75 were more likely to experience suboptimal FMC-to-device times (78.7% vs 36.4%, P = 0.02 and 85.0% vs 58.3%, < 0.01, respectively). Similar findings were observed in Cohort 3 (n = 109) (53.5% vs 32.9%, 56.5% vs 33.3%, respectively; P = 0.05, for both). In Cohort 2 (n = 272), however, there was no significant age-based difference (30.4% vs 21.7%, P = 0.18), and the gap was numerically lower but still significant for women (32.1% vs 20.1%, P = 0.04). When examining prehospital activation cohorts only, female sex (P = 0.03), off-hours presentation (P < 0.01), and physician oversight (P < 0.01) were independent predictors of longer FMC-to-device times. Age ≥ 75 (P < 0.01), Killip class (P < 0.01), and female sex (P = 0.04) were independently associated with in-hospital mortality. Conclusions Automated “physician-blind” STEMI activation was associated with a reduced TD gap in women and the elderly, suggesting possible systemic bias. Appropriately powered confirmatory studies are required, but incorporating automated diagnosis and catheterization laboratory activation may be a solution to treatment gaps in STEMI care.
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17
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Outcomes and Procedural Considerations for Women Undergoing PCI. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00888-w] [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: 11/28/2022]
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18
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Nguyen HC, Qadura M, Singh KK. Role of the Fatty Acid Binding Proteins in Cardiovascular Diseases: A Systematic Review. J Clin Med 2020; 9:E3390. [PMID: 33105856 PMCID: PMC7690604 DOI: 10.3390/jcm9113390] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular diseases (CVD) remain a global pandemic and leading cause of deaths worldwide. While several guidelines have been developed to control the development of CVDs, its prevalence keeps on increasing until this day. Cardiovascular risk factors, such as reduced exercises and high fat or glucose diets, culminate in the development of the metabolic syndrome and eventually atherosclerosis, which is driven by high blood lipid and cholesterol levels, and by endothelial dysfunction. Late complications of atherosclerosis give rise to serious clinical cardiovascular manifestations such as myocardial infarction and hypertension. Therefore, endothelial functions and the lipid metabolism play critical roles in the pathogenesis of CVDs. Fatty acid-binding proteins are a family of intracellular proteins expressed in many cell types known mainly for their interaction with and trafficking of cellular lipids. The roles of a number of isoforms in this family have been implicated in lipid metabolic homeostasis, but their influence on endothelial function and vascular homeostasis remain largely unknown. This review's purpose is to update fundamentals about the connection between cardiovascular disease, metabolism, endothelial function, and mainly the roles of fatty acid-binding proteins.
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Affiliation(s)
- Hien C. Nguyen
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada;
| | - Mohammad Qadura
- Vascular Surgery, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada;
| | - Krishna K. Singh
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada;
- Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada
- Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A1, Canada
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19
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Kouvari M, Souliotis K, Yannakoulia M, Panagiotakos DB. Cardiovascular Diseases in Women: Policies and Practices Around the Globe to Achieve Gender Equity in Cardiac Health. Risk Manag Healthc Policy 2020; 13:2079-2094. [PMID: 33116988 PMCID: PMC7567535 DOI: 10.2147/rmhp.s264672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
The women's global health agenda has recently been reformulated to address more accurately cardiovascular disease (CVD) prevention, diagnosis, and treatment. The aim of the present work was to review the global and national policies and practices that address sex equality in health with a focus on CVDs in women. Scientific databases and health organizations' websites that presented/discussed policies and initiative targeting to enhance a sex-centered approach regarding general health and/or specifically cardiac health care were reviewed in a systematic way. In total, 61 relevant documents were selected. The selected policies and initiatives included position statements, national action plans, evidence-based guidelines, guidance/recommendations, awareness campaigns, regulations/legislation, and state-of-the art reports by national/international projects and conferences. The target audiences of large stakeholders (eg, American Heart Association, European Society of Cardiology, Centers for Disease Control and Prevention) were female citizens, health professionals, and researchers. Much as policy-makers have recognized the sex/gender gap in the CVD field, there is still much to be done. Thereby, tailor-made strategies should be designed, evaluated, and delivered on a global and most importantly a national basis to achieve gender equity with regard to CVDs.
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Affiliation(s)
- Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Kyriakos Souliotis
- Faculty of Social Sciences, University of Peloponnese, Korinthos, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Faculty of Health, University of Canberra, Bruce, Canberra, Australia
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20
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Bortnick AE, Shahid M, Shitole SG, Park M, Broder A, Rodriguez CJ, Scheuer J, Faillace R, Kizer JR. Outcomes of ST-elevation myocardial infarction by age and sex in a low-income urban community: The Montefiore STEMI Registry. Clin Cardiol 2020; 43:1100-1109. [PMID: 33460205 PMCID: PMC7533997 DOI: 10.1002/clc.23412] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/02/2020] [Accepted: 06/11/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To compare outcomes by age and sex in race/ethnic minorities presenting with ST-elevation myocardial infarction (STEMI), as studies are limited. METHODS We studied sociodemographics, management, and outcomes in 1208 STEMI patients evaluated for primary percutaneous coronary intervention between 2008 and 2014 at Montefiore Health System (Bronx, NY). A majority of patients self-identified as nonwhite, and nearly two-thirds were young (<45 years) or middle-aged (45-64 years). RESULTS Risk factors varied significantly across age groups; with more women and non-Hispanic whites, hypertension, diabetes, dyslipidemia, prior cardiovascular disease, non-sinus rhythm, and collagen vascular disease in the older age group (≥65 years); and higher body mass index, smoking, cocaine use, human immunodeficiency virus (HIV) infection and family history of heart disease in the young. Younger women had lower summary socioeconomic scores than younger men. Middle-aged women had more obesity and dysmetabolism, while men had more heavy alcohol use. There was greater disease severity with increasing age; with higher cardiac biomarkers, 3-vessel disease, cardiogenic shock, and coronary artery bypass grafting. Older patients had higher rates of death and death or readmission over 4.3 (interquartile range 2.4, 6.0) years of follow-up. Middle-aged women had higher rates of death or any readmission than men, but these differences were not significant after adjustment. CONCLUSIONS These findings indicate a high burden of risk factors in younger adults with STEMI from an inner-city community. Programs to target sociobehavioral factors in disadvantaged settings, including substance abuse, obesity, and risk of HIV, are necessary to more effectively address health disparities in STEMI and its adverse consequences.
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Affiliation(s)
- Anna E. Bortnick
- Department of Medicine, Division of CardiologyMontefiore Medical Center and Albert Einstein College of MedicineBronxNew YorkUSA
| | - Muhammad Shahid
- Department of Medicine, Division of CardiologyMontefiore Medical Center and Albert Einstein College of MedicineBronxNew YorkUSA
| | - Sanyog G. Shitole
- Cardiology Section, San Francisco Veterans Affairs Health Care System, and Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Michael Park
- Department of Medicine, Division of Cardiovascular MedicineUniversity of BuffaloBuffaloNew YorkUSA
| | - Anna Broder
- Department of Medicine, Division of RheumatologyMontefiore Medical Center and Albert Einstein College of MedicineBronxNew YorkUSA
| | - Carlos J. Rodriguez
- Department of Medicine, Division of CardiologyMontefiore Medical Center and Albert Einstein College of MedicineBronxNew YorkUSA
- Department of Epidemiology and BiostatisticsAlbert Einstein College of MedicineBronxNew YorkUSA
| | - James Scheuer
- Department of Medicine, Division of CardiologyMontefiore Medical Center and Albert Einstein College of MedicineBronxNew YorkUSA
| | - Robert Faillace
- NYC Health and Hospitals Jacobi Medical Center and North Central Bronx HospitalBronxNew YorkUSA
| | - Jorge R. Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System, and Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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21
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Zhang R, Song B, Hong X, Shen Z, Sui L, Wang S. microRNA-9 Inhibits Vulnerable Plaque Formation and Vascular Remodeling via Suppression of the SDC2-Dependent FAK/ERK Signaling Pathway in Mice With Atherosclerosis. Front Physiol 2020; 11:804. [PMID: 32765295 PMCID: PMC7378740 DOI: 10.3389/fphys.2020.00804] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/17/2020] [Indexed: 12/13/2022] Open
Abstract
microRNAs (miRNAs or miRs) play important roles in modulating the occurrence and progression of atherosclerosis and acute coronary syndrome (ACS). Herein, this study aimed to investigate the possible role of miR-9 in the development of atherosclerosis. Initially, the differentially expressed genes associated with ACS were screened and miRNAs that regulate syndecan-2 (SDC2) were predicted using microarray analysis. Furthermore, the biological functions of miR-9 and SDC2 on aortic plaque area, proliferation of collagen fibers, Mac-3-labeled macrophages, inflammatory response, and levels of the focal adhesion kinase/extracellular signal-regulated kinase (FAK/ERK) signaling pathway-related proteins in atherosclerosis were evaluated after ectopic miR-9 expression or SDC2 depletion in ACS mice using oil red O staining, Masson’s trichrome staining, immunohistochemistry, and Western blot analysis, respectively. SDC2 was highly-expressed, while miR-9 was poorly-expressed in atherosclerosis. Additionally, miR-9 targeted SDC2 and negatively-regulated its expression. Up-regulation of miR-9 reduced aortic plaque area, the proliferation of collagen fibers, Mac-3-labeled macrophages and levels of IL-6, IL-1β, and TNF-α by suppressing SDC2 and the FAK/ERK signaling pathway, thereby ameliorating atherosclerosis in ACS mice. In conclusion, the current study provides evidence that miR-9 retards atherosclerosis by repressing SDC2 and the FAK/ERK signaling pathway, highlighting a new theoretical basis for the treatment of atherosclerosis.
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Affiliation(s)
- Ruihong Zhang
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Beibei Song
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaojian Hong
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhiyuan Shen
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li Sui
- Department of Emergency, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Siyu Wang
- Department of Medical Oncology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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22
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van Oosterhout REM, de Boer AR, Maas AHEM, Rutten FH, Bots ML, Peters SAE. Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta-analysis. J Am Heart Assoc 2020; 9:e014733. [PMID: 32363989 PMCID: PMC7428564 DOI: 10.1161/jaha.119.014733] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/13/2020] [Indexed: 12/24/2022]
Abstract
Background Timely recognition of patients with acute coronary syndromes (ACS) is important for successful treatment. Previous research has suggested that women with ACS present with different symptoms compared with men. This review assessed the extent of sex differences in symptom presentation in patients with confirmed ACS. Methods and Results A systematic literature search was conducted in PubMed, Embase, and Cochrane up to June 2019. Two reviewers independently screened title-abstracts and full-texts according to predefined inclusion and exclusion criteria. Methodological quality was assessed using the Newcastle-Ottawa Scale. Pooled odds ratios (OR) with 95% CI of a symptom being present were calculated using aggregated and cumulative meta-analyses as well as sex-specific pooled prevalences for each symptom. Twenty-seven studies were included. Compared with men, women with ACS had higher odds of presenting with pain between the shoulder blades (OR 2.15; 95% CI, 1.95-2.37), nausea or vomiting (OR 1.64; 95% CI, 1.48-1.82) and shortness of breath (OR 1.34; 95% CI, 1.21-1.48). Women had lower odds of presenting with chest pain (OR 0.70; 95% CI, 0.63-0.78) and diaphoresis (OR 0.84; 95% CI, 0.76-0.94). Both sexes presented most often with chest pain (pooled prevalences, men 79%; 95% CI, 72-85, pooled prevalences, women 74%; 95% CI, 72-85). Other symptoms also showed substantial overlap in prevalence. The presence of sex differences has been established since the early 2000s. Newer studies did not materially change cumulative findings. Conclusions Women with ACS do have different symptoms at presentation than men with ACS, but there is also considerable overlap. Since these differences have been shown for years, symptoms should no longer be labeled as "atypical" or "typical."
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Affiliation(s)
- Roos E. M. van Oosterhout
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Annemarijn R. de Boer
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
- Dutch Heart FoundationThe Haguethe Netherlands
| | - Angela H. E. M. Maas
- Department of CardiologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Frans H. Rutten
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Sanne A. E. Peters
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
- The George Institute for Global HealthUniversity of OxfordUnited Kingdom
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23
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DeVon HA, Mirzaei S, Zègre‐Hemsey J. Typical and Atypical Symptoms of Acute Coronary Syndrome: Time to Retire the Terms? J Am Heart Assoc 2020; 9:e015539. [PMID: 32208828 PMCID: PMC7428604 DOI: 10.1161/jaha.119.015539] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/18/2020] [Indexed: 01/12/2023]
Abstract
Studies indicate that symptoms labeled as "atypical" are more common in women evaluated for myocardial infarction (MI) and may contribute to the lower likelihood of a diagnosis and delayed treatment and result in poorer outcomes compared with men with MI. Atypical pain is frequently defined as epigastric or back pain or pain that is described as burning, stabbing, or characteristic of indigestion. Typical symptoms usually include chest, arm, or jaw pain described as dull, heavy, tight, or crushing. In a recent article published in the Journal of the American Heart Association (JAHA), Ferry and colleagues addressed presenting symptoms in men and women diagnosed with MI and reported that typical symptoms in women were more predictive of a diagnosis of MI than for men. A critical question is, are there really typical or atypical symptoms, and if so, who is the reference group? We propose that researchers and clinicians either discontinue using the terms typical and atypical or provide the reference group to which the terms apply (eg, men versus women). We believe it is past time to standardize the symptom assessment for MI so that proper and rapid diagnostic testing can be undertaken; however, we cannot standardize the symptom experience. When we do this, we are at risk of having study results, such as those of Ferry and colleagues, that vary from prior evidence and could lead to what the authors hope to avoid: disadvantaging women in receiving expeditious diagnostic testing and treatment for acute coronary syndrome.
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24
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Brush JE, Krumholz HM, Greene EJ, Dreyer RP. Sex Differences in Symptom Phenotypes Among Patients With Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2020; 13:e005948. [PMID: 32063049 DOI: 10.1161/circoutcomes.119.005948] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The diagnosis of acute myocardial infarction (AMI) is missed more frequently in young women than men, which may be related to the cognitive psychology of the diagnostic process. Physicians start the diagnostic process by intuitively recognizing familiar symptom phenotypes, but little is known about how symptoms combine in individuals as unique symptom phenotypes. We examined how symptoms of AMI combine as unique symptom phenotypes in individual patients to compare the distribution of symptom phenotypes in women versus men. METHODS AND RESULTS The VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) was a multicenter, observational cohort study of 3501 young adults hospitalized with AMI. Data were collected on presenting symptoms with standardized interviews and from medical record abstraction. The number and distribution of unique symptom phenotypes were compared between women and men. Because of the 2:1 female-to-male enrollment ratio, women and men were compared with permutation testing and repeated subsampling. There were 426 interview-symptom phenotypes in women and 280 in men. The observed difference between women and men of 146 phenotypes was significant, even allowing for the greater enrollment of women (permutation P=0.004, median difference 110 under the null hypothesis of no association between sex and phenotype). The repeated subsample analysis also showed significantly more interview-symptom phenotypes in women than men (206.8±7.3 versus 188.6±6.0, P<0.001). Women were more broadly distributed among symptom phenotype subgroups than men (P<0.001). Similar findings were observed in the analysis of symptoms abstracted from the medical record. CONCLUSIONS Women exhibited substantially more variation in unique symptom phenotypes than men, regardless of whether the symptoms were derived from structured interviews or abstracted from the medical record. These findings may provide an explanation for the higher missed diagnosis rate in young women with AMI and may have important implications for teaching and improving clinicians' ability to recognize the diagnosis of AMI in women.
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Affiliation(s)
- John E Brush
- Sentara Healthcare and Eastern Virginia Medical School, Norfolk, VA (J.E.B)
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K), Yale School of Medicine.,Department of Health Policy and Management (H.M.K), Yale School of Public Health.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K, R.P.D)
| | - Erich J Greene
- Department of Biostatistics (E.J.G), Yale School of Public Health
| | - Rachel P Dreyer
- Department of Emergency Medicine (R.P.D), Yale School of Medicine.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K, R.P.D)
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25
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Sweeney M, Bleeze G, Storey S, Cairns A, Taylor A, Holmes C, Hart S, Lawrance N, Oldfield WG, Baker CS. The impact of an acute chest pain pathway on the investigation and management of cardiac chest pain. Future Healthc J 2020; 7:53-59. [PMID: 32104767 PMCID: PMC7032589 DOI: 10.7861/fhj.2019-0025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Emergency department (ED) presentation with chest pain accounts for approximately 20% of acute hospital admissions, and delays in the investigation and management of these patients increase the pressure on emergency and medical departments. We implemented a pathway within our trust to improve the efficiency of acute chest pain management. This included the development of a chest pain management algorithm, a short-stay heart assessment centre and a policy to immediately transfer acute coronary syndrome patients to cardiology. The introduction of the chest pain pathway resulted in fewer admissions from the ED with chest pain (34.2% vs 19.0%; p<0.0001), a reduction in time from ED attendance to cardiology transfer (9.3 hours vs 5.7 hours; p<0.0001) and a reduction in time to angiography (62.5 hours vs 26.6 hours; p<0.0001). Length of stay was reduced for cardiology patients (4.7 days vs 2.4 days, p<0.001) and mean length of stay for all patients attending ED with chest pain was reduced by 8.3 hours (27.5 hours vs 19.1 hours; p<0.0001). The changes have significantly improved the management of acute chest pain within our trust and we would suggest that adoption of these changes in other trusts could significantly improve the quality of the care for these patients throughout the NHS.
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Affiliation(s)
- Mark Sweeney
- Imperial College Healthcare NHS Trust, London, UK and London Institute of Medical Science, London, UK
| | | | - Sarah Storey
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | - Steve Hart
- Imperial College Healthcare NHS Trust, London, UK
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26
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Ko Y, Chee W, Im EO. Evaluation of the cardiovascular symptom index for midlife women in multiethnic/racial midlife women. Health Care Women Int 2019; 41:489-506. [PMID: 31809655 DOI: 10.1080/07399332.2019.1694521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The authors' purpose of this study was to evaluate the validity and reliability of the Cardiovascular Symptom Index for Midlife Women in four ethnic/racial groups of midlife women in the U.S. Data from two internet surveys were used for this secondary analysis. In the construct validity test, five factors were extracted among White and Hispanic women, while more than five factors were extracted among Asian and African American women. In the convergent validity test, all ethnic/racial groups showed similar patterns. Adequate internal consistency among was shown. The Cardiovascular Symptom Index for Midlife Women is useful for assessing cardiovascular symptoms in multiethnic/racial women.
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Affiliation(s)
- Young Ko
- College of Nursing, Gachon University, Incheon, South of Korea
| | - Wonshik Chee
- College of Nursing, Duke University, Durham, North Carolina, USA
| | - Eun-Ok Im
- School of Nursing, Duke University, Durham, North Carolina, USA
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27
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Knight EP, Slebodnik M, Pinder C, DeVon HA. Communicating acute coronary syndrome risk to women in primary care: A scoping review of the literature. PATIENT EDUCATION AND COUNSELING 2019; 102:2156-2161. [PMID: 31326246 DOI: 10.1016/j.pec.2019.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/05/2019] [Accepted: 07/10/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Delay from symptom onset to hospital arrival drives poor outcomes in acute coronary syndrome (ACS), particularly for women. Primary care clinicians can discuss ACS with high-risk women, potentially reducing delay. We conducted a scoping review to assess what is known about ACS risk communication to women in primary care. METHODS We used Arksey and O'Malley's framework. The PubMed, CINAHL, PsycINFO, and Embase databases were searched for relevant articles from inception through September, 2018. No restrictions on study methodology were applied. At least two reviewers assessed each article. Articles addressing risk communication, coronary heart disease, and ACS, related to primary care settings, and including women were retained. RESULTS Eleven articles met inclusion criteria. Cardiovascular disease (CVD) risk communication is common in primary care; however, ACS symptoms are rarely discussed. Structured risk calculators are used to frame discussions. Communication styles include patient-centered discussions, paternalistic orders, and "scare tactics;" no single style is more effective. Analysis of gender differences in risk communication is extremely limited. CONCLUSION There is scant evidence that primary care clinicians communicate effectively about ACS risk, symptoms, and appropriate symptom response. PRACTICE IMPLICATIONS Interventions are needed to improve communication about ACS to at-risk women in the primary care setting.
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Affiliation(s)
- Elizabeth P Knight
- Oregon Health & Science University School of Nursing, Portland, OR, USA.
| | | | - Clare Pinder
- University of Arizona College of Nursing, Tucson, AZ, USA
| | - Holli A DeVon
- University of Illinois at Chicago College of Nursing, Chicago, IL, USA
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28
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Paramasivam G, Devasia T, Ubaid S, Shetty A, Nayak K, Pai U, Rao MS. In-stent restenosis of drug-eluting stents: clinical presentation and outcomes in a real-world scenario. Egypt Heart J 2019; 71:28. [PMID: 31773342 PMCID: PMC6879682 DOI: 10.1186/s43044-019-0025-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/01/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Drug-eluting stents (DES) have substantially reduced the incidence of coronary in-stent restenosis (ISR), but the problem persists. Clinical presentation and outcomes of DES-ISR in a real-world scenario remains underreported. RESULTS In this retrospective study, we examined medical records of 191 consecutive patients with DES-ISR (210 ISR lesions) hospitalized between January 2013 and December 2017. ISR clinical presentation was classified as acute coronary syndrome (ACS) or non-ACS. Clinical, angiographic features and 1-year outcomes [composite of death, myocardial infarction (MI) and repeat-target lesion revascularization] for these two groups were compared. The mean age of study population was 61 ± 10 years and 81.2% were males. ACS was the dominant clinical presentation mode occurring in 118 (61.8%) patients. MI was seen in 66 (34.6%) patients. Female gender (odds ratio, 2.71; 95% confidence interval [CI], 1.13-6.52; P = 0.026) and chronic kidney disease (odds ratio, 3.85; 95% CI, 1.05-14.20; P = 0.043) correlated significantly with ACS ISR presentation. A majority [104 (54.5%)] of patients underwent percutaneous coronary intervention (PCI), of whom 72 (69.2%) received a new DES. The rest either underwent CABG (26.2%) or received medical therapy (19.4%). Patients presenting with ACS had a significantly worse clinical outcome at 1-year follow-up (ACS versus non-ACS presentation: hazard ratio [HR], 2.66; 95% CI, 1.09-6.50; P = 0.032). CONCLUSIONS DES-ISR presents most commonly as ACS. Female gender and chronic kidney disease seem to be associated with ACS presentation. ACS presentation of ISR is associated with worse 1-year outcomes. Early identification of those with ACS risk and closer follow-up may improve outcomes.
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Affiliation(s)
- Ganesh Paramasivam
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Tom Devasia
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Shabeer Ubaid
- Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Ashwitha Shetty
- Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Krishnananda Nayak
- Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Umesh Pai
- Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Mugula Sudhakar Rao
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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29
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Reuter PG, Pradeau C, Huo Yung Kai S, Lhermusier T, Bourdé A, Tentillier E, Combes X, Bongard V, Ducassé JL, Charpentier S. Predicting acute coronary syndrome in males and females with chest pain who call an emergency medical communication centre. Scand J Trauma Resusc Emerg Med 2019; 27:92. [PMID: 31623657 PMCID: PMC6798370 DOI: 10.1186/s13049-019-0670-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022] Open
Abstract
Background Chest pain is a frequent reason for calls in emergency medical communication centre (EMCC). Detecting a coronary origin by phone is a challenge. This is especially so as the presentations differ according to gender. We aimed to establish and validate a sex-based model to predict a coronary origin of chest pain in patients calling an EMCC. Methods This prospective cohort study enrolled patients at 18 years of age or older who called the EMCC because of non-traumatic chest pain. The main outcome was the diagnosis of acute coronary syndrome (ACS) determined by expert evaluation of patient files. Results During 18 months, 3727 patients were enrolled: 2097 (56%) men and 1630 (44%) women. ACS was diagnosed in 508 (24%) men and 139 (9%) women. For men, independent factors associated with an ACS diagnosis were age, tobacco use, severe and permanent pain; retrosternal, breathing non-related and radiating pain; and additional symptoms. The area under the receiver operating characteristic curve (AUC) was 0.76 (95% confidence interval [CI] 0.73–0.79) for predicting ACS. The accuracy of the male model to predict ACS was validated in a validation dataset (Hosmer-Lemeshow test: p = 0.554); the AUC was 0.77 (95%CI 0.73–0.80). For women, independent factors associated with an ACS diagnosis were age ≥ 60 years, personal history of coronary artery disease, and breathing non-related and radiating pain. The AUC was 0.79 (95%CI 0.75–0.83). The accuracy of the female model to predict ACS was not validated in the validation dataset (Hosmer-Lemeshow test: p = 0.035); the AUC was 0.67 (95%CI 0.60–0.74). Conclusions Predictors of an ACS diagnosis in patients calling an EMCC for chest pain differ between men and women. We developed an accurate predictive model for men, but for women, the accuracy was poor. Trial registration This study is registered with ClinicalTrials.gov (NCT02042209).
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Affiliation(s)
- Paul-Georges Reuter
- Emergency Department, Toulouse University Hospital, 31000, Toulouse, France. .,UMR 1027, Paul Sabatier University Toulouse III, Inserm, Toulouse, France. .,SAMU 92, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond Poincaré, 92380, Garches, France.
| | | | - Samantha Huo Yung Kai
- UMR 1027, Paul Sabatier University Toulouse III, Inserm, Toulouse, France.,Unité de Soutien Méthodologique à la Recherche (USMR), Centre Hospitalier Universitaire de Toulouse (CHU de Toulouse), Toulouse, France
| | | | - Arnaud Bourdé
- Department of Emergency, CHU de la Réunion, allée des Topazes, Université de la Réunion, 97400, Saint Denis, France
| | | | - Xavier Combes
- Department of Emergency, CHU de la Réunion, allée des Topazes, Université de la Réunion, 97400, Saint Denis, France
| | - Vanina Bongard
- UMR 1027, Paul Sabatier University Toulouse III, Inserm, Toulouse, France.,Unité de Soutien Méthodologique à la Recherche (USMR), Centre Hospitalier Universitaire de Toulouse (CHU de Toulouse), Toulouse, France
| | - Jean-Louis Ducassé
- Emergency Department, Toulouse University Hospital, 31000, Toulouse, France
| | - Sandrine Charpentier
- Emergency Department, Toulouse University Hospital, 31000, Toulouse, France.,UMR 1027, Paul Sabatier University Toulouse III, Inserm, Toulouse, France
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30
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Ferry AV, Anand A, Strachan FE, Mooney L, Stewart SD, Marshall L, Chapman AR, Lee KK, Jones S, Orme K, Shah ASV, Mills NL. Presenting Symptoms in Men and Women Diagnosed With Myocardial Infarction Using Sex-Specific Criteria. J Am Heart Assoc 2019; 8:e012307. [PMID: 31431112 PMCID: PMC6755854 DOI: 10.1161/jaha.119.012307] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 06/24/2019] [Indexed: 12/12/2022]
Abstract
Background Sex-specific criteria are recommended for the diagnosis of myocardial infarction, but the impact of these on presenting characteristics is unknown. Methods and Results We evaluated patient-reported symptoms in 1941 patients (39% women) with suspected acute coronary syndrome attending the emergency department in a substudy of a prospective trial. Standardized criteria defined typical and atypical presentations based on pain nature, location, radiation, and additional symptoms. Diagnosis of myocardial infarction was adjudicated using a high-sensitivity cardiac troponin I assay with sex-specific thresholds (>16 ng/L women, >34 ng/L men). Patients identified who were missed by the contemporary assay with a uniform threshold (≥50 ng/L) were reclassified by this approach. Type 1 myocardial infarction was diagnosed in 16% (184/1185) of men and 12% (90/756) of women, with 9 (5%) men and 27 (30%) women reclassified using high-sensitivity cardiac troponin I and sex-specific thresholds. Chest pain was the presenting symptom in 91% (1081/1185) of men and 92% (698/756) of women. Typical symptoms were more common in women than in men with myocardial infarction (77% [69/90] versus 59% [109/184]; P=0.007), and differences were similar in those reclassified (74% [20/27] versus 44% [4/9]; P=0.22). The presence of ≥3 typical features was associated with a positive likelihood ratio for the diagnosis of myocardial infarction in women (positive likelihood ratio, 1.18; 95% CI, 1.03-1.31) but not in men (positive likelihood ratio 1.09; 95% CI, 0.96-1.24). Conclusions Typical symptoms are more common and have greater predictive value in women than in men with myocardial infarction whether or not they are diagnosed using sex-specific criteria. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier NCT01852123.
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Affiliation(s)
- Amy V. Ferry
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghUnited Kingdom
| | - Atul Anand
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghUnited Kingdom
| | - Fiona E. Strachan
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghUnited Kingdom
| | | | - Stacey D. Stewart
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghUnited Kingdom
| | - Lucy Marshall
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghUnited Kingdom
| | - Andrew R. Chapman
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghUnited Kingdom
| | - Kuan Ken Lee
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghUnited Kingdom
| | - Simon Jones
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghUnited Kingdom
| | - Katherine Orme
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghUnited Kingdom
| | - Anoop S. V. Shah
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghUnited Kingdom
- Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghUnited Kingdom
| | - Nicholas L. Mills
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghUnited Kingdom
- Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghUnited Kingdom
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31
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Lichtman JH, Leifheit EC, Safdar B, Bao H, Krumholz HM, Lorenze NP, Daneshvar M, Spertus JA, D'Onofrio G. Sex Differences in the Presentation and Perception of Symptoms Among Young Patients With Myocardial Infarction: Evidence from the VIRGO Study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients). Circulation 2019; 137:781-790. [PMID: 29459463 DOI: 10.1161/circulationaha.117.031650] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/11/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some studies report that women are less likely to present with chest pain for acute myocardial infarction (AMI). Information on symptom presentation, perception of symptoms, and care-seeking behaviors is limited for young patients with AMI. METHODS We interviewed 2009 women and 976 men aged 18 to 55 years hospitalized for AMI at 103 US hospitals participating in the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients). Structured patient interviews during the index AMI hospitalization were used to collect information on symptom presentation, perception of symptoms, and care-seeking behaviors. We compared patient characteristics and presentation information by sex. Multivariable hierarchical logistic regression was used to evaluate the association between sex and symptom presentation. RESULTS The majority of women (87.0%) and men (89.5%) presented with chest pain (defined as pain, pressure, tightness, or discomfort). Women were more likely to present with ≥3 associated symptoms than men (eg, epigastric symptoms, palpitations, and pain or discomfort in the jaw, neck, arms, or between the shoulder blades; 61.9% for women versus 54.8% for men, P<0.001). In adjusted analyses, women with an ST-segment-elevation AMI were more likely than men to present without chest pain (odds ratio, 1.51; 95% confidence interval, 1.03-2.22). In comparison with men, women were more likely to perceive symptoms as stress/anxiety (20.9% versus 11.8%, P<0.001) but less likely to attribute symptoms to muscle pain (15.4% versus 21.2%, P=0.029). Approximately 29.5% of women and 22.1% of men sought medical care for similar symptoms before their hospitalization (P<0.001); however, 53% of women reported that their provider did not think these symptoms were heart-related in comparison with 37% of men (P<0.001). CONCLUSIONS The presentation of AMI symptoms was similar for young women and men, with chest pain as the predominant symptom for both sexes. Women presented with a greater number of additional non-chest pain symptoms regardless of the presence of chest pain, and both women and their healthcare providers were less likely to attribute their prodromal symptoms to heart disease in comparison with men.
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Affiliation(s)
- Judith H Lichtman
- Department of Chronic Disease Epidemiology (J.H.L., E.C.L.) .,Yale School of Public Health, New Haven, CT. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (J.H.L., H.B., H.M.K., N.P.L.)
| | | | | | - Haikun Bao
- Yale School of Public Health, New Haven, CT. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (J.H.L., H.B., H.M.K., N.P.L.)
| | - Harlan M Krumholz
- Department of Health Policy and Management (H.M.K.).,Yale School of Public Health, New Haven, CT. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (J.H.L., H.B., H.M.K., N.P.L.).,Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT
| | - Nancy P Lorenze
- Yale School of Public Health, New Haven, CT. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (J.H.L., H.B., H.M.K., N.P.L.)
| | - Mitra Daneshvar
- Department of Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia (M.D.)
| | - John A Spertus
- St. Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.).,University of Missouri-Kansas City (J.A.S.)
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Clerc Liaudat C, Vaucher P, De Francesco T, Jaunin-Stalder N, Herzig L, Verdon F, Favrat B, Locatelli I, Clair C. Sex/gender bias in the management of chest pain in ambulatory care. ACTA ACUST UNITED AC 2019; 14:1745506518805641. [PMID: 30370833 PMCID: PMC6300868 DOI: 10.1177/1745506518805641] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: Cardiovascular diseases (CVD) are the main cause of death worldwide and despite a higher prevalence in men, mortality from CVD is higher among women. Few studies have assessed sex differences in chest pain management in ambulatory care. The objective of this post hoc analysis of data from a prospective cohort study was to assess sex differences in the management of chest pain in ambulatory care. Setting: We used data from the Thoracic Pain in Community cohort study that was realized in 58 primary care practices and one university ambulatory clinic in Switzerland. Participants: In total, 672 consecutive patients aged over 16 years attending a primary care practice or ambulatory care clinic with a complaint of chest pain were included between February and June 2001. Their mean age was 55.2 years and 52.5% were women. Main outcome measures: The main outcome was the proportion of patients referred to a cardiologist at 12 months follow-up. A panel of primary care physicians assessed the final diagnosis retained for chest pain at 12 months. Results: The prevalence of chest pain of cardiovascular origin (n = 108, 16.1%) was similar for men and women (17.5% vs 14.8%, respectively, p = 0.4). Men with chest pain were 2.5 times more likely to be referred to a cardiologist than women (16.6% vs 7.4%, odds ratio: 2.49, 95% confidence interval: 1.52–4.09). After adjustment for the patients’ age and cardiovascular disease risk factors, the estimates did not significantly change (odds ratio: 2.30, 95% confidence interval: 1.30–3.78). Conclusion: Although the same proportion of women and men present with a chest pain of cardiovascular origin in ambulatory care, there is a strong sex bias in their management. These data suggest that effort must be made to assure equity between men and women in medical care.
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Affiliation(s)
- Christelle Clerc Liaudat
- 1 Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Paul Vaucher
- 2 Unit of Traffic Medicine and Psychology, University Centre of Legal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,3 School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Fribourg, Switzerland
| | - Tommaso De Francesco
- 1 Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nicole Jaunin-Stalder
- 1 Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.,4 Cabinet Médical de Cugy, Cugy, Switzerland
| | - Lilli Herzig
- 5 Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland
| | - François Verdon
- 5 Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland
| | - Bernard Favrat
- 1 Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Isabella Locatelli
- 1 Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Carole Clair
- 1 Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
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33
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Madonna R, Balistreri CR, De Rosa S, Muscoli S, Selvaggio S, Selvaggio G, Ferdinandy P, De Caterina R. Impact of Sex Differences and Diabetes on Coronary Atherosclerosis and Ischemic Heart Disease. J Clin Med 2019; 8:jcm8010098. [PMID: 30654523 PMCID: PMC6351940 DOI: 10.3390/jcm8010098] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/30/2018] [Accepted: 01/11/2019] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular diseases (CVD) including coronary artery disease (CAD) and ischemic heart disease (IHD) are the main cause of mortality in industrialized countries. Although it is well known that there is a difference in the risk of these diseases in women and men, current therapy does not consider the sexual dimorphism; i.e., differences in anatomical structures and metabolism of tissues. Here, we discuss how genetic, epigenetic, hormonal, cellular or molecular factors may explain the different CVD risk, especially in high-risk groups such as women with diabetes. We analyze whether sex may modify the effects of diabetes at risk of CAD. Finally, we discuss current diagnostic techniques in the evaluation of CAD and IHD in diabetic women.
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Affiliation(s)
- Rosalinda Madonna
- Center of Aging Sciences and Translational Medicine-CESI-MeT, Institute of Cardiology, "G. d'Annunzio" University, Via dei Vestini 31, 66100 Chieti, Italy.
- Department of Internal Medicine, University of Texas Medical School in Houston, Houston, 77065 TX, USA.
| | - Carmela Rita Balistreri
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90134 Palermo, Italy.
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, University "Magna Græcia'' of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University of Rome, 00133 Rome, Italy.
| | - Stefano Selvaggio
- Geriatric Division, A.R.N.A.S. Ospedale "Garibaldi" Nesima, 95122 Catania, Italy.
| | | | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, 1085 Budapest, Hungary.
- Pharmahungary Group, 6722 Szeged, Hungary.
| | - Raffaele De Caterina
- Institute of Cardiology, University of Pisa, C/o Ospedale di Cisanello, Via Paradisa 2, 56124 Pisa, Italy.
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34
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Andreenko EY, Yavelov IS, Loukianov ММ, Vernohaeva AN, Drapkina OM, Boytsov SA. Ischemic Heart Disease in Subjects of Young Age: Current State of the Problem. Features of Etiology, Clinical Manifestation and Prognosis. ACTA ACUST UNITED AC 2018; 58:24-34. [PMID: 30625075 DOI: 10.18087/cardio.2018.11.10195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 11/24/2018] [Indexed: 11/18/2022]
Abstract
In addition to conventional risk factors in young patients with ischemic heart disease (IHD) numerous other risk factors including genetics play an important role in its causation. Molecular genetic testing is recommended for the detection of monogenic diseases with a high risk of developing IHD, such as familial hypercholesterolemia. In majority ofyoung patients, the first manifestation of IHD is an acute coronary syndrome. Young patients with IHD more often have normal coronary arteries or single-vessel coronary disease, and in up to 20% of them cause of myocardial ischemia is not related to atherosclerosis. In general, young patients with IHD have better prognosis. However, there are sex differences in IHD outcomes the prognosis of patients with premature IHD and reason for this is still unclear.
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Affiliation(s)
- E Yu Andreenko
- National Medical Research Center for Preventive Medicine.
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35
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Billig JI, Sterbenz JM, Zhong L, Chung KC. Gender Disparities in Preoperative Resource Use for Wrist Arthroscopy. Plast Reconstr Surg 2018; 142:1267-1274. [PMID: 30511980 PMCID: PMC6282178 DOI: 10.1097/prs.0000000000004840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although national efforts to minimize gender biases exist, gender differences in surgery persist. This study aims to investigate gender differences in preoperative resource use of patients undergoing wrist arthroscopy for nontraumatic wrist pain. METHODS Patients who underwent a wrist arthroscopy for nontraumatic pain from 2009 to 2015 were selected from the Truven MarketScan databases. Demographic and preoperative resource use data were recorded. Multivariable regression models were performed to examine the relationship between gender and preoperative resource use and to investigate the cost of these services. RESULTS A total of 8792 patients, 3805 men and 4987 women, met our inclusion criteria. Women were less likely to use imaging modalities preoperatively (OR, 0.08; 95 percent CI, 0.07 to 1.00; p = 0.02). However, women used more occupational therapy (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.002), nonnarcotic analgesia (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.001), and narcotic analgesia (OR, 1.6; 95 percent CI, 1.5 to 1.8; p < 0.001). Preoperative costs during the 12 months before surgery were similar between genders ($1308 versus $1367, respectively; p = 0.07). However, women accrued more costs from occupational therapy ($130 versus $93; p = 0.003), and nonnarcotic ($65 versus $46; p < 0.001) and narcotic medications ($568 versus $197; p < 0.001). CONCLUSIONS Significant gender differences exist in the preoperative care for patients undergoing wrist arthroscopy. Men use more imaging, implying more intense preoperative investigation for wrist pain, whereas women use more conservative measures, highlighting possible implicit provider biases in preoperative management and potential gender differences in disease presentation.
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Affiliation(s)
- Jessica I. Billig
- Co-First Author, Resident, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Jennifer M. Sterbenz
- Co-First Author, Research Assistant, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Lin Zhong
- Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Kevin C. Chung
- Professor of Surgery, Section of Plastic Surgery, Dean for Faculty Affairs, University of Michigan Medical School, Ann Arbor, MI
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36
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DeVon HA, Vuckovic K, Burke LA, Mirzaei S, Breen K, Robinson N, Zegre-Hemsey J. What's the Risk? Older Women Report Fewer Symptoms for Suspected Acute Coronary Syndrome than Younger Women. Biores Open Access 2018; 7:131-138. [PMID: 30237934 PMCID: PMC6146306 DOI: 10.1089/biores.2018.0020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The purpose of the study was to determine whether older (≥65 years) and younger (<65 years) women presenting to the emergency department (ED) with symptoms suggestive of acute coronary syndrome (ACS) varied on risk factors, comorbid conditions, functional status, and symptoms that have implications for emergent cardiac care. Women admitted to five EDs were enrolled. The ACS Symptom Checklist was used to measure symptoms. Comorbid conditions and functional status were measured with the Charlson Comorbidity Index and Duke Activity Status Index. Logistic regression models were used to evaluate symptom differences in older and younger women adjusting for ACS diagnosis, functional status, body mass index (BMI), and comorbid conditions. Analyses were stratified by age, and interaction of symptom by age was tested. Four hundred women were enrolled. Mean age was 61.3 years (range 21–98). Older women (n = 163) were more likely to have hypertension, hypercholesterolemia, never smoked, lower BMI, more comorbid conditions, and lower functional status. Younger women (n = 237) were more likely to be members of minority groups, be college-educated, and have a non-ACS discharge diagnosis. Younger women had higher odds of experiencing chest discomfort, chest pain, chest pressure, shortness of breath, nausea, sweating, and palpitations. Lack of chest symptoms and shortness of breath (key symptoms triggering a decision to seek emergency care) may cause older women to delay seeking treatment, placing them at risk for poorer outcomes. Younger African American women may require more comprehensive risk reduction strategies and symptom management.
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Affiliation(s)
- Holli A DeVon
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Karen Vuckovic
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Larisa A Burke
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Sahereh Mirzaei
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Katherine Breen
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Nadia Robinson
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
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37
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Abstract
PURPOSE OF THE REVIEW Paradoxically, although women have a lower burden of coronary atherosclerosis, they experience more symptoms, more frequent hospitalizations, and a worse prognosis compared to men. This is in part due to biological variations in pathophysiology between the two sexes, and in part related to inadequate understanding of these differences, subconscious referral bias, and suboptimal application of existing women-specific guidelines. We sought to review the contemporary literature and provide an update on risk assessment, diagnosis, and management of IHD in women. RECENT FINDINGS IHD in women is often secondary to diffuse non-obstructive atherosclerosis, coronary spasm, inflammation, and endothelial and microvascular dysfunction, and less commonly due to the male pattern of flow-limiting epicardial stenosis. Both IHD patterns likely represent sex-specific manifestations of the same disease process. Additionally, there is a differential expression of risk factors and symptoms between men and women. Application of male-pattern IHD risk factors and presentation to women contributes to under-recognition, under-testing, and under-treatment of IHD in women compared to men. Traditional diagnostic evaluation has focused on detection of epicardial disease, amenable to revascularization. Our improved understanding of sex-specific pathophysiology of IHD has enabled us to also develop tools for detection of microvascular disease. Advances in stress MRI, flow quantification on stress PET, and provocative invasive angiography have filled this void and offer important diagnostic and prognostic information. Despite our improved understanding of sex-specific differences in presentation, risk factors, pathophysiology, diagnostic testing, and management strategies of IHD, women with IHD continue to experience worse outcomes than men. This disparity underscores the need for improved research and understanding of biological sex differences, elimination of subconscious gender bias in referral patterns, and improved application of existing research into clinical practice.
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38
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Freisinger E, Sehner S, Malyar NM, Suling A, Reinecke H, Wegscheider K. Nationwide Routine-Data Analysis of Sex Differences in Outcome of Acute Myocardial Infarction. Clin Cardiol 2018; 41:1013-1021. [PMID: 29667216 DOI: 10.1002/clc.22962] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/10/2018] [Accepted: 04/13/2018] [Indexed: 12/19/2022] Open
Abstract
Women have been reported to suffer from impaired outcome after acute myocardial infarction (AMI). The aim of our study was to determine the impact of sex and age on utilization of inpatient healthcare and outcome in patients with AMI (STEMI and NSTEMI) in a real-life setting. We performed a routine-data-based analysis of 203 106 nationwide inpatients hospitalized with STEMI and NSTEMI, focusing on sex differences regarding risk constellation, treatments, and in-hospital outcome. A logistic regression model was designed to evaluate the use of coronary angiography and interventions and their sex-related impact on mortality (within 30 days). Compared with males, female STEMI patients (25 146, vs 52 965 males) were older and had a higher incidence of diabetes mellitus (27.4% vs 20.6%), heart failure (32.8% vs 26.2%), and chronic kidney disease (19.1% vs 13.5%, respectively; all P < 0.05), and had higher observed in-hospital mortality (STEMI, 16.9% vs 9.9%; NSTEMI, 11.7% vs 8.7%). Females were less likely to receive coronary angiography in STEMI in the age groups <60 and ≥ 80 years (odds ratio: 0.8, 95% confidence interval: 0.76-0.83, P < 0.05), despite similar mortality risk reduction. Estimated overall in-hospital mortality showed no differences with respect to sex in STEMI for age groups 40 to 79 years. However, females age ≥ 80 years had slightly higher in-hospital mortality after adjustment. The increased observed in-hospital mortality in females was attributed to the impact of more unfavorable risk and age distribution. Coronary angiography was associated with lower in-hospital mortality; particularly, older females were less frequently treated.
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Affiliation(s)
- Eva Freisinger
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Susanne Sehner
- Institute of Medical Biometry and Epidemiology, Universitatsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Nasser M Malyar
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Anna Suling
- Institute of Medical Biometry and Epidemiology, Universitatsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Holger Reinecke
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.,DRG Research Group, Münster, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, Universitatsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
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39
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Udell JA, Fonarow GC, Maddox TM, Cannon CP, Frank Peacock W, Laskey WK, Grau-Sepulveda MV, Smith EE, Hernandez AF, Peterson ED, Bhatt DL. Sustained sex-based treatment differences in acute coronary syndrome care: Insights from the American Heart Association Get With The Guidelines Coronary Artery Disease Registry. Clin Cardiol 2018. [PMID: 29521450 DOI: 10.1002/clc.22938] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Sex-based differences in acute coronary syndrome (ACS) mortality may attenuate with age due to better symptom recognition and prompt care. HYPOTHESIS Age is a modifier of temporal trends in sex-based differences in ACS care. METHODS Among 104 817 eligible patients with ACS enrolled in the AHA Get With the Guidelines-Coronary Artery Disease registry between 2003 and 2008, care and in-hospital mortality were evaluated stratified by sex and age. Temporal trends within sex and age groups were assessed for 2 care processes: percentage of STEMI patients presenting to PCI-capable hospitals with a DTB time ≤ 90 minutes (DTB90) and proportion of eligible ACS patients receiving aspirin within 24 hours. RESULTS After adjustment for clinical risk factors and sociodemographic and hospital characteristics, 2276 (51.7%) women and 6276 (56.9%) men with STEMI were treated with DTB90 (adjusted OR: 0.85, 95% CI: 0.80-0.91, P < 0.0001 for women vs men). Time trend analysis showed an absolute increase ranging from 24% to 35% in DTB90 rates among both men and women (P for trend <0.0001 for each group), with consistent differences over time across the 4 age/sex groups (3-way P-interaction = 0.93). Despite high rate of baseline aspirin use (87%-91%), there was a 9% to 11% absolute increase in aspirin use over time, also with consistent differences across the 4 age/sex groups (all 3-way P-interaction ≥0.15). CONCLUSIONS Substantial gains of generally similar magnitude existed in ACS performance measures over 6 years of study across sex and age groups; areas for improvement remain, particularly among younger women.
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Affiliation(s)
- Jacob A Udell
- Cardiovascular Division, Department of Medicine Women's College Hospital and Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gregg C Fonarow
- Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles
| | - Thomas M Maddox
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Christopher P Cannon
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | - Warren K Laskey
- Division of Cardiology, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque
| | | | - Eric E Smith
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke Medical Center, Durham, North Carolina.,Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke Medical Center, Durham, North Carolina.,Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
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40
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Araújo C, Laszczyńska O, Viana M, Melão F, Henriques A, Borges A, Severo M, Maciel MJ, Moreira I, Azevedo A. Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study. BMJ Open 2018; 8:e018798. [PMID: 29476027 PMCID: PMC5855399 DOI: 10.1136/bmjopen-2017-018798] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/22/2017] [Accepted: 01/02/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Prompt diagnosis of acute coronary syndrome (ACS) remains a challenge, with presenting symptoms affecting the diagnosis algorithm and, consequently, management and outcomes. This study aimed to identify sex differences in presenting symptoms of ACS. DESIGN Data were collected within a prospective cohort study (EPIHeart). SETTING Patients with confirmed diagnosis of type 1 (primary spontaneous) ACS who were consecutively admitted to the Cardiology Department of two tertiary hospitals in Portugal between August 2013 and December 2014. PARTICIPANTS Presenting symptoms of 873 patients (227 women) were obtained through a face-to-face interview. OUTCOME MEASURES Typical pain was defined according to the definition of cardiology societies. Clusters of symptoms other than pain were identified by latent class analysis. Logistic regression was used to quantify differences in presentation of ACS symptoms by sex. RESULTS Chest pain was reported by 82% of patients, with no differences in frequency or location between sexes. Women were more likely to feel pain with an intensity higher than 8/10 and this association was stronger for patients aged under 65 years (interaction P=0.028). Referred pain was also more likely in women, particularly pain referred to typical and atypical locations simultaneously. The multiple symptoms cluster, which was characterised by a high probability of presenting with all symptoms, was almost fourfold more prevalent in women (3.92, 95% CI 2.21 to 6.98). Presentation with this cluster was associated with a higher 30-day mortality rate adjusted for the GRACE V.2.0 risk score (4.9% vs 0.9% for the two other clusters, P<0.001). CONCLUSIONS While there are no significant differences in the frequency or location of pain between sexes, women are more likely to feel pain of higher intensity and to present with referred pain and symptoms other than pain. Knowledge of these ACS presentation profiles is important for health policy decisions and clinical practice.
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Affiliation(s)
- Carla Araújo
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Serviço de Cardiologia, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Hospital de São Pedro, Vila Real, Portugal
| | - Olga Laszczyńska
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Marta Viana
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Filipa Melão
- Serviço de Cardiologia, Centro Hospitalar São João, EPE, Porto, Portugal
| | - Ana Henriques
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Andreia Borges
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Milton Severo
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Maria Júlia Maciel
- Serviço de Cardiologia, Centro Hospitalar São João, EPE, Porto, Portugal
| | - Ilídio Moreira
- Serviço de Cardiologia, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Hospital de São Pedro, Vila Real, Portugal
| | - Ana Azevedo
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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41
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McSweeney JC, Cleves MA, Fischer EP, Pettey CM, Beasley B. Using the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey to Predict the Occurrence of Short-Term Coronary Heart Disease Events in Women. Womens Health Issues 2017; 27:660-665. [PMID: 28830656 PMCID: PMC5694369 DOI: 10.1016/j.whi.2017.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/27/2017] [Accepted: 07/11/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Few instruments capture symptoms that predict cardiac events in the short-term. This study examines the ability of the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey to predict acute cardiac events within 3 months of administration and to identify the prodromal symptoms most associated with short-term risk in women without known coronary heart disease. METHODS The McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey was administered to 1,097 women referred to a cardiologist for initial coronary heart disease evaluation. Logistic regression models were used to examine prodromal symptoms individually and in combination to identify the subset of symptoms most predictive of an event within 3 months. RESULTS Fifty-one women had an early cardiac event. In bivariate analyses, 4 of 30 prodromal symptoms were significantly associated with event occurrence within 90 days. In adjusted analyses, women reporting arm pain or discomfort and unusual fatigue were more likely (OR, 4.67; 95% CI, 2.08-10.48) to have a cardiac event than women reporting neither. CONCLUSIONS The McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey may assist in predicting short-term coronary heart disease events in women without known coronary heart disease.
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Affiliation(s)
- Jean C McSweeney
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Mario A Cleves
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ellen P Fischer
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Central Arkansas Veterans Healthcare System Center, for Mental Healthcare and Outcomes Research, North Little Rock, Arkansas
| | - Christina M Pettey
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Brittany Beasley
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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42
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McGregor AJ, Beauchamp GA, Wira CR, Perman SM, Safdar B. Sex as a Biological Variable in Emergency Medicine Research and Clinical Practice: A Brief Narrative Review. West J Emerg Med 2017; 18:1079-1090. [PMID: 29085541 PMCID: PMC5654878 DOI: 10.5811/westjem.2017.8.34997] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 12/16/2022] Open
Abstract
The National Institutes of Health recently highlighted the significant role of sex as a biological variable (SABV) in research design, outcome and reproducibility, mandating that this variable be accounted for in all its funded research studies. This move has resulted in a rapidly increasing body of literature on SABV with important implications for changing the clinical practice of emergency medicine (EM). Translation of this new knowledge to the bedside requires an understanding of how sex-based research will ultimately impact patient care. We use three case-based scenarios in acute myocardial infarction, acute ischemic stroke and important considerations in pharmacologic therapy administration to highlight available data on SABV in evidence-based research to provide the EM community with an important foundation for future integration of patient sex in the delivery of emergency care as gaps in research are filled.
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Affiliation(s)
- Alyson J McGregor
- Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Division of Sex and Gender in Emergency Medicine, Providence, Rhode Island
| | - Gillian A Beauchamp
- Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon
| | - Charles R Wira
- Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Sarah M Perman
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, Colorado
| | - Basmah Safdar
- Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
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43
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Lau ES, Sarma A. Utility of Imaging in Risk Stratification of Chest Pain in Women. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:72. [PMID: 28782082 DOI: 10.1007/s11936-017-0568-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OPINION STATEMENT Recent decades have seen a growing recognition that the understanding of sex differences in cardiovascular disease (CVD) is vital to optimal diagnosis and management, particularly of women (Mosca et al. Circulation 124:2145-54, 2011). There is simultaneously an increasing appreciation of the multifactorial nature of ischemic heart disease (IHD) in many patients, in whom disease may extend beyond the epicardial coronaries. While obstructive coronary artery disease (CAD) remains underdiagnosed in women and still represents a major burden of disease, women also present with nonobstructive CAD more commonly than men (Patel et al. N Engl J Med 362:886-95, 2010). Indeed, microvascular dysfunction, coronary artery vasospasm, and coronary dissections contribute to a larger proportion of IHD in women than men (Bairey Merz et al. J Am Coll Cardiol 47:S21-9, 2006). Here, we review the symptom presentation of women with IHD and the noninvasive modalities used to risk stratify women with suspected IHD.
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Affiliation(s)
- Emily S Lau
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA.
| | - Amy Sarma
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
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44
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Correia LCL, Cerqueira M, Carvalhal M, Ferreira F, Garcia G, Silva ABD, Sá ND, Lopes F, Barcelos AC, Noya-Rabelo M. A Multivariate Model for Prediction of Obstructive Coronary Disease in Patients with Acute Chest Pain: Development and Validation. Arq Bras Cardiol 2017; 108:304-314. [PMID: 28538760 PMCID: PMC5421469 DOI: 10.5935/abc.20170037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/04/2016] [Indexed: 11/20/2022] Open
Abstract
Background Currently, there is no validated multivariate model to predict probability of
obstructive coronary disease in patients with acute chest pain. Objective To develop and validate a multivariate model to predict coronary artery
disease (CAD) based on variables assessed at admission to the coronary care
unit (CCU) due to acute chest pain. Methods A total of 470 patients were studied, 370 utilized as the derivation sample
and the subsequent 100 patients as the validation sample. As the reference
standard, angiography was required to rule in CAD (stenosis ≥ 70%),
while either angiography or a negative noninvasive test could be used to
rule it out. As predictors, 13 baseline variables related to medical
history, 14 characteristics of chest discomfort, and eight variables from
physical examination or laboratory tests were tested. Results The prevalence of CAD was 48%. By logistic regression, six variables remained
independent predictors of CAD: age, male gender, relief with nitrate, signs
of heart failure, positive electrocardiogram, and troponin. The area under
the curve (AUC) of this final model was 0.80 (95% confidence interval
[95%CI] = 0.75 - 0.84) in the derivation sample and 0.86 (95%CI = 0.79 -
0.93) in the validation sample. Hosmer-Lemeshow's test indicated good
calibration in both samples (p = 0.98 and p = 0.23, respectively). Compared
with a basic model containing electrocardiogram and troponin, the full model
provided an AUC increment of 0.07 in both derivation (p = 0.0002) and
validation (p = 0.039) samples. Integrated discrimination improvement was
0.09 in both derivation (p < 0.001) and validation (p < 0.0015)
samples. Conclusion A multivariate model was derived and validated as an accurate tool for
estimating the pretest probability of CAD in patients with acute chest
pain.
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Affiliation(s)
- Luis Cláudio Lemos Correia
- Escola Bahiana de Medicina e Saúde Pública; Salvador, BA - Brazil.,Hospital São Rafael, Salvador, BA - Brazil
| | | | | | - Felipe Ferreira
- Escola Bahiana de Medicina e Saúde Pública; Salvador, BA - Brazil
| | | | | | - Nicole de Sá
- Escola Bahiana de Medicina e Saúde Pública; Salvador, BA - Brazil
| | - Fernanda Lopes
- Escola Bahiana de Medicina e Saúde Pública; Salvador, BA - Brazil
| | | | - Márcia Noya-Rabelo
- Escola Bahiana de Medicina e Saúde Pública; Salvador, BA - Brazil.,Hospital São Rafael, Salvador, BA - Brazil
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45
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Im EO, Ko Y, Chee E, Chee W, Mao JJ. Midlife women's cardiovascular symptoms: A cluster analysis. Health Care Women Int 2017; 38:1275-1288. [PMID: 28532290 DOI: 10.1080/07399332.2017.1332626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Menopausal transition, in which biological and psychosocial changes are caused due to estrogen fluctuations, has been reported to increase cardiovascular risk among midlife women. The purposes of this study were to identify the clusters of midlife women by cardiovascular symptoms and to examine racial/ethnic differences in the clusters. This was a secondary analysis, in which hierarchical cluster and multinomial logistic analyses were conducted with the data (N = 966) collected in two previous studies. Three clusters were adopted: Cluster 1 (high vasomotor and low cardiorespiratory), Cluster 2 (low vasomotor and high cardiorespiratory and high discomfort/pain), and Cluster 3 (high discomfort/pain and high indigestion).
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Affiliation(s)
- Eun-Ok Im
- a School of Nursing , Duke University , Durham , North Carolina , USA
| | - Young Ko
- b School of Nursing , Gachon University , Incheon , South Korea
| | - Eunice Chee
- a School of Nursing , Duke University , Durham , North Carolina , USA
| | - Wonshik Chee
- a School of Nursing , Duke University , Durham , North Carolina , USA
| | - Jun James Mao
- c Memorial Sloan-Kettering Cancer Center , The Bendheim Center for Integrative Medicine , New York , New York , USA
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46
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das Virgens CMB, Lemos Jr L, Noya-Rabelo M, Carvalhal MC, Cerqueira Junior AMDS, Lopes FODA, de Sá NC, Suerdieck JG, de Souza TMB, Correia VCDA, Sodré GS, da Silva AB, Alexandre FKB, Ferreira FRM, Correia LCL. Accuracy of gestalt perception of acute chest pain in predicting coronary artery disease. World J Cardiol 2017; 9:241-247. [PMID: 28400920 PMCID: PMC5368673 DOI: 10.4330/wjc.v9.i3.241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/15/2016] [Accepted: 01/03/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To test accuracy and reproducibility of gestalt to predict obstructive coronary artery disease (CAD) in patients with acute chest pain.
METHODS We studied individuals who were consecutively admitted to our Chest Pain Unit. At admission, investigators performed a standardized interview and recorded 14 chest pain features. Based on these features, a cardiologist who was blind to other clinical characteristics made unstructured judgment of CAD probability, both numerically and categorically. As the reference standard for testing the accuracy of gestalt, angiography was required to rule-in CAD, while either angiography or non-invasive test could be used to rule-out. In order to assess reproducibility, a second cardiologist did the same procedure.
RESULTS In a sample of 330 patients, the prevalence of obstructive CAD was 48%. Gestalt’s numerical probability was associated with CAD, but the area under the curve of 0.61 (95%CI: 0.55-0.67) indicated low level of accuracy. Accordingly, categorical definition of typical chest pain had a sensitivity of 48% (95%CI: 40%-55%) and specificity of 66% (95%CI: 59%-73%), yielding a negligible positive likelihood ratio of 1.4 (95%CI: 0.65-2.0) and negative likelihood ratio of 0.79 (95%CI: 0.62-1.02). Agreement between the two cardiologists was poor in the numerical classification (95% limits of agreement = -71% to 51%) and categorical definition of typical pain (Kappa = 0.29; 95%CI: 0.21-0.37).
CONCLUSION Clinical judgment based on a combination of chest pain features is neither accurate nor reproducible in predicting obstructive CAD in the acute setting.
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47
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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: 49] [Impact Index Per Article: 7.0] [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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48
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Hemal K, Pagidipati NJ, Coles A, Dolor RJ, Mark DB, Pellikka PA, Hoffmann U, Litwin SE, Daubert MA, Shah SH, Ariani K, Bullock-Palmer RP, Martinez B, Lee KL, Douglas PS. Sex Differences in Demographics, Risk Factors, Presentation, and Noninvasive Testing in Stable Outpatients With Suspected Coronary Artery Disease: Insights From the PROMISE Trial. JACC Cardiovasc Imaging 2017; 9:337-46. [PMID: 27017234 DOI: 10.1016/j.jcmg.2016.02.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether presentation, risk assessment, testing choices, and results differ by sex in stable symptomatic outpatients with suspected coronary artery disease (CAD). BACKGROUND Although established CAD presentations differ by sex, little is known about stable, suspected CAD. METHODS The characteristics of 10,003 men and women in the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial were compared using chi-square and Wilcoxon rank-sum tests. Sex differences in test selection and predictors of test positivity were examined using logistic regression. RESULTS Women were older (62.4 years of age vs. 59.0 years of age) and were more likely to be hypertensive (66.6% vs. 63.2%), dyslipidemic (68.9% vs. 66.3%), and to have a family history of premature CAD (34.6% vs. 29.3) (all p values <0.005). Women were less likely to smoke (45.6% vs. 57.0%; p < 0.001), although their prevalence of diabetes was similar to that in men (21.8% vs. 21.0%; p = 0.30). Chest pain was the primary symptom in 73.2% of women versus 72.3% of men (p = 0.30), and was characterized as “crushing/pressure/squeezing/tightness” in 52.5% of women versus 46.2% of men (p < 0.001). Compared with men, all risk scores characterized women as being at lower risk, and providers were more likely to characterize women as having a low (<30%) pre-test probability of CAD (40.7% vs. 34.1%; p < 0.001). Compared with men, women were more often referred to imaging tests (adjusted odds ratio: 1.21; 95% confidence interval: 1.01 to 1.44) than nonimaging tests. Women were less likely to have a positive test (9.7% vs. 15.1%; p < 0.001). Although univariate predictors of test positivity were similar, in multivariable models, age, body mass index, and Framingham risk score were predictive of a positive test in women, whereas Framingham and Diamond and Forrester risk scores were predictive in men. CONCLUSIONS Patient sex influences the entire diagnostic pathway for possible CAD, from baseline risk factors and presentation to noninvasive test outcomes. These differences highlight the need for sex-specific approaches for the evaluation of CAD.
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49
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Yihua L, Yun J, Dongshen Z. Coronary Artery Disease in Premenopausal and Postmenopausal Women. Int Heart J 2017; 58:174-179. [DOI: 10.1536/ihj.16-095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lu Yihua
- Department of Epidemiology, School of Public Health, Nantong University
| | - Jiang Yun
- Department of Cardiothoracic Medicine, Nantong Rich Hospital
| | - Zhao Dongshen
- Department of Cardiovascular Medicine, Nantong First People’s Hospital
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50
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Im EO, Ko Y, Chee E, Chee W. Associations of Immigration Transition to Cardiovascular Symptoms Experienced in Menopausal Transition. FAMILY & COMMUNITY HEALTH 2017; 40:357-366. [PMID: 28820790 PMCID: PMC5785780 DOI: 10.1097/fch.0000000000000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this study was to explore the associations of immigration transition to cardiovascular symptoms among 4 major racial/ethnic groups of 1054 midlife women in the United States. This was a secondary analysis of the data from 2 large national survey studies. The instruments included questions on background characteristics and immigration transition and the Cardiovascular Symptom Index for Midlife Women. The data were analyzed using inferential statistics including hierarchical multiple regressions. Immigrants reported fewer numbers (t = 5.268, P < .01) and lower severity scores (t = 5.493, P < .01) of cardiovascular symptoms compared with nonimmigrants. Self-reported racial/ethnic identify was a significant factor influencing cardiovascular symptoms (P < .01).
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Affiliation(s)
- Eun-Ok Im
- School of Nursing, Duke University, Durham, NC
| | - Young Ko
- College of Nursing, Gachon University, Inchon, South Korea
| | - Eunice Chee
- School of Nursing, Duke University, Durham, NC
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