Ethnic differences in utilization of invasive cardiac procedures and in long-term survival following acute myocardial infarction

Incidence of Achalasia in South Australia Based on Esophageal Manometry Findings

BACKGROUND & AIMS

Achalasia is a disorder of esophageal motility with a reported incidence of 0.5 to 1.6 per 100,000 persons per year in Europe, Asia, Canada, and America. However, estimates of incidence values have been derived predominantly from retrospective searches of databases of hospital discharge codes and personal communications with gastroenterologists, and are likely to be incorrect. We performed a cohort study based on esophageal manometry findings to determine the incidence of achalasia in South Australia.

METHODS

We collected data from the Australian Bureau of Statistics on the South Australian population. Cases of achalasia diagnosed by esophageal manometry were identified from the 3 adult manometry laboratory databases in South Australia. Endoscopy reports and case notes were reviewed for correlations with diagnoses. The annual incidence of achalasia in the South Australian population was calculated for the decade 2004 to 2013. Findings were standardized to those of the European Standard Population based on age.

RESULTS

The annual incidence of achalasia in South Australia ranged from 2.3 to 2.8 per 100,000 persons. The mean age at diagnosis was 62.1 ± 18.1 years. The incidence of achalasia increased with age (Spearman rho, 0.95; P < .01). The age-standardized incidence ranged from 2.1 (95% CI, 1.8-2.3) to 2.5 (95% CI, 2.2-2.7).

CONCLUSIONS

Based on a cohort study of esophageal manometry, we determined the incidence of achalasia in South Australia to be 2.3 to 2.8 per 100,000 persons and to increase with age. South Australia's relative geographic isolation and the population's access to manometry allowed for more accurate identification of cases than hospital code analyses, with a low probability of missed cases.

Standardized Outcome Measurement for Patients With Coronary Artery Disease: Consensus From the International Consortium for Health Outcomes Measurement (ICHOM)

Background

Coronary artery disease (CAD) outcomes consistently improve when they are routinely measured and provided back to physicians and hospitals. However, few centers around the world systematically track outcomes, and no global standards exist. Furthermore, patient-centered outcomes and longitudinal outcomes are under-represented in current assessments.

Methods and Results

The nonprofit International Consortium for Health Outcomes Measurement (ICHOM) convened an international Working Group to define a consensus standard set of outcome measures and risk factors for tracking, comparing, and improving the outcomes of CAD care. Members were drawn from 4 continents and 6 countries. Using a modified Delphi method, the ICHOM Working Group defined who should be tracked, what should be measured, and when such measurements should be performed. The ICHOM CAD consensus measures were designed to be relevant for all patients diagnosed with CAD, including those with acute myocardial infarction, angina, and asymptomatic CAD. Thirteen specific outcomes were chosen, including acute complications occurring within 30 days of acute myocardial infarction, coronary artery bypass grafting surgery, or percutaneous coronary intervention; and longitudinal outcomes for up to 5 years for patient-reported health status (Seattle Angina Questionnaire [SAQ-7], elements of Rose Dyspnea Score, and Patient Health Questionnaire [PHQ-2]), cardiovascular hospital admissions, cardiovascular procedures, renal failure, and mortality. Baseline demographic, cardiovascular disease, and comorbidity information is included to improve the interpretability of comparisons.

Conclusions

ICHOM recommends that this set of outcomes and other patient information be measured for all patients with CAD.

Management of Coronary Artery Disease in South Asian Populations: Why and How to Prevent and Treat Differently

The South Asian (SA) population constitutes one of the largest ethnic groups in the world. Several studies that compared host and migrant populations around the world indicate that SAs have a higher risk of developing cardiovascular disease (CVD) than their native-born counterparts. Herein, we review the literature to address the role of the screening tools, scoring systems, and guidelines for primary, secondary, and tertiary prevention in these populations. Management based on screening for the CVD risk factors in a high-risk population such as SAs can improve health care outcomes. There are many scoring tools for calculating 10-year CVD risk; however, each scoring system has its limitations in this particular ethnicity. Further work is needed to establish a unique scoring and guidelines in SAs.

Myocardial infarction in singapore: ethnic variation in evidence-based therapy and its association with socioeconomic status, social network size and perceived stress level

BACKGROUND

Singapore is a multiethnic Asian country comprising predominantly Chinese, Malays, and Indians. We sought to study the disparities in evidence-based therapy for people from these three ethnic groups who were admitted to hospital with ST-segment elevation myocardial infarction (STEMI). We also examined its association with socioeconomic level and social network size and the influence on psychological stress level.

METHODS

In a prospective study, patients admitted with STEMI were recruited for a questionnaire survey. Relevant demographic and clinical data were collected.

RESULTS

A total of 364 patients were recruited and categorised based on ethnicity: Chinese (222 patients), Malays (72 patients), and Indians (70 patients). Malays and Indians were significantly younger than Chinese at the time of presentation with STEMI. Malays had significantly more children than the Chinese and Indians. Malays were in the lowest socioeconomic class, based on education level (P ≤ .02) and residential type (P ≤ .003). Most (87%) patients were treated with primary percutaneous coronary intervention. There were no significant differences between Chinese, Malays, and Indians in accessibility to primary percutaneous coronary intervention, symptom-to-balloon time, door-to-balloon time, and prescription of evidence-based medications. Malays had larger social networks for information support (P ≤ .05) and financial support (P ≤ .04) than Chinese and Indians. There were no significant differences between the three ethnic groups in satisfaction with social support. The perceived stress level was higher among Malays and Indians than Chinese.

CONCLUSIONS

Although Malays were underprivileged in the socioeconomic level, no significant difference in healthcare disparities were observed among the three ethnic groups. This may be a reflection of the advancement in Singapore's healthcare system. The lower socioeconomic level may also explain the higher perceived stress level in Malays.

Two Adults With Hypertriglyceridemia: How should one manage these persons?(#)

The paper discusses the management of two individuals with asymptomatic hypertriglyceredemia, a common problem faces by Family Physicians in Malaysia. In such instances it is advisable to exclude an underlying disorder (e.g. metabolic syndrome) and take a pragmatic approach.

Circadian analysis of myocardial infarction incidence in an Argentine and Uruguayan population

Background

The occurrence of variations in the spectrum of cardiovascular disease between different regions of the world and ethnic groups have been the subject of great interest. This study report the 24-h variation of myocardial infarction (MI) occurrence in patients recruited from CCU located in Argentina and Uruguay.

Methods

A cohort of 1063 patients admitted to the CCU within 24 h of the onset of symptoms of an acute MI was examined. MI incidence along the day was computed in 1 h-intervals.

Results

A minimal MI incidence between 03:00 and 07:00 h and the occurrence of a first maximum between 08:00 and 12:00 h and a second maximum between 15:00 and 22:00 h were verified. The best fit curve was a 24 h cosinor (acrophase ~ 19:00 h, accounting for 63 % of variance) together with a symmetrical gaussian bell (maximum at ~ 10:00 h, accounting for 37 % of variance). A similar picture was observed for MI frequencies among different excluding subgroups (older or younger than 70 years; with or without previous symptoms; diabetics or non diabetics; Q wave- or non-Q wave-type MI; anterior or inferior MI location). Proportion between cosinor and gaussian probabilities was maintained among most subgroups except for older patients who had more MI at the afternoon and patients with previous symptoms who were equally distributed among the morning and afternoon maxima.

Conclusion

The results support the existence of two maxima (at morning and afternoon hours) in MI incidence in the Argentine and Uruguayan population.