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Gonuguntla K, Badu I, Duhan S, Sandhyavenu H, Chobufo MD, Taha A, Thyagaturu H, Sattar Y, Keisham B, Ali S, Khan MZ, Latchana S, Naeem M, Shaik A, Balla S, Gulati M. Sex and Racial Disparities in Proportionate Mortality of Premature Myocardial Infarction in the United States: 1999 to 2020. J Am Heart Assoc 2024; 13:e033515. [PMID: 38842272 PMCID: PMC11255752 DOI: 10.1161/jaha.123.033515] [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: 11/16/2023] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The incidence of premature myocardial infarction (PMI) in women (<65 years and men <55 years) is increasing. We investigated proportionate mortality trends in PMI stratified by sex, race, and ethnicity. METHODS AND RESULTS CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) was queried to identify PMI deaths within the United States between 1999 and 2020, and trends in proportionate mortality of PMI were calculated using the Joinpoint regression analysis. We identified 3 017 826 acute myocardial infarction deaths, with 373 317 PMI deaths corresponding to proportionate mortality of 12.5% (men 12%, women 14%). On trend analysis, proportionate mortality of PMI increased from 10.5% in 1999 to 13.2% in 2020 (average annual percent change of 1.0 [0.8-1.2, P <0.01]) with a significant increase in women from 10% in 1999 to 17% in 2020 (average annual percent change of 2.4 [1.8-3.0, P <0.01]) and no significant change in men, 11% in 1999 to 10% in 2020 (average annual percent change of -0.2 [-0.7 to 0.3, P=0.4]). There was a significant increase in proportionate mortality in both Black and White populations, with no difference among American Indian/Alaska Native, Asian/Pacific Islander, or Hispanic people. American Indian/Alaska Natives had the highest PMI mortality with no significant change over time. CONCLUSIONS Over the last 2 decades, there has been a significant increase in the proportionate mortality of PMI in women and the Black population, with persistently high PMI in American Indian/Alaska Natives, despite an overall downtrend in acute myocardial infarction-related mortality. Further research to determine the underlying cause of these differences in PMI mortality is required to improve the outcomes after acute myocardial infarction in these populations.
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Affiliation(s)
| | - Irisha Badu
- Department of MedicineOnslow Memorial HospitalJacksonvilleNC
| | - Sanchit Duhan
- Department of MedicineSinai Hospital of BaltimoreBaltimoreMD
| | | | | | - Amro Taha
- Department of MedicineWeiss Memorial HospitalChicagoIL
| | | | - Yasar Sattar
- Department of CardiologyWest Virginia UniversityMorgantownWV
| | - Bijeta Keisham
- Department of MedicineSinai Hospital of BaltimoreBaltimoreMD
| | - Shafaqat Ali
- Department of Internal MedicineLouisiana State UniversityShreveportLA
| | | | - Sharaad Latchana
- American University of Integrative Sciences School of MedicineBridgetownBarbados
| | - Minahil Naeem
- Department of Internal MedicineKing Edward Medical UniversityLahorePakistan
| | - Ayesha Shaik
- Department of CardiologyHartford HospitalHartfordCT
| | - Sudarshan Balla
- Department of CardiologyWest Virginia UniversityMorgantownWV
| | - Martha Gulati
- Department of Cardiology, Barbra Streisand Women’s Heart CenterSmidt Heart Institute, Cedars Sinai Medical CenterLos AngelesCA
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Melgoza E, Cardenas V, Enguídanos S, Bustamante AV, Beltrán-Sánchez H. A Systematic Literature Review of Hispanic Adults' Experiences With the Emergency Medical Services System in the United States Between 2000 and 2021. Med Care 2023; 61:150-156. [PMID: 36598888 PMCID: PMC9931647 DOI: 10.1097/mlr.0000000000001817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This systematic literature review presents an overview of studies that assess the experiences of Hispanic adults with (1) activation of emergency medical services (EMS); (2) on-scene care provided by EMS personnel; (3) mode of transport (EMS vs. non-EMS) to an emergency department (ED); and (4) experiences with EMS before and during the COVID-19 pandemic. METHODS A bibliographic database search was conducted to identify relevant studies on Ovid MEDLINE (PubMed), Web of Science, EMBASE, and CINAHL. Quantitative, mixed methods, and qualitative studies published in English or Spanish were included if they discussed Hispanic adults' experiences with EMS in the US between January 1, 2000 and December 31, 2021. The Hawker and colleagues quality assessment instrument was used to evaluate the quality of studies. RESULTS Of the 43 included studies, 13 examined EMS activation, 13 assessed on-scene care, 22 discussed the mode of transport to an ED, and 4 described Hispanic adults' experiences with EMS during the COVID-19 pandemic. Hispanics were less likely to activate EMS (N=7), less likely to receive certain types of on-scene care (N=6), and less likely to use EMS as the mode of transport to an ED (N=13), compared with non-Hispanic Whites. During the early COVID-19 pandemic period (March to May 2020), EMS use decreased by 26.5% compared with the same months during the previous 4 years. CONCLUSIONS The contribution of this study is its attention to Hispanic adults' experiences with the different phases of the US EMS system.
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Affiliation(s)
- Esmeralda Melgoza
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Valeria Cardenas
- Leonard Davis School of Gerontology, University of Southern California (USC), Los Angeles, CA
| | - Susan Enguídanos
- Leonard Davis School of Gerontology, University of Southern California (USC), Los Angeles, CA
| | - Arturo Vargas Bustamante
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Hiram Beltrán-Sánchez
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA
- California Center for Population Research, UCLA
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Farcas AM, Joiner AP, Rudman JS, Ramesh K, Torres G, Crowe RP, Curtis T, Tripp R, Bowers K, von Isenburg M, Logan R, Coaxum L, Salazar G, Lozano M, Page D, Haamid A. Disparities in Emergency Medical Services Care Delivery in the United States: A Scoping Review. PREHOSP EMERG CARE 2022; 27:1058-1071. [PMID: 36369725 DOI: 10.1080/10903127.2022.2142344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/25/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Emergency medical services (EMS) often serve as the first medical contact for ill or injured patients, representing a critical access point to the health care delivery continuum. While a growing body of literature suggests inequities in care within hospitals and emergency departments, limited research has comprehensively explored disparities related to patient demographic characteristics in prehospital care. OBJECTIVE We aimed to summarize the existing literature on disparities in prehospital care delivery for patients identifying as members of an underrepresented race, ethnicity, sex, gender, or sexual orientation group. METHODS We conducted a scoping review of peer-reviewed and non-peer-reviewed (gray) literature. We searched PubMed, CINAHL, Web of Science, Proquest Dissertations, Scopus, Google, and professional websites for studies set in the U.S. between 1960 and 2021. Each abstract and full-text article was screened by two reviewers. Studies written in English that addressed the underrepresented groups of interest and investigated EMS-related encounters were included. Studies were excluded if a disparity was noted incidentally but was not a stated objective or discussed. Data extraction was conducted using a standardized electronic form. Results were summarized qualitatively using an inductive approach. RESULTS One hundred forty-five full-text articles from the peer-reviewed literature and two articles from the gray literature met inclusion criteria: 25 studies investigated sex/gender, 61 studies investigated race/ethnicity, and 58 studies investigated both. One study investigated sexual orientation. The most common health conditions evaluated were out-of-hospital cardiac arrest (n = 50), acute coronary syndrome (n = 36), and stroke (n = 31). The phases of EMS care investigated included access (n = 55), pre-arrival care (n = 46), diagnosis/treatment (n = 42), and response/transport (n = 40), with several studies covering multiple phases. Disparities were identified related to all phases of EMS care for underrepresented groups, including symptom recognition, pain management, and stroke identification. The gray literature identified public perceptions of EMS clinicians' cultural competency and the ability to appropriately care for transgender patients in the prehospital setting. CONCLUSIONS Existing research highlights health disparities in EMS care delivery throughout multiple health outcomes and phases of EMS care. Future research is needed to identify structured mechanisms to eliminate disparities, address clinician bias, and provide high-quality equitable care for all patient populations.
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Affiliation(s)
- Andra M Farcas
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Anjni P Joiner
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Jordan S Rudman
- Harvard Affiliated Emergency Medicine Residency, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Karthik Ramesh
- School of Medicine, University of California San Diego, San Diego, California
| | | | | | | | - Rickquel Tripp
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Karen Bowers
- Atlanta Fire Rescue Department; Department of Emergency Medicine, University of Tennessee-Chattanooga, Chattanooga, Tennessee
| | - Megan von Isenburg
- Duke University Medical Center Library, Duke University, Durham, North Carolina
| | - Robert Logan
- San Diego Fire - Rescue Department, San Diego, California
| | - Lauren Coaxum
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Michael Lozano
- Division of Emergency Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - David Page
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ameera Haamid
- Section of Emergency Medicine, University of Chicago School of Medicine, Chicago, Illinois
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4
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Weininger D, Cordova JP, Wilson E, Eslava DJ, Alviar CL, Korniyenko A, Bavishi CP, Hong MK, Chorzempa A, Fox J, Tamis-Holland JE. Delays to Hospital Presentation in Women and Men with ST-Segment Elevation Myocardial Infarction: A Multi-Center Analysis of Patients Hospitalized in New York City. Ther Clin Risk Manag 2022; 18:1-9. [PMID: 35018099 PMCID: PMC8742618 DOI: 10.2147/tcrm.s335219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/23/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Previous studies have shown longer delays from symptom onset to hospital presentation (S2P time) in women than men with acute myocardial infarction. The aim of this study is to understand the reasons for delays in seeking care among women and men presenting with an ST-Segment Elevation Myocardial Infarction (STEMI) through a detailed assessment of the thoughts, perceptions and patterns of behavior. Patients/Methods and Results A total of 218 patients with STEMI treated with primary angioplasty at four New York City Hospitals were interviewed (24% female; Women: 68.7 ± 13.1 years and men: 60.7 ± 13.8 years) between January 2009 and August 2012. A significantly larger percentage of women than men had no chest pain (62% vs 36%, p<0.01). Compared to men, a smaller proportion of women thought they were having a myocardial infarction (15% vs 34%, p=0.01). A larger proportion of women than men had S2P time >90 minutes (72% of women vs 54% of men, p= 0.03). Women were more likely than men to hesitate before seeking help, and more women than men hesitated because they did not think they were having an AMI (91% vs 83%, p=0.04). Multivariate regression analysis showed that female sex (Odds Ratio: 2.46, 95% CI 1.10–5.60 P=0.03), subjective opinion it was not an AMI (Odds Ratio 2.44, 95% CI 1.20–5.0, P=0.01) and level of education less than high school (Odds ratio 7.21 95% CI 1.59–32.75 P=0.01) were independent predictors for S2P >90 minutes. Conclusion Women with STEMI have longer pre-hospital delays than men, which are associated with a higher prevalence of atypical symptoms and a lack of belief in women that they are having an AMI. Greater focus should be made on educating women (and men) regarding the symptoms of STEMI, and the importance of a timely response to these symptoms.
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Affiliation(s)
| | | | | | | | - Carlos L Alviar
- NYU Medical Center and Bellevue Hospital Center, New York, NY, USA
| | | | | | - Mun K Hong
- Bassett Healthcare Network, Cooperstown, NY, USA
| | | | - John Fox
- Mount Sinai Beth Israel Hospital, New York, NY, USA
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Abstract
Introduction: Incidence of chest pain and discomfort varies in general population between 2 % and 5 %. Total prehospital delay involves two components: the time it takes for patients to recognise their symptoms as severe and seek medical attention, ie the decision-making time, and the time from seeking help to hospital admission, ie the transport time. Scope of the study was to analyse time loss in patients with chest pain hesitating to contact healthcare services, as well as distribution of acute myocardial infarction (AMI) and angina pectoris (AP) among them. Methods: Retrospective analysis of medical records of physicians working at the emergency medical services (EMS) Department of the City of Belgrade, Serbia, from 20 April 2006 to 22 July 2013 on a total of 5,310 completed field interventions. When placing a call to the EMS, 10.43 % of patients cited chest pain as a major symptom. After deducting all those ones who denied having the symptom on examination thereafter and those for whom there were no data, 349 patients remained, ie 6.57 % of the total number of calls available for analysis. Results: The average time between the onset of chest pain and the decision to call the EMS was 11.97 h, median 2 h and mode 1 h. Patient's minimum prehospital delay was 2 min and the maximum was 20 days. Most patients who experienced chest pain or discomfort waited less than an hour before calling the EMS. Most commonly diagnoses made for a symptom of chest pain were AMI and AP, ie AMI with 12.32 % of the total diagnoses, as well as the elevated arterial pressure. There were more female patients, with no difference found among the age groups. Conclusion: For the majority of patients with chest pain and discomfort presented in this paper the decision-making time was up to one hour, with cardiovascular causes being the at the top of the list.
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6
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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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Kim JM, Stewart R, Lee HJ, Kang HJ, Bae KY, Kim SW, Shin IS, Kim MC, Hong YJ, Ahn Y, Jeong MH, Yoon JS. Impact of Suicidal Ideation on Long-Term Cardiac Outcomes in Patients with Acute Coronary Syndrome: Sex-Specific Differences. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87:311-312. [PMID: 29898458 DOI: 10.1159/000489788] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/02/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Jae-Min Kim
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Hee-Joon Lee
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Kyung-Yeol Bae
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Min-Chul Kim
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jin-Sang Yoon
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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Satilmisoglu MH, Ozyilmaz SO, Gul M, Ak Yildirim H, Kayapinar O, Gokturk K, Aksu H, Erkanli K, Eksik A. Predictive values of D-dimer assay, GRACE scores and TIMI scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction. Ther Clin Risk Manag 2017; 13:393-400. [PMID: 28408834 PMCID: PMC5384739 DOI: 10.2147/tcrm.s124794] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose To determine the predictive values of D-dimer assay, Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) risk scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Patients and methods A total of 234 patients (mean age: 57.2±11.7 years, 75.2% were males) hospitalized with NSTEMI were included. Data on D-dimer assay, GRACE and TIMI risk scores were recorded. Logistic regression analysis was conducted to determine the risk factors predicting increased mortality. Results Median D-dimer levels were 349.5 (48.0–7,210.0) ng/mL, the average TIMI score was 3.2±1.2 and the GRACE score was 90.4±27.6 with high GRACE scores (>118) in 17.5% of patients. The GRACE score was correlated positively with both the D-dimer assay (r=0.215, P=0.01) and TIMI scores (r=0.504, P=0.000). Multivariate logistic regression analysis revealed that higher creatinine levels (odds ratio =18.465, 95% confidence interval: 1.059–322.084, P=0.046) constituted the only significant predictor of increased mortality risk with no predictive values for age, D-dimer assay, ejection fraction, glucose, hemoglobin A1c, sodium, albumin or total cholesterol levels for mortality. Conclusion Serum creatinine levels constituted the sole independent determinant of mortality risk, with no significant values for D-dimer assay, GRACE or TIMI scores for predicting the risk of mortality in NSTEMI patients.
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Affiliation(s)
| | | | | | - Hayriye Ak Yildirim
- Department of Biochemistry, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul
| | - Osman Kayapinar
- Department of Cardiology, Duzce University Faculty of Medicine, Duzce
| | | | | | - Korhan Erkanli
- Department of Thoracic and Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Tan YC, Sinclair H, Ghoorah K, Teoh X, Mehran R, Kunadian V. Gender differences in outcomes in patients with acute coronary syndrome in the current era: A review. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:51-60. [PMID: 26450783 DOI: 10.1177/2048872615610886] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Coronary heart disease is the most common cause of death worldwide. In the United Kingdom in 2010, over 80,000 deaths were attributed to coronary heart disease, and one in 10 female deaths were due to coronary heart disease. Acute coronary syndrome, a subset of coronary heart disease, was responsible for 175,000 inpatient admissions in the United Kingdom in 2012. While men have traditionally been considered to be at higher risk of acute coronary syndrome, various studies have demonstrated that women often suffer from poorer outcomes following an adverse cardiovascular event. This gap is gradually narrowing with the introduction of advanced interventional strategies and pharmacotherapy. However, a better understanding of these differences is of crucial importance for the improvement of the pharmacological and interventional management of acute coronary syndrome and for the development of possible new gender-specific diagnostic and therapeutic options. The goals of this review are to evaluate gender differences in outcomes in patients with acute coronary syndrome in the current era and identify potential mechanisms behind these differences in outcomes following percutaneous coronary intervention.
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Affiliation(s)
- Ying C Tan
- 1 Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, UK
| | - Hannah Sinclair
- 1 Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, UK.,2 Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Kuldeepa Ghoorah
- 2 Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Xuyan Teoh
- 1 Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, UK
| | | | - Vijay Kunadian
- 1 Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, UK.,2 Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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10
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Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN, Lindley KJ, Vaccarino V, Wang TY, Watson KE, Wenger NK. Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation 2016; 133:916-47. [PMID: 26811316 DOI: 10.1161/cir.0000000000000351] [Citation(s) in RCA: 752] [Impact Index Per Article: 94.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction.
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11
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Denton EGD, Shaffer JA, Alcantara C, Cadermil E. Neighborhood matters: the impact of Hispanic ethnic density on future depressive symptoms 1-year following an ACS event among Hispanic patients. J Behav Med 2015; 39:28-40. [PMID: 26407692 DOI: 10.1007/s10865-015-9679-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 09/07/2015] [Indexed: 12/22/2022]
Abstract
The Ethnic Density hypothesis posits that living around others from similar ethnic backgrounds reduces the risk of adverse mental health outcomes such as depression. Contrary to this hypothesis, previous work has shown that Hispanic ethnic density is cross-sectionally associated with increased depressive symptom severity among patients hospitalized with an acute coronary syndrome (ACS; myocardial infarction or unstable angina pectoris). To date, no study has examined the prospective association of Hispanic ethnic density on long-term depressive symptom severity following an acute medical event. We prospectively assessed the impact of Hispanic ethnic density on depressive symptoms, 1-year following an ACS event, among Hispanic adult patients. We tested the non-linear association between ethnic density and depressive symptoms to account for inconsistent findings on the ethnic density hypothesis. At the time of an index ACS event (i.e., baseline, N = 326) and 1-year later (N = 252), Hispanic patients from the Prescription Usage, Lifestyle, and Stress Evaluation prospective cohort study completed the Beck Depression Inventory as a measure of depressive symptom severity. Hispanic ethnic density was defined by the percentage of Hispanic residents within each patient's census tract using data extracted from the American Community Survey Census (2010-2013). Covariates included baseline demographic factors (age, gender, English fluency, education, nativity status), cardiovascular factors (Charlson comorbidity index, left ventricular ejection fraction, Global Registry of Acute Coronary Events 6-month prognostic risk score), and neighborhood factors (residential density, income, and percentage of households receiving public assistance). In an adjusted multivariable linear regression analysis there was a significant curvilinear association between Hispanic ethnic density and depressive symptom severity at 1 year. As Hispanic ethnic density increased from low to moderate density, there was an increase in depressive symptoms, but depressive symptoms slightly declined in census tracts with the highest density of Hispanics. Furthermore, gender significantly moderated the relation between Hispanic ethnic density and 1-year depressive symptom severity, such that Hispanic ethnic density was significantly associated with increased depressive symptom severity for female Hispanic patients with ACS, but not for male Hispanic patients. Previous research suggests that ethnic density may be protective against depression in Hispanic enclaves; however, our findings suggest a non-linear ethnic density effect and an overall more complex association between ethnic density and depression. These data add to a growing body of literature on the effects of sociodemographic and contextual factors on health.
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Affiliation(s)
- Ellen-Ge D Denton
- Department of Psychology, City University of New York College of Staten Island, 2800 Victory Blvd., Building 4S, Room 229, Staten Island, NY, 10314, USA.
| | - Jonathan A Shaffer
- University of Colorado Denver - Denver Campus, CLAS-Psychology, 3NC North Classroom, 1255 10th Street Mall, Denver, CO, 80217, USA
| | - Carmela Alcantara
- Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 810, MC 4600, New York, NY, 10027, USA
| | - Esteban Cadermil
- Department of Psychology, Clark University, 950 Main Street, Worcester, MA, 01610-1477, USA
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Kunath F, Keck B, Bertz S, Brookman-May S, May M, Vergho D, Hartmann A, Riedmiller H, Wullich B, Burger M. Is gender becoming relevant in uro-oncological research? A bibliographical analysis. World J Urol 2013; 31:1065-72. [PMID: 23568444 DOI: 10.1007/s00345-013-1069-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 03/27/2013] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Gender differences are increasingly recognized as important in numerous diseases and found to be relevant in various cancer entities. While a larger number of manuscripts on gender effects in gastro-intestinal and pulmonary neoplasms have been published, urological malignancies involving men and women alike seem less studied in this regard. The present analysis aimed at describing the role of gender effects in general oncological and uro-oncological research and is the first such bibliometrical analysis. METHODS The electronic database MEDLINE was searched for relevant medical subject headings from January 1991 to December 2011. Publication types, publishing journal and impact factors were identified. Trends were assessed by linear regression. RESULTS The numbers of annual publications on all major tumour entities and on urological malignancies increased similarly. While the portion of publications on gender effects was below 1 % for each tumour entity, the annual increase of novel publications on gender effects was significant in most and prominent in pulmonary (1.87, 95 % CI 1.11-2.63; <0.0001) and colorectal neoplasms (2.16, 95 % CI 1.49-2.82; <0.0001). While the annual increase of novel publications on gender effects was significant in bladder cancer (0.33, 95 % CI 0.11-0.54; 0.005), it failed level of significance in renal cell cancer (0.25, 95 % CI -0.19-0.24; 0.82). CONCLUSION While the overall role of gender effect seems small in general oncological research, it is increasing steadily. In uro-oncological research, such trend is also visible in bladder but not in renal cell cancer. Respective awareness on importance of gender effects should be raised.
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Affiliation(s)
- Frank Kunath
- Department of Urology, University of Erlangen, Erlangen, Germany
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