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Kocot E, Ferrero A, Shrestha S, Dubas-Jakóbczyk K. End-of-life expenditure on health care for the older population: a scoping review. HEALTH ECONOMICS REVIEW 2024; 14:17. [PMID: 38427081 PMCID: PMC10905877 DOI: 10.1186/s13561-024-00493-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/05/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The existing evidence shows that the pattern of health expenditure differs considerably between people at the end-of-life and people in other periods of their lives. The awareness of these differences, combined with a detailed analysis of future mortality rates is one of the key pieces of information needed for health spending prognoses. The general objective of this review was to identify and map the existing empirical evidence on end-of-life expenditure related to health care for the older population. METHODS To achieve the objective of the study a systematic scoping review was performed. There were 61 studies included in the analysis. The project has been registered through the Open Science Framework. RESULTS The included studies cover different kinds of expenditure in terms of payers, providers and types of services, although most of them include analyses of hospital spending and nearly 60% of analyses were conducted for insurance expenditure. The studies provide very different results, which are difficult to compare. However, all of the studies analyzing expenditure by survivorship status indicate that expenditure on decedents is higher than on survivors. Many studies indicate a strong relationship between health expenditure and proximity to death and indicate that proximity to death is a more important determinant of health expenditure than age per se. Drawing conclusions on the relationship between end-of-life expenditure and socio-economic status would be possible only by placing the analysis in a broader context, including the rules of a health system's organization and financing. This review showed that a lot of studies are focused on limited types of care, settings, and payers, showing only a partial picture of health and social care systems in the context of end-of-life expenditure for the older population. CONCLUSION The results of studies on end-of-life expenditure for the older population conducted so far are largely inconsistent. The review showed a great variety of problems appearing in the area of end-of-life expenditure analysis, related to methodology, data availability, and the comparability of results. Further research is needed to improve the methods of analyses, as well as to develop some analysis standards to enhance research quality and comparability.
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Affiliation(s)
- Ewa Kocot
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.
| | - Azzurra Ferrero
- Ospedale Michele e Pietro Ferrero, Verduno-Azienda Sanitaria Locale CN2, Alba-Bra, Italy
| | | | - Katarzyna Dubas-Jakóbczyk
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
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2
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Tran VH, Mehawej J, Abboud DM, Tisminetzky M, Hariri E, Filippaios A, Gore JM, Yarzebski J, Goldberg JH, Lessard D, Goldberg R. Age and Sex Differences and Temporal Trends in the Use of Invasive and Noninvasive Procedures in Patients Hospitalized With Acute Myocardial Infarction. J Am Heart Assoc 2022; 11:e025605. [PMID: 36000439 PMCID: PMC9496437 DOI: 10.1161/jaha.122.025605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Few studies have examined age and sex differences in the receipt of cardiac diagnostic and interventional procedures in patients hospitalized with acute myocardial infarction and trends in these possible differences during recent years. Methods and Results Data from patients hospitalized with a first acute myocardial infarction at the major medical centers in the Worcester, Massachusetts, metropolitan area were utilized for this study. Logistic regression analysis was used to examine age (<55, 55–64, 65–74, and ≥75 years) and sex differences in the receipt of echocardiography, exercise stress testing, coronary angiography, percutaneous coronary interventions, and coronary artery bypass graft surgery, and trends in the use of those procedures during patients' acute hospitalization, between 2005 and 2018, while adjusting for important confounding factors. The study population consisted of 1681 men and 1154 women with an initial acute myocardial infarction who were hospitalized on an approximate biennial basis between 2005 and 2018. A smaller proportion of women underwent cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft surgery, while there were no sex differences in the receipt of echocardiography and exercise stress testing. Patients aged ≥75 years were less likely to undergo cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft surgery, but were more likely to receive echocardiography compared with younger patients. Between 2005 and 2018, the use of echocardiography and coronary artery bypass graft surgery nonsignificantly increased among all age groups and both sexes, while the use of cardiac catheterization and percutaneous coronary intervention increased nonsignificantly faster in women and older patients. Conclusions We observed a continued lower receipt of invasive cardiac procedures in women and patients aged ≥75 years with acute myocardial infarction, but age and sex gaps associated with these procedures have narrowed during recent years.
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Affiliation(s)
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine University of Massachusetts Medical School Worcester MA
| | - Donna M Abboud
- Department of Medicine Lebanese American University Beirut Lebanon
| | - Mayra Tisminetzky
- Division of Geriatric Medicine, Department of Medicine University of Massachusetts Medical School Worcester MA.,Department of Population and Quantitative Health Sciences University of Massachusetts Medical School Worcester MA
| | - Essa Hariri
- Department of Medicine Cleveland Clinic Cleveland OH
| | - Andreas Filippaios
- UMass Memorial Medical Group Fitchburg MA.,Division of Cardiovascular Medicine, Department of Medicine University of Massachusetts Medical School Worcester MA
| | - Joel M Gore
- Division of Cardiovascular Medicine, Department of Medicine University of Massachusetts Medical School Worcester MA.,Department of Population and Quantitative Health Sciences University of Massachusetts Medical School Worcester MA
| | - Jorge Yarzebski
- Division of Geriatric Medicine, Department of Medicine University of Massachusetts Medical School Worcester MA
| | - Jordan H Goldberg
- Department of Population and Quantitative Health Sciences University of Massachusetts Medical School Worcester MA
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences University of Massachusetts Medical School Worcester MA
| | - Robert Goldberg
- Department of Population and Quantitative Health Sciences University of Massachusetts Medical School Worcester MA
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3
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Meisel SR, Tal O, Kobo O, Saada M, Nashed H, Fanne RA, Alcalai R, Amsalem N, Levi Y, Mohsen J, Kleiner-Shochat M, Roguin A. Impact of the Admission Pathway on the Gender-Related Mortality of Patients With ST-Elevation Myocardial Infarction. Am J Cardiol 2022; 166:9-17. [PMID: 34969509 DOI: 10.1016/j.amjcard.2021.11.025] [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] [Received: 08/23/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022]
Abstract
The mortality of women with ST-elevation myocardial infarction (STEMI) exceeds that of men, supposedly the result of older age and co-morbidities. Patients with STEMI can be transported directly to the catherization lab by the emergency medical service (EMS) or to the emergency department (ED) by the EMS, a regular ambulance, or independently. This raises the question whether gender disparity in the transport of patients with STEMI may affect time to therapy and consequently explain the disparate outcome in men and women with STEMI. We analyzed a large nationwide registry of prospectively-recorded patients with acute coronary syndromes in order to determine if there is a survival gap between men and women with STEMI, and to assess the gender-related effect of admission pathway on time intervals and 5-year mortality. Study population included 2,740 patients with STEMI who underwent primary percutaneous coronary interventions, comprising 464 women (17%, median-70 years) and 2,276 men (83%, median-58 years). The unadjusted 5-year mortality of women was higher compared with men (26.4% vs 15.6%, p = 0.001) but adjustment abrogated this survival difference. Regardless of adjustment, the 5-year mortality of patients with STEMI admitted directly to the catherization lab or to the ED by EMS was similar for men and women but significantly lower in the directly admitted patients (p <0.028). In contrast, admission to the ED by non-EMS was associated with markedly worse survival among women. These results indicate that women suspected of STEMI benefit from transportation by the EMS and should use this pathway exclusively to reach the hospital.
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Affiliation(s)
- Simcha R Meisel
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Ovdat Tal
- The Israeli Center for Cardiac Research, Sheba Medical Center, Ramat Gan, Israel
| | - Ofer Kobo
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Majdi Saada
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hamuda Nashed
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Rami Abu Fanne
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ronny Alcalai
- The Heart Institute, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Naama Amsalem
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yaniv Levi
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Jameel Mohsen
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michael Kleiner-Shochat
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ariel Roguin
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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4
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Lansky A, Baron SJ, Grines CL, Tremmel JA, Al-Lamee R, Angiolillo DJ, Chieffo A, Croce K, Jacobs AK, Madan M, Maehara A, Mehilli J, Mehran R, Ng V, Parikh PB, Saw J, Abbott JD. SCAI Expert Consensus Statement on Sex-Specific Considerations in Myocardial Revascularization. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100016. [PMID: 39132570 PMCID: PMC11307953 DOI: 10.1016/j.jscai.2021.100016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 08/13/2024]
Affiliation(s)
| | | | - Cindy L. Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia
| | | | | | | | - Alaide Chieffo
- University of Florida Health Sciences Center, Jacksonville, Florida
| | - Kevin Croce
- IRCCS San Raffaele Scientific Institute, Milan, Italy
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Alice K. Jacobs
- Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Mina Madan
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Akiko Maehara
- Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vivian Ng
- Columbia University Irving Medical Center, New York, New York
| | - Puja B. Parikh
- Stony Brook University Medical Center, Stony Brook, New York
| | - Jacqueline Saw
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - J. Dawn Abbott
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
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5
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Alharbi MS, Alanazi BK, Alquhays IA, Alhamied NA, Al Shimemeri A. Effect of Gender on the Outcomes of ST-Elevation Myocardial Infarction at a Tertiary Care Hospital in Riyadh, Saudi Arabia. Cureus 2020; 12:e10118. [PMID: 33005534 PMCID: PMC7523745 DOI: 10.7759/cureus.10118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective This study aimed to evaluate the impact of gender on the outcomes among ST elevation myocardial infarction patients at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Methods This retrospective study analyzed the data of 900 patients (770 males and 130 females) admitted between January 2016 and December 2018 diagnosed with ST-elevation myocardial infarction (STEMI). We recorded the baseline characteristics, comorbidities, treatment, complications, and mortality for all patients, and compared these data between female and male patients. Results The baseline characteristics: BMI and age were higher in females and were statistically significant (p = 0.0001). We found a higher incidence of heart failure in females than in males which was statistically significant (p = 0.0010). In addition, the mortality rate was higher in female than in male patients, although this difference was not statistically significant (p = 0.3850). Conclusion In conclusion, despite the advances in the technology and the use of novel reperfusion therapies females were associated with poorer outcomes after adjustment of the baseline characteristics and risk factors. In other words, heart failure, mitral regurgitation, and arrhythmias were higher in females with significant p values.
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Affiliation(s)
| | | | | | - Nawaf A Alhamied
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abdullah Al Shimemeri
- Internal Medicine: Critical Care, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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6
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Shehab A, AlHabib KF, Bhagavathula AS, Hersi A, Alfaleh H, Alshamiri MQ, Ullah A, Sulaiman K, Almahmeed W, Al Suwaidi J, Alsheikh-Ali AA, Amin H, Al Jarallah M, Salam AM. Clinical Presentation, Quality of Care, Risk Factors and Outcomes in Women with Acute ST-Elevation Myocardial Infarction (STEMI): An Observational Report from Six Middle Eastern Countries. Curr Vasc Pharmacol 2020. [PMID: 29542414 DOI: 10.2174/1570161116666180315104820] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited. AIMS To examine the clinical presentation, patient management, quality of care, risk factors and inhospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East. METHODS Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations, management and in-hospital outcomes were compared between the 2 groups. RESULTS Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia compared with men who were more likely to be smokers (all p<0.001). Women had longer median symptom-onset to emergency department (ED) arrival times (230 vs. 170 min, p<0.001) and ED to diagnostic ECG (8 vs. 6 min., p<0.001). When primary percutaneous coronary intervention (PPCI) was performed, women had longer door-to-balloon time (DBT) (86 vs. 73 min., p=0.009). When thrombolytic therapy was not administered, women were less likely to receive PPCI (69.7 vs. 76.7%, p=0.036). The mean duration of hospital stay was longer in women (6.03 ± 22.51 vs. 3.41 ± 19.45 days, p=0.032) and the crude in-hospital mortality rate was higher in women (10.4 vs. 5.2%, p<0.001). However, after adjustments, multivariate analysis revealed a statistically non-significant trend of higher inhospital mortality among women than men (6.4 vs. 4.6%), (p=0.145). CONCLUSION Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce the high morbidity and mortality of STEMI in our women.
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Affiliation(s)
- Abdulla Shehab
- Internal Medicine Department, College of Medicine and Health Sciences (CMHS), UAE University, Al Ain, United Arab Emirates
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Akshaya S Bhagavathula
- Department of Clinical Pharmacy, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Ahmad Hersi
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Hussam Alfaleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Mostafa Q Alshamiri
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Anhar Ullah
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | | | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Jassim Al Suwaidi
- Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Alwai A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.,Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.,Tufts Clinical and Translational Science Institute, Tufts Medical Center, Boston, MA, United States
| | - Haitham Amin
- Mohammed Bin Khalifa Cardiac Center, Manama, Bahrain
| | | | - Amar M Salam
- Adult Cardiology, Hamad Medical Corporation, Doha, Qatar
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7
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Zandecki L, Janion M, Sadowski M, Kurzawski J, Polonski L, Gierlotka M, Gasior M. Associations of changes in patient characteristics and management with decrease in mortality rates of men and women with ST-elevation myocardial infarction - a propensity score-matched analysis. Arch Med Sci 2020; 16:772-780. [PMID: 32542077 PMCID: PMC7286320 DOI: 10.5114/aoms.2020.93458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/15/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of this study is to estimate how much of the recent decrease in mortality among patients with myocardial infarction with ST-segment elevation (STEMI) can be attributed to improved treatment strategies, and how much it is related to changes in baseline clinical characteristics, and to compare these findings for men and women. MATERIAL AND METHODS This was a retrospective analysis of 32,790 patients with STEMI from the Polish Registry of Acute Coronary Syndromes PL-ACS hospitalised in 2005 and 2011. Changes in treatment strategies including pharmacotherapy were analysed. Observed in-hospital and 12-month mortality rates were compared with the outcomes in the groups matched on the propensity scores. RESULTS There was a substantial improvement in STEMI patient management between 2005 and 2011 in Poland. It included greater use of percutaneous coronary interventions and other guideline-based adjunctive therapies, and it was associated with a significant decline in in-hospital mortality. Relative 12-month mortality reduction rates were less pronounced and more related to changes in patients' clinical characteristics. Higher mortality risk reductions were observed in women and were driven by relatively more positive changes in their baseline risk profiles when compared to men. CONCLUSIONS The progress in the treatment strategies has helped to achieve better survival rates in STEMI patients. However, the ongoing changes in clinical characteristics of patients also played an important role, especially in women. Clinicians should focus on modifiable risk factors and post-discharge management to possibly prolong the positive aspects of in-hospital efforts.
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Affiliation(s)
- Lukasz Zandecki
- 2 Cardiology Clinic, Swietokrzyskie Cardiology Center, Kielce, Poland
- The Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
- Corresponding author: Lukasz Zandecki, 2 Cardiology Clinic Swietokrzyskie Cardiology Center, 45 Grunwaldzka St, 25-736 Kielce, Poland, E-mail:
| | - Marianna Janion
- 2 Cardiology Clinic, Swietokrzyskie Cardiology Center, Kielce, Poland
- The Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Marcin Sadowski
- The Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
- Department of Interventional Cardiology, Swietokrzyskie Cardiology Center, Kielce, Poland
| | - Jacek Kurzawski
- 2 Cardiology Clinic, Swietokrzyskie Cardiology Center, Kielce, Poland
| | - Lech Polonski
- 3 Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Marek Gierlotka
- 3 Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Mariusz Gasior
- 3 Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
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AbuRuz ME, Al-Dweik G. Depressive Symptoms and Complications Early after Acute Myocardial Infarction: Gender Differences. Open Nurs J 2018; 12:205-214. [PMID: 30450145 PMCID: PMC6198415 DOI: 10.2174/1874434601812010205] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 08/05/2018] [Accepted: 09/10/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Cardiovascular disease is the first leading cause of death worldwide. Coronary heart disease is the most common manifestation of cardiovascular disease. Acute myocardial infarction is the primary manifestation of coronary heart disease. Depression is a common and predicted complication after acute myocardial infarction. Limited studies evaluated gender differences in depressive symptoms after acute myocardial infarction especially in developing countries. Objective: The study aimed to determine whether there was a difference in depression levels and rate of complications based on gender early after acute myocardial infarction. Method: This was a prospective comparative study on 230 patients (150 men and 80 women) with a confirmed diagnosis of acute myocardial infarction. All participants signed an informed consent, filled sociodemographic and clinical questionnaire and the Depression Subscale of the Hospital Anxiety and Depression Scale. Clinical data were abstracted from the participants’ medical record after discharge. Results: Eighty-six participants (37.4%), 54 men and 32 women, developed 1 or more complications during hospitalization. Female patients were more depressed (14.4±3.5 vs. 8.3 ± 2.6) and developed more complications (1.9 ± 0.9 vs. 0.8 ± 0.5) than male patients did. Depressive symptoms increased the occurrence of complication by 40% and 33% for female and male patients respectively after controlling for sociodemographic and clinical variables. Conclusion: Depressive symptoms independently predicted complications after acute myocardial infarction in both men and women. The inclusion of depression assessment tools in acute myocardial infarction treatment protocols is highly recommended.
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Affiliation(s)
| | - Ghadeer Al-Dweik
- College of Nursing, Applied Science Private University, Amman, Jordan
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9
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Zandecki Ł, Sadowski M, Janion M, Kurzawski J, Gierlotka M, Poloński L, Gąsior M. Survival benefit from recent changes in management of men and women with ST-segment elevation myocardial infarction treated with percutaneous coronary interventions. Cardiol J 2018; 26:459-468. [PMID: 29924379 DOI: 10.5603/cj.a2018.0057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 10/04/2018] [Accepted: 01/17/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Nowadays, the majority of patients with myocardial infarction with ST-segment elevation (STEMI) are treated with primary percutaneous coronary interventions (PCI). In recent years, there have been ongoing improvements in PCI techniques, devices and concomitant pharmacotherapy. However, reports on further mortality reduction among PCI-treated STEMI patients remain inconclusive. The aim of this study was to compare changes in management and mortality in PCI-treated STEMI patients between 2005 and 2011 in a real-life setting. METHODS Data on 79,522 PCI-treated patients with STEMI from Polish Registry of Acute Coronary Syndromes (PL-ACS) admitted to Polish hospitals between 2005 and 2011 were analyzed. First, temporal trends of in-hospital management in men and women were presented. In the next step, patients from 2005 and 2011 were nearest neighbor matched on their propensity scores to compare in-hospital, 30-day and 1-year mortality rates and in-hospital management strategies and complications. RESULTS Some significant changes were noted in hospital management including shortening of median times from admission to PCI, increased use of drug-eluting stents, potent antiplatelet agents but also less frequent use of statin, beta-blockers and angiotensin converting enzyme inhibitors and angiotensin II receptor blockers. There was a strong tendency toward preforming additional PCI of non-infarct related arteries, especially in women. After propensity score adjustment there were significant changes in inhospital but not in 30-day or 1-year mortality rates between 2005 and 2011. The results were similar in men and women. CONCLUSIONS There were apparent changes in management and significant in-hospital mortality reductions in PCI-treated STEMI patients between 2005 and 2011. However, it did not result in 30-day or 1-year survival benefit at a population level. There may be room for improvement in the use of guideline-recommended pharmacotherapy.
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Affiliation(s)
- Łukasz Zandecki
- 2nd Cardiology Clinic, Swietokrzyskie Cardiology Center, Kielce, Poland. .,The Faculty of Medicine and Health Sciences, The Jan Kochanowski University, Kielce, Poland.
| | - Marcin Sadowski
- Department of Interventional Cardiology, Swietokrzyskie Cardiology Center, Kielce, Poland.,The Faculty of Medicine and Health Sciences, The Jan Kochanowski University, Kielce, Poland
| | - Marianna Janion
- 2nd Cardiology Clinic, Swietokrzyskie Cardiology Center, Kielce, Poland.,The Faculty of Medicine and Health Sciences, The Jan Kochanowski University, Kielce, Poland
| | - Jacek Kurzawski
- 2nd Cardiology Clinic, Swietokrzyskie Cardiology Center, Kielce, Poland
| | - Marek Gierlotka
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.,Department of Cardiology, University Hospital, Institute of Medicine, University of Opole, Poland
| | - Lech Poloński
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
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10
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Liakos M, Parikh PB. Gender Disparities in Presentation, Management, and Outcomes of Acute Myocardial Infarction. Curr Cardiol Rep 2018; 20:64. [DOI: 10.1007/s11886-018-1006-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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11
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Sulzgruber P, Schnaubelt S, Koller L, Goliasch G, Niederdöckl J, Simon A, El-Hamid F, Rothgerber DJ, Wojta J, Niessner A. Cardiac arrest as an age-dependent prognosticator for long-term mortality after acute myocardial infarction: the potential impact of infarction size. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 8:153-160. [PMID: 29856229 DOI: 10.1177/2048872618781370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND: The development of cardiac arrhythmias resulting in cardiac arrest represents a severe complication in patients with acute myocardial infarction. While the worsening of the prognosis in this vulnerable patient collective is well known, less attention has been paid to its age-specific relevance from a long-term perspective. METHODS: Based on a clinical acute myocardial infarction registry we analysed 832 patients with acute myocardial infarction within the current analysis. Patients were stratified into equal groups ( n=208 per group) according to age in less than 45 years, 45-64 years, 65-84 years and 85 years and older via propensity score matching. Multivariate Cox regression analysis was used to assess the age-dependent influence of cardiac arrest on mortality. RESULTS: The total number of cardiac arrests differed significantly between age groups, demonstrating the highest incidence in the youngest population with 18.8% ( n=39), and a significantly lower incidence by increasing age (-11.6%; P=0.01). After a mean follow-up time of 8 years, a total of 264 patients (31.7%) died due to cardiovascular causes. While cardiac arrest was a strong and independent predictor for mortality within the total study population with an adjusted hazard ratio of 3.21 (95% confidence interval 2.23-4.61; P<0.001), there was no significant association with mortality independently in very young patients (<45 years; adjusted hazard ratio of 1.73, 95% confidence interval 0.55-5.53; P=0.35). CONCLUSION: We found that arrhythmias resulting in cardiac arrest are more common in very young acute myocardial infarction patients (<45 years) compared to their older counterparts, and were able to demonstrate that the prognostic value of cardiac arrest on long-term mortality in patients with acute myocardial infarction is clearly age dependent.
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Affiliation(s)
- Patrick Sulzgruber
- 1 Department of Internal Medicine II, Medical University of Vienna, Austria.,2 Ludwig Boltzmann Institute, Cluster for Cardiovascular Research, Austria
| | | | - Lorenz Koller
- 1 Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Georg Goliasch
- 1 Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Jan Niederdöckl
- 3 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Alexander Simon
- 3 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Feras El-Hamid
- 1 Department of Internal Medicine II, Medical University of Vienna, Austria
| | | | - Johann Wojta
- 1 Department of Internal Medicine II, Medical University of Vienna, Austria.,2 Ludwig Boltzmann Institute, Cluster for Cardiovascular Research, Austria
| | - Alexander Niessner
- 1 Department of Internal Medicine II, Medical University of Vienna, Austria
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12
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Chen H, Shi L, Xue M, Wang N, Dong X, Cai Y, Chen J, Zhu W, Xu H, Meng Q. Geographic Variations in In‐Hospital Mortality and Use of Percutaneous Coronary Intervention Following Acute Myocardial Infarction in China: A Nationwide Cross‐Sectional Analysis. J Am Heart Assoc 2018. [PMCID: PMC6015409 DOI: 10.1161/jaha.117.008131] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Prevalence of acute myocardial infarction (AMI) is increasing in China, and AMI has become a major cause of mortality; however, information is very limited about the nationwide geographic and hospital variation in in‐hospital mortality (IHM) and the use of percutaneous coronary intervention (PCI) after AMI. Methods and Results From the Nationwide Hospital Discharge Database of China, we identified 242 866 adult admissions with AMI in 2015 from 1055 tertiary hospitals. We used multivariable logistic regressions to analyze the associations between geographic or hospital characteristics with IHM or PCI use. The national IHM rate was 4.71% (95% confidence interval, 4.62–4.79%). There was a greater risk of mortality in the Northeast (odds ratio [OR]: 1.86), West (OR: 1.73), South (OR: 1.32), and North (OR: 1.14) regions than in the East region of China. Non–teaching hospitals (OR: 1.18) and tertiary level B hospitals (OR: 1.06) were associated with higher IHM rates. The national PCI use rate was 45.3% (95% confidence interval, 45.1–45.5%). Compared with the East region of China, PCI use was lower in the Northeast (OR: 0.50), West (OR: 0.64), North (OR: 0.84), and South (OR: 0.88) regions. Non–teaching hospitals (OR: 0.83) and tertiary level B hospitals (OR: 0.55) were also associated with lower usage rates. There was a significant negative correlation between IHM and PCI use (r=−0.955), and IHM rates for patients with and without PCI both differed by geographic regions. Conclusions There were significant differences in IHM and PCI use among China's tertiary hospitals, linked to both geographic and hospital characteristics. More targeted intervention at national and regional levels is needed to improve access to effective health technologies and, eventually, outcomes following AMI.
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Affiliation(s)
- Hui Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Lizheng Shi
- Department of Global Health Management and Policy, Tulane University, New Orleans, LA
| | - Ming Xue
- Centre for Health Statistics and Information, The National Health and Family Planning Commission of China, Beijing, China
| | - Ni Wang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Xiao Dong
- School of Biomedical Informatics, The University of Texas Health Science Centre at Houston, TX
| | - Yue Cai
- Centre for Health Statistics and Information, The National Health and Family Planning Commission of China, Beijing, China
| | - Jieqing Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Weiguo Zhu
- Department of Information Management, Department of General Internal Medicine, Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences, Beijing, China
| | - Hua Xu
- School of Biomedical Informatics, The University of Texas Health Science Centre at Houston, TX
| | - Qun Meng
- Centre for Health Statistics and Information, The National Health and Family Planning Commission of China, Beijing, China
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13
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Alabas OA, Gale CP, Hall M, Rutherford MJ, Szummer K, Lawesson SS, Alfredsson J, Lindahl B, Jernberg T. Sex Differences in Treatments, Relative Survival, and Excess Mortality Following Acute Myocardial Infarction: National Cohort Study Using the SWEDEHEART Registry. J Am Heart Assoc 2017; 6:e007123. [PMID: 29242184 PMCID: PMC5779025 DOI: 10.1161/jaha.117.007123] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/06/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study assessed sex differences in treatments, all-cause mortality, relative survival, and excess mortality following acute myocardial infarction. METHODS AND RESULTS A population-based cohort of all hospitals providing acute myocardial infarction care in Sweden (SWEDEHEART [Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies]) from 2003 to 2013 was included in the analysis. Excess mortality rate ratios (EMRRs), adjusted for clinical characteristics and guideline-indicated treatments after matching by age, sex, and year to background mortality data, were estimated. Although there were no sex differences in all-cause mortality adjusted for age, year of hospitalization, and comorbidities for ST-segment-elevation myocardial infarction (STEMI) and non-STEMI at 1 year (mortality rate ratio: 1.01 [95% confidence interval (CI), 0.96-1.05] and 0.97 [95% CI, 0.95-0.99], respectively) and 5 years (mortality rate ratio: 1.03 [95% CI, 0.99-1.07] and 0.97 [95% CI, 0.95-0.99], respectively), excess mortality was higher among women compared with men for STEMI and non-STEMI at 1 year (EMRR: 1.89 [95% CI, 1.66-2.16] and 1.20 [95% CI, 1.16-1.24], respectively) and 5 years (EMRR: 1.60 [95% CI, 1.48-1.72] and 1.26 [95% CI, 1.21-1.32], respectively). After further adjustment for the use of guideline-indicated treatments, excess mortality among women with non-STEMI was not significant at 1 year (EMRR: 1.01 [95% CI, 0.97-1.04]) and slightly higher at 5 years (EMRR: 1.07 [95% CI, 1.02-1.12]). For STEMI, adjustment for treatments attenuated the excess mortality for women at 1 year (EMRR: 1.43 [95% CI, 1.26-1.62]) and 5 years (EMRR: 1.31 [95% CI, 1.19-1.43]). CONCLUSIONS Women with acute myocardial infarction did not have statistically different all-cause mortality, but had higher excess mortality compared with men that was attenuated after adjustment for the use of guideline-indicated treatments. This suggests that improved adherence to guideline recommendations for the treatment of acute myocardial infarction may reduce premature cardiovascular death among women. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02952417.
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Affiliation(s)
- Oras A Alabas
- Medical Research Council Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Chris P Gale
- Medical Research Council Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
- Department of Cardiology, York Teaching Hospital NHS Foundation Trust, York, United Kingdom
| | - Marlous Hall
- Medical Research Council Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Mark J Rutherford
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Karolina Szummer
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Sederholm Lawesson
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Joakim Alfredsson
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
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14
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Saner H, Mollet JD, Berlin C, Windecker S, Meier B, Räber L, Zwahlen M, Stute P. No significant gender difference in hospitalizations for acute coronary syndrome in Switzerland over the time period of 2001 to 2010. Int J Cardiol 2017; 243:59-64. [DOI: 10.1016/j.ijcard.2017.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/21/2017] [Accepted: 05/09/2017] [Indexed: 11/29/2022]
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15
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Puymirat E, Simon T, Cayla G, Cottin Y, Elbaz M, Coste P, Lemesle G, Motreff P, Popovic B, Khalife K, Labèque JN, Perret T, Le Ray C, Orion L, Jouve B, Blanchard D, Peycher P, Silvain J, Steg PG, Goldstein P, Guéret P, Belle L, Aissaoui N, Ferrières J, Schiele F, Danchin N. Acute Myocardial Infarction: Changes in Patient Characteristics, Management, and 6-Month Outcomes Over a Period of 20 Years in the FAST-MI Program (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) 1995 to 2015. Circulation 2017; 136:1908-1919. [PMID: 28844989 DOI: 10.1161/circulationaha.117.030798] [Citation(s) in RCA: 330] [Impact Index Per Article: 47.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 08/14/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation myocardial infarction (NSTEMI) management has evolved considerably over the past 2 decades. Little information on mortality trends in the most recent years is available. We assessed trends in characteristics, treatments, and outcomes for acute myocardial infarction in France between 1995 and 2015. METHODS We used data from 5 one-month registries, conducted 5 years apart, from 1995 to 2015, including 14 423 patients with acute myocardial infarction (59% STEMI) admitted to cardiac intensive care units in metropolitan France. RESULTS From 1995 to 2015, mean age decreased from 66±14 to 63±14 years in patients with STEMI; it remained stable (68±14 years) in patients with NSTEMI, whereas diabetes mellitus, obesity, and hypertension increased. At the acute stage, intended primary percutaneous coronary intervention increased from 12% (1995) to 76% (2015) in patients with STEMI. In patients with NSTEMI, percutaneous coronary intervention ≤72 hours from admission increased from 9% (1995) to 60% (2015). Six-month mortality consistently decreased in patients with STEMI from 17.2% in 1995 to 6.9% in 2010 and 5.3% in 2015; it decreased from 17.2% to 6.9% in 2010 and 6.3% in 2015 in patients with NSTEMI. Mortality still decreased after 2010 in patients with STEMI without reperfusion therapy, whereas no further mortality gain was found in patients with STEMI with reperfusion therapy or in patients with NSTEMI, whether or not they were treated with percutaneous coronary intervention. CONCLUSIONS Over the past 20 years, 6-month mortality after acute myocardial infarction has decreased considerably for patients with STEMI and NSTEMI. Mortality figures continued to decline in patients with STEMI until 2015, whereas mortality in patients with NSTEMI appears stable since 2010.
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Affiliation(s)
- Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology; Université Paris-Descartes, Paris, France; INSERM U-970, France (E.P., N.A., N.D.)
| | - Tabassome Simon
- AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Paris, France; Université Pierre et Marie Curie (UPMC-Paris 06); INSERM U-698, France (T.S.)
| | | | - Yves Cottin
- Centre Hospitalier Universitaire du Bocage, Dijon, France (Y.C.)
| | - Meyer Elbaz
- Toulouse University Hospital, Department of Cardiology, France (M.E.)
| | - Pierre Coste
- Hôpital Cardiologique Haut Levêque, CHU de Bordeaux, Pessac, France (P.C.)
| | - Gilles Lemesle
- Lille Regional University Hospital, Department of Cardiology, France (G.L.)
| | - Pascal Motreff
- Department of Cardiology, University Hospital of Clermont-Ferrand, UMR 6284 Auvergne University, France (P.M.)
| | - Batric Popovic
- Département de cardiologie, CHU de Nancy, Vandoeuvre-lès-Nancy, France (B.P.)
| | - Khalife Khalife
- Centre Hospitalier Régional de Metz-Thionville, Mets, France (K.K.)
| | | | - Thibaut Perret
- Department of cardiology, Centre Hospitalier St Joseph et St Luc, Lyon, France (T.P.)
| | | | - Laurent Orion
- Department of Cardiology, Centre Hospitalier de Vendée, La Roche-sur-Yon, France (L.O.)
| | - Bernard Jouve
- Hospital of Aix en Provence, Department of Cardiology, France (B.J.)
| | | | | | - Johanne Silvain
- Institut de Cardiologie, Centre Hospitalier Pitié-Salpêtrière, Paris, France (J.S.)
| | - Philippe Gabriel Steg
- AP-HP, Hôpital Bichat, Paris, France; Université Paris-Diderot, Sorbonne Paris-Cité, France; INSERM U-698, 75018 Paris, France (P.G.S.)
| | - Patrick Goldstein
- Lille Regional University Hospital, Emergency Department, France (P. Goldstein)
| | - Pascal Guéret
- University Hospital Henri Mondor, Department of Cardiology, Créteil, France (P. Guéret)
| | - Loic Belle
- Department of Cardiology, Centre hospitalier Annecy Genevois, Epagny Metz-Tessy, France (L.B.)
| | - Nadia Aissaoui
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology; Université Paris-Descartes, Paris, France; INSERM U-970, France (E.P., N.A., N.D.)
| | - Jean Ferrières
- Toulouse Rangueil University Hospital, Department of Cardiology; UMR1027, INSERM, France (J.F.)
| | - François Schiele
- University Hospital Jean Minjoz, Department of Cardiology, Besançon, France (F.S.)
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology; Université Paris-Descartes, Paris, France; INSERM U-970, France (E.P., N.A., N.D.).
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16
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Trends in sex differences in clinical characteristics, treatment strategies, and mortality in patients with ST-elevation myocardial infarction in Poland from 2005 to 2011. Coron Artery Dis 2017; 28:417-425. [DOI: 10.1097/mca.0000000000000504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Ghaffari S, Pourafkari L, Tajlil A, Bahmani-Oskoui R, Nader ND. Is female gender associated with worse outcome after ST elevation myocardial infarction? Indian Heart J 2016; 69 Suppl 1:S28-S33. [PMID: 28400036 PMCID: PMC5388020 DOI: 10.1016/j.ihj.2016.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/04/2016] [Accepted: 12/11/2016] [Indexed: 12/26/2022] Open
Abstract
Objectives To investigate the impact of gender in outcomes of patients with ST segment myocardial infarction in a setting with limited access to primary percutaneous coronary intervention Methods In 1017 consecutive patients hospitalized with ST segment myocardial infarction during years 2008–2013, distribution of risk factors, therapeutic methods, heart failure and in-hospital mortality were compared between males and females. Association of gender and primary outcomes was determined after adjustment for confounding factors. Results Females were significantly older (66 ± 12.1 years vs. 59.5 ± 12.7 years, p < 0.001). Prevalence of hypertension, hyperlipidemia and diabetes was significantly higher in females (72.2% vs. 39%, p < 0.001, 36.1% vs. 20.3%, p < 0.001, 46.5% vs. 32.1%, p < 0.001, respectively). Presentation delay was similar in males and females. Females received reperfusion therapy more than males (63.2%vs. 55.8%, p = 0.032). Development of heart failure and in-hospital mortality were significantly higher in females (36.5% vs. 27.2%, p = 0.003 and 19.4% vs. 12.1%, p = 0.002, respectively). However in multivariate analysis, female gender was not independently associated with increased rate of heart failure and in-hospital mortality Conclusion In a center with low rate of primary percutaneous coronary intervention, crude rates of heart failure and in-hospital mortality are higher in females; however, the association is lost after adjustment for baseline characteristics
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Affiliation(s)
- Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leili Pourafkari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Anesthesiology Department, University at Buffalo, Buffalo, NY, United States
| | - Arezou Tajlil
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Roza Bahmani-Oskoui
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nader D Nader
- Anesthesiology Department, University at Buffalo, Buffalo, NY, United States.
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18
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Gender differences in plaque characteristics of culprit lesions in patients with ST elevation myocardial infarction. Heart Vessels 2016; 31:1767-1775. [DOI: 10.1007/s00380-016-0806-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
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19
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Sulzgruber P, Koller L, Pavo N, El-Hamid F, Rothgerber DJ, Forster S, Maurer G, Goliasch G, Niessner A. Gender-related differences in elderly patients with myocardial infarction in a European Centre. Eur J Clin Invest 2016; 46:60-9. [PMID: 26575703 DOI: 10.1111/eci.12567] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/07/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Weighing the benefit of revascularization procedures against the risk of adverse events is particularly challenging in elderly patients suffering acute myocardial infarction (AMI). Based on a general gender gap in coronary interventions, the restraint in invasive procedures may be particularly high in elderly women. We therefore investigated gender-related differences in the frequency of coronary interventions as well as gender- and age-specific outcomes after coronary interventions in patients with AMI. DESIGN We included 906 AMI patients in the final analysis. Among patients ≥ 80 years (n = 453), the intention to intervention (lysis and/or coronary angiography) for women was significantly lower compared to men (65·7% vs. 80·8%; P < 0·001), whereas in patients < 80 years (n = 453), the rate was similar between both genders (94·8% vs. 95·1%, P = 0·89). However, the assessment of potential risk factors for adverse events did not explain the gender gap. When assessing the benefit of any coronary intervention (stenting and/or lysis and/or coronary artery bypass graft), elderly women benefited at least as much with a hazard ratio (HR) for cardiovascular mortality of 0·56 (95% confidence interval [CI] 0·37-0·84, P = 0·005) compared to a HR of 0·96 (95% CI 0·76-1·23, P = 0·766) in elderly men. CONCLUSION We observed a lower intention to coronary intervention in elderly women compared with men. However, the distribution of risk factors in elderly women and men who did not undergo coronary intervention was similar and therefore seemed not to be causal for the gender gap although the benefit of any coronary interventions was even higher in elderly women.
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Affiliation(s)
- Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Lorenz Koller
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Noemi Pavo
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Feras El-Hamid
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - David-Jonas Rothgerber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Stefan Forster
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Gerald Maurer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Georg Goliasch
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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Mazzali C, Duca P. Use of administrative data in healthcare research. Intern Emerg Med 2015; 10:517-24. [PMID: 25711312 DOI: 10.1007/s11739-015-1213-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 02/12/2015] [Indexed: 11/29/2022]
Abstract
Health research based on administrative data and the availability of regional or national administrative databases has been increasing in recent years. We will discuss the general characteristics of administrative data and specific aspects of their use for health research purposes, indicating their advantages and disadvantages. Some fields of application will be discussed and described through examples.
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Affiliation(s)
- Cristina Mazzali
- Statistics and Biometrics Unit-'L. Sacco' Department of Biomedical and Clinical Sciences, University of Milan, Via G.B. Grassi, 74, 20157, Milan, Italy,
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Zughaft D, Harnek J. A review of the role of nurses and technicians in ST-elevation myocardial infarction (STEMI). EUROINTERVENTION 2014; 10 Suppl T:T83-6. [PMID: 25256539 DOI: 10.4244/eijv10sta13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The role of nurses and technicians in the treatment of ST-elevation myocardial infarction (STEMI) by primary percutaneous coronary intervention (PPCI) is vital for the success of the multidisciplinary Heart Team. Several editorials have emphasised the importance of a holistic treatment which links each step of care to the next, a chain that is essential for quality and efficacy in the management of STEMI patients. In pre-hospital acute coronary care, the first medical contact is most commonly a nurse and/or a paramedic. The time from symptom onset to reperfusion is crucial for the long-term outcome. On arrival at the hospital, it is important for the nurse or paramedic to share an overview of what has been done to the patient so far, in a structured and evidence-based way, with the receiving nurse and physician. During PPCI, the role of nurses and technicians includes puncture site assessment, administration of pharmaceuticals and the ability to anticipate and prevent complications. In patients with cardiogenic shock and cardiac arrest, advanced knowledge of haemodynamic support systems is required. In the future, this knowledge must be extended from a limited number of individuals in a small number of centres to a standard of care which is available for all citizens throughout Europe. This review demonstrates the necessity for a multidisciplinary team approach where every person plays an equal, important role in every element of PPCI. The future role of nurses and technicians is intriguing and demands education and experience from an advanced medical and nursing point of view, where the multidisciplinary Heart Team and the knowledge of the different key players are vital.
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Affiliation(s)
- David Zughaft
- Department of Cardiology, Lund University, Lund, Sweden
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