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Angarita-Fonseca A, Peebles A, Pilote L. Gender-Related Factors Associated With Outcomes of Acute Coronary Syndrome in Young Female Patients. CJC Open 2024; 6:370-379. [PMID: 38487050 PMCID: PMC10935682 DOI: 10.1016/j.cjco.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/28/2023] [Indexed: 03/17/2024] Open
Abstract
Acute coronary syndrome (ACS) remains a significant global health concern, with a growing recognition of its impact on young adults, particularly young female adults. Although gender-related factors, defined as a social construct that encompasses 4 distinct dimensions (gender roles, gender identity, gender relations, and institutionalized gender) are undoubtedly relevant across age groups, young female patients with ACS face specific challenges and disparities in outcomes, compared to other populations. This narrative review examines the role of gender-related factors-specifically, gender roles, gender identity, gender relations, and institutionalized gender-in influencing objective and subjective ACS outcomes in young female patients. In the 5 articles identified, the objective outcomes included hospital readmission, "door-to-electrocardiography" time, and coronary atherosclerosis progression. Subjective outcomes, such as physical and mental functional status, quality of life, physical limitations, and vital exhaustion, were also examined. Being employed, which is a gender role, emerged as a protective factor against hospital readmission. Gender identity factors such as depression and stress were correlated with negative outcomes, and anxiety influenced "door-to-electrocardiography" times. Institutional factors, including income disparities, affected readmission likelihood. Strong social support decreased physical limitations post-ACS, whereas financial challenges and lower education negatively impacted quality of life and vital exhaustion. These findings underscore the intricate interplay of gender dimensions in shaping ACS outcomes among young female patients. Integrating these insights into clinical practice and research can enhance care, mitigate disparities, and foster improved cardiovascular health in this vulnerable population.
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Affiliation(s)
- Adriana Angarita-Fonseca
- Research Institute of the McGill University Health Centre and Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Alexandra Peebles
- Research Institute of the McGill University Health Centre and Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Louise Pilote
- Research Institute of the McGill University Health Centre and Department of Medicine, McGill University, Montreal, Quebec, Canada
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Khoja A, Andraweera PH, Lassi ZS, Ali A, Zheng M, Pathirana MM, Aldridge E, Wittwer MR, Chaudhuri DD, Tavella R, Arstall MA. Risk Factors for Early-Onset Versus Late-Onset Coronary Heart Disease (CHD): Systematic Review and Meta-Analysis. Heart Lung Circ 2023; 32:1277-1311. [PMID: 37777398 DOI: 10.1016/j.hlc.2023.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 10/02/2023]
Abstract
AIM We aimed to systematically compare literature on prevalence of modifiable and non-modifiable risk factors for early compared to late-onset coronary heart disease (CHD). METHODS PubMed, CINAHL, Embase, and Web of Science databases were searched (review protocol registered in PROSPERO CRD42020173216). Study quality was assessed using the National Heart, Lung and Blood Institute tool for observational and case-control studies. Review Manager 5.3 was used for meta-analysis. Effect sizes were expressed as odds ratio (OR) and mean differences (MD)/standardised MD (SMD) with 95% confidence intervals (CI) for categorical and continuous variables. RESULTS Individuals presenting with early-onset CHD (age <65 years) compared to late-onset CHD had higher mean body mass index (MD 1.07 kg/m2; 95% CI 0.31-1.83), total cholesterol (SMD 0.43; 95% CI 0.23-0.62), low-density lipoprotein (SMD 0.26; 95% CI 0.15-0.36) and triglycerides (SMD 0.50; 95% CI 0.22-0.68) with lower high-density lipoprotein-cholesterol (SMD 0.26; 95% CI -0.42--0.11). They were more likely to be smokers (OR 1.76, 95% CI 1.39-2.22) and have a positive family history of CHD (OR 2.08, 95% CI 1.74-2.48). They had lower mean systolic blood pressure (MD 4.07 mmHg; 95% CI -7.36--0.78) and were less likely to have hypertension (OR 0.47, 95% CI 0.39-0.57), diabetes mellitus (OR 0.56, 95% CI 0.51-0.61) or stroke (OR 0.31, 95% CI 0.24-0.42). CONCLUSION A focus on weight management and smoking cessation and aggressive management of dyslipidaemia in young adults may reduce the risk of early-onset CHD.
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Affiliation(s)
- Adeel Khoja
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia; Cardiology Unit, Northern Adelaide Local Health Network, South Australia, Australia.
| | - Prabha H Andraweera
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia; Cardiology Unit, Northern Adelaide Local Health Network, South Australia, Australia
| | - Zohra S Lassi
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Anna Ali
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Mingyue Zheng
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; School of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Maleesa M Pathirana
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia; Cardiology Unit, Northern Adelaide Local Health Network, South Australia, Australia
| | - Emily Aldridge
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia; Cardiology Unit, Northern Adelaide Local Health Network, South Australia, Australia
| | - Melanie R Wittwer
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Cardiology Unit, Northern Adelaide Local Health Network, South Australia, Australia
| | - Debajyoti D Chaudhuri
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Cardiology Unit, Northern Adelaide Local Health Network, South Australia, Australia
| | - Rosanna Tavella
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Margaret A Arstall
- Cardiology Unit, Northern Adelaide Local Health Network, South Australia, Australia; Medical Specialties, Faculty of Health Sciences, The University of Adelaide, SA, Australia
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Khoja A, Andraweera PH, Lassi ZS, Ali A, Zheng M, Pathirana MM, Aldridge E, Wittwer MR, Chaudhuri DD, Tavella R, Arstall MA. Risk Factors for Premature Coronary Heart Disease in Women Compared to Men: Systematic Review and Meta-Analysis. J Womens Health (Larchmt) 2023; 32:908-920. [PMID: 37184900 DOI: 10.1089/jwh.2022.0517] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Background: We aimed to systematically examine literature on the prevalence of known modifiable and nonmodifiable risk factors for premature coronary heart disease (PCHD) in women compared with men. Materials and Methods: PubMed, CINAHL, Embase, and Web of Science databases were searched. Review protocol is registered in PROSPERO (CRD42020173216). Quality was assessed using the National Heart, Lung, and Blood Institute tool. Review Manager 5.3 was used for meta-analysis. Effect sizes were expressed as odds ratio (OR) and mean differences/standardized mean differences (SMD) with 95% confidence intervals (CIs) for categorical and continuous variables. Results: In this PCHD cohort (age <65 years), the mean age of presentation in women was 3 years older than men. Women had higher total cholesterol (SMD 0.11; 95% CI 0.00 to 0.23) and higher high-density lipoprotein cholesterol (SMD 0.49; 95% CI 0.29 to 0.69). Women were more likely to have hypertension (OR 1.51, 95% CI 1.42 to 1.60), diabetes mellitus (OR 1.78, 95% CI 1.55 to 2.04), obesity (OR 1.33, 95% CI 1.24 to 1.42), metabolic syndrome (OR 3.73, 95% CI 1.60 to 8.69), stroke (OR 1.63, 95% CI 1.51 to 1.77), peripheral vascular disorder (OR 1.67, 95% CI 1.43 to 1.96), and depression (OR 2.29, 95% CI 1.96 to 2.67). Women were less likely to be smokers (OR 0.60, 95% CI 0.55 to 0.66), have reported alcohol intake (OR 0.36, 95% CI 0.33 to 0.40), and reported use of illicit drug (OR 0.32, 95% CI 0.16 to 0.62). Conclusions: Risk factor profile in PCHD has a clear sex difference that supports early, aggressive, holistic, but sex-specific, approach to prevention.
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Affiliation(s)
- Adeel Khoja
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Cardiology Unit, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Prabha H Andraweera
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Cardiology Unit, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Zohra S Lassi
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anna Ali
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mingyue Zheng
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- School of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Maleesa M Pathirana
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Cardiology Unit, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Emily Aldridge
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Cardiology Unit, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Melanie R Wittwer
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Cardiology Unit, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Debajyoti D Chaudhuri
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Cardiology Unit, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Rosanna Tavella
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiology, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Margaret A Arstall
- Cardiology Unit, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
- Medical Specialties, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Sawano M, Lu Y, Caraballo C, Mahajan S, Dreyer R, Lichtman JH, D'Onofrio G, Spatz E, Khera R, Onuma O, Murugiah K, Spertus JA, Krumholz HM. Sex Difference in Outcomes of Acute Myocardial Infarction in Young Patients. J Am Coll Cardiol 2023; 81:1797-1806. [PMID: 37137590 DOI: 10.1016/j.jacc.2023.03.383] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Younger women experience worse health status than men after their index episode of acute myocardial infarction (AMI). However, whether women have a higher risk for cardiovascular and noncardiovascular hospitalizations in the year after discharge is unknown. OBJECTIVES The aim of this study was to determine sex differences in causes and timing of 1-year outcomes after AMI in people aged 18 to 55 years. METHODS Data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study, which enrolled young patients with AMI across 103 U.S. hospitals, were used. Sex differences in all-cause and cause-specific hospitalizations were compared by calculating incidence rates ([IRs] per 1,000 person-years) and IR ratios with 95% CIs. We then performed sequential modeling to evaluate the sex difference by calculating subdistribution HRs (SHRs) accounting for deaths. RESULTS Among 2,979 patients, at least 1 hospitalization occurred among 905 patients (30.4%) in the year after discharge. The leading causes of hospitalization were coronary related (IR: 171.8 [95% CI: 153.6-192.2] among women vs 117.8 [95% CI: 97.3-142.6] among men), followed by noncardiac hospitalization (IR: 145.8 [95% CI: 129.2-164.5] among women vs 69.6 [95% CI: 54.5-88.9] among men). Furthermore, a sex difference was present for coronary-related hospitalizations (SHR: 1.33; 95% CI: 1.04-1.70; P = 0.02) and noncardiac hospitalizations (SHR: 1.51; 95% CI: 1.13-2.07; P = 0.01). CONCLUSIONS Young women with AMI experience more adverse outcomes than men in the year after discharge. Coronary-related hospitalizations were most common, but noncardiac hospitalizations showed the most significant sex disparity.
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Affiliation(s)
- Mitsuaki Sawano
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - Yuan Lu
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - César Caraballo
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - Shiwani Mahajan
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - Rachel Dreyer
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Judith H Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Erica Spatz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - Oyere Onuma
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - Karthik Murugiah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - John A Spertus
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA.
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Stătescu C, Anghel L, Benchea LC, Tudurachi BS, Leonte A, Zăvoi A, Zota IM, Prisacariu C, Radu R, Șerban IL, Sascău RA. A Systematic Review on the Risk Modulators of Myocardial Infarction in the "Young"-Implications of Lipoprotein (a). Int J Mol Sci 2023; 24:ijms24065927. [PMID: 36983001 PMCID: PMC10051886 DOI: 10.3390/ijms24065927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
The presence of a myocardial infarction at a younger age is of special interest, considering the psychological and socioeconomic impact, as well as long-term morbidity and mortality. However, this group has a unique risk profile, with less traditional cardiovascular risk factors that are not well studied. This systematic review aims to evaluate traditional risk factors of myocardial infarction in the "young", highlighting the clinical implications of lipoprotein (a). We performed a comprehensive search using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards; we systematically searched the PubMed, EMBASE, and Science Direct Scopus databases, using the terms: "myocardial infarction", "young", "lipoprotein (a)", "low-density lipoprotein", "risk factors". The search identified 334 articles which were screened, and, at the end, 9 original research articles regarding the implications of lipoprotein (a) in myocardial infarction in the "young" were included in the qualitative synthesis. Elevated lipoprotein (a) levels were independently associated with an increased risk of coronary artery disease, especially in young patients, where this risk increased by threefold. Thus, it is recommended to measure the lipoprotein (a) levels in individuals with suspected familial hypercholesterolaemia or with premature atherosclerotic cardiovascular disease and no other identifiable risk factors, in order to identify patients who might benefit from a more intensive therapeutic approach and follow-up.
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Affiliation(s)
- Cristian Stătescu
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
| | - Larisa Anghel
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
| | - Laura-Cătălina Benchea
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
| | - Bogdan-Sorin Tudurachi
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
| | - Andreea Leonte
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
| | - Alexandra Zăvoi
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
| | - Ioana Mădălina Zota
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
| | - Cristina Prisacariu
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
| | - Rodica Radu
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
| | | | - Radu Andy Sascău
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
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Abstract
PURPOSE OF REVIEW The past decade has brought increased efforts to better understand causes for ACS readmissions and strategies to minimize them. This review seeks to provide a critical appraisal of this rapidly growing body of literature. RECENT FINDINGS Prior to 2010, readmission rates for patients suffering from ACS remained relatively constant. More recently, several strategies have been implemented to mitigate this including improved risk assessment models, transition care bundles, and development of targeted programs by federal organizations and professional societies. These strategies have been associated with a significant reduction in ACS readmission rates in more recent years. With this, improvements in 30-day post-discharge mortality rates are also being appreciated. As we continue to expand our knowledge on independent risk factors for ACS readmissions, further strategies targeting at-risk populations may further decrease the rate of readmissions. Efforts to understand and reduce 30-day ACS readmission rates have resulted in overall improved quality of care for patients.
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Haddadin F, Beydoun H, Sabharwal B, Rzechorzek W, Khandaker M, Munoz Estrella A, Weininger D, Yue B, De La Villa R, Tamis-Holland JE. Differences in Social Hardships in Women and Men with Acute Myocardial Infarction: Impact on 30-Day Readmission. WOMEN'S HEALTH REPORTS 2022; 3:437-442. [PMID: 35559357 PMCID: PMC9081060 DOI: 10.1089/whr.2021.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 11/13/2022]
Abstract
Background: Studies have shown that women with acute myocardial infarction (AMI) have a higher prevalence of unfavorable social variables then men and have a worse outcome. Less is known regarding the impact of these social variables on 30-day readmission after AMI. Materials and Methods: We analyzed adult patients with AMI enrolled in a Quality Improvement Program intended to improve the peri-discharge care of patients with an AMI, and decrease all-cause 30-day unplanned readmissions. We compared clinical and social variables by gender. Multivariate logistic regression, with separate adjustment for clinical and for social variable, was used to measure adjusted odds for readmission by gender. Results: Among 208 patients included in our project 68 (32.7%) were women. Only 30.9% of women were married or had domestic partner at the time of the interview and only 16.2% were employed. Nearly half of women (48.5%) needed help with medical care, and 39.7% of women did not speak English as their first language. These variables were significantly different by gender. Rates of 30-day readmissions were higher in women than men (22.1% vs. 7.8%, p = 0.024). After adjusting for clinical variables this difference by gender in 30-day readmissions remained significant (odds ratio [OR] 3.34 95% confidence interval [CI] 1.1–11.1, p = 0.049). However, when adjusting for social variables, this difference was no longer noted (OR 0.87 95% CI 0.27–2.78, p = 0.822). Conclusion: Women with AMI are more likely than men to have unfavorable social factors that can impact recovery from AMI and women have a higher 30-day readmission rate. The higher 30-day readmissions in women appears to be influenced by these social factors. Health care interventions aimed at reducing 30-day readmission after AMI should focus on eliciting a detailed social history and providing aid for those requiring additional social support at home.
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Affiliation(s)
- Faris Haddadin
- Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Hassan Beydoun
- Department of Cardiology, University of Arizona COM-Phoenix, Phoenix, Arizona, USA
| | - Basera Sabharwal
- Department of Cardiology, Icahn School of Medicine at Mount Sinai Morningside, New York, New York, USA
| | - Wojciech Rzechorzek
- Department of Cardiovascular Medicine, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Mariam Khandaker
- Department of Cardiology, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Alba Munoz Estrella
- Department of Cardiology, Icahn School of Medicine at Mount Sinai Morningside, New York, New York, USA
| | - David Weininger
- Department of Cardiovascular Medicine, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Bing Yue
- Department of Cardiology, Icahn School of Medicine at Mount Sinai Morningside, New York, New York, USA
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Steitieh D, Sharma N, Singh HS. How Technology Is Changing Interventional Cardiology. CURRENT CARDIOVASCULAR RISK REPORTS 2022. [DOI: 10.1007/s12170-021-00686-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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9
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Bekendam MT, Mommersteeg PMC, Kop WJ, Widdershoven JW, Vermeltfoort IAC. Anxiety and hemodynamic reactivity during cardiac stress testing: The role of gender and age in myocardial ischemia. J Nucl Cardiol 2021; 28:2581-2592. [PMID: 32112295 PMCID: PMC8709819 DOI: 10.1007/s12350-020-02079-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/10/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND The prevalence of myocardial ischemia is associated with anxiety. State and trait anxiety are more common in younger women compared to men, and high anxiety levels could affect hemodynamic reactivity during cardiac stress testing. The aim is to examine whether anxiety plays a role in gender differences in patients ≤ 65 and > 65 years in hemodynamic reactivity and ischemia during cardiac stress testing. METHODS AND RESULTS Included were 291 patients (66.8 ± 8.7 years, 45% women) with suspect ischemia undergoing myocardial perfusion single-photon emission computed tomography (MPI-SPECT). Primary outcomes were semi-quantitative summed difference score (SDS) and summed stress score (SSS), as continuous indicators of myocardial ischemia. Analyses were stratified by age. Trait anxiety was measured using a validated questionnaire (GAD-7) and state anxiety using facial expression analyses software. Overall, trait and state anxiety were not associated with the prevalence of ischemia (N = 107, 36%). A significant interaction was found between gender and trait anxiety in women ≤ 65 years for SDS (F(1,4) = 5.73, P = .019) and SSS (F(1,10) = 6.50, P = .012). This was not found for state anxiety. CONCLUSION SDS and SSS were significantly higher in women younger than 65 years with high trait anxiety. This interaction was not found in men and women over 65 years.
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Affiliation(s)
- Maria T Bekendam
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Warandelaan 2, P.O. Box 90153, 5037 AB, Tilburg, The Netherlands
| | - Paula M C Mommersteeg
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Warandelaan 2, P.O. Box 90153, 5037 AB, Tilburg, The Netherlands.
| | - Willem J Kop
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Warandelaan 2, P.O. Box 90153, 5037 AB, Tilburg, The Netherlands
| | - Jos W Widdershoven
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Warandelaan 2, P.O. Box 90153, 5037 AB, Tilburg, The Netherlands
- Department of Cardiology, Elizabeth-TweeSteden Hospital, Tilburg, The Netherlands
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Nazir S, Minhas AMK, Kamat IS, Ariss RW, Moukarbel GV, Gomez JCP, Fedson S, Nair A, Bozkurt B, Jneid H. Patient Characteristics and Outcomes of Type 2 Myocardial Infarction During Heart Failure Hospitalizations in the United States. Am J Med 2021; 134:1371-1379.e2. [PMID: 34214459 PMCID: PMC9131468 DOI: 10.1016/j.amjmed.2021.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Type 2 myocardial infarction (MI) is increasingly diagnosed in patients with heart failure (HF). A paucity of data exists pertinent to the contemporary prevalence and impact of type 2 MI in patients with HF. We studied the patient profiles and the prognostic impact of type 2 MI on outcomes of HF hospitalizations. METHODS The Nationwide Readmission Database 2018 was queried for patients with HF hospitalizations with and without type 2 MI. Baseline characteristics, inpatient outcomes, and 30-day all-cause readmissions between both cohorts were compared. RESULTS Of 1,072,674 primary HF hospitalizations included in the study, 28,813 (2.7%) had type 2 MI. Patients with type 2 MI were more likely to be males (56.5% vs 51.6%; P < .001) and had a higher prevalence of hypertension (94% vs 92.2%; P < .001), prior myocardial infarction (17.1% vs 14.9%; P < .001), anemia (9.1% vs 8.1%; P < .001), chronic kidney disease (55.7% vs 49.4%; P < .001), neurological disorders (9.4% vs 7.3%; P < .001), and weight loss (7.3% vs 5.6%; P < .001). Compared with their counterparts without type 2 MI, patients with HF with type 2 MI had significantly higher in-hospital mortality (adjusted odds ratio [aOR], 1.53; 95% confidence interval [CI], 1.37-1.72), hospital costs (adjusted parameter estimate, $1785; 95% CI, 1388-2182), discharge to nursing facility (aOR, 1.22; 95% CI, 1.15-1.29), longer length of stay (adjusted parameter estimate, 0.53; 95% CI, 0.42-0.64), and rate of 30-day all-cause readmissions (aOR, 1.06; 95% CI, 1.01-1.12). CONCLUSION Type 2 MI in patients hospitalized with HF is associated with higher mortality and resource utilization in the United States.
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Affiliation(s)
- Salik Nazir
- Section of Cardiology, University of Toledo Medical Center, Toledo, Ohio
| | | | - Ishan S Kamat
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Robert W Ariss
- Section of Cardiology, University of Toledo Medical Center, Toledo, Ohio
| | - George V Moukarbel
- Section of Cardiology, University of Toledo Medical Center, Toledo, Ohio
| | | | - Savitri Fedson
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Ajith Nair
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Biykem Bozkurt
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Hani Jneid
- Section of Cardiology, Baylor College of Medicine, Houston, Texas.
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Unplanned hospital readmissions after acute myocardial infarction: a nationwide analysis of rates, trends, predictors and causes in the United States between 2010 and 2014. Coron Artery Dis 2021; 31:354-364. [PMID: 31972608 DOI: 10.1097/mca.0000000000000844] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Unplanned hospital readmissions are an important quality metric for benchmarking, but there are limited data following an acute myocardial infarction (AMI). This study aims to examine the 30-day unplanned readmission rate, predictors, causes and outcomes after hospitalization for AMI. METHODS The USA Nationwide Readmission Database was utilized to analyze patients with a primary diagnosis of AMI between 2010 and 2014. Rates of readmissions, causes and costs were determined and multiple logistic regressions were used to identify predictors of readmissions. RESULTS Of 2 204 104 patients with AMI, the 30-day unplanned readmission rate was 12.3% (n = 270 510), which changed from 13.0 to 11.5% between 2010 and 2014. The estimated impact of readmissions in AMI was ~718 million USD and ~281000 additional bed days per year. Comorbidities such as diabetes [odds ratio (OR) 1.27, 95% confidence interval (CI) 1.25-1.29], chronic lung disease (OR 1.29, 95% CI 1.26-1.31), renal failure (OR 1.38, 95% CI 1.35-1.40) and cancer (OR 1.35, 95% CI 1.30-1.41) were independently associated with unplanned readmission. Discharge against medical advice was the variable most strongly associated with unplanned readmission (OR 2.40, 95% CI 2.27-2.54). Noncardiac causes for readmissions accounted for 52.9% of all readmissions. The most common cause of cardiac readmission was heart failure (14.3%) and for noncardiac readmissions was infections (8.8%). CONCLUSION Readmissions during the first month after AMI occur in more than one in 10 patients resulting in a healthcare cost of ~718 million USD per year and ~281000 additional bed days per year. These findings have important public health implications. Strategies to identify and reduce readmissions in AMI will dramatically reduce healthcare costs for society.
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12
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Polsook R, Aungsuroch Y. Factors influencing readmission among Thais with myocardial infarction. BELITUNG NURSING JOURNAL 2021; 7:15-23. [PMID: 37469799 PMCID: PMC10353658 DOI: 10.33546/bnj.1234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/11/2020] [Accepted: 01/07/2021] [Indexed: 07/21/2023] Open
Abstract
Background Readmission among patients with myocardial infarction is costly, and it has become a marker of quality of care. Therefore, factors related to readmission warrant examination. Objective This study aimed at examining factors influencing readmission in Thai with myocardial infarction. Methods This was a cross-sectional study with 200 participants randomly selected from five regional hospitals in Thailand. All research tools used indicated acceptable validity and reliability. Linear Structural Relationship version 8.72 was used for the data analysis. Results The findings showed that the hypothesized model with social support, depression, symptom severity, comorbidity, and quality of life could explain 4% (R2 = 0.04) of the variance in readmission (χ2 = 1.39, df = 2, p < 0.50, χ2/df = 0.69, GIF = 1.00, RMSEA = 0.00, SRMR = 0.01, and AGFI = 0.98). Symptom severity was the most influential factor that had a positive and direct effect on the readmission rate (0.06, p < 0.05). Conclusion These findings serve as an input to decrease readmission in patients with myocardial infarction by reducing the symptom severity and comorbidity and promoting a better quality of life.
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Affiliation(s)
- Rapin Polsook
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
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13
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Algowhary M. Association between age and infection in patients with acute ST-elevation myocardial infarction. Egypt Heart J 2021; 73:12. [PMID: 33515355 PMCID: PMC7847417 DOI: 10.1186/s43044-021-00137-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/21/2021] [Indexed: 12/13/2022] Open
Abstract
Background ST-elevation myocardial infarction (STEMI) in young patients has a unique risk profile. We aimed to detect bacteria in aspirate of infarct artery in young versus old patients. Results Aspirates of consecutive 140 patients who underwent a primary coronary intervention were taken for bacteriological, microscopical, and immunohistochemical (for bacterial pneumolysin) examinations. Their results were calculated in young (≤ 50 years) versus old (> 50 years) patients. Median age (interquartile range) was 45 (38–48) years in young (60 patients) and 59 (55–65) years in old (80 patients) patients, p < 0.0001. Both groups had similar baseline data except age, males, diabetes, hyperlipidemia, family history, lesion length, and ectatic vessel. Different bacteria were cultured in 11.3% of all patients involving 22.6% of young and 2.8% of old patients [hazard ratio 8.03 (95% CI 1.83–51.49), p = 0.002]. By multivariate analyses, age groups and leukocytic count were independent predictors of infection (bacteria and pneumolysin), p = 0.027 and p < 0.0001, respectively. Optimal cutoff value of leukocytic count was 12,250 cells/μl [ROC curve sensitivity 85.7%, specificity 86.4%, and AUC 0.97 (95% CI 0.95–1.0), p < 0.001]. Infection was an independent predictor of STEMI in young versus old patients, p < 0.001. Nevertheless, in-hospital events occurred insignificantly different and neither age groups nor infection was predictor of in-hospital events. Conclusions Young patients had significantly higher percentage of bacteria in their infarcted artery than old patients. High leukocytic count in patients below 50 predicts infection that causes acute myocardial infarction. Antibacterial trials directed toward this group are required for secondary prevention.
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Affiliation(s)
- Magdy Algowhary
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Asyut, 71515, Egypt.
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14
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Steitieh DA, Lu DY, Kalil RK, Kim LK, Sharma G, Yeo I, Feldman DN, Cheung JW, Mecklai A, Paul TK, Ascunce RR, Amin NP. Sex-based differences in revascularization and 30-day readmission after ST-segment-elevation myocardial infarction in the United States. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 31:41-47. [PMID: 33358184 DOI: 10.1016/j.carrev.2020.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death for women in the United States. Revascularization is considered the standard of care for treatment of ST-segment elevation myocardial infarction (STEMI) and is known to reduce readmission. However there is a paucity of data that examines the sex-dependent impact of revascularization on readmission. We aimed to investigate sex differences in revascularization rates, 30-day readmission rates, and primary cause of readmissions following STEMIs. METHODS STEMI hospitalizations were selected in the Nationwide Readmissions Database from 2010 to 2014. Revascularization rates, 30-day readmission rates, and primary cause of readmission were examined. Interaction between sex and revascularization was assessed. Multivariable regression analysis was performed to identify predictors of 30-day readmission and revascularization for both sexes. RESULTS 219,944 women and 489,605 men were admitted with STEMIs. Women were more likely to be older, and have more comorbidities. Women were less likely to undergo revascularization by percutaneous coronary intervention (adjusted odds ratio [OR]: 0.68; 95% confidence interval [CI]: 0.66-0.70) or coronary artery bypass graft surgery (adjusted OR 0.40; CI 0.39-0.44). Women had higher 30-day readmission rates (15.7% vs. 10.8%, p < 0.001; OR 1.20, CI 1.17-1.23), and revascularization in women was not associated with a decreased likelihood of 30-day readmission. The primary cardiac cause of readmission in women was heart failure. CONCLUSION Compared to men, women with STEMIs had lower rates of revascularization and higher rates of 30-day readmission. When revascularized, women were still more likely to be readmitted as compared to non-revascularized women.
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Affiliation(s)
- Diala A Steitieh
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America.
| | - Daniel Y Lu
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America
| | - Ramsey K Kalil
- Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Box 130, New York, NY 10065, United States of America
| | - Luke K Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America; Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor - Cardiology, New York, NY 10021, United States of America
| | - Garima Sharma
- Ciccarone Center for Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, 601 N. Caroline Street, 7th Floor, Baltimore, MD 21287, United States of America
| | - Ilhwan Yeo
- Division of Cardiology, New York Presbyterian Queens Hospital, 56-45 Main Street, Flushing, NY 11355, United States of America
| | - Dmitriy N Feldman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America; Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor - Cardiology, New York, NY 10021, United States of America
| | - Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America; Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor - Cardiology, New York, NY 10021, United States of America
| | - Alicia Mecklai
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America; Weill Cornell Women's Heart Program, Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8th Floor - Cardiology, New York, NY 10021, United States of America
| | - Tracy K Paul
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America; Weill Cornell Women's Heart Program, Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8th Floor - Cardiology, New York, NY 10021, United States of America
| | - Rebecca R Ascunce
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America; Weill Cornell Women's Heart Program, Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8th Floor - Cardiology, New York, NY 10021, United States of America
| | - Nivee P Amin
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America; Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor - Cardiology, New York, NY 10021, United States of America; Weill Cornell Women's Heart Program, Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8th Floor - Cardiology, New York, NY 10021, United States of America
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Trends, Predictors, and Outcomes Associated With 30-Day Hospital Readmissions After Percutaneous Coronary Intervention in a High-Volume Center Predominantly Using Radial Vascular Access. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1525-1531. [DOI: 10.1016/j.carrev.2020.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/18/2020] [Indexed: 11/22/2022]
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16
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Nyhof BB, Jameel B, Dunn S, Grace SL, Khanlou N, Stewart DE, Gagliardi AR. Identifying strategies to implement patient-centred care for women: Qualitative interviews with women. PATIENT EDUCATION AND COUNSELING 2020; 103:1422-1427. [PMID: 32063437 DOI: 10.1016/j.pec.2020.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/02/2020] [Accepted: 02/07/2020] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Patient-centred care (PCC) is one approach for mitigating gendered inequities in health care quality. Little is known about how to implement PCC for women (PCCW). This study explored women's views about PCCW implementation. METHODS Descriptive analysis of semi-structured qualitative telephone interviews with diverse women about PCC using an established 6-domain PCC framework. RESULTS Participants were 33 women who varied in health care experience, age, education and setting. Themes were consistent across these characteristics. Women said that clinicians often dismissed their healthcare concerns. We transformed desired PCC elements into strategies to implement PCCW, 27 at the point-of-care (i.e. assume a non-judgmental disposition, demonstrate active listening, elicit questions, acknowledge emotions, explore preferences for treatment, and offer self-care information) and 3 at the system level (education for women/girls and clinicians about PCCW, widespread access to women's-only services or women clinicians). CONCLUSION Many women experienced suboptimal PCC. By sharing their PCC experiences, women identified PCC elements of importance to them, and insight on actionable point-of-care and system-level strategies to implement PCCW. PRACTICE IMPLICATIONS This study revealed numerous ways that clinicians can foster PCCW, and insight on how healthcare managers and policy-makers can support PCCW implementation.
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Affiliation(s)
- Bryanna B Nyhof
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Bismah Jameel
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Sheila Dunn
- Women's College Hospital Research Institute, Women's College Hospital, Toronto, Canada
| | - Sherry L Grace
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada; Faculty of Health, York University, Toronto, Canada
| | | | - Donna E Stewart
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
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17
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Barriers and facilitators of patient centered care for immigrant and refugee women: a scoping review. BMC Public Health 2020; 20:1013. [PMID: 32590963 PMCID: PMC7318468 DOI: 10.1186/s12889-020-09159-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/22/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Migrants experience disparities in healthcare quality, in particular women migrants. Despite international calls to improve healthcare quality for migrants, little research has addressed this problem. Patient-centred care (PCC) is a proven approach for improving patient experiences and outcomes. This study reviewed published research on PCC for migrants. METHODS We conducted a scoping review by searching MEDLINE, CINAHL, SCOPUS, EMBASE and the Cochrane Library for English-language qualitative or quantitative studies published from 2010 to June 2019 for studies that assessed PCC for adult immigrants or refugees. We tabulated study characteristics and findings, and mapped findings to a 6-domain PCC framework. RESULTS We identified 581 unique studies, excluded 538 titles/abstracts, and included 16 of 43 full-text articles reviewed. Most (87.5%) studies were qualitative involving a median of 22 participants (range 10-60). Eight (50.0%) studies involved clinicians only, 6 (37.5%) patients only, and 2 (12.5%) both patients and clinicians. Studies pertained to migrants from 19 countries of origin. No studies evaluated strategies or interventions aimed at either migrants or clinicians to improve PCC. Eleven (68.8%) studies reported barriers of PCC at the patient (i.e. language), clinician (i.e. lack of training) and organization/system level (i.e. lack of interpreters). Ten (62.5%) studies reported facilitators, largely at the clinician level (i.e. establish rapport, take extra time to communicate). Five (31.3%) studies focused on women, thus we identified few barriers (i.e. clinicians dismissed their concerns) and facilitators (i.e. women clinicians) specific to PCC for migrant women. Mapping of facilitators to the PCC framework revealed that most pertained to 2 domains: fostering a healing relationship and exchanging information. Few facilitators mapped to the remaining 4 domains: address emotions/concerns, manage uncertainty, make decisions, and enable self-management. CONCLUSIONS While few studies were included, they revealed numerous barriers of PCC at the patient, clinician and organization/system level for immigrants and refugees from a wide range of countries of origin. The few facilitators identified pertained largely to 2 PCC domains, thereby identifying gaps in knowledge of how to achieve PCC in 4 domains, and an overall paucity of knowledge on how to achieve PCC for migrant women.
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18
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Li J, Dharmarajan K, Bai X, Masoudi FA, Spertus JA, Li X, Zheng X, Zhang H, Yan X, Dreyer RP, Krumholz HM. Thirty-Day Hospital Readmission After Acute Myocardial Infarction in China. Circ Cardiovasc Qual Outcomes 2020; 12:e005628. [PMID: 31092023 DOI: 10.1161/circoutcomes.119.005628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Readmission after acute myocardial infarction in low- and middle-income countries like China is not well characterized. Methods and Results We approached consecutive patients with acute myocardial infarction hospitalized within 24 hours of symptom onset and discharged alive from 53 geographically diverse hospitals in China. We described rates of unplanned 30-day readmission, their timing and admitting diagnoses, and fit Cox proportional hazards models to identify factors associated with readmission. Among 3387 patients, median (interquartile range) age was 61 (52-69) years, and 76.9% were men. The index median length of stay was 11 (8-14) days. Unplanned 30-day readmission occurred in 6.3% of the cohort; most readmissions (77.7%) were for cardiovascular diagnoses. Nearly half (41.9% of all-cause readmissions; 44.3% of cardiovascular readmissions) occurred within 5 days of discharge. Mini-Global Registry of Acute Coronary Events scores at admission (hazard ratio [HR], 1.15 for every 10-point increase; 95% CI, 1.05-1.25), longer length of stay (HR, 1.03; 95% CI, 1.00-1.06 for each extra day), and in-hospital recurrent angina (HR, 1.40; 95% CI, 1.04-1.89) were associated with higher unplanned all-cause readmission. Revascularization during the index hospitalization (70.2% of the cohort) was associated with lower risks of all-cause readmission (HR, 0.27; 95% CI, 0.18-0.42). In addition, left ventricular ejection fraction <0.4 (HR, 1.79; 95% CI, 1.05-3.07) and in-hospital complication (HR, 1.20; 95% CI, 1.03-1.39) were associated with higher risk of unplanned cardiovascular readmission, and ST-segment-elevation myocardial infarction (HR, 0.60; 95% CI, 0.36-0.98) was associated with lower risk of unplanned cardiovascular readmission. Sex, family income, depression, stress level, lower social support, disease-specific health status, and medications were not associated with readmission. Conclusions In China, most readmissions are for cardiovascular events, and almost half occur within 5 days of discharge. Clinical factors identify patients at higher and lower unplanned readmissions. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT01624909.
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Affiliation(s)
- Jing Li
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Kumar Dharmarajan
- Clover Health, Jersey City, NJ (K.D.).,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.D., R.P.D., H.M.K.).,Section of Cardiovascular Medicine (K.D., H.M.K.), Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Xueke Bai
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Frederick A Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (J.A.S.)
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Xin Zheng
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Haibo Zhang
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Xiaofang Yan
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Rachel P Dreyer
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.D., R.P.D., H.M.K.).,Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (R.P.D.)
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.D., R.P.D., H.M.K.).,Section of Cardiovascular Medicine (K.D., H.M.K.), Department of Internal Medicine, Yale School of Medicine, New Haven, CT.,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
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Culler SD, Kugelmass AD, Cohen DJ, Reynolds MR, Katz MR, Brown PP, Schlosser ML, Simon AW. Understanding Readmissions in Medicare Beneficiaries During the 90-Day Follow-Up Period of an Acute Myocardial Infarction Admission. J Am Heart Assoc 2019; 8:e013513. [PMID: 31663436 PMCID: PMC6898831 DOI: 10.1161/jaha.119.013513] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Medicare has a voluntary episodic payment model for Medicare beneficiaries that bundles payment for the index acute myocardial infarction (AMI) hospitalization and all post‐discharge services for a 90‐day follow‐up period. The purpose of this study is to report on the types and frequency of readmissions and identify demographic and clinical factors associated with readmission of Medicare beneficiaries that survived their AMI hospitalization. Methods and Results This retrospective study used the Inpatient Standard Analytical File for 2014. There were 143 286 Medicare beneficiaries with AMI who were discharged alive from 3619 hospitals. All readmissions occurring in any hospital within 90 days of the index AMI discharge date were identified. Of 143 286 Medicare beneficiaries discharged alive from their index AMI hospitalization, 28% (40 145) experienced at least 1 readmission within 90 days and 8% (11 477) had >1 readmission. Readmission rates were higher among Medicare beneficiaries who did not undergo a percutaneous coronary intervention in their index AMI admission (34%) compared with those that underwent a percutaneous coronary intervention (20.2%). Using all Medicare beneficiary's index AMI, 27 comorbid conditions were significantly associated with the likelihood of a Medicare beneficiary having a readmission during the follow‐up period. The strongest clinical characteristics associated with readmissions were dialysis dependence, type 1 diabetes mellitus, and heart failure. Conclusions This study provides benchmark information on the types of hospital readmissions Medicare beneficiaries experience during a 90‐day AMI bundle. This paper also suggests that interventions are needed to alleviate the need for readmissions in high‐risk populations, such as, those managed medically and those at risk of heart failure.
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Affiliation(s)
| | | | - David J Cohen
- Saint Luke's Mid America Heart Institute Kansas City MO
| | | | - Marc R Katz
- Medical University of South Carolina Charleston SC
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Gupta V, Bubis L, Kidane B, Mahar AL, Ringash J, Sutradhar R, Darling GE, Coburn NG. Readmission rates following esophageal cancer resection are similar at regionalized and non-regionalized centers: A population-based cohort study. J Thorac Cardiovasc Surg 2019; 158:934-942.e2. [DOI: 10.1016/j.jtcvs.2019.04.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/28/2019] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
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Wang H, Zhao T, Wei X, Lu H, Lin X. The prevalence of 30-day readmission after acute myocardial infarction: A systematic review and meta-analysis. Clin Cardiol 2019; 42:889-898. [PMID: 31407368 PMCID: PMC6788479 DOI: 10.1002/clc.23238] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/11/2019] [Accepted: 07/17/2019] [Indexed: 11/10/2022] Open
Abstract
Objective The 30‐day readmission is associated with increased medical costs, which has become an important quality metric in several medical institutions. This current study is aimed at clarifying the prevalence, the underlying risk factors, and reasons of the 30‐day readmission after acute myocardial infarction (AMI). Methods PubMed, Cochrane Library, and EMBASE were systematically searched to identify eligible studies. Random‐effect models were employed to perform pooled analyses. Means and 95% confidence intervals (CIs) were used to estimate prevalence and reasons for 30‐day readmission. We also used Odds ratios (ORs) to explore the potential significant predictors of risk factors of 30‐day readmission after AMI. Potential publication bias was assessed using funnel plot and Begg'test. Results A total of 14 relevant studies were included in this systematic review and meta‐analysis. The pooled 30‐day readmission rate of AMI was 12% (95% CI 0.11‐0.14). Acute coronary syndrome (ACS), angina and acute ischemic heart disease, and heart failure (HF) were the principal cardiovascular reasons of 30‐day readmission. Meanwhile, non‐specific chest pain was regarded as the significant cause among non‐cardiovascular reasons. The common co‐morbidities kidney disease, HF and diabetes mellitus were significant risk factors for 30‐day readmission. No significant publication bias was found by funnel plot and statistical tests. Conclusions The 30‐day readmission rate of post‐AMI ranged from 11% to 14% and can be mainly attributed to cardiovascular and non‐cardiovascular events. The common co‐morbidities, such as kidney disease, HF, and diabetes mellitus were significant risk factors for 30‐day readmission.
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Affiliation(s)
- Huijie Wang
- Department of Cardiology and Cardiovascular Intervention, Interventional Medical CenterThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiPR China
| | - Ting Zhao
- Department of Cardiology and Cardiovascular Intervention, Interventional Medical CenterThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiPR China
| | - Xiaoliang Wei
- Department of Cardiology and Cardiovascular Intervention, Interventional Medical CenterThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiPR China
| | - Huifang Lu
- Department of Cardiology and Cardiovascular Intervention, Interventional Medical CenterThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiPR China
| | - Xiufang Lin
- Department of Cardiology and Cardiovascular Intervention, Interventional Medical CenterThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiPR China
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22
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Abstract
Heart disease is the leading cause of death among women in the industrialized world. However, women after myocardial infarctions (MIs) are less likely to receive preventive medications or revascularization and as many as 47% experience heart failure, stroke or die within 5 years. Premenopausal women with MIs frequently have coronary plaque erosions or dissections. Women under 50 years with angina and nonobstructive epicardial coronary artery disease often have coronary microvascular dysfunction (CMD) with reductions in coronary flow reserve that may require nontraditional therapies. In women with coronary artery disease treated with stents, the 3-year incidence of recurrent MI or death is 9.2%. Coronary bypass surgery operative mortality averages 4.6% for women compared with 2.4% in men. Addition of internal mammary artery and radial artery coronary grafts in women does not increase operative survival but improves 5-year outcome to greater than 80%.
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Lam L, Ahn HJ, Okajima K, Schoenman K, Seto TB, Shohet RV, Miyamura J, Sentell TL, Nakagawa K. Gender Differences in the Rate of 30-Day Readmissions after Percutaneous Coronary Intervention for Acute Coronary Syndrome. Womens Health Issues 2018; 29:17-22. [PMID: 30482594 DOI: 10.1016/j.whi.2018.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/27/2018] [Accepted: 09/06/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND It has been reported that women have higher 30-day readmission rates than men after acute coronary syndrome (ACS). However, readmission after percutaneous coronary intervention (PCI) for ACS is a distinct subset of patients in whom gender differences have not been adequately studied. METHODS Hawaii statewide hospitalization data from 2010 to 2015 were assessed to compare gender differences in 30-day readmission rates among patients hospitalized with ACS who underwent PCI during the index hospitalization. Readmission diagnoses were categorized using an aggregated version of the Centers for Medicare and Medicaid Services Condition Categories. Multivariable logistic regression was applied to evaluate the effect of gender on the 30-day readmission rate. RESULTS A total of 5,354 patients (29.4% women) who were hospitalized with a diagnosis of ACS and underwent PCI were studied. Overall, women were older, with more identified as Native Hawaiian, and had a higher prevalence of cardiovascular risk factors compared with men. The 30-day readmission rate was 13.9% in women and 9.6% in men (p < .0001). In the multivariable model, female gender (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.09-1.60), Medicaid (OR, 1.48; 95% CI, 1.07-2.06), Medicare (1.72; 95% CI, 1.35-2.19), heart failure (1.88; 95% CI, 1.53-2.33), atrial fibrillation (OR, 1.54; 95% CI-1.21-1.95), substance use (OR, 1.88; 95% CI, 1.27-2.77), history of gastrointestinal bleeding (OR, 2.43; 95% CI, 1.29-4.58), and chronic kidney disease (OR, 1.78; 95% CI, 1.42-2.22) were independent predictors of 30-day readmissions. Readmission rates were highest during days 1 through 6 (peak, day 3) after discharge. The top three cardiac causes of readmissions were heart failure, recurrent angina, and recurrent ACS. CONCLUSIONS Female gender is an independent predictor of 30-day readmission after ACS that requires PCI. Our finding suggests women are at a higher risk of post-ACS cardiac events such as heart failure and recurrent ACS, and further gender-specific intervention is needed to reduce 30-day readmission rate in women after ACS.
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Affiliation(s)
- Luke Lam
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii.
| | - Hyeong Jun Ahn
- Department of Complementary and Integrative Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Kazue Okajima
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Katie Schoenman
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Todd B Seto
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; The Queen's Medical Center, Honolulu, Hawaii
| | - Ralph V Shohet
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Jill Miyamura
- Hawaii Health Information Corporation, Honolulu, Hawaii
| | - Tetine L Sentell
- Office of Public Health Studies, University of Hawaii, Honolulu, Hawaii
| | - Kazuma Nakagawa
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; The Queen's Medical Center, Honolulu, Hawaii
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Kim LK, Yeo I, Cheung JW, Swaminathan RV, Wong SC, Charitakis K, Adejumo O, Chae J, Minutello RM, Bergman G, Singh H, Feldman DN. Thirty-Day Readmission Rates, Timing, Causes, and Costs after ST-Segment-Elevation Myocardial Infarction in the United States: A National Readmission Database Analysis 2010-2014. J Am Heart Assoc 2018; 7:e009863. [PMID: 30371187 PMCID: PMC6222940 DOI: 10.1161/jaha.118.009863] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/23/2018] [Indexed: 01/14/2023]
Abstract
Background Readmission after ST-segment-elevation myocardial infarction ( STEMI ) poses an enormous economic burden to the US healthcare system. Efforts to prevent readmissions should be based on understanding the timing and causes of these readmissions. This study aimed to investigate contemporary causes, timing, and cost of 30-day readmissions after STEMI . Methods and Results All STEMI hospitalizations were selected in the Nationwide Readmissions Database ( NRD ) from 2010 to 2014. The 30-day readmission rate as well as the primary cause and cost of readmission were examined. Multivariate regression analysis was performed to identify the predictors of 30-day readmission and increased cumulative cost. From 2010 to 2014, the 30-day readmission rate after STEMI was 12.3%. Within 7 days of discharge, 43.9% were readmitted, and 67.3% were readmitted within 14 days. The annual rate of 30-day readmission decreased by 19% from 2010 to 2014 ( P<0.001). Female sex, AIDS , anemia, chronic kidney disease , collagen vascular disease, diabetes mellitus, hypertension, pulmonary hypertension, congestive heart failure , atrial fibrillation, and increased length of stay were independent predictors of 30-day readmission. A large proportion of patients (41.6%) were readmitted for noncardiac reasons. After multivariate adjustment, 30-day readmission was associated with a 47.9% increase in cumulative cost ( P<0.001). Conclusions Two thirds of patients were readmitted within the first 14 days after STEMI , and a large proportion of patients were readmitted for noncardiac reasons. Thirty-day readmission was associated with an ≈50% increase in cumulative hospitalization costs. These findings highlight the importance of closer surveillance of both cardiac and general medical conditions in the first several weeks after STEMI discharge.
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Affiliation(s)
- Luke K. Kim
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Ilhwan Yeo
- Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Jim W. Cheung
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | | | - S. Chiu Wong
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Konstantinos Charitakis
- Department of CardiologyMcGovern Medical SchoolUniversity of Texas Health Science CenterHoustonTX
| | - Oluwayemisi Adejumo
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - John Chae
- Weill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Robert M. Minutello
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Geoffrey Bergman
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Harsimran Singh
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Dmitriy N. Feldman
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
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Yang TS, Hsia DW, Chang DW. Patient- and Hospital-Level Factors Associated With Readmission for Malignant Pleural Effusion. J Oncol Pract 2018; 14:e547-e556. [DOI: 10.1200/jop.18.00201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: Readmission after hospitalization for malignant pleural effusion (MPE) may represent gaps in the quality of health care delivery. The goal of this study was to determine the frequency of 30-day readmission for MPE and identify clinical factors associated with rehospitalization. Patients and Methods: A retrospective cohort of adults hospitalized for MPE from 2009 to 2011 was analyzed using an administrative database. The primary outcome was all-cause 30-day readmission rate. Hierarchic mixed-effects logistic regression models were used to examine associations between patient- and hospital-level factors and 30-day readmission and assess variation in readmission rates across hospitals. Results: The 7-, 14-, 30-, 60-, and 90-day readmission rates for MPE were 16.1%, 25.9%, 38.3%, 52.5%, and 63.8%, respectively. The most common primary diagnoses for 30-day readmission were MPE (69.5%) and other clinical issues related to malignancy (21.1%). Clinical factors associated with 30-day readmission were female sex (odds ratio [OR], 0.78; 95% CI, 0.63 to 0.95), greater number of medical comorbidities (OR, 1.51; 95% CI, 1.15 to 1.99), and having a do-not-resuscitate order (OR, 1.37; 95% CI, 1.03 to 1.84). Hospitals in the 90th percentile were only 1.1 times more likely to have a 30-day readmission for MPE than those in the lowest 10th percentile (40.9% v 37%). Conclusion: Readmission for MPE is common and frequently results from progression of malignancy. Readmission rates were similar across all hospitals, suggesting they are unlikely to be mutable using conventional approaches to reduce rehospitalizations. Instead, interventions may need to focus on addressing care planning at the end of life.
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Affiliation(s)
- Theresa S. Yang
- Harbor–University of California Los Angeles Medical Center, Torrance, CA
| | - David W. Hsia
- Harbor–University of California Los Angeles Medical Center, Torrance, CA
| | - Dong W. Chang
- Harbor–University of California Los Angeles Medical Center, Torrance, CA
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Kwok CS, Potts J, Gulati M, Alasnag M, Rashid M, Shoaib A, Ul Haq MA, Bagur R, Mamas MA. Effect of Gender on Unplanned Readmissions After Percutaneous Coronary Intervention (from the Nationwide Readmissions Database). Am J Cardiol 2018; 121:810-817. [PMID: 29448978 DOI: 10.1016/j.amjcard.2017.12.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/13/2017] [Accepted: 12/27/2017] [Indexed: 11/28/2022]
Abstract
Women who undergo percutaneous coronary intervention (PCI) are at higher risk of adverse outcomes compared with men, but it is unknown whether gender affects early unplanned rehospitalization. We analyzed 832,753 patients who underwent PCI from 2013 to 2014 in the Nationwide Readmissions Database. We compared gender differences in incidences, predictors, causes, and cost of unplanned 30-day readmissions and examined the effect of co-morbidity. A total of 832,753 men and women who survived the index PCI and were not admitted for a planned readmission were included in the analysis. Overall, 9.4% of patients had an unplanned readmission within 30 days. Thirty-day readmission rates were higher in women compared with men (11.5% vs 8.4%, p <0.001) even after multivariate adjustment (odds ratio 1.19, 95% confidence interval 1.16 to 1.22, p <0.001), although women had significantly lower costs associated with the readmission ($11,927 vs $12,758, p <0.001). The cause of readmission for women and men were similar and the majority of the readmissions were due to noncardiac causes (58% vs 55%), the most common of which were nonspecific chest pain, gastrointestinal disease, and infections. In contrast, for cardiac readmissions, women are more likely to be readmitted for heart failure (29.64% vs 22.34%), whereas men are more likely to be readmitted for coronary artery disease, including angina (33.47% vs 28.54%). In conclusion, gender disparities exist in rates of unplanned rehospitalization after PCI, where more than 1 in 10 women who undergo PCI are readmitted within 30 days. Gender differences were not observed for causes of noncardiac readmissions, whereas important differences were observed for cardiovascular causes.
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Affiliation(s)
- Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
| | - Jessica Potts
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, Arizona
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Muhammad Ayyaz Ul Haq
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Rodrigo Bagur
- Division of Cardiology, London Health Sciences Centre, Department of Medicine, and Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Mamas Andreas Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
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Kwok CS, Rao SV, Potts JE, Kontopantelis E, Rashid M, Kinnaird T, Curzen N, Nolan J, Bagur R, Mamas MA. Burden of 30-Day Readmissions After Percutaneous Coronary Intervention in 833,344 Patients in the United States: Predictors, Causes, and Cost. JACC Cardiovasc Interv 2018; 11:665-674. [DOI: 10.1016/j.jcin.2018.01.248] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/18/2017] [Accepted: 01/09/2018] [Indexed: 10/17/2022]
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