1
|
Malvindi PG, Bifulco O, Berretta P, Alfonsi J, Cefarelli M, Zingaro C, Capestro F, D’Alfonso A, Di Eusanio M. Improved Early Outcomes in Women Undergoing Aortic Valve Interventions. J Clin Med 2023; 12:5749. [PMID: 37685816 PMCID: PMC10488507 DOI: 10.3390/jcm12175749] [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: 07/20/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Surgical aortic valve replacement (SAVR) in female patients has been associated with higher mortality (up to 3.3-8.9%) and postoperative complication rates when compared with their male counterparts. In recent years, TAVI has been shown to provide a greater benefit than SAVR in women. We sought to assess the early outcomes of the contemporary aortic valve intervention practice (surgical and transcatheter) in patients referred to our cardiac surgery unit. The data of consecutive patients who underwent isolated aortic valve intervention for aortic valve stenosis during the 2018-2022 period were retrieved from our internal database. Several preoperative, intraoperative, and postoperative variables were analyzed, including the predicted risk of a prosthesis-patient mismatch. Nine hundred and fifty-five consecutive patients-514 women and 441 men-were included. Among them, 480 patients-276 female and 204 male-received a transcatheter procedure, and 475-238 women and 237 men-had conventional SAVR. The women were older and had higher EuroSCORE II, while the male patients presented a higher incidence of cardiovascular comorbidities. There was no difference in mortality or major postoperative complication rates after either the surgical or transcatheter procedures between the female and male populations. The availability and targeted use of different techniques and technologies have enabled the safe and effective treatment of female patients treated for severe symptomatic aortic valve stenosis with similar results when compared with their male counterparts.
Collapse
|
2
|
Does Gender Influence the Indication of Treatment and Long-Term Prognosis in Severe Aortic Stenosis? J Cardiovasc Dev Dis 2023; 10:jcdd10020038. [PMID: 36826534 PMCID: PMC9963043 DOI: 10.3390/jcdd10020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/05/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION It is a matter of controversy whether the therapeutic strategy for severe aortic stenosis (AS) differs according to gender. METHODS Retrospective study of patients diagnosed with severe AS (transvalvular mean gradient ≥ 40 mmHg and/or aortic valvular area < 1 cm2) between 2009 and 2019. Our aim was to assess the association of sex on AVR or medical management and outcomes in patients with severe AS. RESULTS 452 patients were included. Women (51.1%) were older than men (80 ± 8.4 vs. 75.8 ± 9.9 years; p < 0.001). Aortic valve replacement (AVR) was performed less frequently in women (43.4% vs. 53.2%; p = 0.03), but multivariate analyses showed that sex was not an independent predictor factor for AVR. Age, Charlson index and symptoms were predictive factors (OR 0.81 [0.82-0.89], OR 0.81 [0.71-0.93], OR 22.02 [6.77-71.64]). Survival analysis revealed no significant association of sex within all-cause and cardiovascular mortalities (log-rank p = 0.63 and p = 0.07). Cox proportional hazards analyses showed AVR (HR: 0.1 [0.06-0.15]), Charlson index (HR: 1.13 [1.06-1.21]) and reduced LVEF (HR: 1.9 [1.32-2.73]) to be independent cardiovascular mortality predictors. CONCLUSIONS Gender is not associated with AVR or long-term prognosis. Cardiovascular mortality was associated with older age, more comorbidity and worse LVEF.
Collapse
|
3
|
Iribarren AC, AlBadri A, Wei J, Nelson MD, Li D, Makkar R, Merz CNB. Sex differences in aortic stenosis: Identification of knowledge gaps for sex-specific personalized medicine. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 21:100197. [PMID: 36330169 PMCID: PMC9629620 DOI: 10.1016/j.ahjo.2022.100197] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/18/2022] [Accepted: 08/20/2022] [Indexed: 06/16/2023]
Abstract
Objectives This review summarizes sex-based differences in aortic stenosis (AS) and identifies knowledge gaps that should be addressed by future studies. Background AS is the most common valvular heart disease in developed countries. Sex-specific differences have not been fully appreciated, as a result of widespread under diagnosis of AS in women. Summary Studies including sex-stratified analyses have shown differences in pathophysiology with less calcification and more fibrosis in women's aortic valve. Women have impaired myocardial perfusion reserve and different compensatory response of the left ventricle (LV) to pressure overload, with concentric remodeling and more diffuse fibrosis, in contrast to men with more focal fibrosis and more dilated/eccentrically remodeled LV. There is sex difference in clinical presentation and anatomical characteristics, with women having more paradoxical low-flow/low-gradient AS, under-diagnosis and severity underestimated, with less referral to aortic valve replacement (AVR) compared to men. The response to therapies is also different: women have more adverse events with surgical AVR and greater survival benefit with transcatheter AVR. After AVR, women would have more favorable LV remodeling, but sex-related differences in changes in myocardial reserve flow need future research. Conclusions Investigation into these described sex-related differences in AS offers potential utility for improving prevention and treatment of AS in women and men. To better understand sex-based differences in pathophysiology, clinical presentation, and response to therapies, sex-specific critical knowledge gaps should be addressed in future research for sex-specific personalized medicine.
Collapse
Affiliation(s)
- Ana C. Iribarren
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Ahmed AlBadri
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
- Cedars-Sinai Biomedical Imaging Research Institute, Los Angeles, CA, United States of America
| | - Michael D. Nelson
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Debiao Li
- Cedars-Sinai Biomedical Imaging Research Institute, Los Angeles, CA, United States of America
| | - Raj Makkar
- Cedars-Sinai Cardiovascular Intervention Center, Smidt Heart Institute, Los Angeles, CA, United States of America
| | - C. Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| |
Collapse
|
4
|
Soomro BA, Shah N. COVID-19 complications and entrepreneurial intention among the entrepreneurs of Pakistan: evidence from the second wave of the pandemic. JOURNAL OF SCIENCE AND TECHNOLOGY POLICY MANAGEMENT 2021. [DOI: 10.1108/jstpm-12-2020-0175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose
At present, nearly the whole globe is facing a severe threat of COVID-19. This study aims to examine the COVID-19 complications and entrepreneurial intention among the entrepreneurs of Pakistan.
Design/methodology/approach
The study used a deductive approach. An online survey is conducted to collect cross-sectional data from entrepreneurs of Pakistan. Convenience sampling is applied to target the respondents. In total, 278 usable answers proceed for final analysis. The structural equation model (SEM) is used to infer the results.
Findings
The findings of the study highlight a significant negative effect of fear of COVID-19 (FO19), perceived susceptibility (PSU) and perceived severity (PSE) on entrepreneurial intention (EI) among the entrepreneurs.
Practical implications
The study would provide the guidelines for policymakers and planners to combat the barriers of fear, PSU and PSE during a pandemic. The findings of the second wave of COVID-19 may provide a warning to the government to take preventive measures to face the severe effect of the pandemic. Finally, the outcomes of the study may enrich the depth of COVID-19 literature globally.
Originality/value
This study is the first study highlighting factors such as fear, PSU and PSE toward EI in COVID-19 second wave.
Collapse
|
5
|
DeVon HA, Daya MR, Knight E, Brecht ML, Su E, Zegre-Hemsey J, Mirzaei S, Frisch S, Rosenfeld AG. Unusual Fatigue and Failure to Utilize EMS Are Associated With Prolonged Prehospital Delay for Suspected Acute Coronary Syndrome. Crit Pathw Cardiol 2020; 19:206-212. [PMID: 33009074 PMCID: PMC7669539 DOI: 10.1097/hpc.0000000000000245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Rapid reperfusion reduces infarct size and mortality for acute coronary syndrome (ACS), but efficacy is time dependent. The aim of this study was to determine if transportation factors and clinical presentation predicted prehospital delay for suspected ACS, stratified by final diagnosis (ACS vs. no ACS). METHODS A heterogeneous sample of emergency department (ED) patients with symptoms suggestive of ACS was enrolled at 5 US sites. Accelerated failure time models were used to specify a direct relationship between delay time and variables to predict prehospital delay by final diagnosis. RESULTS Enrolled were 609 (62.5%) men and 366 (37.5%) women, predominantly white (69.1%), with a mean age of 60.32 (±14.07) years. Median delay time was 6.68 (confidence interval 1.91, 24.94) hours; only 26.2% had a prehospital delay of 2 hours or less. Patients presenting with unusual fatigue [time ratio (TR) = 1.71, P = 0.002; TR = 1.54, P = 0.003, respectively) or self-transporting to the ED experienced significantly longer prehospital delay (TR = 1.93, P < 0.001; TR = 1.71, P < 0.001, respectively). Predictors of shorter delay in patients with ACS were shoulder pain and lightheadedness (TR = 0.65, P = 0.013 and TR = 0.67, P = 0.022, respectively). Predictors of shorter delay for patients ruled out for ACS were chest pain and sweating (TR = 0.071, P = 0.025 and TR = 0.073, P = 0.032, respectively). CONCLUSION Patients self-transporting to the ED had prolonged prehospital delays. Encouraging the use of EMS is important for patients with possible ACS symptoms. Calling 911 can be positively framed to at-risk patients and the community as having advanced care come to them because EMS capabilities include 12-lead ECG acquisition and possibly high-sensitivity troponin assays.
Collapse
Affiliation(s)
- Holli A. DeVon
- University of California Los Angeles, School of Nursing, Los Angeles, CA, USA
| | - Mohamud R. Daya
- Oregon Health & Science University, School of Medicine, Portland, OR, USA
| | - Elizabeth Knight
- Oregon Health & Science University, School of Nursing, Portland, OR, USA
| | - Mary-Lynn Brecht
- University of California Los Angeles, School of Nursing, Los Angeles, CA, USA
| | - Erica Su
- University of California Los Angeles, Department of Biostatistics, Los Angeles, CA, USA
| | | | - Sahereh Mirzaei
- University of California Los Angeles, School of Nursing, Los Angeles, CA, USA
| | - Stephanie Frisch
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA
| | | |
Collapse
|
6
|
Gamaza S, Díaz-Retamino E, Gaitero JC, Giráldez A, Zafra FM, Martín-Santana A, Oneto J. Outcome implication of sex-related effective orifice area normalized to body size in aortic stenosis. Echocardiography 2020; 37:1732-1740. [PMID: 33070386 DOI: 10.1111/echo.14868] [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: 04/21/2020] [Revised: 08/10/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Although several echocardiographic parameters have different values according to sex, there are no studies in echocardiographic variables of aortic stenosis (AS) severity. Our aim was to evaluate the sex-related prognosis of several echocardiographic parameters in AS. METHODS Two hundred and twenty-five patients with at least moderate AS (effective orifice area [EOA] ≤ 1.50 cm2 ) were prospectively enrolled. EOA was normalized to body surface area (BSA), height, and body mass index (BMI). Receiver operating characteristic curves, in women and men separately, were plotted to determine the best cutoff value for predicting cardiovascular death. RESULTS The largest area under the curve (AUC) to predict cardiovascular death was EOA in men (AUC 0.74, P < .001) and EOA/height in women (AUC 0.81, P < .001). An EOA/height cutoff value of 0.55 cm2 /m in women had a sensitivity of 100% and specificity of 61%; a cutoff of 0.50 cm2 /m in men obtained a sensitivity of 92% and a specificity of 56%. During a mean follow-up of 247 ± 183 days, there were 33 cardiovascular deaths. Women with EOA/height ≤ 0.55 cm2 /m had higher cardiovascular mortality (22% vs 0%, P < .001) and men with EOA/height ≤ 0.50 cm2 /m (21% vs 2%, P < .001). One-year survival in women with EOA/height ≤ 0.55 cm2 /m was 67 ± 8% and 100 ± 0% in EOA/height > 0.55 cm2 /m (P < .001). In men, 1-year survival was 70 ± 8% in EOA/height ≤ 0.50 cm2 /m, and 93 ± 6% in EOA/height > 0.50 cm2 /m (P = .004). CONCLUSIONS Normalization of EOA is useful in AS, especially in women. We recommend using an EOA/height cutoff value of 0.55 cm2 /m in women, and 0.50 cm2 /m in men to identify a subgroup with higher cardiovascular risk.
Collapse
Affiliation(s)
- Sergio Gamaza
- Cardiology Department, Hospital de Jerez, Jerez de la Frontera, Spain
| | | | | | - Alberto Giráldez
- Cardiology Department, Hospital de Jerez, Jerez de la Frontera, Spain
| | | | | | - Jesús Oneto
- Cardiology Department, Hospital de Jerez, Jerez de la Frontera, Spain
| |
Collapse
|
7
|
How Do Patients and Doctors Perceive Medical Services for Rare Diseases Differently in China? Insights from Two National Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165961. [PMID: 32824597 PMCID: PMC7460109 DOI: 10.3390/ijerph17165961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/31/2020] [Accepted: 08/13/2020] [Indexed: 11/17/2022]
Abstract
Background: Increasing attention is being paid to improve the quality of life of patients with rare diseases in China. However, we are currently unaware of the problems encountered in the medical services of rare diseases from the viewpoints of doctors and patients. This study addressed the differences in the perceived barriers of diagnosis and treatments for rare diseases between doctors and patients in China. Methods: Two independent cross-sectional surveys on the perception of Chinese doctors’ and patients’ experiences with rare diseases were launched online between January and February 2018. A non-probability, convenience sampling method was employed to recruit participants. Results: In all, 45 rare diseases were reported by 139 doctors and 1853 patients. Patients with rare diseases faced significantly more difficulties in receiving accurate diagnosis (72.0%) and accessing information related to diagnosis and treatment (77.3%) as compared with doctors (34.5% and 40.3%, p < 0.0001, respectively). Specially, patients felt more difficulties than doctors in obtaining sustainable treatment for rare diseases (84.3% vs. 49.6%, p < 0.001). A higher percentage of patients (58.7%) than that of doctors (39.1%) had concerns in terms of the affordability of drugs. Further, 66.3% patients claimed that the drugs used to treat their conditions were not covered by their current medical insurances, whereas only 21.6% for doctors (p < 0.0001). Moreover, 35.3% of doctors responded that they recommended patients to visit the specialist they knew or were acquainted with, whereas 30.0% of patients said that their doctors chose to treat them based on their past experiences (p < 0.001). Conclusion: The perceived experience of patients with regard to diagnosis and treatment was significantly different from that of doctors. An integrated medical service platform should be established to facilitate better communication and mutual understanding of rare diseases between patients and doctors.
Collapse
|
8
|
Shan Y, Pellikka PA. Aortic stenosis in women. Heart 2020; 106:970-976. [DOI: 10.1136/heartjnl-2019-315407] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 12/17/2022] Open
Abstract
Aortic stenosis (AS) is a common valve disorder in an ageing population in western countries, and women, with longer life expectancy, comprise a substantial percentage of elderly patients with AS. Compared with men, women exhibit distinctive characteristics at the level of stenotic valve leaflets and subsequent compensatory responses of the left ventricle to chronic pressure overload, and in clinical presentation, consequences and response to intervention. Randomised controlled trials of transcatheter aortic valve implantation have yielded new evidence of sex differences in both short-term and long-term outcomes after intervention. A comprehensive knowledge of the existing evidence may inform our understanding of gender differences during assessment and treatment of patients with AS. In this paper, we review the available evidence regarding sex differences in AS in terms of symptoms, clinical presentation, anatomical differences and pathophysiological progression, management and outcomes after aortic valve replacement. Implications for further research are suggested.
Collapse
|
9
|
Olmastroni E, Boccalari MT, Tragni E, Rea F, Merlino L, Corrao G, Catapano AL, Casula M. Sex-differences in factors and outcomes associated with adherence to statin therapy in primary care: Need for customisation strategies. Pharmacol Res 2019; 155:104514. [PMID: 31678211 DOI: 10.1016/j.phrs.2019.104514] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 12/25/2022]
Abstract
Despite the invaluable efficacy of statins, adherence to therapy is extremely poor in clinical practice. Improvement interventions should be as personalized as possible, but it is necessary to know factors that most influence adherence, and sex seems to be a key determinant. Thus, we aimed at exploring potential areas of sex-differences in statin adherence in a real-world population. For this purpose, we assessed adherence (as proportion of days covered) on a wide cohort of new statin users aged >40 years, and we evaluated its association with several covariates through sex-stratified log-binomial regression models. In addition, to compare also the benefits of optimal statin adherence in primary prevention of cardiovascular disease between men and women, we implemented sex-stratified Cox proportional hazard models. Our study showed that women are more likely to stop or be less adherent to statin treatment than men. Moreover, we observed significant sex-differences on effect size of several factors associated with adherence that should be taken into consideration for the management of patients. Finally, we observed no significant difference between men and women regarding statin efficacy in terms of reduction of incident hospitalization for ischemic heart disease and/or non-haemorrhagic cerebrovascular disease. These results invoke the responsibility of physicians to a prompt and personalized intervention. Physicians should consider routine screening for non-adherence in their clinical practice, target patients at higher risk of non-adherence, and improved motivation and communication.
Collapse
Affiliation(s)
- Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.
| | - Mezio T Boccalari
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Elena Tragni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Federico Rea
- National Centre for Healthcare Research & Pharmacoepidemiology, Milan, Italy; Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Luca Merlino
- Epidemiologic Observatory, Lombardy Regional Health Service, Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research & Pharmacoepidemiology, Milan, Italy; Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Alberico L Catapano
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS MultiMedica, Sesto S. Giovanni (MI), Italy
| | - Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS MultiMedica, Sesto S. Giovanni (MI), Italy
| |
Collapse
|
10
|
Luna MJ, Ameli R, Sinaii N, Cheringal J, Panahi S, Berger A. Gender Differences in Psycho-Social-Spiritual Healing. J Womens Health (Larchmt) 2019; 28:1513-1521. [PMID: 31502927 PMCID: PMC6862956 DOI: 10.1089/jwh.2019.7837] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Many individuals exhibit significant distress in response to serious and/or life-limiting illness. However, there are others who make life-transforming changes, which involve healing experiences in the psychological, social, and spiritual domains of life regardless of illness outcome. The aim of the present study is to determine if there are any differences in psycho-social-spiritual healing between genders. Materials and Methods: The NIH Healing Experiences in All Life Stressors (NIH-HEALS), a 35-item measure of psycho-social-spiritual healing, is composed of three factors: Connection, Reflection & Introspection, and Trust & Acceptance. NIH-HEALS and a demographic questionnaire were administered to 193 patients with serious and/or life-limiting illness at the National Institutes of Health Clinical Center. Results: In response to NIH-HEALS, men and women significantly differed on the Reflection & Introspection factor. Women reported increased enjoyment of mind–body practices (p < 0.001), compassion (p = 0.005), gratitude (p = 0.014), and a desire to be more positive (p = 0.044) compared to men. Men rated their pain levels (p = 0.035) and severity of illness (p = 0.016) higher and their overall level of health (p = 0.010) poorer compared to women. Women's responses to items regarding compassion (rs = 0.37, p < 0.001) and gratitude (rs = 0.24, p = 0.015) correlated positively with better overall health ratings. Conclusion: Men and women show some differences in their self-reported psycho-social-spiritual healing, which may have implications when designing interventions aimed at promoting a healing experience in the context of serious and life-limiting illness.
Collapse
Affiliation(s)
- María José Luna
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rezvan Ameli
- National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Ninet Sinaii
- Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Julia Cheringal
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Samin Panahi
- Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Ann Berger
- Clinical Center, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
11
|
Mishra R, Monica. Determinants of cardiovascular disease and sequential decision-making for treatment among women: A Heckman's approach. SSM Popul Health 2019; 7:100365. [PMID: 30766910 PMCID: PMC6360511 DOI: 10.1016/j.ssmph.2019.100365] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/02/2018] [Accepted: 01/22/2019] [Indexed: 01/08/2023] Open
Abstract
Women over age 40, from lower socio-economic status and those widowed/divorced are at elevated risk. Diabetes, hypertension, obesity and unhealthy diet are the major risk factors. Treatment-seeking is higher in women over age 40, from upper socio-economic status and those married. Autonomy, accessibility, affordability and availability influence treatment-seeking behaviour.
Collapse
Affiliation(s)
- Raman Mishra
- International Institute for Population Sciences, Mumbai, India
| | - Monica
- International Institute for Population Sciences, Mumbai, India
| |
Collapse
|
12
|
Pérez Boluda M, Morales Asencio J, Carrera Vela A, García Mayor S, León Campos A, López Leiva I, Rengel Díaz C, Kaknani-Uttumchandani S. The dynamic experience of pain in burn patients: A phenomenological study. Burns 2016; 42:1097-1104. [DOI: 10.1016/j.burns.2016.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 12/19/2022]
|
13
|
Morales-Asencio JM, Martin-Santos FJ, Kaknani S, Morilla-Herrera JC, Cuevas Fernández-Gallego M, García-Mayor S, León-Campos Á, Morales-Gil IM. Living with chronicity and complexity: Lessons for redesigning case management from patients' life stories - A qualitative study. J Eval Clin Pract 2016; 22:122-132. [PMID: 25546074 DOI: 10.1111/jep.12300] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Case management is commonly used to provide health care for patients with multiple chronic conditions. However, the most effective form of team organization and the necessary support structures need to be identified. In this respect, patients' views could provide a valuable contribution to improving the design of these services. To analyse the experiences of patients with chronic diseases and of caregivers, in relation to health care services and mechanisms, and to identify means of modelling case management services. METHODS The method used was a qualitative study based on life stories, and semi-structured interviews with 18 patients with complex chronic diseases and with their family caregivers, selected by purposeful sampling in primary health care centres in Andalusia (southern Spain) from 2009 to 2011. RESULTS Three transition points were clearly identified: the onset and initial adaptation, the beginning of quality-of-life changes, and the final stage, in which the patients' lives are governed by the complexity of their condition. Health care providers have a low level of proactivity with respect to undertaking early measures for health promotion and self-care education. Care is fragmented into a multitude of providers and services, with treatments aimed at specific problems. CONCLUSIONS Many potentially valuable interventions in case management, such as information provision, self-care education and coordination between services and providers, are still not provided.
Collapse
Affiliation(s)
| | - Francisco Javier Martin-Santos
- Faculty of Health Sciences, University of Málaga, Málaga, Spain.,District of Primary Health Care, Andalusian Healthcare Service, Málaga, Spain
| | - Shakira Kaknani
- Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Juan Carlos Morilla-Herrera
- Faculty of Health Sciences, University of Málaga, Málaga, Spain.,District of Primary Health Care, Andalusian Healthcare Service, Málaga, Spain
| | - Magdalena Cuevas Fernández-Gallego
- Faculty of Health Sciences, University of Málaga, Málaga, Spain.,District of Primary Health Care, Andalusian Healthcare Service, Málaga, Spain
| | | | | | | |
Collapse
|
14
|
Accounting for clinical action reduces estimates of gender disparities in lipid management for diabetic veterans. J Gen Intern Med 2013; 28 Suppl 2:S529-35. [PMID: 23807061 PMCID: PMC3695267 DOI: 10.1007/s11606-013-2340-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Women with diabetes have higher low-density lipoprotein (LDL) levels than men, resulting in apparent disparities between genders on quality indicators tied to LDL thresholds. OBJECTIVE To investigate whether gender disparities persist when accounting for clinical action with statins or cardiovascular risk. DESIGN Retrospective cohort study. PARTICIPANTS Veterans Health Administration patients (21,780 women and 646,429 men) aged 50-75 with diabetes. MAIN MEASURES Threshold measure: LDL < 100 mg/dL; clinical action measure: LDL < 100 mg/dL; or LDL ≥ 100 mg/dL and the patient was prescribed a moderate or high-dose statin at the time of the test; or LDL ≥ 100 mg/dL and the patient received other appropriate clinical action within 90 days; adherence: continuous multiple interval measure of gaps in dispensed medication (CMG). KEY RESULTS Women were much less likely to have LDL < 100 mg/dL than were men (55 % vs. 68 %). This disparity narrowed from 13 % to 6 % for passing the clinical action measure (79 % vs. 85 %). These gender differences persisted among those with ischemic heart disease (IHD). Women had a lower odds of passing the clinical action measure (odds ratio 0.68, 95 % confidence interval 0.66-0.71). Among those with IHD, the gender gap increased with age. Differences in pass rates were explained by women's higher LDL levels, but not by their slightly worse adherence (3 % higher CMG). CONCLUSIONS Women and men veterans receive more similar quality of care for lipids in diabetes than previously indicated. Less reassuringly, the remaining gender differences appear to be as common in women at high cardiovascular risk as in those at low risk. Rather than focus on simply improving LDL levels in all women with diabetes, future efforts should ensure that patients with high cardiovascular risk are appropriately treated with statins when clinically indicated, feasible, and concordant with patient preferences.
Collapse
|
15
|
Golden KE, Chang AM, Hollander JE. Sex preferences in cardiovascular testing: the contribution of the patient-physician discussion. Acad Emerg Med 2013; 20:680-8. [PMID: 23859581 PMCID: PMC3810172 DOI: 10.1111/acem.12169] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 11/30/2012] [Accepted: 02/20/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Prior studies suggest that a decreased cardiac catheterization rate for women with acute coronary syndrome (ACS) is partially attributed to gender differences in patient preferences for testing. The hypothesis was that these preferences are influenced by physician recommendations for cardiovascular testing. METHODS This was a cohort study of patients who presented to an emergency department (ED) with chest pain. At the time of ED disposition, patients were surveyed to assess whether or not the doctor discussed the possibility of coronary artery disease (CAD), the physician's recommendations for diagnostic testing, and the patient's preferences for further testing. The survey was repeated at the time of discharge from the hospital if the patient was admitted and again at 30 days for all patients. The main outcome was patient-reported physician recommendation for testing, and the secondary outcome was patient preference for cardiovascular testing. RESULTS There were 206 patients enrolled (118 women, 88 men). Women were less likely than men to receive cardiac catheterization as inpatients (9.8% vs. 20.0%, p = 0.04). In the ED, women were less likely to be recommended for stress testing (8.5% vs. 19.3%, p = 0.02) or cardiac catheterization (4.2% vs. 13.6%, p = 0.02) or to see a cardiologist (8.5% vs. 22.7%, p < 0.01). As inpatients, women were more likely to be told that no further testing was needed (70.5% vs. 50.0%, p = 0.03). While there was higher incidence of prior CAD and myocardial infarction among the men in the study, analysis after removal of these patients did not alter results. Physicians were less likely to counsel women about diagnostic testing options in the ED (10.1% vs. 22.7%, p = 0.03), as inpatients (11.5% vs. 40.0%, p < 0.01), and as outpatients (26.1% vs. 48.6%, p = 0.04). No patients in the study refused their doctors' recommendations. Women were less likely to prefer catheterization in the ED (5.1% vs. 15.9%, p = 0.01) and were more likely to prefer no further testing as inpatients (60.7% vs. 40.0%, p = 0.02). CONCLUSIONS Women who presented to the ED with symptoms concerning for ACS reported lower rates of physician recommendation for cardiovascular testing, as well as lower rates of counseling regarding cardiac etiologies of their chest pain. These findings suggest sex differences in preference for cardiovascular testing may be partially explained by the discussions between women and their doctors.
Collapse
Affiliation(s)
- Katie E Golden
- Departments of Emergency Medicine, Brigham & Women's Hospital, Baltimore, MD, USA.
| | | | | |
Collapse
|
16
|
Balajonda N, Bisanar TL, Mathew JP, Pang H, Voils CI. Determinants of a subject's decision to participate in clinical anesthesia research. Anesth Analg 2013; 116:448-54. [PMID: 23302987 DOI: 10.1213/ane.0b013e318277dd7d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A top priority for research studies is to ensure that potential participants receive adequate information to make a truly informed decision. Understanding patient experiences with the recruitment process may identify areas for improvement in the consent process. We examined which factors were associated with the decision to consent in a clinical research study. METHODS Patients scheduled for elective surgery were asked to complete a questionnaire about the consent process, immediately after being approached to participate in an anesthesia-related research study. Sociodemographic characteristics, preoperative levels of anxiety and depression, medical comorbidities, factors that may affect decision to participate in a research study, and study design features were collected. A multivariable logistic regression model was estimated to identify factors associated with providing consent. Performance of the prediction model was assessed using the receiver operating characteristic curve. Internal validity was assessed by a bootstrap analysis. RESULTS In all, 282 participants completed the questionnaire. Of those, 179 (63%) had consented to participate in research, and 103 (37%) had declined to participate. In the multivariable logistic regression model, the odds of providing consent were higher for males (odds ratio [OR] [95% confidence interval]=2.49 [1.29-4.79]) and for patients with higher levels of patient comfort (OR=1.84 [1.22-2.78]). The odds of providing consent were lower for protocols that require additional testing (OR=0.15 [0.06-0.39]) and patients with higher levels of concern about blood sampling (OR=0.70 [0.54-0.90]) or worry about study risks (OR=0.72 [0.55-0.95]). Bootstrap analysis revealed a stable model with high internal validity. CONCLUSIONS The 2 strongest predictors of consent were male gender and comfort; predictors of refusal were protocol type that requires additional testing, greater concern about blood sampling and study risks, and lower overall patient comfort with the study. These patient and study characteristics may inform modification of the consent process for clinical research studies and facilitate the development of more accurate enrollment projections and strategies.
Collapse
Affiliation(s)
- Naraida Balajonda
- Department of Anesthesiology, Duke University Medical Center, 315 Trent Dr., Hanes House Rm. 285, Durham, NC 27710, USA.
| | | | | | | | | |
Collapse
|
17
|
Kaufman KR, Velez AE, Wong S, Mani R. Low-dose lacosamide-induced atrial fibrillation: Case analysis with literature review. EPILEPSY & BEHAVIOR CASE REPORTS 2012; 1:22-5. [PMID: 25688049 PMCID: PMC4150593 DOI: 10.1016/j.ebcr.2012.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 10/30/2012] [Indexed: 11/19/2022]
Abstract
Lacosamide (LCM) is a novel antiepileptic drug (AED) approved by the FDA for adjunctive treatment of partial epilepsy with and without secondary generalization. Lacosamide dose-dependent dysrhythmias (PR-interval prolongation, AV block, and atrial fibrillation/flutter) have been reported. This case represents the first instance of LCM-induced atrial fibrillation following a low loading dose (200 mg). Risk factors for atrial fibrillation are addressed and discussed in the context of this case. Full cardiac history is recommended prior to patients being initiated on LCM. Cardiac monitoring may be required for at-risk patients on LCM. Clinicians need to be cognizant of this potential adverse effect.
Collapse
Affiliation(s)
- Kenneth R. Kaufman
- Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, Suite #2200, New Brunswick, NJ 08901, USA
- Department of Neurology, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, Suite #6200, New Brunswick, NJ 08901, USA
- Department of Anesthesiology, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, Suite #3100, New Brunswick, NJ 08901, USA
- Corresponding author at: Departments of Psychiatry, Neurology and Anesthesiology, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, Suite #2200, New Brunswick, NJ 08901, USA. Fax: + 1 732 235 7677.
| | - Arnaldo E. Velez
- Department of Neurology, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, Suite #6200, New Brunswick, NJ 08901, USA
| | - Stephen Wong
- Department of Neurology, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, Suite #6200, New Brunswick, NJ 08901, USA
| | - Ram Mani
- Department of Neurology, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, Suite #6200, New Brunswick, NJ 08901, USA
| |
Collapse
|
18
|
Abstract
OBJECTIVE To collate data on women and cardiovascular disease in Australia and globally to inform public health campaigns and health care interventions. DESIGN Literature review. RESULTS Women with acute coronary syndromes show consistently poorer outcomes than men, independent of comorbidity and management, despite less anatomical obstruction of coronary arteries and relatively preserved left ventricular function. Higher mortality and complication rates are best documented amongst younger women and those with ST-segment-elevation myocardial infarction. Sex differences in atherogenesis and cardiovascular adaptation have been hypothesised, but not proven. Atrial fibrillation carries a relatively greater risk of stroke in women than in men, and anticoagulation therapy is associated with higher risk of bleeding complications. The degree of risk conferred by single cardiovascular risk factors and combinations of risk factors may differ between the sexes, and marked postmenopausal changes are seen in some risk factors. Sociocultural factors, delays in seeking care and differences in self-management behaviours may contribute to poorer outcomes in women. Differences in clinical management for women, including higher rates of misdiagnosis and less aggressive treatment, have been reported, but there is a lack of evidence to determine their effects on outcomes, especially in angina. Although enrolment of women in randomised clinical trials has increased since the 1970s, women remain underrepresented in cardiovascular clinical trials. CONCLUSIONS Improvement in the prevention and management of CVD in women will require a deeper understanding of women's needs by the community, health care professionals, researchers and government.
Collapse
|
19
|
Frick U, Gutzwiller FS, Maggiorini M, Christen S. A questionnaire on treatment satisfaction and disease specific knowledge among patients with acute coronary syndrome. II: Insights for patient education and quality improvement. PATIENT EDUCATION AND COUNSELING 2012; 86:366-371. [PMID: 21719236 DOI: 10.1016/j.pec.2011.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 03/22/2011] [Accepted: 06/04/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Secondary prevention for coronary heart disease is achieved by pharmaceutical control of risk factors and patients' own self management behaviour. To comply with longterm treatment patients need sufficient knowledge of their condition and should be satisfied with acute care. Therefore a questionnaire measuring both issues was constructed. METHODS AND RESULTS Latent class analysis applied in a sample of over 2000 patients suffering from acute coronary syndrome revealed 4 configurative patterns of knowledge and 5 distinct patterns of (dis-)satisfaction. Nearly 50% of all patients displayed insufficient knowledge upon discharge. Deficits clustered around misinformation on necessary lifestyle changes versus dysfunctional strategies for future emergency situations. Satisfaction and disease specific knowledge were interrelated in complex patterns. CONCLUSIONS Disease specific knowledge and satisfaction with treatment proved to be psychometrically valid indicators of the quality of the treatment process that might also have an impact on outcome. PRACTICE IMPLICATIONS A validated questionnaire is ready for routine administration after discharge of patients with acute coronary syndrome from acute hospital care. Patient education efforts and quality improvement in treatment centres might be effectively monitored using this questionnaire.
Collapse
Affiliation(s)
- Ulrich Frick
- Department of Healthcare Management, Carinthia University of Applied Sciences, Feldkirchen, Austria.
| | | | | | | |
Collapse
|
20
|
|
21
|
Zimmerman L, Barnason S, Hertzog M, Young L, Nieveen J, Schulz P, Tu C. Gender differences in recovery outcomes after an early recovery symptom management intervention. Heart Lung 2011; 40:429-39. [PMID: 21501872 DOI: 10.1016/j.hrtlng.2010.07.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 07/15/2010] [Accepted: 07/23/2010] [Indexed: 01/29/2023]
Abstract
BACKGROUND Despite known gender differences in recovery, few studies have examined symptom management (SM) interventions or responses by gender after coronary artery bypass surgery (CABS). OBJECTIVE The purpose of this subanalysis was to describe and evaluate differences in response by gender to an SM intervention on the presence and burden of symptoms, physical activity, and physical functioning in elderly CABS patients during the early discharge period (3 and 6 weeks after CABS, and 3 and 6 months after CABS). METHODS The parent study whose data were analyzed to examine gender differences involved a two-group, randomized clinical trial design. The 6-week early recovery SM telehealth intervention was delivered by the Health Buddy. Measures included the Cardiac Symptom Survey, a Modified 7-Day Activity Interview, an RT3 accelerometer, an Activity Diary, and the Medical Outcomes Study Short Form 36. This study was not powered for a gender × group analysis, and we used descriptive statistics, χ(2) tests, t tests, and analysis of variance for statistical analyses. RESULTS Subjects (n = 232) included 192 men and 40 women, with a mean age of 71.2 SD, 7 years. The intervention group consisted of 86 men and 23 women, and the usual care (UC) group consisted of 106 men and 17 women. Data trends suggest that the SM intervention exerted greater impact on women than on men for symptoms such as fatigue, depression, sleep problems, and pain. Again, men exhibited higher levels of physical activity than did women. However, women in the SM group generally had higher scores than did women in the UC group. CONCLUSION Although the parent study found no effect of an early recovery SM intervention, this exploratory secondary analysis indicated that women in the intervention group demonstrated more improvement in measures of physical activity than did those in the UC group. Further study, using a larger sample, is necessary to test these preliminary results.
Collapse
Affiliation(s)
- Lani Zimmerman
- College of Nursing, University of Nebraska Medical Center, Lincoln, Nebraska 68588-0220, USA.
| | | | | | | | | | | | | |
Collapse
|
22
|
Mumma BE, Baumann BM, Diercks DB, Takakuwa KM, Campbell CF, Shofer FS, Chang AM, Jones MK, Hollander JE. Sex bias in cardiovascular testing: the contribution of patient preference. Ann Emerg Med 2010; 57:551-560.e4. [PMID: 21146255 DOI: 10.1016/j.annemergmed.2010.09.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 09/02/2010] [Accepted: 09/24/2010] [Indexed: 01/23/2023]
Abstract
STUDY OBJECTIVE Women with potential acute coronary syndromes are less likely to receive cardiac catheterization or revascularization than men. We hypothesize that this may be due to different diagnostic test preferences of female and male patients. METHODS We conducted a cohort study at 4 emergency departments enrolling patients who presented with symptoms of potential acute coronary syndromes. After hearing the potential benefits and harms of each test, subjects completed a 21-item survey assessing their preference for noninvasive testing versus cardiac catheterization. Based on hypothetical test results, similar questions about medical versus interventional management were asked. Subjects were also queried about likelihood of following physician recommendation for each test or intervention. Actual 30-day testing and interventions were recorded. The main outcome was patient preference about each procedure and the likelihood of patient saying they would accept the physician recommendation. RESULTS One thousand eighty patients enrolled; 652 (60%) were admitted to the hospital. With regard to diagnostic test preference, both women and men preferred stress test to catheterization (women 58% versus men 52%; difference 6% [95% confidence interval {CI} -0.06% to 12%]), and the proportion of women and men who would accept the physician recommendation for stress tests was similar (85% for both); however, the stated acceptance rate for cardiac catheterization was lower for women (65% versus 75%; difference -10% [95% CI -15% to -4%]). Women were 6% less likely (67% versus 73%; 95% CI for difference 12% to 0.5%) to accept percutaneous coronary intervention over medical therapy and 7% less likely (61% versus 68%; 95% CI for difference -13% to 1%) to desire coronary artery bypass grafting over medical therapy. The survey results are consistent with the patients' clinical course. During the initial hospitalization, women were less likely to receive diagnostic testing of any type (38% versus 45%; difference -7%; 95% CI for the difference -13% to -1.5%) and cardiac catheterization (10% versus 17%; difference -7% [95% CI -11% to -2%]). Revascularization was infrequent in both groups (4% versus 6%; difference -2% [95% CI -5% to 0.6%]). CONCLUSION Although women and men had similar preferences about cardiac diagnostic tests and treatment options, women were less likely than men to say they would accept the physician recommendation for any intervention. Patient preference may partially explain the disparity in cardiovascular testing between women and men.
Collapse
Affiliation(s)
- Bryn E Mumma
- Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Morales-Asencio JM, Martin-Santos FJ, Morilla-Herrera JC, Fernández-Gallego MC, Celdrán-Mañas M, Navarro-Moya FJ, Rodríguez-Salvador MM, Muñoz-Ronda FJ, Gonzalo-Jiménez E, Carrasco AM. Design of a case management model for people with chronic disease (Heart Failure and COPD). Phase I: modeling and identification of the main components of the intervention through their actors: patients and professionals (DELTA-icE-PRO Study). BMC Health Serv Res 2010; 10:324. [PMID: 21126369 PMCID: PMC3018450 DOI: 10.1186/1472-6963-10-324] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 12/02/2010] [Indexed: 11/11/2022] Open
Abstract
Background Chronic diseases account for nearly 60% of deaths around the world. The extent of this silent epidemic has not met determined responses in governments, policies or professionals in order to transform old Health Care Systems, configured for acute diseases. There is a large list of research about alternative models for people with chronic conditions, many of them with an advanced practice nurse as a key provider, as case management. But some methodological concerns raise, above all, the design of the intervention (intensity, frequency, components, etc). Methods/Design Objectives: General: To develop the first and second phases (theorization and modeling) for designing a multifaceted case-management intervention in people with chronic conditions (COPD and heart failure) and their caregivers. Specific aims: 1) To identify key events in people living with chronic disease and their relation with the Health Care System, from their point of view. 2) To know the coping mechanisms developed by patients and their caregivers along the story with the disease. 3) To know the information processing and its utilization in their interactions with health care providers. 4) To detect potential unmet needs and the ways deployed by patients and their caregivers to resolve them. 5) To obtain a description from patients and caregivers, about their itineraries along the Health Care System, in terms of continuity, accessibility and comprehensiveness of care. 6) To build up a list of promising case-management interventions in patients with Heart Failure and COPD with this information in order to frame it into theoretical models for its reproducibility and conceptualization. 7) To undergo this list to expert judgment to assess its feasibility and pertinence in the Andalusian Health Care. Design: Qualitative research with two phases: For the first five objectives, a qualitative technique with biographic stories will be developed and, for the remaining objectives, an expert consensus through Delphi technique, on the possible interventions yielded from the first phase. The study will be developed in the provinces of Almería, Málaga and Granada in the Southern Spain, from patients included in the Andalusian Health Care Service database with the diagnosis of COPD or Heart Failure, with the collaboration of case manager nurses and general practitioners for the assessment of their suitability to inclusion criteria. Patients and caregivers will be interviewed in their homes or their Health Centers, with their family or their case manager nurse as mediator. Discussion First of a series of studies intended to design a case-management service for people with heart failure and COPD, in the Andalusian Health Care System, where case management has been implemented since 2002. Accordingly with the steps of a theoretical model for complex interventions, in this study, theorization and intervention modeling phases will be developed.
Collapse
|
24
|
Saab FA, Steg PG, Avezum A, López-Sendón J, Anderson FA, Huang W, Eagle KA. Can an elderly woman's heart be too strong? Increased mortality with high versus normal ejection fraction after an acute coronary syndrome. The Global Registry of Acute Coronary Events. Am Heart J 2010; 160:849-54. [PMID: 21095271 DOI: 10.1016/j.ahj.2010.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 07/13/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Coronary artery disease is the leading cause of death in women. We sought to validate previous clinical experience in which we have observed that elderly women with a very high left ventricular ejection fraction (LVEF) are at increased risk of death compared with elderly women with acute coronary syndromes with a normal LVEF. METHODS Data from 5,127 elderly female patients (age >65 years) enrolled in the Global Registry of Acute Coronary Events were collected. Patients were divided into 3 groups based on their LVEF: group I had a low ejection fraction (<55%), group II had a normal ejection fraction (55%-65%), and group III had a high ejection fraction (>65%). χ² test and multiple logistic regression analysis were performed. The main outcome measures were death in-hospital and death, stroke, rehospitalization, and myocardial infarction at 6-month follow-up. RESULTS Hospital mortality was 12% in group I. Patients in group III were more likely to die in-hospital than those in group II (P = .003). Multivariable logistic regression showed that high ejection fraction was an independent predictor of hospital death (odds ratio [OR] 2.5, 95% CI [CI] 1.2-5.2, P = .01), 6-month death (OR 2.0, 95% CI 1.1-3.4, P = .01), and cardiac arrest/ventricular fibrillation (OR 2.5, 95% CI 1.2-5.0, P = .01) compared with the normal ejection fraction group. CONCLUSIONS Having a very high LVEF (> 65%) is associated with worse survival and higher rates of sudden cardiac death than an LVEF considered to be in the reference range.
Collapse
Affiliation(s)
- Fadi A Saab
- Department of Internal Medicine, Tufts University School of Medicine-Baystate Medical Center, Springfield, MA, USA.
| | | | | | | | | | | | | |
Collapse
|
25
|
Sedlak TL, Pu A, Aymong E, Gao M, Khan N, Quan H, Humphries KH. Sex differences in coronary catheterization and revascularization following acute myocardial infarction: time trends from 1994 to 2003 in British Columbia. Can J Cardiol 2010; 26:360-4. [PMID: 20847962 DOI: 10.1016/s0828-282x(10)70410-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Studies before the turn of the century reported sex differences in procedure rates. It is unknown whether these differences persist. OBJECTIVES To examine time trends and sex differences in coronary catheterization and revascularization following acute myocardial infarction (AMI). METHODS A retrospective analysis was performed of all patients 20 years of age or older who were admitted to hospital in British Columbia with an AMI between April 1, 1994, and March 31, 2003. Segmented regression analysis was used to examine the inflection point of the time trend in 90-day catheterization rates post-AMI. Multivariable Cox regression modelling was used to evaluate sex differences in receiving catheterization and revascularization following AMI. RESULTS Ninety-day coronary catheterization rates increased significantly over the study period for both men and women (P<0.0001 for trend), with a steeper increase beginning in September 2000. Women were less likely to undergo catheterization than men, even after adjustment for baseline differences; this sex effect was modified by age and care in the intensive care unit or cardiac care unit (ICU⁄CCU). Specifically, ICU⁄CCU admission eliminated the sex difference among patients who were younger than 65 years of age. Conditional on receiving cardiac catheterization post-AMI, female sex was not associated with a lower likelihood of receiving revascularization within one year (HR 0.96; 95% CI 0.91 to 1.02). CONCLUSIONS Despite recent increases in catheterization rates post-AMI, women were less likely to undergo catheterization than men. Interestingly, access to ICU⁄CCU care removed the sex difference in catheterization access in patients younger than 65 years of age.
Collapse
|
26
|
Serrano‐Gallardo P, Díaz‐Olalla J, Otero Á, Bolumar F. Self‐Perceived Health among Migrant and Native Populations in Madrid: A Gender Perspective. INTERNATIONAL JOURNAL OF MIGRATION HEALTH AND SOCIAL CARE 2010. [DOI: 10.5042/ijmhsc.2010.0231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
27
|
Halvorsen S, Risøe C. Symptomer og diagnostikk av koronarsykdom hos kvinner. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:1853-7. [DOI: 10.4045/tidsskr.09.0115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
28
|
Ford ES, Mokdad AH, Li C, McGuire LC, Strine TW, Okoro CA, Brown DW, Zack MM. Gender Differences in Coronary Heart Disease and Health-Related Quality of Life: Findings from 10 States from the 2004 Behavioral Risk Factor Surveillance System. J Womens Health (Larchmt) 2008; 17:757-68. [DOI: 10.1089/jwh.2007.0468] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Earl S. Ford
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ali H. Mokdad
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chaoyang Li
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa C. McGuire
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tara W. Strine
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Catherine A. Okoro
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David W. Brown
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew M. Zack
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
29
|
McCollum M, Hansen LB, Ghushchyan V, Sullivan PW. Inconsistent health perceptions for US women and men with diabetes. J Womens Health (Larchmt) 2008; 16:1421-8. [PMID: 18062757 DOI: 10.1089/jwh.2006.0251] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Two health status measures for adults with diabetes are compared in order to identify gender-based differences between norm-based scores for health status and self-rated health scores. METHODS Data were obtained from the 2001 and 2003 Medical Expenditure Panel Survey(MEPS). Diabetes was identified by self-report or ICD-9 code. Demographic and clinical (e.g., body mass index [BMI], comorbidities) parameters were included. Outcomes were norm-based measures of physical and mental health (SF-12 Physical and Mental Component Scores: SF-12 PCS and SF-12 MCS) and self-rated perception of health status. Sex-based differences in the three outcome measures, SF-12 PCS, SF-12 MCS, and self-rated health scores, were evaluated in univariate analyses and multivariate linear regression for survey data. RESULTS A cohort of 3640 respondents with diabetes was identified (2037 women, 1603 men). In unadjusted analyses, women were older than men (60.7 vs. 59.3 years, p<0.001), reported higher mean BMI (31.1 vs. 30.4), more comorbidities, depression, and physical limitations (all p<0.001), had poorer SF-12 MCS scores (p=0.01), and self-rated their health status significantly higher than did men (p<0.01). In adjusted analyses, female gender was associated with lower SF-12 MCS scores and higher self-rated health scores. No factors were positively associated with higher scores across all three measures; only cognitive limitations consistently predicted lower health status scores in all three measures. CONCLUSIONS Among adults with diabetes in a nationally representative sample of the U.S. adult population, discrepancies exist in health status measures. Despite being older, having more comorbidities and physical limitations, and lower norm-based scores for mental functional status, women self-rate their own health status higher than do men. Further research into the gender-based determinants and clinical implications of self-rated health status is warranted.
Collapse
Affiliation(s)
- Marianne McCollum
- Department of Clinical Pharmacy, University of Colorado at Denver, and Health Sciences Center, Denver, Colorado, USA.
| | | | | | | |
Collapse
|
30
|
Ferrara A, Mangione CM, Kim C, Marrero DG, Curb D, Stevens M, Selby JV. Sex disparities in control and treatment of modifiable cardiovascular disease risk factors among patients with diabetes: Translating Research Into Action for Diabetes (TRIAD) Study. Diabetes Care 2008; 31:69-74. [PMID: 17934157 DOI: 10.2337/dc07-1244] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Cardiovascular disease (CVD) mortality has decreased in men but not in women with diabetes. We investigated whether sex differences in control and treatment of CVD risk factors might underlie this disparity. RESEARCH DESIGN AND METHODS We performed cross-sectional analyses from a cohort of patients with diabetes sampled from 10 U.S. managed care health plans. Study end points included not being in control for CVD risk factors (>or=140 mmHg for systolic blood pressure [SBP], >or=3.35 mmol/l for LDL cholesterol, and >or=8.0% for A1C) and the intensity of medication management (number of medication classes) for patients not in control. Logistic regression models with random intercepts were used to adjust probabilities of control and management for demographics, clinical characteristics, and clustering within health plans. RESULTS There were 1,315 women and 1,575 men with a history of CVD and 3,415 women and 2,516 men without a history of CVD. Among patients with CVD, adjusted estimated probabilities for not being in control and risk differences varied significantly between men and women for SBP (men 41.2%, women 46.6%; risk difference -5.4% [95% CI -9.5 to -1.3]) and LDL cholesterol (men 22.4%, women 28.3%; risk difference -5.9% [-9.9 to -1.8]). There were no significant sex differences in intensity of medication management for patients not in control. In patients without CVD there were no significant differences in control or intensity of medication management. CONCLUSIONS In diabetic patients with CVD, poorer control of SBP and LDL cholesterol for women may contribute to the sex disparity in CVD mortality trends.
Collapse
Affiliation(s)
- Assiamira Ferrara
- Division of Research, Kaiser Permanente Medical Care Program of Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Effects of gender and depression on oral medication adherence in persons with type 2 diabetes mellitus. ACTA ACUST UNITED AC 2007; 4:205-13. [DOI: 10.1016/s1550-8579(07)80041-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2007] [Indexed: 11/24/2022]
|
32
|
Chou AF, Scholle SH, Weisman CS, Bierman AS, Correa-de-Araujo R, Mosca L. Gender Disparities in the Quality of Cardiovascular Disease Care in Private Managed Care Plans. Womens Health Issues 2007; 17:120-30. [PMID: 17448685 DOI: 10.1016/j.whi.2007.03.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 01/11/2007] [Accepted: 03/13/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies have shown that women with cardiovascular disease (CVD) are screened and treated less aggressively than men and are less likely to undergo cardiac procedures. Research in this area has primarily focused on the acute setting, and there are limited data on the ambulatory care setting, particularly among the commercially insured. To that end, the objective of this study is to determine if gender disparities in the quality of CVD care exist in commercial managed care populations. METHODS Using a national sample of commercial health plans, we analyzed member-level data for 7 CVD quality indicators from the Healthcare Effectiveness Data and Information Set (HEDIS) collected in 2005. We used hierarchical generalized linear models to estimate these HEDIS measures as a function of gender, controlling for race/ethnicity, socioeconomic status, age, and plans' clustering effects. RESULTS Results showed that women were less likely than men to have low-density lipoprotein (LDL) cholesterol controlled at <100 mg/dL in those who have diabetes (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.76-0.86) or a history of CVD (OR, 0.72; CI 95%, 0.64-0.82). The difference between men and women in meeting the LDL control measures was 5.74% among those with diabetes (44.3% vs. 38.5%) and 8.53% among those with a history of CVD (55.1% vs. 46.6%). However, women achieved higher performance than men in controlling blood pressure (OR, 1.12; 95% CI, 1.02-1.21), where the rate of women meeting this quality indicator exceeded that of men by 1.94% (70.8% for women vs. 68.9% for men). CONCLUSIONS Gender disparities in the management and outcomes of CVD exist among patients in commercial managed care plans despite similar access to care. Poor performance in LDL control was seen in both men and women, with a lower rate of control in women suggesting the possibility of less intensive cholesterol treatment in women. The differences in patterns of care demonstrate the need for interventions tailored to address gender disparities.
Collapse
Affiliation(s)
- Ann F Chou
- Department of Health Administration and Policy, College of Public Health and College of Medicine, University of Oklahoma, 801 NE 13th Street, Oklahoma City, OK 73120, USA.
| | | | | | | | | | | |
Collapse
|
33
|
Kaneda H, Ako J, Kataoka T, Takahashi T, Terashima M, Waseda K, Miyazawa A, Hassan AHM, Honda Y, Yock PG, Fitzgerald PJ. Impact of gender on neointimal hyperplasia following coronary artery stenting. Am J Cardiol 2007; 99:491-3. [PMID: 17293191 DOI: 10.1016/j.amjcard.2006.09.094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 09/13/2006] [Accepted: 09/13/2006] [Indexed: 11/29/2022]
Abstract
Whether gender affects long-term outcomes after bare metal stent implantation remains controversial. The aim of this study was to examine the impact of gender on neointimal hyperplasia in a large cohort of patients after stent implantation using 3-dimensional intravascular ultrasound. Lumen and stent areas were manually traced at 0.5-mm intervals throughout the stented segment. Using Simpson's method, lumen, stent, and neointimal (stent - lumen) volumes were calculated and standardized by stent length. Women were older, presented more often with hyperlipidemia or hypertension, and had smaller reference vessel diameter and mean stent area, compared with men. Although neointimal hyperplasia and neointimal thickness in women were similar to that in men, the percentage of neointimal hyperplasia (neointimal area divided by stent area) was higher in women due to the smaller stent area. After adjusting for stent area, the percentage of neointimal hyperplasia did not differ by gender. In conclusion, the results of this study indicate that neointimal hyperplasia after bare metal stent implantation in women is similar to that seen in men. Despite the similarity in outcome, there are several gender-specific differences in baseline characteristics.
Collapse
Affiliation(s)
- Hideaki Kaneda
- Center for Research in Cardiovascular Interventions, Stanford University, Stanford, California, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Perers E, From Attebring M, Caidahl K, Herlitz J, Karlsson T, Wahrborg P, Hartford M. Low risk is associated with poorer quality of life than high risk following acute coronary syndrome. Coron Artery Dis 2006; 17:501-10. [PMID: 16905961 DOI: 10.1097/00019501-200609000-00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Morbidity after acute coronary syndromes includes both physical and mental disorders affecting quality of life. The aim of this investigation was to study quality of life at a 3-month follow-up in patients with acute coronary syndrome, with the main objective of exploring whether unstable angina pectoris and myocardial infarction (MI) patients differ in this respect. METHODS This investigation was part of a prospective risk stratification study of consecutive patients with acute coronary syndrome of whom 814 below the age of 75 years (278 diagnosed with unstable angina pectoris and 536 with myocardial infarction) accepted an invitation to a follow-up visit 3 months after discharge. At follow-up, the patients completed the Cardiac Health Profile, a disease-specific quality of life questionnaire, designed to evaluate perceived cognitive, emotional, social and physical function. RESULTS Quality of life was mainly influenced by patient characteristics and previous history. The Cardiac Health Profile scores in unstable angina pectoris patients were significantly higher (i.e. poorer quality of life) than myocardial infarction patients at the 3-month visit (34, 22, 50; median, 25th, 75th percentile and 30, 19, 44; median, 25th, 75th percentile, respectively, P=0.006). The adjusted odds ratio for a poorer quality of life in unstable angina pectoris patients in relation to myocardial infarction patients was 1.39 (95% confidence interval 1.03, 1.87; P=0.03). The highest Cardiac Health Profile scores were seen in the unstable angina pectoris patients without electrocardiogram signs of ongoing ischemia and/or elevated markers of myocardial necrosis. CONCLUSION Patients with unstable angina pectoris, especially of the low-risk type, and therefore treated accordingly, are more likely to experience poorer quality of life following an acute hospitalization than patients with other types of acute coronary syndrome. Once myocardial infarction or high-risk unstable angina pectoris has been ruled out, these patients still require a careful and systematic follow-up.
Collapse
Affiliation(s)
- Elisabeth Perers
- Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
| | | | | | | | | | | | | |
Collapse
|