1
|
Nelson BD, McLaughlin CJ, Rivera OE, Kaul K, Ferdock AJ, Matuzsan ZM, Yazdanyar AR, Gopal JV, Patel AY, Chaska RM, Feldman BA, Jacoby JL. Implementation of a Novel Prehospital Clinical Decision Tool and ECG Transmission for STEMI Significantly Reduces Door-to-Balloon Time and Sex-Based Disparities. PREHOSP EMERG CARE 2024:1-7. [PMID: 38771723 DOI: 10.1080/10903127.2024.2357595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/30/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND An important method employed to reduce door to balloon time (DTBT) for ST segment elevation Myocardial Infarctions (STEMIs) is a prehospital MI alert. The purpose of this retrospective study was to examine the effects of an educational intervention using a novel decision support method of STEMI notification and prehospital electrocardiogram (ECG) transmission on DTBT. METHODS An ongoing database (April 4, 2000 - present) is maintained to track STEMI alerts. In 2007, an MI alert program began; emergency medicine physicians could activate a "prehospital MI alert". In October 2015, modems were purchased for Emergency Medical Services personnel to transmit ECGs. There was concurrent implementation of a decision support tool for identifying STEMI. Sex was assigned as indicated in the medical record. Data were analyzed in two groups: Pre-2016 (PRE) and 2016-2022 (POST). RESULTS In total, 3,153 patients (1,301 PRE; 1,852 POST) were assessed; the average age was 65.2 years, 32.6% female, 87.7% white with significant differences in age and race between the two cohorts. Of the total 3,153 MI alerts, 239 were false activations, leaving 2,914 for analysis. 2,115 (72.6%) had cardiac catheterization while 16 (6.7%) of the 239 had a cardiac catheterization. There was an overall decrease in DTBT of 27.5% PRE to POST of prehospital ECG transmission (p < 0.001); PRE median time was 74.5 min vs. 55 min POST. There was no significant difference between rates of cardiac catheterization PRE and POST for all patients. After accounting for age, race, and mode of arrival, DTBT was 12.2% longer in women, as compared to men (p < 0.001) PRE vs. POST. DTBT among women was significantly shorter when comparing PRE to POST periods (median 77 min vs. 60 min; p = 0.0001). There was no significant sex difference in the proportion of those with cardiac catheterization between the two cohorts (62.5% vs. 63.5%; p = 0.73). CONCLUSION Introduction of a decision support tool with prehospital ECG transmission with prehospital ECG transmission decreased overall DTBT by 20 min (27.5%). Women in the study had a 17-minute decrease in DTBT (22%), but their DTBT remained 12.2% longer than men for reasons that remain unclear.
Collapse
Affiliation(s)
- Bryan D Nelson
- Lehigh Valley Health Network, Morsani College of Medicine, Heart and Vascular Institute/University of South Florida, Allentown, Pennsylvania
| | - Conor J McLaughlin
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Morsani College of Medicine, University of South Florida, Allentown, Pennsylvania
| | - Orlando E Rivera
- Lehigh Valley Health Network, Morsani College of Medicine, Heart and Vascular Institute/University of South Florida, Allentown, Pennsylvania
- Emergency Medical Services, Hospital of Second Chances Health System, Norristown, Pennsylvania
| | - Kashyap Kaul
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Morsani College of Medicine, University of South Florida, Allentown, Pennsylvania
| | - Andrew J Ferdock
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Morsani College of Medicine, University of South Florida, Allentown, Pennsylvania
| | - Zachary M Matuzsan
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Morsani College of Medicine, University of South Florida, Allentown, Pennsylvania
- Center for Health Care Education, Morsani College of Medicine, Lehigh Valley Health Network Campus, University of South Florida, Center Valley, Pennsylvania
| | - Ali R Yazdanyar
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Morsani College of Medicine, University of South Florida, Allentown, Pennsylvania
- Department of Medicine, Division of Hospital Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jay V Gopal
- Center for Health Care Education, Morsani College of Medicine, Lehigh Valley Health Network Campus, University of South Florida, Center Valley, Pennsylvania
- Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Ayushi Y Patel
- Center for Health Care Education, Morsani College of Medicine, Lehigh Valley Health Network Campus, University of South Florida, Center Valley, Pennsylvania
- Lehigh Valley Health Network, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Allentown, Pennsylvania
| | - Rachael M Chaska
- Center for Health Care Education, Morsani College of Medicine, Lehigh Valley Health Network Campus, University of South Florida, Center Valley, Pennsylvania
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Bruce A Feldman
- Lehigh Valley Health Network, Morsani College of Medicine, Heart and Vascular Institute/University of South Florida, Allentown, Pennsylvania
| | - Jeanne L Jacoby
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Morsani College of Medicine, University of South Florida, Allentown, Pennsylvania
- Center for Health Care Education, Morsani College of Medicine, Lehigh Valley Health Network Campus, University of South Florida, Center Valley, Pennsylvania
| |
Collapse
|
2
|
Chen N, Xu Y, Xu C, Duan J, Zhou Y, Jin M, Xia H, Yuan W, Chen R. Effects of triglyceride glucose (TyG) and TyG-body mass index on sex-based differences in the early-onset heart failure of ST-elevation myocardial infarction. Nutr Metab Cardiovasc Dis 2024; 34:590-597. [PMID: 37996372 DOI: 10.1016/j.numecd.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/20/2023] [Accepted: 09/28/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND AND AIM Heart failure (HF) is an important complication of ST-elevation myocardial infarction (STEMI), including early- and late-onset HF. This study aimed to investigate the association between insulin resistance (IR)-related parameters triglyceride glucose (TyG) and TyG-body mass index (TyG-BMI) index and early-onset HF in STEMI between sexes. METHODS AND RESULTS This cross-sectional study included patients with STEMI who underwent primary percutaneous coronary intervention (PCI) between January 2016 and September 2022. Patients were divided into tertiles according to TyG/TyG-BMI index levels in males and females. The presence of early-onset HF was compared between tertiles in both sexes. Moreover, patients were stratified according to the tertiles of TyG/Tyg-BMI index. Differences in early-onset HF of STEMI were compared between males and females in each tertile group. 1118 patients were included in this study, 20.3% of whom were females. The incidence rate of early-onset HF was significantly higher in females than in males (29% vs. 14.8%). TyG-BMI index was negatively correlated with early-onset HF. In both females and males, there was no difference in the occurrence of early-onset HF between the highest and lowest TyG/TyG-BMI index groups. Sex disparity was observed in females who had a significantly higher prevalence of early-onset HF than males in each TyG/TyG-BMI index tertile group; however, after adjustment, the differences disappeared. CONCLUSIONS For patients with STEMI who undergo primary PCI, the incidence of early-onset HF is higher in females than in males. The TyG/TyG-BMI index do not contribute to the difference in early-onset HF between sexes.
Collapse
Affiliation(s)
- Nan Chen
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yao Xu
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Chong Xu
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Junying Duan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Ye Zhou
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Mingfeng Jin
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Hao Xia
- Department of Cardiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Wei Yuan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Rui Chen
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
| |
Collapse
|
3
|
Boivin-Proulx LA, Ieroncig F, Demers SP, Nozza A, Soltani M, Ghersi I, Verreault-Julien L, Alansari Y, Massie C, Simard P, Rosca L, Lalancette JS, Massicotte G, Chen-Tournoux A, Daneault B, Paradis JM, Diodati JG, Pranno N, Jolicoeur M, Potter BJ, Marquis-Gravel G, Pacheco C. Antithrombotic Management and Outcomes of Anterior ST-Elevation Myocardial Infarction With New-Onset Wall Motion Abnormalities in Men and Women. CJC Open 2024; 6:362-369. [PMID: 38487067 PMCID: PMC10935678 DOI: 10.1016/j.cjco.2023.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/10/2023] [Indexed: 03/17/2024] Open
Abstract
Background In patients with anterior ST-elevation myocardial infarction (STEMI) and new-onset antero-apical wall motion abnormalities (WMAs), whether the rate of prophylaxis against left ventricular thrombus and outcomes differ between men and women is unknown. Methods A multicentre retrospective cohort study of patients with STEMI and new-onset antero-apical WMAs treated with primary percutaneous coronary intervention was conducted. Patients with an established indication of oral anticoagulation (OAC) were excluded. The rates of triple therapy (double antiplatelet therapy + OAC) at discharge were compared for women vs men. The rates of net adverse clinical events, a composite of mortality, myocardial infarction, stroke or transient ischemic attack, systemic thromboembolism or Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding at 6 months were compared across sex using a multivariate logistic regression model. Results A total of 1664 patients were included in the primary analysis, of whom 402 (24.2%) were women and 1262 (75.8%) were men. A total of 138 women (34.3%) and 489 men (38.7%) received a triple therapy prescription at discharge (P = 0.11). At 6 months, 33 women (8.2%) and 96 men (7.6%) experienced a net adverse clinical event (adjusted odds ratio 0.82; 95% confidence interval 0.49-1.37). No difference occurred in the risk of bleeding events and ischemic events between men and women, when these were analyzed separately. Conclusions The rates of OAC prescription for left ventricular thrombus prophylaxis and clinical outcomes at 6 months were similar in women and men following anterior STEMI with new-onset antero-apical WMAs.
Collapse
Affiliation(s)
- Laurie-Anne Boivin-Proulx
- Division of Cardiology, Interventional Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Fabrice Ieroncig
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Simon-Pierre Demers
- Centre intégré universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Sacré-Coeur Hospital, Cardiology Division, Montreal, Quebec, Canada
| | - Anna Nozza
- Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marwa Soltani
- Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | | | | | - Yahya Alansari
- Division of Cardiology, Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada
| | - Charles Massie
- Centre intégré universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Sacré-Coeur Hospital, Cardiology Division, Montreal, Quebec, Canada
| | - Philippe Simard
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Lorena Rosca
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
| | | | | | - Annabel Chen-Tournoux
- Division of Cardiology, Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada
| | - Benoit Daneault
- Sherbrooke University Hospital Center, Sherbrooke, Quebec, Canada
| | | | - Jean G. Diodati
- Centre intégré universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Sacré-Coeur Hospital, Cardiology Division, Montreal, Quebec, Canada
| | | | - Marc Jolicoeur
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Québec, Canada
| | - Brian J. Potter
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Québec, Canada
| | | | - Christine Pacheco
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Québec, Canada
- Hôpital Pierre-Boucher, Centre intégré de soins et de services sociaux de la Montérégie Est, Longueuil, Quebec, Canada
| |
Collapse
|
4
|
Piliuk K, Tomforde S. Artificial intelligence in emergency medicine. A systematic literature review. Int J Med Inform 2023; 180:105274. [PMID: 37944275 DOI: 10.1016/j.ijmedinf.2023.105274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
Motivation and objective: Emergency medicine is becoming a popular application area for artificial intelligence methods but remains less investigated than other healthcare branches. The need for time-sensitive decision-making on the basis of high data volumes makes the use of quantitative technologies inevitable. However, the specifics of healthcare regulations impose strict requirements for such applications. Published contributions cover separate parts of emergency medicine and use disparate data and algorithms. This study aims to systematize the relevant contributions, investigate the main obstacles to artificial intelligence applications in emergency medicine, and propose directions for further studies. METHODS The contributions selection process was conducted with systematic electronic databases querying and filtering with respect to established exclusion criteria. Among the 380 papers gathered from IEEE Xplore, ACM Digital Library, Springer Library, ScienceDirect, and Nature databases 116 were considered to be a part of the survey. The main features of the selected papers are the focus on emergency medicine and the use of machine learning or deep learning algorithms. FINDINGS AND DISCUSSION The selected papers were classified into two branches: diagnostics-specific and triage-specific. The former ones are focused on either diagnosis prediction or decision support. The latter covers such applications as mortality, outcome, admission prediction, condition severity estimation, and urgent care prediction. The observed contributions are highly specialized within a single disease or medical operation and often use privately collected retrospective data, making them incomparable. These and other issues can be addressed by creating an end-to-end solution based on human-machine interaction. CONCLUSION Artificial intelligence applications are finding their place in emergency medicine, while most of the corresponding studies remain isolated and lack higher generalization and more sophisticated methodology, which can be a matter of forthcoming improvements.
Collapse
Affiliation(s)
| | - Sven Tomforde
- Christian-Albrechts-Universität zu Kiel, 24118 Kiel, Germany
| |
Collapse
|
5
|
Berga Congost G, Martinez Momblan MA, Valverde Bernal J, Márquez López A, Ruiz Gabalda J, Garcia-Picart J, Puig Campmany M, Brugaletta S. Association of sex and age and delay predictors on the time of primary angioplasty activation for myocardial infarction patients in an emergency department. Heart Lung 2023; 58:6-12. [PMID: 36335910 DOI: 10.1016/j.hrtlng.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Time between Emergency Department (ED) and ST-segment elevation acute myocardial infarction (STEMI) activation time is a good indicator of ED quality. STEMI delays are of particular importance in some subgroups, such as women and the elderly. OBJECTIVE To determine the association of sex and age with activation time in STEMI patients admitted to the ED. METHODS An observational retrospective study was conducted including all patients admitted to the ED activated as a STEMI. The main variable was activation time. To evaluate the independent predictors of activation time, a multivariate logistic regression analysis was carried out, variables were sex, age, sex and age combined, chest pain, ST elevation in the electrocardiogram, and first medical contact (FMC) at the hospital's ED. RESULTS A total of 330 patients were included. They were classified by sex: 23.9% (78) women and 76.1% (249) men; and age: 51.1% (167) <65 yo and 48.9% (160) ≥65 yo. Women and elderly patients exhibited a more atypical presentation. Multivariate analysis shows that showed that elderly age (OR=1.976 95%; CI=1.257-3.104; p = 0.003) and FMC prior to attending the ED (OR=1.762; 95% CI=1.117-2.779; p = 0.015) were associated with a longer activation time. Women older than 65 years old showed the longest activation time. CONCLUSION STEMI delays are longer in women and the elderly with atypical presentation. Age ≥65 and FMC outside the ED were associated with an increase in the activation time. This highlights the need to develop strategies to improve activation time for these specific patient groups.
Collapse
Affiliation(s)
- Gemma Berga Congost
- Interventional Cardiology Department, Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Biomedical Research Institute, Barcelona, Spain; University of Barcelona Faculty of Medicine and Health Sciences, Barcelona, Spain
| | - Maria Antonia Martinez Momblan
- University of Barcelona Faculty of Medicine and Health Sciences, Barcelona, Spain; Research Networking Centre of Rare Diseases. CIBER-ER, Unit 747, Spain.
| | - Jonatan Valverde Bernal
- Interventional Cardiology Department, Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Biomedical Research Institute, Barcelona, Spain
| | - Adrián Márquez López
- Interventional Cardiology Department, Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Biomedical Research Institute, Barcelona, Spain; University of Barcelona Faculty of Medicine and Health Sciences, Barcelona, Spain
| | - Judit Ruiz Gabalda
- Interventional Cardiology Department, Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Joan Garcia-Picart
- Interventional Cardiology Department, Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Mireia Puig Campmany
- Sant Pau Biomedical Research Institute, Barcelona, Spain; Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Salvatore Brugaletta
- University of Barcelona Faculty of Medicine and Health Sciences, Barcelona, Spain; Interventional Cardiology Department, Cardiology, Hospital Clinic, Barcelona, Spain; Biomedical Research Institute IDIBAPS, Barcelona, Spain
| |
Collapse
|
6
|
Motovska Z, Hlinomaz O, Aschermann M, Jarkovsky J, Želízko M, Kala P, Groch L, Svoboda M, Hromadka M, Widimsky P. Trends in outcomes of women with myocardial infarction undergoing primary angioplasty-Analysis of randomized trials. Front Cardiovasc Med 2023; 9:953567. [PMID: 36684569 PMCID: PMC9845716 DOI: 10.3389/fcvm.2022.953567] [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: 05/26/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
Background Sex- and gender-associated differences determine the disease response to treatment. Aim The study aimed to explore the hypothesis that progress in the management of STE-myocardial infarction (STEMI) overcomes the worse outcome in women. Methods and results We performed an analysis of three randomized trials enrolling patients treated with primary PCI more than 10 years apart. PRAGUE-1,-2 validated the preference of transport for primary PCI over on-site fibrinolysis. PRAGUE-18 enrollment was ongoing at the time of the functional network of 24/7PCI centers, and the intervention was supported by intensive antiplatelets. The proportion of patients with an initial Killip ≥ 3 was substantially higher in the more recent study (0.6 vs. 6.7%, p = 0.004). Median time from symptom onset to the door of the PCI center shortened from 3.8 to 3.0 h, p < 0.001. The proportion of women having total ischemic time ≤3 h was higher in the PRAGUE-18 (OR [95% C.I.] 2.65 [2.03-3.47]). However, the percentage of patients with time-to-reperfusion >6 h was still significant (22.3 vs. 27.2% in PRAGUE-18). There was an increase in probability for an initial TIMI flow >0 in the later study (1.49 [1.0-2.23]), and also for an optimal procedural result (4.24 [2.12-8.49], p < 0.001). The risk of 30-day mortality decreased by 61% (0.39 [0.17-0.91], p = 0.029). Conclusion The prognosis of women with MI treated with primary PCI improved substantially with 24/7 regional availability of mechanical reperfusion, performance-enhancing technical progress, and intensive adjuvant antithrombotic therapy. A major modifiable hindrance to achieving this benefit in a broad population of women is the timely diagnosis by health professional services.
Collapse
Affiliation(s)
- Zuzana Motovska
- Cardiocentre, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia,*Correspondence: Zuzana Motovska,
| | - Ota Hlinomaz
- Department of Cardioangiology, International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czechia
| | - Michael Aschermann
- Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czechia
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses Ltd., Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Michael Želízko
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia
| | - Petr Kala
- Department of Internal and Cardiology, Faculty of Medicine, Masaryk University and University Hospital Brno-Bohunice, Brno, Czechia
| | - Ladislav Groch
- Department of Cardioangiology, International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czechia
| | - Michal Svoboda
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia
| | - Milan Hromadka
- Department of Cardiology, Charles University, University Hospital in Pilsen, Pilsen, Czechia
| | - Petr Widimsky
- Cardiocentre, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia
| |
Collapse
|
7
|
Sex Differences in Acute Myocardial Infarction: Good News and Bad News. Can J Cardiol 2022; 38:1661-1663. [PMID: 36334936 DOI: 10.1016/j.cjca.2022.08.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 12/24/2022] Open
|
8
|
Boivin-Proulx LA, Pacheco C, Matteau A, Mansour S, Potter BJ. Pre-Hospital STEMI Referral Systems and Sex-Related Bias in Canada: A National Survey. CJC Open 2022; 4:829-832. [PMID: 36254323 PMCID: PMC9568687 DOI: 10.1016/j.cjco.2022.05.006] [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: 04/18/2022] [Accepted: 05/26/2022] [Indexed: 11/25/2022] Open
Abstract
Background Prehospital electrocardiographic ST-elevation myocardial infarction (STEMI) diagnosis and prehospital cardiac catheterization laboratory activation have been shown to significantly reduce average treatment delay, and further standardization of such systems may help reduce sex-related treatment and outcome gaps. However, what types of prehospital STEMI activation systems are in place across Canada, and to what extent sex-based STEMI treatment disparities are tracked, is unknown. Methods We conducted a national survey of catheterization laboratory directors between October 11 and December 25, 2021. Seventeen catheterization laboratory directors representing 6 community and 11 academic centres completed the survey (40% response rate). Results : All responding centres use a prehospital STEMI diagnosis and cardiac catheterization laboratory activation system, and the majority (59%) rely on real-time physician oversight. Slightly less than half (47%) of percutaneous coronary intervention centres reported prospectively tracking sex-related differences in STEMI care, and only one respondent believed that a significant systemic sex-related bias was present in their prehospital STEMI referral system. Patient factors (symptom description or time to presentation; 23.5%) and limitations of electrocardiogram diagnosis of STEMI in women (23.5%) were cited most frequently as contributing to sex-related bias in STEMI referral systems. In contrast, implicit bias in the referral algorithm, prehospital provider bias, and physician bias were not considered important contributing factors. Conclusions Although all responding centres employ prehospital activation systems, less than half tracked sex-related differences, and most respondents believed that no sex-related bias existed in their prehospital STEMI system.
Collapse
|
9
|
Parry M, Van Spall HG, Mullen KA, Mulvagh SL, Pacheco C, Colella TJF, Clavel MA, Jaffer S, Foulds HJ, Grewal J, Hardy M, Price JA, Levinsson AL, Gonsalves CA, Norris CM. The Canadian Women’s Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women-Chapter 6: Sex- And Gender-Specific Diagnosis and Treatment. CJC Open 2022; 4:589-608. [PMID: 35865023 PMCID: PMC9294990 DOI: 10.1016/j.cjco.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/12/2022] [Indexed: 10/26/2022] Open
|
10
|
Pacheco C, Mullen KA, Coutinho T, Jaffer S, Parry M, Van Spall HG, Clavel MA, Edwards JD, Sedlak T, Norris CM, Dhukai A, Grewal J, Mulvagh SL. THE CANADIAN WOMEN’S HEART HEALTH ALLIANCE ATLAS ON THE EPIDEMIOLOGY, DIAGNOSIS, AND MANAGEMENT OF CARDIOVASCULAR DISEASE IN WOMEN -- CHAPTER 5: SEX- AND GENDER-UNIQUE MANIFESTATIONS OF CARDIOVASCULAR DISEASE. CJC Open 2021; 4:243-262. [PMID: 35386135 PMCID: PMC8978072 DOI: 10.1016/j.cjco.2021.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/17/2021] [Indexed: 12/15/2022] Open
|