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Chaturvedi A, Garcia-Garcia HM, Cellamare M, Zhang C, Chandrika P, Abusnina W, Chitturi KR, Haberman D, Lupu L, Merdler I, Case BC, Hashim HD, Ben-Dor I, Waksman R. Racial Disparities in Outcomes of Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction Secondary to Spontaneous Coronary Artery Dissection. Am J Cardiol 2024; 225:52-60. [PMID: 38906395 DOI: 10.1016/j.amjcard.2024.06.018] [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: 04/28/2024] [Revised: 06/01/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024]
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of ST-segment elevation myocardial infarction (STEMI), predominantly affecting women. Because primary percutaneous coronary intervention (PPCI) is reserved for a select group of patients, vulnerable and minority patients may experience delays in appropriate management and adverse outcomes. We examined the racial differences in the outcomes for patients with SCAD who underwent PPCI for STEMI. Records of patients aged ≥18 years who underwent PPCI for SCAD-related STEMI between 2016 and 2020 were identified from the National Inpatient Sample database. Clinical, socioeconomic, and hospital characteristics were compared between non-White and White patients. Weighted multivariate analysis assessed the association of race with inpatient mortality, length of stay (LOS), and hospitalization costs. The total weighted estimate of patients with SCAD-STEMI who underwent PPCI was 4,945, constituting 25% non-White patients. Non-White patients were younger (56 vs 60.7 years, p <0.001); had a higher prevalence of diabetes, acute renal failure, and obesity; and were more likely to be uninsured and be in the lowest income group. Inpatient mortality (7.7% vs 8.4%, p = 0.74) and hospitalization costs ($34,213 vs $31,858, p = 0.27) were similar for non-White and White patients, and the adjusted analysis did not show any association between the patients' race and inpatient mortality (odds ratio 0.60, 95% confidence interval [CI] 0.32 to 1.13, p = 0.11) or hospitalization costs (β [β coefficient]: 215, 95% CI -4,193 to 4,623, p >0.90). Similarly, there was no association between the patients' race and LOS (incident rate ratio 1.20, 95% CI 1.00 to 1.45, p = 0.054). The weighted multivariate analysis showed that age; clinical co-morbidities such as diabetes, acute renal failure, valvular dysfunction, and obesity; low-income status; and hospitalization in the western region were associated with adverse outcomes. In conclusion, our study does not show any differences in inpatient mortality, LOS, and hospitalization costs between non-White and White patients who underwent PPCI for SCAD-related STEMI.
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Affiliation(s)
- Abhishek Chaturvedi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia.
| | - Matteo Cellamare
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Parul Chandrika
- Internal Medicine, MedStar Shah Medical Group, White Plains, Maryland
| | - Waiel Abusnina
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Kalyan R Chitturi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Dan Haberman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Lior Lupu
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Ilan Merdler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Hayder D Hashim
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia.
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2
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Park DY, Singireddy S, Mangalesh S, Fishman E, Ambrosini A, Jamil Y, Vij A, Sikand NV, Ahmad Y, Frampton J, Nanna MG. The association of timing of coronary artery bypass grafting for non-ST-elevation myocardial infarction and clinical outcomes in the contemporary United States. Coron Artery Dis 2024; 35:261-269. [PMID: 38164979 DOI: 10.1097/mca.0000000000001314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND In contrast to the timing of coronary angiography and percutaneous coronary intervention, the optimal timing of coronary artery bypass grafting (CABG) in non-ST-elevation myocardial infarction (NSTEMI) has not been determined. Therefore, we compared in-hospital outcomes according to different time intervals to CABG surgery in a contemporary NSTEMI population in the USA. METHODS We identified all NSTEMI hospitalizations from 2016 to 2020 where revascularization was performed with CABG. We excluded NSTEMI with high-risk features using prespecified criteria. CABG was stratified into ≤24 h, 24-72 h, 72-120 h, and >120 h from admission. Outcomes of interest included in-hospital mortality, perioperative complications, length of stay (LOS), and hospital cost. RESULTS A total of 147 170 NSTEMI hospitalizations where CABG was performed were assessed. A greater percentage of females, Blacks, and Hispanics experienced delays to CABG surgery. No difference in in-hospital mortality was observed, but CABG at 72-120 h and at >120 h was associated with higher odds of non-home discharge and acute kidney injury compared with CABG at ≤24 h from admission. In addition to these differences, CABG at >120 h was associated with higher odds of gastrointestinal hemorrhage and need for blood transfusion. All 3 groups with CABG delayed >24 h had longer LOS and hospital-associated costs compared with hospitalizations where CABG was performed at ≤24 h. CONCLUSION CABG delays in patients with NSTEMI are more frequently experienced by women and minority populations and are associated with an increased burden of complications and healthcare cost.
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Affiliation(s)
- Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, Illinois
| | | | - Sridhar Mangalesh
- Department of Medicine, Army College of Medical Sciences, New Delhi, Delhi, India
| | | | | | - Yasser Jamil
- Department of Medicine, Yale-Waterbury Hospital, New Haven, Connecticut
| | - Aviral Vij
- Division of Cardiology, Cook County Health
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Nikhil V Sikand
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Yousif Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Frampton
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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3
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Hoagland A, Kipping S. Challenges in Promoting Health Equity and Reducing Disparities in Access Across New and Established Technologies. Can J Cardiol 2024; 40:1154-1167. [PMID: 38417572 DOI: 10.1016/j.cjca.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024] Open
Abstract
Medical innovations and novel technologies stand to improve the return on high levels of health spending in developed countries, particularly in cardiovascular care. However, cardiac innovations also disrupt the landscape of accessing care, potentially creating disparities in who has access to novel and extant technologies. These disparities might disproportionately harm vulnerable groups, including those whose nonmedical conditions-including social determinants of health-inhibit timely access to diagnoses, referrals, and interventions. We first document the barriers to access novel and existing technologies in isolation, then proceed to document their interaction. Novel cardiac technologies might affect existing available services, and change the landscape of care for vulnerable patient groups who seek access to cardiology services. There is a clear need to identify and heed lessons learned from the dissemination of past innovations in the development, funding, and dissemination of future medical technologies to promote equitable access to cardiovascular care. We conclude by highlighting and synthesizing several policy implications from recent literature.
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Affiliation(s)
- Alex Hoagland
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario Shores Centre for Mental Health Sciences, Toronto, Ontario, Canada.
| | - Sarah Kipping
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario Shores Centre for Mental Health Sciences, Toronto, Ontario, Canada
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4
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Angeli F, Ricci F, Moscucci F, Sciomer S, Bucciarelli V, Bianco F, Mattioli AV, Pizzi C, Gallina S. Sex- and gender-related disparities in chest pain syndromes: the feminine mystique of chest pain. Curr Probl Cardiol 2024; 49:102457. [PMID: 38342350 DOI: 10.1016/j.cpcardiol.2024.102457] [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: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024]
Abstract
Chest pain syndromes encompass a wide range of different clinical conditions, being coronary artery disease one of the most important and feared aetiology. Sex and gender disparities have been reported in pathophysiology, clinical presentations, diagnostic work-up and outcomes of patients admitted for chest pain. Biological differences in sexual hormones and neurological pain procession pathways have been proposed as contributors to disparities between men and women; however, gender-related disparities in socio-economic and psychological status have emerged as additional factors involved in these conditions. A better understanding of gender- and sex-related disparities will lead to improved clinical care and management of chest pain syndromes in both men and women. In this comprehensive review, we describe the existing knowledge regarding sex and gender-based differences in management and outcomes of chest pain syndromes in order to stimulate and promote the development of a more sex- and gender-oriented approach to these conditions.
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Affiliation(s)
- Francesco Angeli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Federica Moscucci
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, Viale del Policlinico n. 155, 00161 Rome, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, 'Sapienza', Rome University, Viale dell'Università, 37, 00185, Rome, Italy
| | - Valentina Bucciarelli
- Cardiovascular Sciences Department-Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Francesco Bianco
- Cardiovascular Sciences Department-Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Anna Vittoria Mattioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via Giuseppe Massarenti 9, 40138, Bologna, Italy.
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
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Kaldal A, Tonstad S, Jortveit J. Sex differences in secondary preventive follow-up after coronary heart events. BMC Cardiovasc Disord 2023; 23:459. [PMID: 37710178 PMCID: PMC10502978 DOI: 10.1186/s12872-023-03483-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND AND AIMS Some studies point to sex differences in cardiovascular preventive practices. The aim of this study was to investigate differences in achievement of secondary preventive targets and long-term outcome in men and women after a coronary heart event. METHODS This study was a subanalysis from a randomized controlled trial of hospital-based versus primary care-based secondary preventive follow-up at Sorlandet Hospital, Norway, 2007-2022 and included both groups. The main outcome was achievement of treatment targets two years after the index event. Event-free survival was calculated based on the composite of mortality, coronary intervention, stroke, or myocardial infarction during follow-up. Participants were followed-up for up to 10 years after the index event through out-patient consultations. RESULTS In total, 337 women and 1203 men were eligible for the study. Due to loss of follow-up during the first two years after the index coronary event 106 (7%) participants were excluded from further analysis (53% withdrawal of consent, 12% death, and 35% other causes) leaving 307 (21%) women and 1127 (79%) men. After two years of follow-up we found no differences between women and men in achievement of blood pressure targets (61% vs. 59%; p = 0.57), LDL-cholesterol goals (64% vs. 69%; p = 0.15), HbA1c-goal in patients with diabetes (49% vs. 45%; p = 0.57), non-smoking (79% vs. 81%; p = 0.34), healthy diets (14% vs. 13%, p = 0.89), physical activity (55% vs. 58%; p = 0.38), use of acetylsalicylic acid (93% vs. 94%; p = 0.39), and use of lipid lowering therapy (92% vs. 94%; p = 0.15). After a median follow-up time of 5.0 [SD 3.2] years there were no differences between women and men regarding composite endpoint (89 [30.0%] vs. 345 [30.6]; p = 0.58), and composite endpoint-free survival did not differ between women and men (hospital-based follow-up HR for women versus men, 0.87, 95% CI 0.62-1.23; p = 0.44 and primary care service HR for women versus men 0.95, 95% CI 0.69-1.31; p = 0.78). CONCLUSIONS The study show no sex differences in achievement of secondary preventive targets or composite endpoint after coronary heart events. However, many women and men did not achieve treatment goals, and further improvement in secondary prevention is needed. TRIAL REGISTRATION The study is registered in ClinicalTrials.gov (NCT00679237).
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Affiliation(s)
- Anete Kaldal
- Department of Research, Sørlandet Hospital, Kristiansand S, Norway.
| | - Serena Tonstad
- Department of Endocrinology, Obesity and Preventive Medicine, Section of Preventive Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jarle Jortveit
- Department of Cardiology, Sorlandet Hospital, Arendal, Norway
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6
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Barton JC, Wozniak A, Scott C, Chatterjee A, Titterton GN, Corrigan AE, Kuri A, Shah V, Soh I, Kaski JC. Between-Sex Differences in Risk Factors for Cardiovascular Disease among Patients with Myocardial Infarction-A Systematic Review. J Clin Med 2023; 12:5163. [PMID: 37568564 PMCID: PMC10420061 DOI: 10.3390/jcm12155163] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
Between-sex differences in the presentation, risk factors, management, and outcomes of acute myocardial infarction (MI) are well documented. However, as such differences are highly sensitive to cultural and social changes, there is a need to continuously re-evaluate the evidence. The present contemporary systematic review assesses the baseline characteristics of men and women presenting to secondary, tertiary, and quaternary centres with acute myocardial infarction (MI). Over 1.4 million participants from 18 studies, including primary prospective, cross sectional and retrospective observational studies, as well as secondary analysis of registry data are included in the study. The study showed that women were more likely than men to have a previous diagnosis of diabetes, hypertension, cerebrovascular disease, and heart failure. They also had lower odds of presenting with previous ischaemic heart disease and angina, dyslipidaemia, or a smoking history. Further work is necessary to understand the reasons for these differences, and the role that gender-specific risk factors may have in this context. Moreover, how these between-gender differences are implicated in management and outcomes also requires further work.
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Affiliation(s)
- Jack Charles Barton
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London E1 4NS, UK; (A.W.); (C.S.)
| | - Anna Wozniak
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London E1 4NS, UK; (A.W.); (C.S.)
| | - Chloe Scott
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London E1 4NS, UK; (A.W.); (C.S.)
| | - Abhisekh Chatterjee
- Department of Medicine, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK; (A.C.); (V.S.)
| | - Greg Nathan Titterton
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK; (G.N.T.); (A.K.)
| | | | - Ashvin Kuri
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK; (G.N.T.); (A.K.)
| | - Viraj Shah
- Department of Medicine, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK; (A.C.); (V.S.)
| | - Ian Soh
- St. George’s University of London, London SW17 0RE, UK;
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George’s University of London, London SW17 0RE, UK;
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7
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Osho A, Fernandes MF, Poudel R, de Lemos J, Hong H, Zhao J, Li S, Thomas K, Kikuchi DS, Zegre-Hemsey J, Ibrahim N, Shah NS, Hollowell L, Tamis-Holland J, Granger CB, Cohen M, Henry T, Jacobs AK, Jollis JG, Yancy CW, Goyal A. Race-Based Differences in ST-Segment-Elevation Myocardial Infarction Process Metrics and Mortality From 2015 Through 2021: An Analysis of 178 062 Patients From the American Heart Association Get With The Guidelines-Coronary Artery Disease Registry. Circulation 2023; 148:229-240. [PMID: 37459415 DOI: 10.1161/circulationaha.123.065512] [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: 05/07/2023] [Accepted: 06/13/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Systems of care have been developed across the United States to standardize care processes and improve outcomes in patients with ST-segment-elevation myocardial infarction (STEMI). The effect of contemporary STEMI systems of care on racial and ethnic disparities in achievement of time-to-treatment goals and mortality in STEMI is uncertain. METHODS We analyzed 178 062 patients with STEMI (52 293 women and 125 769 men) enrolled in the American Heart Association Get With The Guidelines-Coronary Artery Disease registry between January 1, 2015, and December 31, 2021. Patients were stratified into and outcomes compared among 3 racial and ethnic groups: non-Hispanic White, Hispanic White, and Black. The primary outcomes were the proportions of patients achieving the following STEMI process metrics: prehospital ECG obtained by emergency medical services; hospital arrival to ECG obtained within 10 minutes for patients not transported by emergency medical services; arrival-to-percutaneous coronary intervention time within 90 minutes; and first medical contact-to-device time within 90 minutes. A secondary outcome was in-hospital mortality. Analyses were performed separately in women and men, and all outcomes were adjusted for age, comorbidities, acuity of presentation, insurance status, and socioeconomic status measured by social vulnerability index based on patients' county of residence. RESULTS Compared with non-Hispanic White patients with STEMI, Hispanic White patients and Black patients had lower odds of receiving a prehospital ECG and achieving targets for door-to-ECG, door-to-device, and first medical contact-to-device times. These racial disparities in treatment goals were observed in both women and men, and persisted in most cases after multivariable adjustment. Compared with non-Hispanic White women, Hispanic White women had higher adjusted in-hospital mortality (odds ratio, 1.39 [95% CI, 1.12-1.72]), whereas Black women did not (odds ratio, 0.88 [95% CI, 0.74-1.03]). Compared with non-Hispanic White men, adjusted in-hospital mortality was similar in Hispanic White men (odds ratio, 0.99 [95% CI, 0.82-1.18]) and Black men (odds ratio, 0.96 [95% CI, 0.85-1.09]). CONCLUSIONS Race- or ethnicity-based disparities persist in STEMI process metrics in both women and men, and mortality differences are observed in Hispanic White compared with non-Hispanic White women. Further research is essential to evolve systems of care to mitigate racial differences in STEMI outcomes.
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Affiliation(s)
- Asishana Osho
- Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Boston (A.O.)
| | | | - Ram Poudel
- American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)
| | - James de Lemos
- University of Texas Southwestern Medical Center, Dallas (J.d.L.)
| | - Haoyun Hong
- American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)
| | - Juan Zhao
- American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)
| | - Shen Li
- American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)
| | - Kathie Thomas
- American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)
| | - Daniel S Kikuchi
- Osler Medical Residency, Johns Hopkins Hospital, Baltimore, MD (D.S.K.)
| | | | - Nasrien Ibrahim
- Harvard T.H. Chan School of Public Health, Boston, MA (N.I.)
| | - Nilay S Shah
- Department of Medicine, Division of Cardiology, Northwestern University Medical School, Chicago, IL (N.S.S., C.W.Y.)
| | - Lori Hollowell
- American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)
| | | | | | | | - Timothy Henry
- The Christ Hospital Heart and Vascular Institute, Cincinnati, OH (T.H., J.G.J.)
| | | | - James G Jollis
- The Christ Hospital Heart and Vascular Institute, Cincinnati, OH (T.H., J.G.J.)
| | - Clyde W Yancy
- Department of Medicine, Division of Cardiology, Northwestern University Medical School, Chicago, IL (N.S.S., C.W.Y.)
| | - Abhinav Goyal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.)
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8
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Liu Y, Guan S, Xu H, Zhang N, Huang M, Liu Z. Inflammation biomarkers are associated with the incidence of cardiovascular disease: a meta-analysis. Front Cardiovasc Med 2023; 10:1175174. [PMID: 37485268 PMCID: PMC10360053 DOI: 10.3389/fcvm.2023.1175174] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/26/2023] [Indexed: 07/25/2023] Open
Abstract
Background Inflammation is a risk factor for cardiovascular disease (CVD), and particular inflammatory parameters can be used to predict the incidence of CVD. The aim of this study was to assess the association between fibrinogen (FIB), interleukin-6 (IL-6), C-reactive protein (CRP) and galectin-3 (Gal-3) and the risk of cardiovascular disease using meta-analysis. Methods PubMed, Embase, Scopus, and Web of Science databases were searched with the appropriate strategies to identify observational studies relevant to this meta-analysis. A random-effects model was used to combine inflammation factor-associated outcomes and cardiovascular disease outcomes, except in the case of galectin-3, where a fixed-effects model was used because of less heterogeneity. Location, age, type of cardiovascular disease, and sample size factors were used to explore heterogeneity in stratification and metaregression for subgroup analysis. A case-by-case literature exclusion approach was used for sensitivity analysis. The funnel plot and Begg's test were combined to assess publication bias. Results Thirty-three papers out of 11,456 were screened for inclusion in the analysis. Four inflammation biomarkers were significantly associated with the development of CVD: FIB (OR: 1.21, 95% CI: 1.15-1.27, P < 0.001; HR: 1.04, 95% CI: 1.00-1.07, P < 0.05), IL-6 (HR: 1.16, 95% CI: 1.10-1.22, P < 0.001), CRP (OR: 1.25, 95% CI: 1.15-1.35, P < 0.001; HR: 1.20, 95% CI: 1.14-1.25, P < 0.001) and Gal-3 (HR: 1.09, 95% CI: 1.05-1.14, P < 0.001). Location factors help explain the source of heterogeneity, and there is publication bias in the Gal-3 related literature. Conclusion Taken together, the current research evidence suggests that high levels of fibrinogen, interleukin-6, C-reactive protein and galectin-3 are risk factors for cardiovascular disease and can be used as biomarkers to predict the development of cardiovascular disease to some extent. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42023391844.
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Affiliation(s)
- Yifei Liu
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Suzhen Guan
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Haiming Xu
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Na Zhang
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Min Huang
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zhihong Liu
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, Ningxia, China
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9
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Hsiao YT, Hung JF, Zhang SQ, Yeh YN, Tsai MJ. The Impact of Emergency Department Arrival Time on Door-to-Balloon Time in Patients with ST-Segment Elevation Myocardial Infarction Receiving Primary Percutaneous Coronary Intervention. J Clin Med 2023; 12:jcm12062392. [PMID: 36983392 PMCID: PMC10059039 DOI: 10.3390/jcm12062392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Door-to-balloon (DTB) time significantly affects the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). The effects of temporal differences in emergency department (ED) arrival time on DTB time and on different segments of DTB time remain inconclusive. Therefore, we performed a retrospective study in a tertiary hospital between January 2013 and December 2021 and investigated the relationship between a patient's arrival time and both their DTB time and different segments of their DTB time. Of 732 STEMI patients, 327 arrived during the daytime (08:01-16:00), 268 during the evening (16:01-24:00), and 137 at night (00:01-08:00). Significantly higher odds of delay in DTB time were observed during the nighttime (adjusted odds ratio (aOR): 2.87; 95% confidence interval (CI): 1.50-5.51, p = 0.002) than during the daytime. This delay was mainly attributed to a delay in cardiac catheterization laboratory (cath lab) activation-to-arrival time (aOR: 6.25; 95% CI: 3.75-10.40, p < 0.001), particularly during the 00:00-04:00 time range. Age, sex, triage level, and whether patients arrived during the COVID-19 pandemic also had independent effects on different segments of DTB time. Further studies are required to investigate the root causes of delay in DTB time and to develop specific strategies for improvement.
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Affiliation(s)
- Yu-Ting Hsiao
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600, Taiwan
| | - Jui-Fu Hung
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600, Taiwan
| | - Shi-Quan Zhang
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600, Taiwan
| | - Ya-Ni Yeh
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600, Taiwan
| | - Ming-Jen Tsai
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600, Taiwan
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10
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Sambola A, García Del Blanco B, Kunadian V, Vogel B, Chieffo A, Vidal M, Ratcovich H, Botti G, Wilkinson C, Mehran R. Sex-based Differences in Percutaneous Coronary Intervention Outcomes in Patients With Ischemic Heart Disease. Eur Cardiol 2023. [DOI: 10.15420/ecr.2022.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
In high-income countries, ischaemic heart disease is the leading cause of death in women and men, accounting for more than 20% of deaths in both sexes. However, women are less likely to receive guideline-recommended percutaneous coronary intervention (PCI) than men. Women undergoing PCI have poorer unadjusted outcomes because they are older and have greater comorbidity than men, but uncertainty remains whether sex affects outcome after these differences in clinical characteristics are considered. In this paper, we review recent published evidence comparing outcomes between men and women undergoing PCI. We focus on the sex differences in PCI outcomes in different scenarios: acute coronary syndromes, stable angina and complex lesions, including the approach of left main coronary artery. We also review how gender is considered in recent guidelines and offer a common clinical scenario to illustrate the contemporary management strategies an interventional cardiologist should consider when performing PCI on a female patient.
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Affiliation(s)
- Antonia Sambola
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma, Bellaterra, Spain
| | - Bruno García Del Blanco
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma, Bellaterra, Spain
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, US
| | - Alaide Chieffo
- nterventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - María Vidal
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma, Bellaterra, Spain
| | - Hanna Ratcovich
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Giulia Botti
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Chris Wilkinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, US
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11
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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.
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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
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12
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O'Conor KJ, Young L, Tomobi O, Golden SH, Samen CDK, Banks MC. Implementing pathways to anesthesiology: Promoting diversity, equity, inclusion, and success. Int Anesthesiol Clin 2023; 61:34-41. [PMID: 36480648 DOI: 10.1097/aia.0000000000000386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Katie J O'Conor
- Faculty, Chief Diversity & Equity Officer, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Lisa Young
- Johns Hopkins University School of Medicine
| | - Oluwakemi Tomobi
- Global Alliance of Perioperative Professionals, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Sherita Hill Golden
- Hugh P. McCormick Family Professor of Endocrinology and Metabolism, Vice President, Chief Diversity Officer, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine
| | - Christelle D K Samen
- Clinical Fellow, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Michael C Banks
- Assistant Professor, Vice Chair for Diversity, Equity, and Inclusion, Assistant Residency Director, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine; Adjunct Faculty, Johns Hopkins School of Education
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13
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Impact of Sex on Clinical Outcomes in Patients undergoing Complex Percutaneous Coronary Angioplasty (from the e-ULTIMASTER Study). Am J Cardiol 2023; 186:71-79. [PMID: 36368145 DOI: 10.1016/j.amjcard.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/03/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022]
Abstract
Female gender has been shown to be associated with worse clinical outcomes after percutaneous coronary intervention (PCI). However, the impact of gender on the clinical outcomes of complex PCI is still poorly understood. This study examined the differences in patient and coronary lesion characteristics and longer-term clinical outcomes in male and female patients who underwent complex PCI. This was a sub-analysis of the e-ULTIMASTER study, which was a large, multicontinental, prospective, observational study enrolling 37,198 patients who underwent PCI with the Ultimaster stent. Patients who underwent complex PCI were stratified by gender. The primary outcome was target lesion failure at 12 months, defined as the composite of cardiac death, target vessel-related myocardial infarction, and clinically driven target lesion revascularization at 12 months. A total of 13,623 patients underwent complex procedures, of which 35.7% were women. Women were twice as likely as men to be aged ≥80 years (17.6% vs 9%, p <0.0001) and had a higher prevalence of cardiovascular risk factors. Women had fewer lesions treated than men (1.5 ± 0.8 vs 1.6 ± 0.8, p <0.0001) and fewer stents implanted (2.0 ± 1.1 vs 2.1 ± 1.1, p <0.0001). There was no statistically significant difference in clinical outcomes at 12 months between women and men. Event rates were comparable in women and men for target lesion failure (4.7% vs 4.3%, p = 0.30), target vessel failure (5.1% vs 4.9%, p = 0.73), and cardiac death (1.8% vs 1.7%, p = 0.80).In conclusion, our findings suggest no significant differences in clinical outcomes between women and men who underwent complex PCI.
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14
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Savage M, Hay K, Murdoch D, Walters DL, Denman R, Ranasinghe I, Raffel C. Sex differences in time to primary percutaneous coronary intervention and outcomes in patients presenting with ST-segment elevation myocardial infarction. Catheter Cardiovasc Interv 2022; 100:520-529. [PMID: 35971748 PMCID: PMC9804760 DOI: 10.1002/ccd.30357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/11/2022] [Accepted: 07/27/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We assessed sex differences in treatment and outcomes in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). BACKGROUND Historically, delays to timely reperfusion and poorer outcomes have been described in women who suffer STEMI. However, whether these sex discrepancies still exist with contemporary STEMI treatment remains to be evaluated. METHODS Consecutive STEMI patients treated with primary PCI patients over a 10-year period (January 1, 2010 to December 31, 2019) from a tertiary referral center were assessed. Comparisons were performed between patient's sex. Primary outcomes were 30-day and 1-year mortality. Secondary outcomes were STEMI performance measures. RESULTS Most patients (n = 950; 76%) were male. Females were on average older (66.8 vs. 61.4 years males; p < 0.001). Prehospital treatment delays did not differ between sexes (54 min [IQR: 44-65] females vs. 52 min [IQR: 43-62] males; p = 0.061). STEMI performance measures (door-to-balloon, first medical contact-to-balloon [FMCTB]) differed significantly with longer median durations in females and fewer females achieving FMCTB < 90 min (28% females vs. 39% males; p < 0.001). Women also experienced greater rates of initial radial arterial access failure (11.3% vs. 3.1%; p < 0.001). However, there were no significant sex differences in crude or adjusted mortality between sexes at 30-days (3.6% male vs. 5.1% female; p = 0.241, adjusted OR: 1.1, 95% CI: 0.5-2.2, p = 0.82) or at 1-year (4.8% male vs. 6.8% female; p = 0.190, adjusted OR: 1.0, (95% CI: 0.5-1.8; p = 0.96). CONCLUSION Small discrepancies between sexes in measures of timely reperfusion for STEMI still exist. No significant sex differences were observed in either 30-day or 1-year mortality.
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Affiliation(s)
- Michael L. Savage
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Karen Hay
- School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,QIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Dale J. Murdoch
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Darren L. Walters
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Russell Denman
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Isuru Ranasinghe
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Christopher Raffel
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
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15
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Khan SU, Yedlapati SH, Lone AN, Khan MS, Wenger NK, Watson KE, Gulati M, Hays AG, Michos ED. A comparative analysis of premature heart disease- and cancer-related mortality in women in the USA, 1999-2018. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:315-323. [PMID: 33555018 DOI: 10.1093/ehjqcco/qcaa099] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/25/2020] [Accepted: 12/30/2020] [Indexed: 12/28/2022]
Abstract
AIMS To compare premature heart disease- and cancer-related deaths in women in the USA. METHODS AND RESULTS We analysed the US national database of death certificates of women aged <65 from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database between 1999 and 2018. We measured annual percentage changes (APCs) in age-adjusted mortality rates (AAMRs) and years of potential life lost per 100 000 persons due to heart disease and cancer. Overall, cancer was a more prevalent cause of premature death compared with heart disease. Between 1999 and 2018, the AAMRs decreased for both cancer (61.9/100 000 to 45.6/100 000) and heart disease (29.2/100 000 to 22.6/100 000). However, while APC in AAMR for cancer declined consistently over time, after an initial decline, APC in AAMR for heart disease increased between 2010 and 2018 [0.53 95% confidence interval (0.18-0.89)], with a significant rise in Midwest, medium/small metros, and rural areas after 2008. Compared with cancer, APC in AAMR for heart disease increased in women aged 25-34 years [2.24 (0.30-4.22); 2013-18) and 55-64 years [0.46 (0.13-0.80); 2009-13], as well as Non-Hispanic (NH) Whites [APC, 0.79 (0.46-1.13); 2009-18] and NH American Indian/Alaskan Native [2.71 (0.59-4.87); 2011-2018]. Consequently, the mortality gap between cancer and heart disease has narrowed from an AAMR of 32.7/100 000 to 23.0/100 000. CONCLUSIONS The mortality gap between cancer and heart disease is decreasing among women <65 years. Intensive cardiovascular health interventions are required focusing on vulnerable young demographic subgroups and underserved regional areas to meet the American Heart Association's Impact Goal and Million Hearts Initiative.
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Affiliation(s)
- Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Siva H Yedlapati
- Department of Medicine, Erie County Medical Center, Buffalo, NY, USA
| | - Ahmad N Lone
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | | | - Nanette K Wenger
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Karol E Watson
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Martha Gulati
- Department of Medicine, Division of Cardiology, University of Arizona, Phoenix, AZ, USA
| | - Allison G Hays
- Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Blalock 524-B, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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16
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Gottfried S. Women: Diet, Cardiometabolic Health, and Functional Medicine. Phys Med Rehabil Clin N Am 2022; 33:621-645. [DOI: 10.1016/j.pmr.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Johnson AK, Tweet MS, Rouleau SG, Sadosty AT, Hayes SN, Raukar NP. The presentation of spontaneous coronary artery dissection in the emergency department: Signs and symptoms in an unsuspecting population. Acad Emerg Med 2022; 29:423-428. [PMID: 34897898 PMCID: PMC10403148 DOI: 10.1111/acem.14426] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Spontaneous coronary artery dissection (SCAD) has emerged as a common cause of acute coronary syndrome (ACS) in young women, although it is rarely discussed in the differential diagnosis for chest pain in the emergency department (ED). In a population otherwise considered low risk for myocardial infarction, there is a danger of incomplete workup and missed diagnosis. In this study, we aim to describe the clinical presentation of those who present to the ED with SCAD to increase awareness of this potentially fatal diagnosis among emergency practitioners. METHODS Data were queried from the Mayo Clinic "Virtual" Multicenter SCAD Registry, a large multisite international disease registry. The registry includes demographic information as well as data from both medical records and surveys administered following the SCAD event. Symptom presentation was abstracted from survey narrative responses. Data analysis was performed using descriptive statistics. RESULTS Of 1196 subjects included, chest pain was reported during initial SCAD event in 95.7%. Most common chest symptoms descriptors were pain, pressure/weight, and tightness, with radiation most often in one or both arms/shoulders. Other common symptoms included nausea, shortness of breath, and diaphoresis. Most common electrocardiogram (ECG) findings reported were ST elevation, T-wave abnormality, and normal ECG. Initial troponin values were within normal range in 20.1% of patients. CONCLUSION With young healthy women often considered "low risk" for ACS, it is important to understand that SCAD is a cause of ACS, and familiarity with presentation can improve awareness among emergency physicians. Our data can provide insight in helping to identify young women who present with chest pain due to SCAD so they can be appropriately evaluated.
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Affiliation(s)
- Alexis K. Johnson
- Department of Emergency Medicine University of California at San Diego San Diego California USA
| | - Marysia S. Tweet
- Department of Cardiovascular Diseases College of Medicine and Science Mayo Clinic Rochester Minnesota USA
| | - Samuel G. Rouleau
- Department of Emergency Medicine University of California at Davis Davis California USA
| | - Annie T. Sadosty
- Department of Emergency Medicine Mayo Clinic Rochester Minnesota USA
| | - Sharonne N. Hayes
- Department of Cardiovascular Diseases College of Medicine and Science Mayo Clinic Rochester Minnesota USA
| | - Neha P. Raukar
- Department of Emergency Medicine Mayo Clinic Rochester Minnesota USA
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18
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Meisel SR, Tal O, Kobo O, Saada M, Nashed H, Fanne RA, Alcalai R, Amsalem N, Levi Y, Mohsen J, Kleiner-Shochat M, Roguin A. Impact of the Admission Pathway on the Gender-Related Mortality of Patients With ST-Elevation Myocardial Infarction. Am J Cardiol 2022; 166:9-17. [PMID: 34969509 DOI: 10.1016/j.amjcard.2021.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022]
Abstract
The mortality of women with ST-elevation myocardial infarction (STEMI) exceeds that of men, supposedly the result of older age and co-morbidities. Patients with STEMI can be transported directly to the catherization lab by the emergency medical service (EMS) or to the emergency department (ED) by the EMS, a regular ambulance, or independently. This raises the question whether gender disparity in the transport of patients with STEMI may affect time to therapy and consequently explain the disparate outcome in men and women with STEMI. We analyzed a large nationwide registry of prospectively-recorded patients with acute coronary syndromes in order to determine if there is a survival gap between men and women with STEMI, and to assess the gender-related effect of admission pathway on time intervals and 5-year mortality. Study population included 2,740 patients with STEMI who underwent primary percutaneous coronary interventions, comprising 464 women (17%, median-70 years) and 2,276 men (83%, median-58 years). The unadjusted 5-year mortality of women was higher compared with men (26.4% vs 15.6%, p = 0.001) but adjustment abrogated this survival difference. Regardless of adjustment, the 5-year mortality of patients with STEMI admitted directly to the catherization lab or to the ED by EMS was similar for men and women but significantly lower in the directly admitted patients (p <0.028). In contrast, admission to the ED by non-EMS was associated with markedly worse survival among women. These results indicate that women suspected of STEMI benefit from transportation by the EMS and should use this pathway exclusively to reach the hospital.
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Affiliation(s)
- Simcha R Meisel
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Ovdat Tal
- The Israeli Center for Cardiac Research, Sheba Medical Center, Ramat Gan, Israel
| | - Ofer Kobo
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Majdi Saada
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hamuda Nashed
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Rami Abu Fanne
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ronny Alcalai
- The Heart Institute, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Naama Amsalem
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yaniv Levi
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Jameel Mohsen
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michael Kleiner-Shochat
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ariel Roguin
- Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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19
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Mehta PK, Wei J, Shufelt C, Quesada O, Shaw L, Bairey Merz CN. Gender-Related Differences in Chest Pain Syndromes in the Frontiers in CV Medicine Special Issue: Sex & Gender in CV Medicine. Front Cardiovasc Med 2021; 8:744788. [PMID: 34869650 PMCID: PMC8635525 DOI: 10.3389/fcvm.2021.744788] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/13/2021] [Indexed: 12/30/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of morbidity and mortality among both women and men, yet women continue to have delays in diagnosis and treatment. The lack of recognition of sex-specific biological and socio-cultural gender-related differences in chest pain presentation of CAD may, in part, explain these disparities. Sex and gender differences in pain mechanisms including psychological susceptibility, the autonomic nervous system (ANS) reactivity, and visceral innervation likely contribute to chest pain differences. CAD risk scores and typical/atypical angina characterization no longer appear relevant and should not be used in women and men. Women more often have ischemia with no obstructive CAD (INOCA) and myocardial infarction, contributing to diagnostic and therapeutic equipoise. Existing knowledge demonstrates that chest pain often does not relate to obstructive CAD, suggesting a more thoughtful approach to percutaneous coronary intervention (PCI) and medical therapy for chest pain in stable obstructive CAD. Emerging knowledge regarding the central and ANS and visceral pain processing in patients with and without angina offers explanatory mechanisms for chest pain and should be investigated with interdisciplinary teams of cardiologists, neuroscientists, bio-behavioral experts, and pain specialists. Improved understanding of sex and gender differences in chest pain, including biological pathways as well as sociocultural contributions, is needed to improve clinical care in both women and men.
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Affiliation(s)
- Puja K Mehta
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute and Emory Women's Heart Center, Emory University School of Medicine, Atlanta, GA, United States
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Chrisandra Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart Institute, Cincinnati, OH, United States
| | - Leslee Shaw
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
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20
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Mathew A, Hong Y, Yogasundaram H, Nagendran J, Punnoose E, Ashraf S, Fischer L, Abdullakutty J, Pisharody S, Bainey K, Graham M. Sex and Medium-term Outcomes of ST-Segment Elevation Myocardial Infarction in Kerala, India: A Propensity Score–Matched Analysis. CJC Open 2021; 3:S71-S80. [PMID: 34993436 PMCID: PMC8712709 DOI: 10.1016/j.cjco.2021.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background Sex-based differences have been found in outcomes following ST-segment myocardial infarction (STEMI). Studies assessing sex-based differences in STEMI among Indian patients have reported conflicting results. Methods A prospective multicenter registry of consecutive patients with STEMI who presented to percutaneous coronary intervention (PCI)–capable hospitals in the Indian state of Kerala between June 2013 and March 2017 was used to assess 1-year outcomes. The primary endpoint was a composite of major adverse cardiac events (MACE), including death, stroke, nonfatal myocardial infarction, and rehospitalization for heart failure. Outcomes of 2 sex-based propensity score–matched groups were compared. Results We included 3194 patients (19.4% women). Women presenting with STEMI were older, had more traditional cardiovascular risk factors, and were more likely to be classified as living in poverty. After propensity-score matching, women experienced greater incidence of MACE (20.9% vs 14.3%, P < 0.01), primarily driven by increased 1-year mortality (14.3% vs 8.6%, P < 0.01). Women were more likely to experience prehospital delays, compared with men. Although reperfusion rates were similar between the groups, men were more likely than women to undergo reperfusion within the first 12 hours of chest pain onset. Among patients undergoing primary PCI, women were more likely to have delayed PCI than were men (80.2% vs 72.9%, P = 0.03). Procedural characteristics were similar between groups. Conclusions Women in this cohort experienced higher incidence of MACE at 1 year, compared to men, primarily owing to increased mortality. Timeliness of reperfusion appears to be the primary factor impacting differences in outcomes between the 2 groups and may represent an attractive target for quality-improvement initiatives.
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Affiliation(s)
- Anoop Mathew
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
- Division of Cardiology, Malankara Orthodox Syrian Christian Medical College Hospital, Kolenchery, Kerala, India
- Corresponding author: Dr Anoop Mathew, Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, 2C2 WMC, 8440 – 112 St, NW, Edmonton, Alberta T6G 2B7, Canada
| | - Yongzhe Hong
- Division of Cardiac Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Haran Yogasundaram
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Eapen Punnoose
- Division of Cardiology, Malankara Orthodox Syrian Christian Medical College Hospital, Kolenchery, Kerala, India
| | - S.M. Ashraf
- Division of Cardiology, Government Medical College Hospital, Pariyaram, Kerala, India
| | - Louie Fischer
- Division of Cardiology, Malankara Orthodox Syrian Christian Medical College Hospital, Kolenchery, Kerala, India
| | | | - Sunil Pisharody
- Division of Cardiology, Elamkulam Manakkal Sankaran Memorial Co-operative Hospital and Research Centre, Perinthalmanna, Kerala, India
| | - Kevin Bainey
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Michelle Graham
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
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21
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Babiolakis CS, Sharma S, Sayed N, Abunassar JG, Haseeb S, Abuzeid W. The effect of sex on door-to-balloon time in patients presenting with ST-elevation myocardial infarction and referred for primary percutaneous coronary intervention: A systematic review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:120-127. [PMID: 34334335 DOI: 10.1016/j.carrev.2021.07.011] [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: 03/30/2021] [Revised: 06/19/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Abstract
Timely reperfusion using primary percutaneous coronary intervention (pPCI) is the cornerstone of acute ST-elevation myocardial infarction (STEMI) management. We conducted a systematic review to examine the effect of sex on door-to-balloon (D2B) time and symptom-to-balloon (S2B) time. We observed longer D2B times and S2B times in female patients presenting with STEMI and referred for pPCI when compared to male patients. Future work is required to try and elucidate and mitigate sex-based front-line treatment delays for female STEMI patients.
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Affiliation(s)
- Corinne S Babiolakis
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Shubham Sharma
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Nawid Sayed
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Joseph G Abunassar
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Sohaib Haseeb
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia.
| | - Wael Abuzeid
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
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22
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Rayner-Hartley E, Wong GC, Fayowski C, Cairns JA, Singer J, Lee T, Sedlak T, Humphries KH, Perry-Arnesen M, Mackay M, Fordyce CB. Impact of regionalizing ST-elevation myocardial infarction care on sex differences in reperfusion times and clinical outcomes. Clin Cardiol 2021; 44:1113-1119. [PMID: 34101211 PMCID: PMC8364721 DOI: 10.1002/clc.23658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/04/2021] [Accepted: 05/18/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Women with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention historically experience worse in-hospital outcomes compared to men. HYPOTHESIS Implementation of a regional STEMI system will reduce care gaps in reperfusion times and in-hospital outcomes between women and men. METHODS 1928 patients (413 women, 21.4%) presented with an acute STEMI between June 2007 and March 2016. The population was divided into an early cohort (n = 728 patients, 2007-May 2011), and a late cohort (n = 1200 patients, June 2011-2016). The primary endpoints evaluated were reperfusion times and in-hospital outcomes. RESULTS Compared to men, women experienced significant delays in first medical contact (FMC) to arrival at the emergency room (26.0 vs. 22.0 min, p < 0.001) and FMC-to-device (109 vs. 101 min p = 0.001). Women had higher incidences of post-PCI heart failure and death compared to men (p < 0.05). Following multivariable adjustment, no mortality difference was observed for women versus men (adjusted OR; 0.82; 95% confidence interval [CI], 0.51-1.34; p = 0.433) or for early versus late cohorts (adjusted OR; 1.04; 95% CI, 0.68-1.60; p = 0.856). CONCLUSION Following STEMI regionalization, women continued to experience significantly longer reperfusion times, although there was no difference in adjusted mortality. These results highlight the ongoing disparity of STEMI care between women and men, and suggest that regionalization alone is insufficient to close sex-based care gaps.
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Affiliation(s)
- Erin Rayner-Hartley
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Royal Columbian Hospital, Division of Cardiology, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Graham C Wong
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Cassandra Fayowski
- Division of General Internal Medicine, Western University, London, Ontario, Canada
| | - John A Cairns
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tara Sedlak
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karin H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michele Perry-Arnesen
- Royal Columbian Hospital, Division of Cardiology, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Martha Mackay
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher B Fordyce
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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23
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Gender Disparities in Cardiac Catheterization Rates Among Emergency Department Patients With Chest Pain. Crit Pathw Cardiol 2021; 20:67-70. [PMID: 33116062 DOI: 10.1097/hpc.0000000000000247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Previous studies have noted differences in rates of cardiac testing based on gender of patients. We evaluated cardiac catheterization rates for men and women presenting to the emergency department (ED) with chest pain, particularly among patients without a history of myocardial infarction (MI) or recent positive stress test. METHODS We performed a prospective evaluation of patients presenting to an urban, academic medical center for assessment of chest pain. We recorded baseline information, testing, and outcomes related to ED, observation unit, and inpatient stay. Primary outcomes included gender differences in cardiac catheterization and stenting rates among patients without an MI or positive stress test. RESULTS Over the 5.5 year study period, 2242 ED patients with chest pain participated in the study (45% male). Men and women had similar rates of cardiac stress testing (16.7% vs. 15.2%, P = 0.317) as well as similar rates of positive cardiac stress testing (2.9% vs. 1.9%, P = 0.116). Men were more likely to undergo cardiac catheterization (10.4% vs. 4.9%, P < 0.001). Men who had neither MI nor positive stress test were more likely than women to undergo cardiac catheterization: 5.8% versus 3.3%, P = 0.010. Similarly, men in this group were more likely to experience stent placement: 2.1% versus 0.7%, P = 0.003. CONCLUSIONS Similar to previous studies, we noted disparities in cardiac testing by gender. Men were more likely to go to cardiac catheterization without an MI or a positive stress test. This disparity in a more aggressive strategy of cardiac catheterization in men may result in higher stenting rates in this group.
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Abstract
Cardiovascular diseases show many sex-related differences in prevalence, etiology, phenotype expression, and outcomes. Complex molecular mechanisms underlie this diverse pathological manifestation, from sex-determined differential gene expression to sex hormones interaction with their specific receptors in different tissues. More recently, differential non-coding RNAs regulation also turned out to be an involved mechanism. This review focuses on sex impact on the various heart failure syndromes, including coronary artery disease, heart failure with preserved ejection fraction and with reduced ejection fraction, with particular attention to dilated cardiomyopathy. Despite similar genetic predisposition in terms of identified causative mutations, other causes, such as cardiotoxic drugs exposure or stress-induced cardiomyopathy, are more prevalent in women. Beyond this, differences in disease presentation and natural history reveal a more severe clinical onset with otherwise better long-term outcomes in women compared to men. Understanding the varying characteristics of disease manifestation and outcomes is warranted for a prompt and tailored treatment for both men and women. This is a mandatory step in the road to the personalized medicine. Moreover, despite a higher enrollment in the last years, the under-representation of females in clinical trials is the first obstacle to overcome in the long way to develop appropriate sex-based therapy approach.
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25
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Geraghty L, Figtree GA, Schutte AE, Patel S, Woodward M, Arnott C. Cardiovascular Disease in Women: From Pathophysiology to Novel and Emerging Risk Factors. Heart Lung Circ 2021; 30:9-17. [DOI: 10.1016/j.hlc.2020.05.108] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/05/2020] [Accepted: 05/24/2020] [Indexed: 12/12/2022]
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26
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Hertler C, Seiler A, Gramatzki D, Schettle M, Blum D. Sex-specific and gender-specific aspects in patient-reported outcomes. ESMO Open 2020; 5:e000837. [PMID: 33184099 PMCID: PMC7662538 DOI: 10.1136/esmoopen-2020-000837] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/22/2020] [Accepted: 10/07/2020] [Indexed: 01/10/2023] Open
Abstract
Patient-reported outcomes (PROs) are important tools in patient-centred medicine and allow for individual assessment of symptom burden and aspects of patients’ quality of life. While sex and gender differences have emerged in preclinical and clinical medicine, these differences are not adequately represented in the development and use of patient-reported outcome measures. However, even in personalised approaches, undesirable biases may occur when samples are unbalanced for certain characteristics, such as sex or gender. This review summarises the current status of the literature and trends in PROs with a focus on sex and gender aspects.
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Affiliation(s)
- Caroline Hertler
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
| | - Annina Seiler
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Dorothee Gramatzki
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Markus Schettle
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - David Blum
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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27
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Mauvais-Jarvis F, Bairey Merz N, Barnes PJ, Brinton RD, Carrero JJ, DeMeo DL, De Vries GJ, Epperson CN, Govindan R, Klein SL, Lonardo A, Maki PM, McCullough LD, Regitz-Zagrosek V, Regensteiner JG, Rubin JB, Sandberg K, Suzuki A. Sex and gender: modifiers of health, disease, and medicine. Lancet 2020; 396:565-582. [PMID: 32828189 PMCID: PMC7440877 DOI: 10.1016/s0140-6736(20)31561-0] [Citation(s) in RCA: 946] [Impact Index Per Article: 236.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 02/09/2023]
Abstract
Clinicians can encounter sex and gender disparities in diagnostic and therapeutic responses. These disparities are noted in epidemiology, pathophysiology, clinical manifestations, disease progression, and response to treatment. This Review discusses the fundamental influences of sex and gender as modifiers of the major causes of death and morbidity. We articulate how the genetic, epigenetic, and hormonal influences of biological sex influence physiology and disease, and how the social constructs of gender affect the behaviour of the community, clinicians, and patients in the health-care system and interact with pathobiology. We aim to guide clinicians and researchers to consider sex and gender in their approach to diagnosis, prevention, and treatment of diseases as a necessary and fundamental step towards precision medicine, which will benefit men's and women's health.
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Affiliation(s)
- Franck Mauvais-Jarvis
- Diabetes Discovery & Sex-Based Medicine Laboratory, Section of Endocrinology, John W Deming Department of Medicine, Tulane University School of Medicine and Southeast Louisiana Veterans Health Care System Medical Center, New Orleans, LA, USA.
| | - Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Peter J Barnes
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Roberta D Brinton
- Department of Pharmacology and Department of Neurology, College of Medicine, Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, USA
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics and Center for Gender Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dawn L DeMeo
- Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Geert J De Vries
- Neuroscience Institute and Department of Biology, Georgia State University, Atlanta, GA, USA
| | - C Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Ramaswamy Govindan
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Sabra L Klein
- W Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amedeo Lonardo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - Pauline M Maki
- Department of Psychiatry, Department of Psychology, and Department of Obstetrics & Gynecology, University of Illinois at Chicago, Chicago, IL, USA
| | - Louise D McCullough
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Vera Regitz-Zagrosek
- Berlin Institute of Gender Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Cardiology, University Hospital Zürich, University of Zürich, Switzerland
| | - Judith G Regensteiner
- Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joshua B Rubin
- Department of Medicine, Department of Paediatrics, and Department of Neuroscience, Washington University School of Medicine St Louis, MO, USA
| | - Kathryn Sandberg
- Center for the Study of Sex Differences in Health, Aging and Disease, Georgetown University, Washington, DC, USA
| | - Ayako Suzuki
- Division of Gastroenterology, Duke University Medical Center Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA
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28
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Shehab A, AlHabib KF, Bhagavathula AS, Hersi A, Alfaleh H, Alshamiri MQ, Ullah A, Sulaiman K, Almahmeed W, Al Suwaidi J, Alsheikh-Ali AA, Amin H, Al Jarallah M, Salam AM. Clinical Presentation, Quality of Care, Risk Factors and Outcomes in Women with Acute ST-Elevation Myocardial Infarction (STEMI): An Observational Report from Six Middle Eastern Countries. Curr Vasc Pharmacol 2020. [PMID: 29542414 DOI: 10.2174/1570161116666180315104820] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited. AIMS To examine the clinical presentation, patient management, quality of care, risk factors and inhospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East. METHODS Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations, management and in-hospital outcomes were compared between the 2 groups. RESULTS Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia compared with men who were more likely to be smokers (all p<0.001). Women had longer median symptom-onset to emergency department (ED) arrival times (230 vs. 170 min, p<0.001) and ED to diagnostic ECG (8 vs. 6 min., p<0.001). When primary percutaneous coronary intervention (PPCI) was performed, women had longer door-to-balloon time (DBT) (86 vs. 73 min., p=0.009). When thrombolytic therapy was not administered, women were less likely to receive PPCI (69.7 vs. 76.7%, p=0.036). The mean duration of hospital stay was longer in women (6.03 ± 22.51 vs. 3.41 ± 19.45 days, p=0.032) and the crude in-hospital mortality rate was higher in women (10.4 vs. 5.2%, p<0.001). However, after adjustments, multivariate analysis revealed a statistically non-significant trend of higher inhospital mortality among women than men (6.4 vs. 4.6%), (p=0.145). CONCLUSION Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce the high morbidity and mortality of STEMI in our women.
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Affiliation(s)
- Abdulla Shehab
- Internal Medicine Department, College of Medicine and Health Sciences (CMHS), UAE University, Al Ain, United Arab Emirates
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Akshaya S Bhagavathula
- Department of Clinical Pharmacy, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Ahmad Hersi
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Hussam Alfaleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Mostafa Q Alshamiri
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Anhar Ullah
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | | | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Jassim Al Suwaidi
- Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Alwai A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.,Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.,Tufts Clinical and Translational Science Institute, Tufts Medical Center, Boston, MA, United States
| | - Haitham Amin
- Mohammed Bin Khalifa Cardiac Center, Manama, Bahrain
| | | | - Amar M Salam
- Adult Cardiology, Hamad Medical Corporation, Doha, Qatar
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29
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Women and Cardiovascular Disease: Pregnancy, the Forgotten Risk Factor. Heart Lung Circ 2020; 29:662-667. [DOI: 10.1016/j.hlc.2019.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/25/2019] [Accepted: 09/26/2019] [Indexed: 02/06/2023]
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30
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Shehab A, Bhagavathula AS, Alhabib KF, Ullah A, Suwaidi JA, Almahmeed W, AlFaleh H, Zubaid M. Age-Related Sex Differences in Clinical Presentation, Management, and Outcomes in ST-Segment-Elevation Myocardial Infarction: Pooled Analysis of 15 532 Patients From 7 Arabian Gulf Registries. J Am Heart Assoc 2020; 9:e013880. [PMID: 32063127 PMCID: PMC7070221 DOI: 10.1161/jaha.119.013880] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background No studies from the Arabian Gulf region have taken age into account when examining sex differences in ST-segment-elevation myocardial infarction (STEMI) presentation and outcomes. We examined the relationship between sex differences and presenting characteristics, revascularization procedures, and in-hospital mortality after accounting for age in patients hospitalized with STEMI in the Arabian Gulf region from 2005 to 2017. Methods and Results This study was a pooled analysis of 31 620 patients with a diagnosis of acute coronary syndrome enrolled in 7 Arabian Gulf registries. Of these, 15 532 patients aged ≥18 years were hospitalized with a primary diagnosis of STEMI. A multiple variable regression model was used to assess sex differences in revascularization, in-hospital mortality, and 1-year mortality. Odds ratios and 95% CIs were calculated. Women were, on average, 8.5 years older than men (mean age: 61.7 versus 53.2 years; absolute standard mean difference: 68.9%). The age-stratified analysis showed that younger women (aged <65 years) with STEMI were more likely to seek acute medical care and were less likely to receive thrombolytic therapies or primary percutaneous coronary intervention and guideline-recommended pharmacotherapy than men. Women had higher crude in-hospital mortality than men, driven mainly by younger age (46-55 years, odds ratio: 2.60 [95% CI, 1.80-3.7]; P<0.001; 56-65 years, odds ratio: 2.32 [95% CI, 1.75-3.08]; P<0.001; and 66-75 years, odds ratio: 1.79 [95% CI, 1.33-2.41]; P<0.001). Younger women had higher adjusted in-hospital and 1-year mortality rates than younger men (P<0.001). Conclusions Younger women (aged ≤65 years) with STEMI were less likely to receive guideline-recommended pharmacotherapy and revascularization than younger men during hospitalization and had higher in-hospital and 1-year mortality rates.
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Affiliation(s)
- Abdulla Shehab
- Department of internal medicine College of Medicine and Health Sciences UAE University Al Ain Abu Dhabi United Arab Emirates
| | - Akshaya Srikanth Bhagavathula
- Department of internal medicine College of Medicine and Health Sciences UAE University Al Ain Abu Dhabi United Arab Emirates
| | - Khalid F Alhabib
- Department of Clinical Sciences College of Medicine King Saud University Riyadh Saudi Arabia
| | - Anhar Ullah
- Department of Clinical Sciences College of Medicine King Saud University Riyadh Saudi Arabia
| | - Jassim Al Suwaidi
- Department of Cardiology and Cardiovascular Surgery Hamad Medical Corporation (HMC) Doha Qatar
| | - Wael Almahmeed
- Cardiology Heart & Vascular Institute Cleveland Clinic Abu Dhabi United Arab Emirates
| | - Hussam AlFaleh
- Department of Clinical Sciences College of Medicine King Saud University Riyadh Saudi Arabia
| | - Mohammad Zubaid
- Department of Medicine Faculty of Medicine Kuwait University Kuwait
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31
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Muhrbeck J, Maliniak E, Eurenius L, Hofman-Bang C, Persson J. Few with ST-segment elevation myocardial infarction are diagnosed within 10 minutes from first medical contact, and women have longer delay times than men. IJC HEART & VASCULATURE 2020; 26:100458. [PMID: 31921973 PMCID: PMC6948248 DOI: 10.1016/j.ijcha.2019.100458] [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: 10/01/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022]
Abstract
Background Previous reports have questioned the feasibility and gender equality of obtaining a prehospital ECG within 10 minutes of ambulance arrival for patients with ST-segment elevation myocardial infarction (STEMI). The main objective of this study was to investigate the proportion of STEMI patients with a prehospital ECG within 10 minutes of ambulance arrival. The secondary objective was to study the gender differences in delay times in prehospital STEMI care. Methods This study was a retrospective study based on 539 patients with STEMI at the investigating hospital. Ambulance and medical charts, as well as the national quality registry “SWEDEHEART”, were reviewed for each patient for demographics and time information. Results A prehospital ECG was obtained within 10 minutes of ambulance arrival for 99 (29%) of the men and 19 (14%) of the women, p = 0.001. Women had a 2 minutes longer delay between ambulance arrival and prehospital ECG (95% CI 0–4 min, p = 0.018) than men. Women also had a significantly longer patient delay. None of the other time intervals differed among men and women. Conclusions Only for a minority of patients is a prehospital ECG taken within the recommended ten minutes from ambulance arrival. Women have longer patient delay times, as well as delay times to the acquisition of a prehospital ECG than men. Improvements of prehospital ECG acquisition and adjustments of the guidelines are warranted.
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32
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Aldridge E, Verburg PE, Sierp S, Andraweera P, Dekker GA, Roberts CT, Arstall MA. A Protocol for Nurse-Practitioner Led Cardiovascular Follow-Up After Pregnancy Complications in a Socioeconomically Disadvantaged Population. Front Cardiovasc Med 2020; 6:184. [PMID: 31970161 PMCID: PMC6960097 DOI: 10.3389/fcvm.2019.00184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/05/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Women who experience pregnancy complications have an increased risk of future cardiovascular disease when compared to their healthy counterparts. Despite recommendations, there is no standardized cardiovascular follow-up in the postpartum period for these women, and the Australian follow-up protocols that have been previously described are research-based. This study proposes a new model of care for a nurse practitioner-led postpartum intervention clinic for women who experience severe hypertensive disorders of pregnancy, gestational diabetes mellitus requiring medication, severe intrauterine growth restriction, idiopathic preterm delivery, or placental abruption, in a socioeconomically disadvantaged population. Methods: All women receiving antenatal care or who deliver at the Lyell McEwin Hospital, a tertiary acute care facility located in the northern Adelaide metropolitan area, following a severe complication of pregnancy are referred to the intervention clinic for review at 6 months postpartum. A comprehensive assessment is conducted from demographics, medical history, diet and exercise habits, psychosocial information, health literacy, pathology results, and physical measurements. Subsequently, patient-specific education and clinical counseling are provided by a specialized nurse practitioner. Clinic appointments are repeated at 18 months and 5 years postpartum. All data is also collated into a registry, which aims to assess the efficacy of the intervention at improving modifiable cardiovascular risk factors and reducing cardiovascular risk. Discussion: There is limited information on the efficacy of postpartum intervention clinics in reducing cardiovascular risk in women who have experienced pregnancy complications. Analyses of the data collected in the registry will provide essential information about how best to reduce cardiovascular risk in women in socioeconomically disadvantaged and disease-burdened populations.
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Affiliation(s)
- Emily Aldridge
- Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Petra E Verburg
- Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Department of Obstetrics and Gynaecology, Rijnstate Hospital, Arnhem, Netherlands
| | - Susan Sierp
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Prabha Andraweera
- Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Gustaaf A Dekker
- Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Claire T Roberts
- Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Margaret A Arstall
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Lyell McEwin Hospital, Adelaide, SA, Australia
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Mehta PK, Bess C, Elias-Smale S, Vaccarino V, Quyyumi A, Pepine CJ, Bairey Merz CN. Gender in cardiovascular medicine: chest pain and coronary artery disease. Eur Heart J 2019; 40:3819-3826. [PMID: 31713592 PMCID: PMC7963141 DOI: 10.1093/eurheartj/ehz784] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/26/2019] [Accepted: 10/23/2019] [Indexed: 01/10/2023] Open
Abstract
Ischaemic heart disease (IHD) remains the leading cause of morbidity and mortality among women and men yet women are more often underdiagnosed, have a delay in diagnosis, and/or receive suboptimal treatment. An implicit gender-bias with regard to lack of recognition of sex-related differences in presentation of IHD may, in part, explain these differences in women compared with men. Indeed, existing knowledge demonstrates that angina does not commonly relate to obstructive coronary artery disease (CAD). Emerging knowledge supports an inclusive approach to chest pain symptoms in women, as well as a more thoughtful consideration of percutaneous coronary intervention for angina in stable obstructive CAD, to avoid chasing our tails. Emerging knowledge regarding the cardiac autonomic nervous system and visceral pain pathways in patients with and without obstructive CAD offers explanatory mechanisms for angina. Interdisciplinary investigation approaches that involve cardiologists, biobehavioural specialists, and anaesthesia/pain specialists to improve angina treatment should be pursued.
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Affiliation(s)
- Puja K Mehta
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road NE, Suite 505, Atlanta, GA, USA
| | - Courtney Bess
- J. Willis Hurst Internal Residency Program, Emory University, 49 Jesse Hill Jr Drive, FOB Building, 4th floor, Box #92, Atlanta, GA, USA
| | - Suzette Elias-Smale
- Department of Cardiology, Radboud University Medical Center, Geert grooteplein Zuid 10, GA Nijmegen, The Netherlands
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, CNR Building, Room 3041, Atlanta, GA, USA
| | - Arshed Quyyumi
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road NE, Suite 505, Atlanta, GA, USA
| | - Carl J Pepine
- Divsion of Cardiology, University of Florida, 1329 SW 6th Street, PO Box 100288, Gainesville, FL, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, 127 S. San Vicente Blvd, Suite A3600, Los Angeles, CA, USA
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Calé R, Pereira H, Pereira E, Vitorino S, de Mello S. Time to reperfusion in high-risk patients with myocardial infarction undergoing primary percutaneous coronary intervention. Rev Port Cardiol 2019; 38:637-646. [DOI: 10.1016/j.repc.2018.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/06/2018] [Accepted: 12/02/2018] [Indexed: 12/01/2022] Open
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35
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Calé R, Pereira H, Pereira E, Vitorino S, de Mello S. Time to reperfusion in high-risk patients with myocardial infarction undergoing primary percutaneous coronary intervention. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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36
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Nagumo S, Mori H, Maeda A, Akashi YJ, Ako J, Ikari Y, Ebina T, Sato N, Tamura K, Namiki A, Fukui K, Michishita I, Kimura K, Suzuki H. Sex-Related Differences in In-Hospital Mortality in Japanese ST-Elevation Acute Myocardial Infarction Patients Presenting to Hospital in the 24 Hours After Symptom Onset - Results From K-ACTIVE. Circ Rep 2019; 1:313-319. [PMID: 33693156 PMCID: PMC7892487 DOI: 10.1253/circrep.cr-19-0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background:
Despite the drastic advances in clinical care for patients with acute ST-elevation myocardial infarction (STEMI), female STEMI patients have higher in-hospital mortality rates than male patients. This study assessed the influence of sex on in-hospital mortality in STEMI patients in Kanagawa Prefecture, Japan. Methods and Results:
From October 2015 to June 2018, 2,491 consecutive STEMI patients (23.9% female) who presented to hospital in the 24 h after symptom onset were analyzed. The female patients were 9 years older and less frequently had diabetes, smoking and prior MI than male patients. Pre-hospital managements, including prehospital 12-lead electrocardiography, and symptom-to-door time were similar between the sexes. A door-to-device time ≤90 min was achieved in 61.3% of female cases and in 65.0% of male cases (P=0.13). Reperfusion therapy was provided to 94.6% of female and 97.6% of male patients (P<0.001). In-hospital mortality rate was not significantly different between female and male patients (6.6% vs. 7.8%, P=0.37). On multivariate logistic regression analysis, female sex itself was not associated with in-hospital mortality (OR, 1.52; 95% CI: 0.67–3.47, P=0.32). Conclusions:
There was no sex discrepancy in the in-hospital mortality of STEMI patients in this study. Guideline-based treatment, such as advanced pre-hospital management and a high use of reperfusion therapy might have attenuated the sex-related differences in the in-hospital mortality.
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Affiliation(s)
- Sakura Nagumo
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital Yokohama Japan
| | - Hiroyoshi Mori
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital Yokohama Japan
| | - Atsuo Maeda
- Department of Emergency and Disaster Medicine, Showa University Hospital Tokyo Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Kawasaki Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine Isehara Japan
| | - Toshiaki Ebina
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center Yokohama Japan
| | - Naoki Sato
- Division of Cardiology, Nippon Medical University Musashi Kosugi Hospital Kawasaki Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Atsuo Namiki
- Department of Cardiology, Kanto Rosai Hospital Kawasaki Japan
| | - Kazuki Fukui
- Department of Cardiovascular Medicine, Kanagawa Cardiovascular and Respiratory Center Yokohama Japan
| | - Ichiro Michishita
- Division of Cardiology, Yokohama Sakae Kyosai Hospital Yokohama Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center Yokohama Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital Yokohama Japan
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Chieffo A, Buchanan GL, Mehilli J, Capodanno D, Kunadian V, Petronio AS, Mikhail GW, Capranzano P, Gonzal N, Karam N, Manzo-Silberman S, Schüpke S, Byrne RA, Capretti G, Appelman Y, Morice MC, Presbitero P, Radu M, Mauri J. Percutaneous coronary and structural interventions in women: a position statement from the EAPCI Women Committee. EUROINTERVENTION 2018; 14:e1227-e1235. [PMID: 29786536 DOI: 10.4244/eij-d-18-00225] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Several expert documents on sex-based differences in interventional outcomes are now available, however this is the first position paper from the EAPCI Women Committee discussing the potential influence of sex in the percutaneous treatment of coronary and structural heart disease. Despite the misconception that coronary artery disease is a 'man's disease', contemporary data shows a growing incidence in women. However, women are under-represented in randomised coronary clinical trials (~25%). The generalisation of such studies is therefore problematic in decision-making for females undergoing coronary intervention. Differences in pathophysiology between sexes exist, highlighting the need for greater awareness amongst healthcare professionals to enable best evidence-based therapies for women as well as for men. Reassuringly, women represent half of the population included in transcatheter aortic valve implantation clinical trials and may actually benefit more. Growing evidence is also emerging for other interventional atrial procedures which may well be advantageous to women. Awareness of sex disparities is increasing, and we must all work collaboratively within our profession to ensure we provide effective care for all patients with heart disease. The EAPCI Women Committee aim to highlight such issues through this position paper and through visibility within the interventional community.
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38
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Zandecki Ł, Sadowski M, Janion M, Kurzawski J, Gierlotka M, Poloński L, Gąsior M. Survival benefit from recent changes in management of men and women with ST-segment elevation myocardial infarction treated with percutaneous coronary interventions. Cardiol J 2018; 26:459-468. [PMID: 29924379 DOI: 10.5603/cj.a2018.0057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 10/04/2018] [Accepted: 01/17/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Nowadays, the majority of patients with myocardial infarction with ST-segment elevation (STEMI) are treated with primary percutaneous coronary interventions (PCI). In recent years, there have been ongoing improvements in PCI techniques, devices and concomitant pharmacotherapy. However, reports on further mortality reduction among PCI-treated STEMI patients remain inconclusive. The aim of this study was to compare changes in management and mortality in PCI-treated STEMI patients between 2005 and 2011 in a real-life setting. METHODS Data on 79,522 PCI-treated patients with STEMI from Polish Registry of Acute Coronary Syndromes (PL-ACS) admitted to Polish hospitals between 2005 and 2011 were analyzed. First, temporal trends of in-hospital management in men and women were presented. In the next step, patients from 2005 and 2011 were nearest neighbor matched on their propensity scores to compare in-hospital, 30-day and 1-year mortality rates and in-hospital management strategies and complications. RESULTS Some significant changes were noted in hospital management including shortening of median times from admission to PCI, increased use of drug-eluting stents, potent antiplatelet agents but also less frequent use of statin, beta-blockers and angiotensin converting enzyme inhibitors and angiotensin II receptor blockers. There was a strong tendency toward preforming additional PCI of non-infarct related arteries, especially in women. After propensity score adjustment there were significant changes in inhospital but not in 30-day or 1-year mortality rates between 2005 and 2011. The results were similar in men and women. CONCLUSIONS There were apparent changes in management and significant in-hospital mortality reductions in PCI-treated STEMI patients between 2005 and 2011. However, it did not result in 30-day or 1-year survival benefit at a population level. There may be room for improvement in the use of guideline-recommended pharmacotherapy.
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Affiliation(s)
- Łukasz Zandecki
- 2nd Cardiology Clinic, Swietokrzyskie Cardiology Center, Kielce, Poland. .,The Faculty of Medicine and Health Sciences, The Jan Kochanowski University, Kielce, Poland.
| | - Marcin Sadowski
- Department of Interventional Cardiology, Swietokrzyskie Cardiology Center, Kielce, Poland.,The Faculty of Medicine and Health Sciences, The Jan Kochanowski University, Kielce, Poland
| | - Marianna Janion
- 2nd Cardiology Clinic, Swietokrzyskie Cardiology Center, Kielce, Poland.,The Faculty of Medicine and Health Sciences, The Jan Kochanowski University, Kielce, Poland
| | - Jacek Kurzawski
- 2nd Cardiology Clinic, Swietokrzyskie Cardiology Center, Kielce, Poland
| | - Marek Gierlotka
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.,Department of Cardiology, University Hospital, Institute of Medicine, University of Opole, Poland
| | - Lech Poloński
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
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39
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Mackey C, Diercks DB. Gender Bias in the Management of Patients Still Exists. Acad Emerg Med 2018; 25:467-469. [PMID: 29479769 DOI: 10.1111/acem.13394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Huded CP, Johnson M, Kravitz K, Menon V, Abdallah M, Gullett TC, Hantz S, Ellis SG, Podolsky SR, Meldon SW, Kralovic DM, Brosovich D, Smith E, Kapadia SR, Khot UN. 4-Step Protocol for Disparities in STEMI Care and Outcomes in Women. J Am Coll Cardiol 2018. [PMID: 29535061 DOI: 10.1016/j.jacc.2018.02.039] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Women with ST-segment elevation myocardial infarction (STEMI) receive suboptimal care and have worse outcomes than men. Whether strategies to reduce STEMI care variability impact disparities in the care and outcomes of women with STEMI is unknown. OBJECTIVES The study assessed the care and outcomes of men versus women with STEMI before and after implementation of a comprehensive STEMI protocol. METHODS On July 15, 2014, the authors implemented: 1) emergency department catheterization lab activation; 2) STEMI Safe Handoff Checklist; 3) immediate transfer to an immediately available catheterization lab; and 4) radial first approach to percutaneous coronary intervention (PCI). The authors prospectively studied consecutive patients with STEMI and assessed guideline-directed medical therapy (GDMT) before PCI, median door-to-balloon time (D2BT), in-hospital adverse events, and 30-day mortality stratified by sex before (January 1, 2011 to July 14, 2014; control group) and after (July 15, 2014 to December 31, 2016) implementation of the STEMI protocol. RESULTS Of 1,272 participants (68% men, 32% women), women were older with more comorbidities than men. In the control group, women had less GDMT (77% vs. 69%; p = 0.019) and longer D2BT (median 104 min; [interquartile range (IQR): 79 to 133] min vs. 112 [IQR: 85 to 147] min; p = 0.023). Women had more in-hospital stroke, vascular complications, bleeding, transfusion, and death. In the comprehensive 4-step STEMI protocol, sex disparities in GDMT (84% vs. 80%; p = 0.32), D2BT (89 [IQR: 68 to 106] min vs. 91 [IQR: 68 to 114] min; p = 0.15), and in-hospital adverse events resolved. The absolute sex difference in 30-day mortality decreased from the control group (6.1% higher in women; p = 0.002) to the comprehensive 4-step STEMI protocol (3.2% higher in women; p = 0.090). CONCLUSIONS A systems-based approach to STEMI care reduces sex disparities and improves STEMI care and outcomes in women.
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Affiliation(s)
- Chetan P Huded
- Heart and Vascular Institute Center for Healthcare Delivery Innovation, Cleveland, Ohio; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael Johnson
- Heart and Vascular Institute Center for Healthcare Delivery Innovation, Cleveland, Ohio; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Venu Menon
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mouin Abdallah
- Heart and Vascular Institute Center for Healthcare Delivery Innovation, Cleveland, Ohio; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Travis C Gullett
- Emergency Services Institute of the Cleveland Clinic, Cleveland, Ohio
| | - Scott Hantz
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephen G Ellis
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Seth R Podolsky
- Emergency Services Institute of the Cleveland Clinic, Cleveland, Ohio
| | - Stephen W Meldon
- Emergency Services Institute of the Cleveland Clinic, Cleveland, Ohio
| | - Damon M Kralovic
- Emergency Services Institute of the Cleveland Clinic, Cleveland, Ohio
| | | | - Elizabeth Smith
- Emergency Services Institute of the Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Umesh N Khot
- Heart and Vascular Institute Center for Healthcare Delivery Innovation, Cleveland, Ohio; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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41
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Madonis SM, Skelding KA, Roberts M. Management of acute coronary syndromes: special considerations in women. Heart 2018; 103:1638-1646. [PMID: 28970234 DOI: 10.1136/heartjnl-2016-309938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 06/07/2017] [Accepted: 07/02/2017] [Indexed: 01/18/2023] Open
Affiliation(s)
- Stephanie M Madonis
- Department of General Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Kimberly A Skelding
- Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Madhur Roberts
- Department of Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
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42
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Langabeer JR, Henry TD, Fowler R, Champagne-Langabeer T, Kim J, Jacobs AK. Sex-Based Differences in Discharge Disposition and Outcomes for ST-Segment Elevation Myocardial Infarction Patients Within a Regional Network. J Womens Health (Larchmt) 2018; 27:1001-1006. [PMID: 29319393 DOI: 10.1089/jwh.2017.6553] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND It is known that women with ST-segment elevation myocardial infarction (STEMI) have higher mortality in comparison to men. While the reasons for this sex-based difference are not completely understood, biologic differences and disparities in care have been implicated. Whether these differences persist within an urban, regional STEMI system of care with defined protocols is unclear. Our objective was to explore sex-related effects in outcomes in a large regional system of care. MATERIALS AND METHODS Data were drawn from a regional subset of the National Cardiovascular Data Registry for 33 hospitals in and around Dallas County, Texas from 2010 to 2015. We explored adjusted differences between women and men for discharge disposition, door to balloon (D2B), total ischemic time (TIS), length of stay, and in-hospital mortality rates. RESULTS Multivariate regressions to control for confounding factors, including age, D2B, and TIS, were significantly prolonged in women compared to men (D2B 58 vs. 54 minutes; TIS 206 vs. 178 minutes; both p < 0.001). Length of stay was 0.45 median days longer. Women were also much less likely to survive at discharge than men [odds ratio (OR): 0.63; 95% confidence interval (CI): 0.52-0.76]. Most notably, they were much less likely to be discharged to home than men (88% vs. 92%, p < 0.001). CONCLUSIONS In this study, we found that sex-based disparities persist for both cardiovascular outcomes and discharge disposition, even in a modern regionalized system of care.
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Affiliation(s)
- James R Langabeer
- 1 School of Biomedical Informatics, University of Texas Health Science Center , Houston, Texas
| | | | - Raymond Fowler
- 3 Department of Emergency Medicine, University of Texas Southwestern Medical Center , Dallas, Texas
| | | | - Junghyun Kim
- 1 School of Biomedical Informatics, University of Texas Health Science Center , Houston, Texas
| | - Alice K Jacobs
- 4 Department of Cardiology, Boston Medical Center, Boston University School of Medicine , Boston, Massachusetts
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43
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Differences in Presentation, Management and Outcomes in Women and Men Presenting to an Emergency Department With Possible Cardiac Chest Pain. Heart Lung Circ 2017; 26:1282-1290. [DOI: 10.1016/j.hlc.2017.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 11/07/2016] [Accepted: 01/07/2017] [Indexed: 11/20/2022]
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44
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Hinohara TT, Al-Khalidi HR, Fordyce CB, Gu X, Sherwood MW, Roettig ML, Corbett CC, Monk L, Tamis-Holland JE, Berger PB, Burchenal JEB, Wilson BH, Jollis JG, Granger CB. Impact of Regional Systems of Care on Disparities in Care Among Female and Black Patients Presenting With ST-Segment-Elevation Myocardial Infarction. J Am Heart Assoc 2017; 6:e007122. [PMID: 29066448 PMCID: PMC5721895 DOI: 10.1161/jaha.117.007122] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The American Heart Association Mission: Lifeline STEMI (ST-segment-elevation myocardial infarction) Systems Accelerator program, conducted in 16 regions across the United States to improve key care processes, resulted in more patients being treated within national guideline goals (time from first medical contact to device: <90 minutes for direct presenters to hospitals capable of performing percutaneous coronary intervention; <120 minutes for transfers). We examined whether the effort reduced reperfusion disparities in the proportions of female versus male and black versus white patients. METHODS AND RESULTS In total, 23 809 patients (29.3% female, 82.3% white, and 10.7% black) presented with acute STEMI between July 2012 and March 2014. Change in the proportion of patients treated within guideline goals was compared between sex and race subgroups for patients presenting directly to hospitals capable of performing percutaneous coronary intervention (n=18 267) and patients requiring transfer (n=5542). The intervention was associated with an increase in the proportion of men treated within guideline goals that presented directly (58.7-62.1%, P=0.01) or were transferred (43.3-50.7%, P<0.01). An increase was also seen among white patients who presented directly (57.7-59.9%, P=0.02) or were transferred (43.9-48.8%, P<0.01). There was no change in the proportion of female or black patients treated within guideline goals, including both those presenting directly and transferred. CONCLUSION The STEMI Systems Accelerator project was associated with an increase in the proportion of patients meeting guideline reperfusion targets for male and white patients but not for female or black patients. Efforts to organize systems of STEMI care should implement additional processes targeting barriers to timely reperfusion among female and black patients.
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Affiliation(s)
- Tomoya T Hinohara
- Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Hussein R Al-Khalidi
- Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Christopher B Fordyce
- Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | | | - Matthew W Sherwood
- Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | | | | | - Lisa Monk
- Duke Clinical Research Institute, Durham, NC
| | | | - Peter B Berger
- Cardiovascular Center for Clinical Research, Danville, PA
| | | | - B Hadley Wilson
- Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, NC
| | | | - Christopher B Granger
- Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
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45
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Ubrich R, Barthel P, Haller B, Hnatkova K, Huster KM, Steger A, Müller A, Malik M, Schmidt G. Sex differences in long-term mortality among acute myocardial infarction patients: Results from the ISAR-RISK and ART studies. PLoS One 2017; 12:e0186783. [PMID: 29053758 PMCID: PMC5650173 DOI: 10.1371/journal.pone.0186783] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/06/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Mortality rates in females who survived acute myocardial infarction (AMI) exceed those in males. Differences between sexes in age, cardiovascular risk factors and revascularization therapy have been proposed as possible reasons. OBJECTIVE To select sets of female and male patients comparable in respect of relevant risk factors in order to compare the sex-specific risk in a systematic manner. METHODS Data of the ISAR-RISK and ART studies were investigated. Patients were enrolled between 1996 and 2005 and suffered from AMI within 4 weeks prior to enrolment. Patients of each sex were selected with 1:1 equivalent age, previous AMI history, sinus-rhythm presence, hypertension, diabetes mellitus, smoking status, left ventricular ejection fraction (LVEF), and revascularization therapy. Survival times were compared between sex groups in the whole study cohort and in the matched cohort. RESULTS Of 3840 consecutive AMI survivors, 994 (25.9%) were females and 2846 (74.1%) were males. Females were older and suffered more frequently from hypertension and diabetes mellitus. In the whole cohort, females showed an increased mortality with a hazard ratio (HR) of 1.54 compared to males (p<0.0001). The matched cohort comprised 802 patients of each sex and revealed a trend towards poorer survival in females (HR for female sex 1.14; p = 0.359). However, significant mortality differences with a higher risk in matched females was observed during the first year after AMI (HR = 1.61; p = 0.045) but not during the subsequent years. CONCLUSION Matched sub-groups of post-AMI patients showed a comparable long-term mortality. However, a female excess mortality remained during first year after AMI and cannot be explained by differences in age, cardiovascular risk factors, and modes of acute treatment. Other causal factors, including clinical as well as psychological and social aspects, need to be considered. Female post-AMI patients should be followed more actively particularly during the first year after AMI.
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Affiliation(s)
- Romy Ubrich
- Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Petra Barthel
- Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Haller
- Institut für Medizinische Statistik und Epidemiologie, Technische Universität München, Munich, Germany
| | - Katerina Hnatkova
- National Heart and Lung Institute, Imperial College, London, England
| | - Katharina Maria Huster
- Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander Steger
- Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander Müller
- Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London, England
| | - Georg Schmidt
- Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany
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Shaw LJ, Pepine CJ, Xie J, Mehta PK, Morris AA, Dickert NW, Ferdinand KC, Gulati M, Reynolds H, Hayes SN, Itchhaporia D, Mieres JH, Ofili E, Wenger NK, Bairey Merz CN. Quality and Equitable Health Care Gaps for Women: Attributions to Sex Differences in Cardiovascular Medicine. J Am Coll Cardiol 2017; 70:373-388. [PMID: 28705320 DOI: 10.1016/j.jacc.2017.05.051] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/17/2017] [Accepted: 05/17/2017] [Indexed: 12/20/2022]
Abstract
The present review synthesizes evidence and discusses issues related to health care quality and equity for women, including minority population subgroups. The principle of "sameness" or women and men receiving equitable, high-quality care is a near-term target, but optimal population health cannot be achieved without consideration of the unique, gendered structural determinants of health and the development of unique care pathways optimized for women. The aim of this review is to promote enhanced awareness, develop critical thinking in sex and gender science, and identify strategic pathways to improve the cardiovascular health of women. Delineation of the components of high-quality health care, including a women-specific research agenda, remains a vital part of strategic planning to improve the lives of women at risk for or living with cardiovascular disease.
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Affiliation(s)
- Leslee J Shaw
- Emory University School of Medicine, Atlanta, Georgia.
| | | | - Joe Xie
- Emory University School of Medicine, Atlanta, Georgia
| | - Puja K Mehta
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | - Martha Gulati
- University of Arizona College of Medicine, Phoenix, Arizona
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Abstract
OBJECTIVE To determine rates and predictors of albumin administration, and estimated costs in hospitalized adults in the United States. DESIGN Cohort study of adult patients from the University HealthSystem Consortium database from 2009 to 2013. SETTING One hundred twenty academic medical centers and 299 affiliated hospitals. PATIENTS A total of 12,366,264 hospitalization records. INTERVENTIONS Analysis of rates and predictors of albumin administration, and estimated costs. MEASUREMENTS AND MAIN RESULTS Overall the proportion of admissions during which albumin was administered increased from 6.2% in 2009 to 7.5% in 2013; absolute difference 1.3% (95% CI, 1.30-1.40%; p < 0.0001). The increase was greater in surgical patients from 11.7% in 2009 to 15.1% in 2013; absolute difference 3.4% (95% CI, 3.26-3.46%; p < 0.0001). Albumin use varied geographically being lowest with no increase in hospitals in the North Eastern United States (4.9% in 2009 and 5.3% in 2013) and was more common in bigger (> 750 beds; 5.2% in 2009 and 7.3% in 2013) compared to smaller hospitals (< 250 beds; 4.4% in 2009 to 6.2% in 2013). Factors independently associated with albumin use were appropriate indication for albumin use (odds ratio, 65.220; 95% CI, 62.459-68.103); surgical admission (odds ratio, 7.942; 95% CI, 7.889-7.995); and high severity of illness (odds ratio, 8.933; 95% CI, 8.825-9.042). Total estimated albumin cost significantly increased from $325 million in 2009 to $468 million in 2013; (absolute increase of $233 million), p value less than 0.0001. CONCLUSIONS The proportion of hospitalized adults in the United States receiving albumin has increased, with marked, and currently unexplained, geographic variability and variability by hospital size.
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Kanic V, Vollrath M, Tapajner A, Sinkovic A. Sex-Related 30-Day and Long-Term Mortality in Acute Myocardial Infarction Patients Treated with Percutaneous Coronary Intervention. J Womens Health (Larchmt) 2017; 26:374-379. [DOI: 10.1089/jwh.2016.5957] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Vojko Kanic
- Department of Cardiology and Angiology, University Medical Centre Maribor, Maribor, Slovenia
| | | | - Alojz Tapajner
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Andreja Sinkovic
- Department of Cardiology and Angiology, University Medical Centre Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
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50
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Jortveit J, Govatsmark RES, Langørgen J, Hole T, Mannsverk J, Olsen S, Risøe C, Halvorsen S. Gender differences in the assessment and treatment of myocardial infarction. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:1215-22. [PMID: 27554562 DOI: 10.4045/tidsskr.16.0224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Previous studies have shown that there are gender-related differences in the assessment and treatment of myocardial infarction, despite international guidelines that prescribe identical treatment for women and men. We investigated whether these differences occurred in Norway. MATERIAL AND METHOD All patients admitted to Norwegian hospitals with myocardial infarction from 1 January 2013 to 31 December 2014 and registered in the Norwegian Myocardial Infarction Registry were included. Data from the registry were used to analyse differences in the assessment, treatment, complications and survival of women and men in different age groups. RESULTS A total of 26 447 myocardial infarctions were registered in the Norwegian Myocardial Infarction Registry in the period 2013 – 2014. Fewer women than men were assessed by means of coronary angiography. Percutaneous coronary intervention (PCI) was used to virtually the same extent for both genders if coronary stenosis was found. Women were recommended secondary prophylactic medication to a lesser extent than men. There were no major differences between men and women in the incidence of complications in the course following myocardial infarction or in survival. INTERPRETATION Fewer women than men suffering acute myocardial infarction were assessed by means of coronary angiography, and women were recommended secondary prophylactic medication less often than men. The reason for the gender differences is not known, but comorbidity and a potentially greater risk of adverse reactions in women may be contributory factors. The different views of doctors providing treatment may also play a part.
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Affiliation(s)
| | | | | | | | - Jan Mannsverk
- Hjertemedisinsk avdeling Universitetssykehuset Nord-Norge
| | - Siv Olsen
- Medisinsk klinikk Universitetssykehuset Nord-Norge, Harstad
| | - Cecilie Risøe
- Kardiologisk avdeling Oslo universitetssykehus, Rikshospitalet
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