1
|
Liu R, Xu F, Zhou Y, Liu T, Wu X. Effect of diabetes mellitus on young female patients with acute coronary syndrome. Diabetes Res Clin Pract 2023; 204:110904. [PMID: 37708978 DOI: 10.1016/j.diabres.2023.110904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/23/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is one of the most important risk factors of acute coronary syndrome (ACS). There have been many studies on the relationship between DM and ACS. However, the effect of DM on young females with ACS is still unclear. OBJECTIVE To explore the effect of DM on coronary arteries lesions in young females with ACS. METHODS 1278 young females (age ≤ 44 years) undergoing coronary angiography were divided into DM group (n = 197) and control group (n = 1081) according to whether they had diabetes. Based on whether the patient has ACS, each group was further divided into DM-ACS subgroup and Non-DM-ACS subgroup to compare the characteristics and severity of coronary artery lesions and follow-up outcomes. RESULTS The prevalence of diabetes was 15.41% (197/1278). Overweight (58.88%) and depression or anxiety (11.17%) in the DM group was significantly higher than those (32.22% and 6.20%) in the control group (P < 0.05). The prevalence of ACS (85.28%) in the DM group was significantly higher than that (25.35%) in the control group (P < 0.05). The proportion of type A lesions in the DM-ACS subgroup was lesser than that in the Non-DM-ACS subgroup (P < 0.05). The type C lesions in the DM-ACS subgroup were significantly higher than that in the Non-DM-ACS subgroup (P < 0.01). The number of stents implantation in the DM-ACS subgroup was no significant difference compared with the Non-DM-subgroup (P > 0.05). The length of stent implantation in the DM-ACS subgroup was significantly longer than that in the Non-DM-ACS subgroup (P < 0.05). The rate of MACE was not statistically significant between the two subgroups (P > 0.05), but the rate of all-cause death (2.98%) in the DM-ACS subgroup was significantly higher than that (0.36%) in the Non-DM-ACS subgroup (P < 0.05). CONCLUSIONS DM is an important risk factor in young females with ACS. Young women with diabetes are prone to coronary heart disease. The coronary artery lesions in DM patients were more severe than those in Non-DM patients, despite the protective effect of estrogen on the cardiovascular system. Therefore, young women with DM should be treated to prevent ACS and future events activelyandpurposefully.
Collapse
Affiliation(s)
- Ruifang Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Fangxing Xu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Tongku Liu
- The Center of Cardiology, Affiliated Hospital of Beihua University, Jilin, Jilin 132011, China
| | - Xiaofan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
| |
Collapse
|
2
|
Wouters LTCM, Zwart DLM, Erkelens DCA, De Groot E, van Smeden M, Hoes AW, Damoiseaux RAMJ, Rutten FH. Gender-stratified analyses of symptoms associated with acute coronary syndrome in telephone triage: a cross-sectional study. BMJ Open 2021; 11:e042406. [PMID: 34172542 PMCID: PMC8237735 DOI: 10.1136/bmjopen-2020-042406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To identify clinical variables that are associated with the diagnosis acute coronary syndrome (ACS) in women and men with chest discomfort who contact out-of-hours primary care (OHS-PC) by telephone, and to explore whether there are indications whether these variables differ among women and men. DESIGN Cross-sectional study in which we compared patient and call characteristics of triage call recordings between women with and without ACS, and men with and without ACS. SETTING Nine OHS-PC in the Netherlands. PARTICIPANTS 993 women and 802 men who called OHS-PC for acute chest discomfort (pain, pressure, tightness or discomfort) between 2014 and 2016. PRIMARY OUTCOME MEASURE Diagnosis of ACS retrieved from the patient's medical record in general practice, including hospital specialists' discharge letters. RESULTS Among 1795 patients (mean age 58.8 (SD 19.5) years, 55.3% women), 15.0% of men and 8.6% of women had an ACS. In both sexes, retrosternal chest pain was associated with ACS (women with ACS vs without 62.3% vs 40.3%, p=0.002; men with ACS vs without 52.5% vs 39.7%, p=0.032; gender interaction, p=0.323), as was pressing/heavy/tightening pain (women 78.6% vs 61.5%, p=0.011; men 82.1% vs 57.4%, p=<0.001; gender interaction, p=0.368) and radiation to the arm (women 75.6% vs 45.9%, p<0.001; men 56.0% vs 34.8%, p<0.001; gender interaction, p=0.339). Results indicate that only in women were severe pain (65.4% vs 38.1%, p=0.006; gender interaction p=0.007) and radiation to jaw (50.0% vs 22.9%, p=0.007; gender interaction p=0.015) associated with ACS.Ambulances were dispatched equally in women (72.9%) and men with ACS (70.0%). CONCLUSION Our results indicate there were more similarities than differences in symptoms associated with the diagnosis ACS for women and men. Important exceptions were pain severity and radiation of pain in women. Whether these differences have an impact on predicting ACS needs to be further investigated with multivariable analyses. TRIAL REGISTRATION NUMBER NTR7331.
Collapse
Affiliation(s)
- Loes T C M Wouters
- Julius Center for Health Sciences and Primary Care, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Dorien L M Zwart
- Julius Center for Health Sciences and Primary Care, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Daphne C A Erkelens
- Julius Center for Health Sciences and Primary Care, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Esther De Groot
- Julius Center for Health Sciences and Primary Care, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Maarten van Smeden
- Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Roger A M J Damoiseaux
- Julius Center for Health Sciences and Primary Care, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| |
Collapse
|
3
|
Meyering SH, Schrader CD, Kumar D, Zhou Y, Alanis N, Shaikh S, Cheeti R, Smiley R, Iloma C, Wang H. Role of HEART score in evaluating clinical outcomes among emergency department patients with different ethnicities. J Int Med Res 2021; 49:3000605211010638. [PMID: 33926275 PMCID: PMC8113935 DOI: 10.1177/03000605211010638] [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] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective We aimed to examine the role of the HEART (history, EKG, age, risk factors,
and troponin) score in the evaluation of six clinical outcomes among three
groups of patients in the emergency department (ED). Methods We performed a retrospective observational study among three ED patient
groups including White, Black, and Hispanic patients. ED providers used the
HEART score to assess the need for patient hospital admission and for
emergent cardiac imaging tests (CITs). HEART scores were measured using
classification accuracy rates. Performance accuracies were measured in terms
of HEART score in relation to four clinical outcomes (positive findings of
CITs, ED returns, hospital readmissions, and 30-day major adverse cardiac
events [MACE]). Results A high classification accuracy rate (87%) was found for use of the HEART
score to determine hospital admission. HEART scores showed moderate accuracy
(area under the receiver operating characteristic curve 0.66–0.78) in
predicting results of emergent CITs, 30-day hospital readmissions, and
30-day MACE outcomes. Conclusions Providers adhered to use of the HEART score to determine hospital admission.
The HEART score may be associated with emergent CIT findings, 30-day
hospital readmissions, and 30-day MACE outcomes, with no differences among
White, Black, and Hispanic patient populations.
Collapse
Affiliation(s)
- Stefan H Meyering
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, USA
| | - Chet D Schrader
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, USA
| | - Darren Kumar
- Department of Cardiology, JPS Health Network, 1500 S. Main St., Fort Worth, TX, USA
| | - Yuan Zhou
- Department of Industrial, Manufacturing, and Systems Engineering, The University of Texas at Arlington, 701 S. Nedderman Dr., Arlington, TX, USA
| | - Naomi Alanis
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, USA
| | - Sajid Shaikh
- Department of Information Technology, JPS Health Network, 1500 S. Main St., Fort Worth, TX, USA
| | - Radhika Cheeti
- Department of Information Technology, JPS Health Network, 1500 S. Main St., Fort Worth, TX, USA
| | - Rebecca Smiley
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, USA
| | - Chukwuagozie Iloma
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, USA
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, USA
| |
Collapse
|
4
|
Severino P, D'Amato A, Netti L, Pucci M, Infusino F, Maestrini V, Mancone M, Fedele F. Myocardial Ischemia and Diabetes Mellitus: Role of Oxidative Stress in the Connection between Cardiac Metabolism and Coronary Blood Flow. J Diabetes Res 2019; 2019:9489826. [PMID: 31089475 PMCID: PMC6476021 DOI: 10.1155/2019/9489826] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/23/2019] [Accepted: 03/13/2019] [Indexed: 12/27/2022] Open
Abstract
Ischemic heart disease (IHD) has several risk factors, among which diabetes mellitus represents one of the most important. In diabetic patients, the pathophysiology of myocardial ischemia remains unclear yet: some have atherosclerotic plaque which obstructs coronary blood flow, others show myocardial ischemia due to coronary microvascular dysfunction in the absence of plaques in epicardial vessels. In the cross-talk between myocardial metabolism and coronary blood flow (CBF), ion channels have a main role, and, in diabetic patients, they are involved in the pathophysiology of IHD. The exposition to the different cardiovascular risk factors and the ischemic condition determine an imbalance of the redox state, defined as oxidative stress, which shows itself with oxidant accumulation and antioxidant deficiency. In particular, several products of myocardial metabolism, belonging to oxidative stress, may influence ion channel function, altering their capacity to modulate CBF, in response to myocardial metabolism, and predisposing to myocardial ischemia. For this reason, considering the role of oxidative and ion channels in the pathophysiology of myocardial ischemia, it is allowed to consider new therapeutic perspectives in the treatment of IHD.
Collapse
Affiliation(s)
- Paolo Severino
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Andrea D'Amato
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Lucrezia Netti
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Mariateresa Pucci
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Fabio Infusino
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Viviana Maestrini
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Massimo Mancone
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, 00161 Rome, Italy
| |
Collapse
|
5
|
Bowles JR, McEwen MM, Rosenfeld AG. Acute Myocardial Infarction Experience Among Mexican American Women. HISPANIC HEALTH CARE INTERNATIONAL 2018; 16:62-69. [PMID: 29886775 DOI: 10.1177/1540415318779926] [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] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Health disparities in cardiovascular disease risk factors affect a burgeoning segment of the U.S. population-Mexican American (MA) women. MAs experience disparities in the prevalence of heart disease risk factors. However, there are no studies describing acute myocardial infarction (AMI) symptoms unique to this Hispanic subgroup. The aim of the study was to describe MA women's AMI symptom experience. METHODS A qualitative descriptive design guided the study. Data were collected in semistructured interviews with eight MA women who reported having an AMI within the past 18 months. Data were analyzed using qualitative content analysis. RESULTS The overall theme was "The nature of my AMI experience." This theme, composed of four categories, described their prodromal and AMI symptom experience: my perception of AMI, having a heart attack, AMI symptoms, and actions taken. No participants recognized prodromal or symptoms of AMI. Asphyxiatia (asphyxiating) and menos fuerza (less strength) were commonly described symptoms. CONCLUSION Participants attributed both prodromal and AMI symptoms to noncardiac causes, self-managed symptoms, and delay in seeking health care. Findings suggest that community engagement through culturally tailored family-focused heart health education for MA women and their family members may improve recognition of prodromal symptoms.
Collapse
|
6
|
Abstract
BACKGROUND Studies have identified sex differences in symptoms of acute coronary syndrome (ACS); however, retrospective designs, abstraction of symptoms from medical records, and variations in assessment forms make it difficult to determine the clinical significance of sex differences. OBJECTIVE The aim of this study is to determine the influence of sex on the occurrence and distress of 13 symptoms for patients presenting to the emergency department for symptoms suggestive of ACS. METHODS A total of 1064 patients admitted to 5 emergency departments with symptoms triggering a cardiac evaluation were enrolled. Demographic and clinical variables, symptoms, comorbid conditions, and functional status were measured. RESULTS The sample was predominantly male (n = 664, 62.4%), white (n = 739, 69.5%), and married (n = 497, 46.9%). Women were significantly older than men (61.3 ± 14.6 vs 59.5 ± 13.6 years). Most patients were discharged with a non-ACS diagnosis (n = 590, 55.5%). Women with ACS were less likely to report chest pain as their chief complaint and to report more nausea (odds ratio [OR], 1.56; confidence interval [CI], 1.00-2.42), shoulder pain (OR, 1.76; CI, 1.13-2.73), and upper back pain (OR, 2.92; CI, 1.81-4.70). Women with ACS experienced more symptoms (6.1 vs 5.5; P = .026) compared with men. Men without ACS had less symptom distress compared with women. CONCLUSIONS Women and men evaluated for ACS reported similar rates of chest pain but differed on other classic symptoms. These findings suggest that women and men should be counseled that ACS is not always accompanied by chest pain and multiple symptoms may occur simultaneously.
Collapse
|
7
|
Berman N, Jones MM, De Coster DA. 'Just like a normal pain', what do people with diabetes mellitus experience when having a myocardial infarction: a qualitative study recruited from UK hospitals. BMJ Open 2017; 7:e015736. [PMID: 28918410 PMCID: PMC5640147 DOI: 10.1136/bmjopen-2016-015736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 06/14/2017] [Accepted: 07/07/2017] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The objective of the study was to investigate the symptoms people with diabetes experience when having a myocardial infarction (MI), their illness narrative and how they present their symptoms to the health service. SETTING Three London (UK) hospitals (coronary care units and medical wards). PARTICIPANTS Patients were recruited with diabetes mellitus (DM) (types 1 and 2) with a clinical presentation of MI (ST elevated MI (STEMI), non-ST elevated MI (NSTEMI), acute MI unspecified and cardiac arrest). A total of 43 participants were recruited, and 39 interviews met the study criteria and were analysed. They were predominantly male (n=30), aged 40-90 years and white British (18/39), and just over a half were from other ethnic groups. The majority had type 2 DM (n=35), 24 had an NSTEMI, 10 had an STEMI and five had other cardiac events. DEFINITIONS OF SELECTION/EXCLUSION CRITERIA A diagnosis of MI and DM and the ability to communicate enough English to complete the interview. Ward staff made a clinical judgement that the participant was post-treatment, clinically stable and well enough to participate. METHODS A qualitative study using taped and transcribed interviews analysed using a thematic analysis. RESULTS While most participants did experience chest pain, it was often not their most striking symptom. As their chest pain did not match their expectations of what a 'heart attack' should be, participants developed narratives to explain these symptoms, including the symptoms being effects of their DM ('hypos'), side effects of medication (oral hypoglycaemics) or symptoms (such as breathlessness and indigestion) related to other comorbidities, often leading to delays in seeking care. CONCLUSIONS While truly absent chest pain during MI among people with DM was rare in this study, patients' attenuated symptoms often led to delay in seeking attention, and this may result in delays in receiving treatment.
Collapse
Affiliation(s)
- Nikita Berman
- Research Department of Primary Care and Population Health, UCL Medical School, London, UK
- Dept of Psychiatry,Swn-y-Gwynt Day Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Melvyn Mark Jones
- Research Department of Primary Care and Population Health, UCL Medical School, London, UK
| | - Daan A De Coster
- Core Medical Trainee, Princess Royal University Hospital Bromley, King's College NHS Trust, Bromley, UK
| |
Collapse
|
8
|
|
9
|
Ängerud KH, Brulin C, Eliasson M, Näslund U, Hörnsten Å. The Process of Care-seeking for Myocardial Infarction Among Patients With Diabetes. J Cardiovasc Nurs 2015; 30:E1-8. [PMID: 25325370 PMCID: PMC4540334 DOI: 10.1097/jcn.0000000000000195] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND People with diabetes have a higher risk for myocardial infarction (MI) than do people without diabetes. It is extremely important that patients with MI seek medical care as soon as possible after symptom onset because the shorter the time from symptom onset to treatment, the better the prognosis. OBJECTIVE The aim of this study was to explore how people with diabetes experience the onset of MI and how they decide to seek care. METHODS We interviewed 15 patients with diabetes, 7 men and 8 women, seeking care for MI. They were interviewed 1 to 5 days after their admission to hospital. Five of the participants had had a previous MI; 5 were being treated with insulin; 5, with a combination of insulin and oral antidiabetic agents; and 5, with oral agents only. Data were analyzed according to grounded theory. RESULTS The core category that emerged, "becoming ready to act," incorporated the related categories of perceiving symptoms, becoming aware of illness, feeling endangered, and acting on illness experience. Our results suggest that responses in each of the categories affect the care-seeking process and could be barriers or facilitators in timely care-seeking. Many participants did not see themselves as susceptible to MI and MI was not expressed as a complication of diabetes. CONCLUSIONS Patients with diabetes engaged in a complex care-seeking process, including several delaying barriers, when they experienced symptoms of an MI. Education for patients with diabetes should include discussions about their increased risk of MI, the range of individual variation in symptoms and onset of MI, and the best course of action when possible symptoms of MI occur.
Collapse
Affiliation(s)
- Karin Hellström Ängerud
- Karin Hellström Ängerud, RN, MSc PhD Student, Department of Nursing, Umeå University, Umeå, Sweden. Christine Brulin, RNT, PhD Professor, Department of Nursing, Umeå University, Umeå, Sweden. Mats Eliasson, MD, PhD Professor, Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden. Ulf Näslund, MD, PhD Professor, Department of Public Health and Clinical Medicine, Cardiology, Heart Centre, Umeå University, Umeå, Sweden. Åsa Hörnsten, RN, PhD Associate Professor, Department of Nursing, Umeå University, Umeå, Sweden
| | | | | | | | | |
Collapse
|
10
|
Asgar Pour H, Norouzzadeh R, Heidari MR. Gender differences in symptom predictors associated with acute coronary syndrome: A prospective observational study. Int Emerg Nurs 2015. [PMID: 26216449 DOI: 10.1016/j.ienj.2015.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Signs and symptoms (typical and atypical symptoms) of acute coronary syndromes (ACS) differ between men and women. Identification of gender differences has implications for both health care providers and the general public. The aim of this study was to determine the symptom predictors of the acute coronary syndromes in men and women. In this prospective study, nurse data collectors directly observed 256 men and 182 women (N = 438) with symptoms suggestive of ACS in the Emergency Departments of eight hospitals in Tehran. ACS was eventually diagnosed in 183 (57.2%) men and 137 (42.8%) women on the basis of standard electrocardiogram and cardiac enzyme (CPK-MB) level. In men, chest symptoms (OR = 3.22, CI = 0.137-0.756, P = 0.009), dyspnea (OR = 2.65, CI = 1.78-4.123 P = 0.001) and diaphoresis (OR = 2.175, CI = 1.020-4.639, P = 0.044) were significantly associated with the diagnosis of ACS 3.78, 2.72 and 1.87 times more than in women having these symptoms, respectively. These results indicated that chest symptoms, diaphoresis and dyspnea were the more pronounced typical symptoms of ACS in men compared to women. Additionally, the numbers of typical symptoms can be considered as more predictive of ACS in men (OR = 1.673, CI = 1.211-2.224, P < 0.001) than women (OR = 1.271, CI = 1.157-2.331, P = 0.212). Therefore, clinicians need to take men showing typical symptoms into consideration carefully.
Collapse
Affiliation(s)
- Hossein Asgar Pour
- Department of Surgical Nursing, Aydın Health School, Adnan Menderes University, Aydın, Turkey.
| | - Reza Norouzzadeh
- Faculty of Midwifery and Nursing, Shahed University, Tehran, Iran
| | | |
Collapse
|
11
|
O'Keefe-McCarthy S, McGillion MH, Victor JC, Jones J, McFetridge-Durdle J. Prodromal symptoms associated with acute coronary syndrome acute symptom presentation. Eur J Cardiovasc Nurs 2015; 15:e52-9. [PMID: 25851233 DOI: 10.1177/1474515115580910] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 03/18/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Prodromal symptoms (PS), indicative of myocardial ischemia, are frequently unrecognized by individuals prior to an acute coronary syndrome (ACS). ACSs are the leading cause of death worldwide. This study describes (1) the prevalence and association of PS with patients' baseline ACS-related acute symptoms of pain intensity and state anxiety and (2) the relationship of PS to co-morbidity. METHODS An exploratory sub-analysis was performed. Cross sectional data identified prodromal predictors of ACS pain intensity (numeric rating scale 0-10 (NRS)) and state anxiety (Speilberger state-trait anxiety personality inventory (STAI)). ACS patients (n=121) admitted to a community rural emergency department completed the prodromal symptom screening scale (PS-SS) and reported baseline cardiac pain intensity, state, and trait anxiety. RESULTS Increased ACS pain intensity was associated with PS. Median pain scores were higher by two points for those with prodromal headache, p=0.006, and anxiety, p=0.017, and one point higher for those with sleep disturbances, p=0.012. PS were not associated with state or trait anxiety. Hypertensive individuals were 7.5 times more likely to experience prodromal fatigue prior to their ACS event. CONCLUSION Results extend current knowledge of the predictive value that prodromal headache, sleep disturbance and anxiety may have on individuals' acute symptom presentation. A prospective, prognostic study is required in order to determine whether PS are predictive of adverse cardiac events and if PS are a stronger predictor of ACS acute symptom presentation, compared with typical ACS-related co-morbidities.
Collapse
|
12
|
Abed Y, Jamee A. Characteristics and Risk Factors Attributed to Coronary Artery Disease in Women Attended Health Services in Gaza-Palestine Observational Study. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/wjcd.2015.51002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
13
|
Canto JG, Canto EA, Goldberg RJ. Time to Standardize and Broaden the Criteria of Acute Coronary Syndrome Symptom Presentations in Women. Can J Cardiol 2014; 30:721-8. [DOI: 10.1016/j.cjca.2013.10.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/20/2013] [Accepted: 10/20/2013] [Indexed: 11/30/2022] Open
|
14
|
|
15
|
Angerud KH, Brulin C, Näslund U, Eliasson M. Patients with diabetes are not more likely to have atypical symptoms when seeking care of a first myocardial infarction. An analysis of 4028 patients in the Northern Sweden MONICA Study. Diabet Med 2012; 29:e82-7. [PMID: 22211855 DOI: 10.1111/j.1464-5491.2011.03561.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM To describe symptoms of a first myocardial infarction in men and women with and without diabetes. METHODS We conducted a population-based study of 4028 people aged 25-74 years, with first myocardial infarction registered in the Northern Sweden Multinational MONItoring of trends and determinants in CArdiovascular disease (MONICA) myocardial infarction registry between 2000 and 2006. Symptoms were classified as typical or atypical according to the World Health Organization MONICA manual. RESULTS Among patients with diabetes, 90.1% reported typical symptoms of myocardial infarction; the corresponding proportion among patients without diabetes was 91.5%. In the diabetes group, 88.8% of women and 90.8% of men had typical symptoms of myocardial infarction. No differences were found in symptoms of myocardial infarction between women with and without diabetes or between men with and without diabetes. Atypical symptoms were more prevalent in the older age groups (> 65 years) than in the younger age groups (< 65 years). The increases were approximately equal among men and women, with and without diabetes. Diabetes was not an independent predictor for having atypical symptoms of myocardial infarction. CONCLUSIONS Typical symptoms of myocardial infarction were equally prevalent in patients with and without diabetes and there were no sex differences in symptoms among persons with diabetes. Diabetes was not a predictor of atypical symptoms.
Collapse
Affiliation(s)
- K H Angerud
- Cardiology, Heart Centre and Department of Nursing, Umeå University, Umeå, Sweden.
| | | | | | | |
Collapse
|
16
|
DeVon HA, Ryan CJ, Rankin SH, Cooper BA. Classifying subgroups of patients with symptoms of acute coronary syndromes: A cluster analysis. Res Nurs Health 2010; 33:386-97. [PMID: 20672306 DOI: 10.1002/nur.20395] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of the study was to identify subgroups of patients presenting with acute coronary syndromes based on symptom clusters. Two hundred fifty-six patients completed a symptom assessment in their hospital rooms. Latent class cluster analysis and analysis of variance were used to classify subgroups of patients according to selected clinical characteristics. Four subgroups were identified and labeled as Heavy Symptom Burden, Chest Pain Only, Sweating and Weak, and Short of Breath and Weak (model fit χ(2) [130,891, n = 256] = 867.5, p = 1.00). The largest group of patients experienced classic symptoms of chest pain and shortness of breath but not sweating. Younger patients were more likely to cluster in the Heavy Symptom Burden group (F = 5.08, p = .002). Interpretation of the clinical significance of these groupings requires further study.
Collapse
Affiliation(s)
- Holli A DeVon
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA 95817, USA
| | | | | | | |
Collapse
|
17
|
Leuzzi C, Sangiorgi GM, Modena MG. Gender-specific aspects in the clinical presentation of cardiovascular disease. Fundam Clin Pharmacol 2010; 24:711-7. [PMID: 20840353 DOI: 10.1111/j.1472-8206.2010.00873.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
More than a quarter of a million women die each year in the industrialized countries from cardiovascular diseases (CVD), and current projections indicate that this number will continue to rise with our ageing population. Important sex-related differences in the prevalence, presentation, management and outcomes of different CVD have discovered in the last two decades of cardiovascular research. Nevertheless, much evidence supporting contemporary recommendations for testing, prevention and treatment of CVD in women is still extrapolated from studies conducted predominantly in men. The compendium of CVD indicates that current research and strategy development must focus on gender-specific issues to address the societal burden and costs related to these incremental shifts in female gender involvement. Indeed, this significant burden of CVD in women places unique diagnostic, treatment and financial encumbrances on our society that are only further intensified by a lack of public awareness about the disease on the part of patients and clinicians alike. This societal burden of the disease is, in part, related to our poor understanding of gender-specific pathophysiologic differences in the presentation and prognosis of CVD and the paucity of diagnostic and treatment guidelines tailored to phenotypic differences in women. In this, scenario is of outmost importance to know these differences to provide the best care for female patients, because under-recognition of CVD in women may contribute to a worse clinical outcome. This review will provide a synopsis of available evidence on gender-based differences in the initial presentation, pathophysiology and clinical outcomes of women affected by CVD.
Collapse
Affiliation(s)
- Chiara Leuzzi
- Department of Cardiology, University Hospital of Modena, Modena, Italy
| | | | | |
Collapse
|
18
|
Leuzzi C, Modena MG. Coronary artery disease: clinical presentation, diagnosis and prognosis in women. Nutr Metab Cardiovasc Dis 2010; 20:426-435. [PMID: 20591634 DOI: 10.1016/j.numecd.2010.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 02/01/2010] [Accepted: 02/18/2010] [Indexed: 11/16/2022]
Abstract
Recent advances in the field of cardiovascular medicine have not led to significant declines in case-fatality rates for women as in men. There are gender-specific differences in symptoms profile, diagnosis and treatment of coronary disease in women. For women presenting for coronary heart disease (CHD) evaluation, traditional disease management approaches that focus on detection of a 'critical stenosis' often fail to identify those women critically at-risk. Symptoms do not help physicians in differential diagnosis of chest pain in women; indeed the most common presentation of obstructive CHD in women is atypical symptoms. In 50% of the cases, non-obstructive CHD at coronary angiography, due to 'noncardiac chest pain' or coronary microvascular dysfunction is frequently reported. For these reasons, the evidence reviewed suggests that prognostic risk assessment may work relatively better than diagnostic obstructive coronary disease assessment for women.
Collapse
Affiliation(s)
- C Leuzzi
- Department of Cardiology, University Hospital of Modena, Modena, Italy
| | | |
Collapse
|
19
|
Hwang SY, Park EH, Shin ES, Jeong MH. Comparison of factors associated with atypical symptoms in younger and older patients with acute coronary syndromes. J Korean Med Sci 2009; 24:789-94. [PMID: 19794972 PMCID: PMC2752757 DOI: 10.3346/jkms.2009.24.5.789] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2008] [Accepted: 11/28/2008] [Indexed: 12/30/2022] Open
Abstract
Patients with acute coronary syndromes (ACS) who are accompanied by atypical symptoms are frequently misdiagnosed and under-treated. This study was conducted to examine and compare the factors associated with atypical symptoms other than chest pain in younger (<70 yr) and older (> or =70 yr) patients with first-time ACS. Data were obtained from the electronic medical records of the patients (n=931) who were newly diagnosed as ACS and hospitalized from 2005 to 2006. The 7.8% (n=49) of the younger patients and 13.4% (n=41) of the older patients were found to have atypical symptoms. Older patients were more likely to complain of indigestion or abdominal discomfort (P=0.019), nausea and/or vomiting (P=0.040), and dyspnea (P<0.001), and less likely to have chest pain (P=0.007) and pains in the arm and shoulder (P=0.018). A logistic regression analysis showed that after adjustment made for the gender and ACS type, diabetes and hyperlipidemia significantly predicted atypical symptoms in the younger patients. In the older patients, the co-morbid conditions such as stroke or chronic obstructive pulmonary disease were positive predictors. Health care providers need to have an increased awareness of possible presence of ACS in younger persons with diabetes and older persons with chronic concomitant diseases when evaluating patients with no chest pain.
Collapse
Affiliation(s)
- Seon Young Hwang
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
| | - Eun Hee Park
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
| | - Eun Sook Shin
- The Heart Research Center of Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Research Center of Chonnam National University Hospital, Gwangju, Korea
| |
Collapse
|
20
|
Ethnic variation in acute myocardial infarction presentation and access to care. Am J Cardiol 2009; 103:1368-73. [PMID: 19427430 DOI: 10.1016/j.amjcard.2009.01.344] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 01/17/2009] [Accepted: 01/17/2009] [Indexed: 11/22/2022]
Abstract
Given the growing ethnic diversity in Canada, it is essential to recognize potential ethnic variability in acute myocardial infarction (AMI) symptoms to increase timely and effective treatment. We thus examined ethnic variation in symptom presentation and access to care of patients presenting to the emergency department (ED) with AMI. A random sample of 406 health records of Caucasian, Chinese, South Asian, Southeast Asian, and First Nations patients discharged from hospitals in the Calgary Health Region (Alberta, Canada) was audited. Measured variables were compared across ethnic groups and associations with classic AMI symptom profile and timely presentation to a hospital were examined. Chinese, South Asian, and Southeast Asian patients were 64% to 69% less likely than Caucasian patients to have a classic symptom profile reported and were less likely to speak English than their Caucasian and First Nations counterparts (p <0.001). Thirty-nine percent of patients who had a reported distinct time of symptom onset waited >12 hours to present to the ED; even in patients who presented with a classic symptom profile, South Asians were 70% less likely than Caucasians to report to the ED within 3 hours of symptom onset. Caucasians were significantly more likely to undergo angiography within 3 hours of presentation to the ED (42%, p = 0.001). In conclusion, explanatory variables associated with variability in symptom presentation and access to care associated with ethnicity require further exploration to ultimately develop effective strategies aimed at increasing timely presentation and care access.
Collapse
|