1
|
Gonuguntla K, Badu I, Duhan S, Sandhyavenu H, Chobufo MD, Taha A, Thyagaturu H, Sattar Y, Keisham B, Ali S, Khan MZ, Latchana S, Naeem M, Shaik A, Balla S, Gulati M. Sex and Racial Disparities in Proportionate Mortality of Premature Myocardial Infarction in the United States: 1999 to 2020. J Am Heart Assoc 2024; 13:e033515. [PMID: 38842272 PMCID: PMC11255752 DOI: 10.1161/jaha.123.033515] [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: 11/16/2023] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The incidence of premature myocardial infarction (PMI) in women (<65 years and men <55 years) is increasing. We investigated proportionate mortality trends in PMI stratified by sex, race, and ethnicity. METHODS AND RESULTS CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) was queried to identify PMI deaths within the United States between 1999 and 2020, and trends in proportionate mortality of PMI were calculated using the Joinpoint regression analysis. We identified 3 017 826 acute myocardial infarction deaths, with 373 317 PMI deaths corresponding to proportionate mortality of 12.5% (men 12%, women 14%). On trend analysis, proportionate mortality of PMI increased from 10.5% in 1999 to 13.2% in 2020 (average annual percent change of 1.0 [0.8-1.2, P <0.01]) with a significant increase in women from 10% in 1999 to 17% in 2020 (average annual percent change of 2.4 [1.8-3.0, P <0.01]) and no significant change in men, 11% in 1999 to 10% in 2020 (average annual percent change of -0.2 [-0.7 to 0.3, P=0.4]). There was a significant increase in proportionate mortality in both Black and White populations, with no difference among American Indian/Alaska Native, Asian/Pacific Islander, or Hispanic people. American Indian/Alaska Natives had the highest PMI mortality with no significant change over time. CONCLUSIONS Over the last 2 decades, there has been a significant increase in the proportionate mortality of PMI in women and the Black population, with persistently high PMI in American Indian/Alaska Natives, despite an overall downtrend in acute myocardial infarction-related mortality. Further research to determine the underlying cause of these differences in PMI mortality is required to improve the outcomes after acute myocardial infarction in these populations.
Collapse
Affiliation(s)
| | - Irisha Badu
- Department of MedicineOnslow Memorial HospitalJacksonvilleNC
| | - Sanchit Duhan
- Department of MedicineSinai Hospital of BaltimoreBaltimoreMD
| | | | | | - Amro Taha
- Department of MedicineWeiss Memorial HospitalChicagoIL
| | | | - Yasar Sattar
- Department of CardiologyWest Virginia UniversityMorgantownWV
| | - Bijeta Keisham
- Department of MedicineSinai Hospital of BaltimoreBaltimoreMD
| | - Shafaqat Ali
- Department of Internal MedicineLouisiana State UniversityShreveportLA
| | | | - Sharaad Latchana
- American University of Integrative Sciences School of MedicineBridgetownBarbados
| | - Minahil Naeem
- Department of Internal MedicineKing Edward Medical UniversityLahorePakistan
| | - Ayesha Shaik
- Department of CardiologyHartford HospitalHartfordCT
| | - Sudarshan Balla
- Department of CardiologyWest Virginia UniversityMorgantownWV
| | - Martha Gulati
- Department of Cardiology, Barbra Streisand Women’s Heart CenterSmidt Heart Institute, Cedars Sinai Medical CenterLos AngelesCA
| |
Collapse
|
2
|
Luna P, Kim LK, Yeo I, Narula N, Steitieh D, Subramanyam P, Karas MG, Iannacone EM, Naka Y, Girardi NI, Srivastava A, Majure DT, Kanduri J, Horn EM, Cheung JW, Feldman DN, Lu DY. Sex Disparities in the Management, Outcomes, and Transfer of Patients Hospitalized for Cardiogenic Shock. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101212. [PMID: 39131782 PMCID: PMC11307867 DOI: 10.1016/j.jscai.2023.101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 08/13/2024]
Abstract
Background Previous studies have shown that women have worse outcomes for cardiogenic shock (CS) than men. Patients who receive care in CS "hubs" have also been shown to have improved outcomes when compared to those treated at "spokes." This study aimed to examine the presence of sex disparities in the outcomes of CS in relation to hospital type. Methods Hospitalizations of adults with a diagnosis of CS were identified using data from the 2016-2019 Nationwide Readmissions Database. CS "hubs" were defined as any centers receiving at least 1 interhospital transfer with CS, while those without such transfers were classified as "spokes." Data were combined across years and multivariable logistic regression modeling was used to evaluate the association of sex with in-hospital mortality, invasive procedures, and transfer to hubs. Results There were a total of 618,411 CS hospitalizations (62.2% men) with CS related to acute myocardial infarction comprising 15.3 to 17.3% of women hospitalizations and 17.8 to 20.3% of men hospitalizations. In-hospital mortality was lower at hubs (34.5% for direct admissions, 31.6% for transfers) than at spokes (40.3%, all P < .01). Women underwent fewer invasive procedures (right heart catheterization, percutaneous coronary intervention, mechanical circulatory support) and had higher mortality than men. Female sex was independently associated with decreased transfers to hubs (odds ratio, 0.93; 95% CI, 0.89-0.96) and increased mortality (odds ratio, 1.09; 95% CI, 1.05-1.12). Conclusions Women with CS were less likely to be treated at a hub or transferred to a hub, had higher in-hospital mortality, and had a lower likelihood of receiving CS-related procedures than men. Further research is needed to understand sex-specific gaps in CS outcomes.
Collapse
Affiliation(s)
- Paulina Luna
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Luke K. Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Weill Cornell Medical College, New York, New York
| | - Ilhwan Yeo
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Nupoor Narula
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Diala Steitieh
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Pritha Subramanyam
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Maria G. Karas
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Erin M. Iannacone
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Yoshifumi Naka
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Natalia I. Girardi
- Department of Anesthesiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Ankur Srivastava
- Department of Anesthesiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - David T. Majure
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Jaya Kanduri
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Evelyn M. Horn
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Jim W. Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Weill Cornell Medical College, New York, New York
| | - Dmitriy N. Feldman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Weill Cornell Medical College, New York, New York
| | - Daniel Y. Lu
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Weill Cornell Medical College, New York, New York
| |
Collapse
|
3
|
Rossello X, Mas-Lladó C, Pocock S, Vicent L, van de Werf F, Chin CT, Danchin N, Lee SWL, Medina J, Huo Y, Bueno H. Sex differences in mortality after an acute coronary syndrome increase with lower country wealth and higher income inequality. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:392-400. [PMID: 34175245 DOI: 10.1016/j.rec.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/05/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Although several factors associated with sex differences in the management and outcomes after acute coronary syndrome (ACS) have been reported, little is known about the influence of socioeconomic factors on sex disparities. Our aim was to evaluate the influence of country wealth and income inequality on national sex differences in mortality after ACS. METHODS Sex differences in 2-year postdischarge mortality were evaluated in 23 489 ACS patients from the EPICOR and EPICOR Asia registries. Adjusted Cox regression models by country-based terciles of gross national income per capita and income inequality were used. RESULTS Women (24.3%) were older than men (65.5 vs 59.4 years, P <.001), had more comorbidities, were less often revascularized (63.6% vs 75.6%, P <.001) and received fewer guideline recommended therapies at discharge. Compared with men, a higher percentage of women died during follow-up (6.4% vs 4.9%, P <.001). The association between sex and mortality changed direction from hazard ratio (HR) 1.32 (95%CI, 1.17-1.49) in the univariate assessment to HR 0.76 (95%CI, 0.67-0.87) after adjustment for confounders. These differences were more evident with increasing country wealth (HRlow-incomecountries = 0.85; 95%CI, 0.72-1.00; HRmid-incomecountries = 0.66; 95%CI, 0.50-0.87; HRhigh-incomecountries = 0.60; 95%CI, 0.40-0.90; trend test P = .115) and with decreasing income inequality (HRlow-inequalityindex = 0.54; 95%CI, 0.36-0.81; HRintermediate-inequalityindex = 0.66; 95%CI, 0.50-0.88; HRhigh-inequalityindex = 0.87; 95%CI, 0.74-1.03; trend test P = .031). CONCLUSIONS Women with ACS living in high socioeconomic countries showed a lower postdischarge mortality risk compared with men. This risk was attenuated in countries with poorer socioeconomic background, where adjusted mortality rates were similar between women and men.
Collapse
Affiliation(s)
- Xavier Rossello
- Servicio de Cardiología, Hospital Universitari Son Espases (HUSE), Palma, Balearic Islands, Spain; Grupo de Fisiopatología y Terapéutica Cardiovascular, Institut d'Investigació Sanitària Illes Balears (IdISBa), University Hospital Son Espases, Palma, Balearic Islands, Spain; Laboratorio Traslacional para la Imagen y Terapia Cardiovascular, Centro Nacional de Investigaciones Cardiovasculares Carlos (CNIC), Madrid, Spain; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom; Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Balearic Islands, Spain
| | - Caterina Mas-Lladó
- Servicio de Cardiología, Hospital Universitari Son Espases (HUSE), Palma, Balearic Islands, Spain; Grupo de Fisiopatología y Terapéutica Cardiovascular, Institut d'Investigació Sanitària Illes Balears (IdISBa), University Hospital Son Espases, Palma, Balearic Islands, Spain
| | - Stuart Pocock
- Laboratorio Traslacional para la Imagen y Terapia Cardiovascular, Centro Nacional de Investigaciones Cardiovasculares Carlos (CNIC), Madrid, Spain; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lourdes Vicent
- Instituto de Investigación i+12 y Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Frans van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Chee Tang Chin
- Cardiology Department, National Heart Centre Singapore, Singapore, Republic of Singapore
| | - Nicolas Danchin
- Service de Cardiologie, Hôpital Européen Georges Pompidou & René Descartes University, Paris, France
| | - Stephen W L Lee
- Cardiology Department, Queen Mary Hospital, Pok Fu Lam, China
| | | | - Yong Huo
- Cardiology Department, Beijing University First Hospital, Beijing, China
| | - Héctor Bueno
- Laboratorio Traslacional para la Imagen y Terapia Cardiovascular, Centro Nacional de Investigaciones Cardiovasculares Carlos (CNIC), Madrid, Spain; Instituto de Investigación i+12 y Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| |
Collapse
|
4
|
Rossello X, Mas-Lladó C, Pocock S, Vicent L, Van de Werf F, Chin CT, Danchin N, Lee SW, Medina J, Huo Y, Bueno H. Las diferencias por sexo en la mortalidad tras un síndrome coronario agudo se incrementan en los países de menor riqueza y mayor desigualdad de ingresos. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
5
|
Rashidi A, Whitehead L, Glass C. Factors affecting hospital readmission rates following an acute coronary syndrome: A systematic review. J Clin Nurs 2021; 31:2377-2397. [PMID: 34811845 PMCID: PMC9546456 DOI: 10.1111/jocn.16122] [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] [Received: 06/29/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 01/04/2023]
Abstract
Aim To synthesise quantitative evidence on factors that impact hospital readmission rates following ACS with comorbidities. Design Systematic review and narrative synthesis. Data sources A search of eight electronic databases, including Embase, Medline, PsycINFO, Web of Science, CINAHL, Cochrane Library, Scopus and the Joanna Briggs Institute (JBI). Review methods The search strategy included keywords and MeSH terms to identify English language studies published between 2001 and 2020. The quality of included studies was assessed by two independent reviewers, using Joanna Briggs Institute (JBI) critical appraisal tools. Results Twenty‐four articles were included in the review. All cause 30‐day readmission rate was most frequently reported and ranged from 4.2% to 81%. Reported factors that were associated with readmission varied across studies from socio‐demographic, behavioural factors, comorbidity factors and cardiac factors. Findings from some of the studies were limited by data source, study designs and small sample size. Conclusion Strategies that integrate comprehensive discharge planning and individualised care planning to enhance behavioural support are related to a reduction in readmission rates. It is recommended that nurses are supported to influence discharge planning and lead the development of nurse‐led interventions to ensure discharge planning is both coordinated and person‐centred.
Collapse
Affiliation(s)
- Amineh Rashidi
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
| | - Courtney Glass
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
| |
Collapse
|
6
|
[Care and follow-up of cardiovascular disease in women]. SOINS; LA REVUE DE RÉFÉRENCE INFIRMIÈRE 2021; 66:14-18. [PMID: 34103126 DOI: 10.1016/s0038-0814(21)00121-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The condition of women has vastly improved over recent decades: respect of equality, better salary conditions and health status. Although women, like men, are living longer, certain differences in care are emerging. This survey studies the characteristics of women's cardiovascular health, especially in terms of treatment and follow-up.
Collapse
|
7
|
Rossello X, Ferreira JP, Caimari F, Lamiral Z, Sharma A, Mehta C, Bakris G, Cannon CP, White WB, Zannad F. Influence of sex, age and race on coronary and heart failure events in patients with diabetes and post-acute coronary syndrome. Clin Res Cardiol 2021; 110:1612-1624. [DOI: 10.1007/s00392-021-01859-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/14/2021] [Indexed: 12/21/2022]
|
8
|
Carlson B, Hoyt H, Kunath J, Bratzke LC. Gender Differences in Hispanic Patients of Mexican Origin Hospitalized with Heart Failure. Womens Health Issues 2020; 30:384-392. [PMID: 32660828 DOI: 10.1016/j.whi.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 05/15/2020] [Accepted: 06/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND More than 3 million women in the United States die of heart failure (HF) annually. Women are significantly underrepresented in studies that inform practice guidelines, especially women hospitalized for HF despite the associated negative outcomes. HF is common in Hispanic people, the largest ethnic minority group in the United States, who are mostly of Mexican origin. There are no studies of gender differences in Mexican-Hispanic persons hospitalized for HF. We sought to describe gender differences in demographic and clinical characteristics, clinical presentation, treatment, in-hospital outcomes, and discharge status in Mexican-Hispanic patients hospitalized for HF. METHODS We conducted a secondary analysis of data collected for a study examining readmission in patients hospitalized with HF in a 107-bed community; hospital near the U.S.-Mexico border. RESULTS Of 155 self-identified Hispanic patients, 43.2% (n = 67) were women. Compared with men, women were equally affected by obesity, on average 6 years older (p < .01), and more likely to be widowed (31% vs 6%; p < .001). Women had significantly higher ejection fractions, more total comorbid conditions, more hyperlipidemia, more arthritis, more anxiety, and were less likely to be treated with digoxin and more likely to be treated with calcium channel blockers. At discharge, women were significantly less likely to receive an angiotensin-converting enzyme inhibitor or an aldosterone receptor blocker and had a higher systolic blood pressure. CONCLUSIONS Key gender differences in chronic illness burden, treatment, and discharge status were found, highlighting the heterogeneity of women with HF and the need for further gender-specific research to develop care strategies specific to women of all races and ethnicities.
Collapse
Affiliation(s)
- Beverly Carlson
- San Diego State University, School of Nursing, San Diego, California.
| | - Helina Hoyt
- San Diego State University, School of Nursing, San Diego, California
| | - Julie Kunath
- San Diego State University, School of Nursing, San Diego, California; Pioneers Memorial Hospital, Brawley, California
| | - Lisa C Bratzke
- University of Wisconsin - Madison, School of Nursing, Madison, Wisconsin
| |
Collapse
|
9
|
Chera-Aree P, Tengtrakulcharoen P, Leetheeragul J, Sampaojarean U, Surasereewong S, Wataganara T. Clinical Experiences of Intravenous Hydralazine and Labetalol for Acute Treatment of Severe Hypertension in Pregnant Thai Women. J Clin Pharmacol 2020; 60:1662-1670. [PMID: 32598488 DOI: 10.1002/jcph.1685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/04/2020] [Indexed: 12/28/2022]
Abstract
Response to acute treatment of severe hypertension during pregnancy in Asian women was not known. Labor and delivery checklists of Thai women treated with intravenous hydralazine or labetalol for systolic blood pressure (SBP) ≥ 160 or diastolic blood pressure (DBP) ≥ 110 mm Hg from January 2011 to December 2013 were reviewed as parts of an audit. Primary outcome was prompt achievement of SBP 140-150 and DBP 90-100 mm Hg after the first bolus. Secondary outcomes were medication-related undesired effects. The mean ± standard deviation age and prevalence of chronic hypertension in hydralazine (n = 62) versus labetalol (n = 64) groups were 32.5 ± 6 versus 29.9 ± 6.8 years and 50% versus 21.9%, respectively (P < .05). Magnesium sulfate was promptly administered on admission to every woman to prevent seizure. Targeted blood pressure was timely achieved in 41.9% and 67.2% of the hydralazine and labetalol groups, respectively (P < .05). Nonreassuring fetal heart rate occurred in 51.6% and 32.8% of the hydralazine and labetalol groups, respectively (P = .05). The prevalence of cesarean section and Apgar score < 7 were not significantly different (P > .05). Real-life clinical experiences suggested significant advantages of intravenous labetalol over hydralazine in pregnant women with severe hypertension.
Collapse
Affiliation(s)
- Pattraporn Chera-Aree
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | | | - Jarunee Leetheeragul
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Urai Sampaojarean
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Supitchaya Surasereewong
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Tuangsit Wataganara
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| |
Collapse
|
10
|
Rafiq M, Keel G, Mazzocato P, Spaak J, Guttmann C, Lindgren P, Savage C. Extreme Consumers of Health Care: Patterns of Care Utilization in Patients with Multiple Chronic Conditions Admitted to a Novel Integrated Clinic. J Multidiscip Healthc 2019; 12:1075-1083. [PMID: 31920324 PMCID: PMC6935286 DOI: 10.2147/jmdh.s214770] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 11/12/2019] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Patients with multiple chronic conditions (MCC) of diabetes, cardiovascular and kidney diseases; hereafter referred to as HND (heart/cardiac-, nephrology-, diabetes mellitus-) patients, are high utilizers of health care. However, the care received is often insufficiently coordinated between different specialties and health-care providers. This study aims to describe the characteristics of HND patients and to explore the initial effects of a multidisciplinary and person-centered care on total care utilization. PATIENTS AND METHODS We conducted a sub-study of HND patients recruited in an ongoing randomized trial CareHND (NCT03362983). Descriptive statistics of patient characteristics, including diagnostic data and Charlson Comorbidity Index scores, informed a comparison of care utilization patterns between HND patient care and traditional care. Diagnostic and care utilization data were collected from a regional database. Wilcoxon signed ranked sum tests were performed to compare care utilization frequencies between the two groups. RESULTS Patients included in the study were care-intensive with several diagnoses and experienced a high level of variation in care utilization and diagnoses profiles. HND patients were sicker than their counterparts in the control group. Utilization indicators were similar between the two arms. There was some indication that the HND center is beginning to perform as expected, but no results were statistically significant. CONCLUSION This study sits among many studies reporting difficulties obtaining statistically significant findings for MCC patients. However, previous research has shown that the key components of this intervention, such as integrated, multidisciplinary, inter-professional collaboration within patient-centered care have had a positive effect on health-care outcomes. More innovative methods beyond the RCT, such as machine learning should be explored to evaluate the impact of integrated care interventions on care utilization.
Collapse
Affiliation(s)
- Muhammad Rafiq
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - George Keel
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Pamela Mazzocato
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Department for Research, Development, Education and Innovation, Södertälje Hospital, Södertälje152 40, Sweden
| | - Jonas Spaak
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm182 88, Sweden
| | - Christian Guttmann
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Tieto Sweden AB, Stockholm115 83, Sweden
- Nordic Artificial Intelligence Institute, Stockholm113 31, Sweden
| | - Peter Lindgren
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Carl Savage
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
11
|
Sex Differences in Acute Myocardial Infarction Hospital Management and Outcomes: Update From Facilities With Comparable Standards of Quality Care. J Cardiovasc Nurs 2019; 33:568-575. [PMID: 29877884 PMCID: PMC6200370 DOI: 10.1097/jcn.0000000000000509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental digital content is available in the text. Background: Acute myocardial infarction (AMI) sex disparities in management and outcomes have long been attributed to multiple factors, although questions regarding their relevance have not been fully addressed. Objective: The aim of this study was to identify current factors associated with sex-related AMI management and outcomes disparities in hospitals with comparable quality care standards. Methods: This is a cross-sectional study of 299 women and 540 men with AMI discharged in 2013 from 3 southern California hospitals with tertiary cardiac care. Outcomes (adjusted by demographic/clinical variables using multiple logistic regression) included mortality (in-hospital, 30 days), 30-day readmissions, invasive/revascularization procedures, and quality medication performance measures (aspirin, statins/antilipids, β-blockers, angiotensin-converting enzyme inhibitors, <90-minute door-balloon time). Results: Performance was similar to the top 10% National Inpatient Quality AMI Measures. Women had similar mortality, 30-day readmission rates, and performance on medication quality measures compared with men; readmissions were higher in patients with County Services/Medicaid or no medical insurance regardless of sex. Women had similar cardiac catheterization and ST-segment elevation myocardial infarction percutaneous coronary intervention rates but significantly less percutaneous coronary intervention for non–ST-segment elevation myocardial infarction (39.1% vs 52.1%, P = .008) and coronary artery bypass graft (6.7% vs 14.1%, P < .001) than men. Conclusions: Women with AMI had similar early mortality, 30-day readmissions and quality performance measures compared with men across hospitals with current quality care standards. Type of medical insurance influenced readmission rates for both sexes. Sex disparities in coronary revascularization procedures were likely determined by differences in AMI type and coronary disease vascular expression.
Collapse
|
12
|
Differences in Patient Experience Between Hispanic and Non-Hispanic White Patients Across U.S. Hospitals. J Healthc Qual 2019; 40:292-300. [PMID: 29252871 DOI: 10.1097/jhq.0000000000000113] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Despite the increased emphasis on patient experience, little is known about whether there are meaningful differences in hospital satisfaction between Hispanic and non-Hispanic whites. METHODS To determine if satisfaction differs, we used Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data (2009-2010) reported by hospitals to compare responses between Hispanic and non-Hispanic white patients. Clustered logistic regression models identified within-hospital and between-hospital differences in satisfaction. RESULTS Of the 3,864,938 respondents, 6.2% were Hispanics, who were more often younger and females and less likely to have graduated from high school. Hispanics were overall more likely to recommend their hospital (74.1% vs. 70.9%, p < .001) and to rate it 9 or 10 (72.5% vs. 65.9%, p < .001) than whites. Increased satisfaction among Hispanics was more pronounced when compared with whites within the same hospitals, with significantly higher ratings on all HCAHPS measures. However, hospitals serving a higher percentage of Hispanics had lower satisfaction scores for both Hispanic and white patients than other hospitals. CONCLUSION There were significant but only modest-sized differences in patient experience between Hispanic and white patients across U.S. hospitals. Hispanics tended to be more satisfied with their care but received care at lower-performing hospitals.
Collapse
|
13
|
Hasman A, Prins H. Appropriateness of ICD-coded Diagnostic Inpatient Hospital Discharge Data for Medical Practice Assessment. Methods Inf Med 2018; 52:3-17. [DOI: 10.3414/me12-01-0022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 09/20/2012] [Indexed: 11/09/2022]
Abstract
SummaryObjectives: We performed a systematic review to investigate the quality of diagnostic hospital discharge data (DHDD) in order to gain insight in the usefulness of these data for medical practice assessment. We investigated the methods used to evaluate data quality, factors that determine data quality and its consequences for medical practice assessment.Methods: We selected studies in which both completeness (or sensitivity: SENS) and correctness (or positive predictive value: PPV) were measured. We used the random-effects model to calculate mean SENS and PPV and to explore the effect of a number of covariates.Results: The 101 included studies were very heterogeneous. We distinguished six typical study designs. We found a mean SENS of 0.67 (95%CI: 0.62– 0.73) and PPV of 0.76 (95%CI: 0.73– 0.79); SENS was significantly lower for comorbidity and complication studies than for some single disease studies. PPV was significantly higher for Scandinavian countries than for other countries. Recoding compared to re-abstracting of the medical record as a gold standard gave a significantly lower PPV. Diagnostic data were considered appropriate by the authors of the studies for quality of care purposes when both SENS and PPV were at least 0.85. Only 13% of the studies fulfilled this criterion.Conclusions: Variability in quality of care between settings can easily be overshadowed by variability in data quality. However, the use of DHDD by physicians to evaluate their own medical practice may be useful. But only if physicians are willing to critically interpret the meaning of the information for their medical practice assessment.
Collapse
|
14
|
Feasibility of including patients with migration background in a structured heart failure management programme: A prospective case-control study exemplarily on Turkish migrants. PLoS One 2017; 12:e0187358. [PMID: 29117200 PMCID: PMC5695597 DOI: 10.1371/journal.pone.0187358] [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: 06/22/2016] [Accepted: 10/18/2017] [Indexed: 11/19/2022] Open
Abstract
AIMS Structured management programmes deliver optimized care in heart failure patients and improve outcome. We examined the feasibility of including patients with migration background speaking little or no German in a heart failure management programme. METHODS AND RESULTS After adaption of script material and staff to Turkish language we aimed to recruit 300 Turkish and 300 German (control group) patients within 18 months using the operational basis of a local heart failure management programme for screening, contact and inclusion. Of 488 and 1,055 eligible Turkish and German patients identified through screening, 165 Turkish (34%) and 335 German (32%) patients consented on participation (p = 0.46). General practitioners contributed significantly more of the Turkish (84%) than of the German patients (16%, p<0.001). Contact attempts by programme staff were significantly less successful in Turkish (52%) than in German patients (60%, p = 0.005) due to significantly higher rate of missing phone numbers (36% vs 25%), invalid address data (28% vs 7%) and being unreachable by phone more frequently (39% vs 26%, all p<0.001). Consent rate was significantly higher in successfully contacted Turkish (63%) compared to German patients (50%, p<0.001). CONCLUSION The inclusion of Turkish minority patients into a heart failure management programme is feasible with higher consent rate than in Germans. However, effort is high due to inherent logistic adaptions and barriers in identification and contacting of patients. TRIAL REGISTRATION DRKS00007780.
Collapse
|
15
|
Romero T, Greenwood KL, Glaser D. Update on quality of care in Hispanics and other racial-ethnic groups in the United States discharged with the diagnosis of Acute Myocardial Infarction in 2013. Int J Cardiol 2017; 248:28-33. [PMID: 28716521 DOI: 10.1016/j.ijcard.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/08/2017] [Accepted: 07/03/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Disparities in Acute Myocardial Infarction (AMI) care and outcomes have been frequently reported in racial-ethnic minorities in the U.S. Some studies have attributed disparities in Hispanics and other minorities to lower quality of services at hospitals where they seek care. Current information from hospitals with large Hispanic representations and updated quality resources is needed. METHODS Retrospective observational study of 839 AMI patients discharged in 2013 from three Southern California Hospitals (A, B, C) with tertiary cardiac care level. Non-Hispanic Whites (NHW) and Hispanics (H) were the larger racial-ethnic groups (68.3%), and the comparison of these two groups constitutes the focus of the study. Mortality, 30day readmissions, medication/performance measures (PRx); aspirin, statins/anti-lipids, beta-blockers, ACEI/ARB for LV systolic dysfunction, <90min door-balloon time, and revascularization procedures were compared between hospitals, NHW and H, using Chi-squared tests (χ2), Odds Ratios (OR) with 95% confidence intervals (CI), and Z tests for proportions - independent groups. RESULTS No significant differences in hospital, 30day mortality, PRx or procedures were observed between NHW, H and other racial-ethnic minority groups, or hospitals. Hospital C had 47.3% H and Hospitals A+B 14.6% (p<0.001, effect size=0.430). AMI performance measures exceeded 2013 national rates across all facilities. NHW had more private/commercial insurance (52.5% vs. 25.4%, OR 3.24, 95% CI 2.19-4.80, p<0.001) than H. CONCLUSIONS Equitable access to quality hospital services in three Southern California hospitals offset previously reported disparities in AMI management in Hispanics. These results may not necessarily reflect the reality of AMI care for Hispanics in other U.S. regions.
Collapse
Affiliation(s)
- Tomás Romero
- University of California - San Diego, La Jolla, CA, United States.
| | | | - Dale Glaser
- Glaser Consulting, San Diego, CA, United States; University of San Diego, San Diego, CA, United States
| |
Collapse
|
16
|
Ku E, McCulloch CE, Grimes BA, Johansen KL. Racial and Ethnic Disparities in Survival of Children with ESRD. J Am Soc Nephrol 2017; 28:1584-1591. [PMID: 28034898 PMCID: PMC5407725 DOI: 10.1681/asn.2016060706] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/17/2016] [Indexed: 12/19/2022] Open
Abstract
Observational studies have reported that black and Hispanic adults receiving maintenance dialysis survive longer than non-Hispanic white counterparts. Whether there are racial disparities in survival of children with ESRD is not clear. We compared mortality risk among non-Hispanic black, Hispanic, and non-Hispanic white children who started RRT between 1995 and 2011 and were followed through 2012. We examined all-cause mortality using adjusted Cox models. Of 12,123 children included for analysis, 1600 died during the median follow-up of 7.1 years. Approximately 25% of children were non-Hispanic black, and 26% of children were of Hispanic ethnicity. Non-Hispanic black children had a 36% higher risk of death (95% confidence interval [95% CI], 1.21 to 1.52) and Hispanic children had a 34% lower risk of death (95% CI, 0.57 to 0.77) than non-Hispanic white children. Adjustment for transplant as a time-dependent covariate abolished the higher risk of death in non-Hispanic black children (hazard ratio, 0.99; 95% CI, 0.88 to 1.12) but did not attenuate the finding of a lower risk of death in Hispanic children (hazard ratio, 0.59; 95% CI, 0.51 to 0.68). In conclusion, Hispanic children had lower mortality than non-Hispanic white children. Non-Hispanic black children had higher mortality than non-Hispanic white children, which was related to differences in access to transplantation by race. Parity in access to transplantation in children and improvements in strategies to prolong graft survival could substantially reduce disparities in mortality risk of non-Hispanic black children treated with RRT.
Collapse
Affiliation(s)
- Elaine Ku
- Division of Nephrology, Department of Medicine,
- Division of Pediatric Nephrology, Department of Pediatrics, and
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Barbara A Grimes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | | |
Collapse
|
17
|
Sakakibara BM, Ross E, Arthur G, Brown-Ganzert L, Petrin S, Sedlak T, Lear SA. Using Mobile-Health to Connect Women with Cardiovascular Disease and Improve Self-Management. Telemed J E Health 2017; 23:233-239. [DOI: 10.1089/tmj.2016.0133] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Brodie M. Sakakibara
- Faculty of Health Sciences, Simon Fraser University, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, British Columbia, Canada
- Healthy Heart Program, St. Paul's Hospital, Providence Health Care, British Columbia, Canada
| | - Emily Ross
- Faculty of Health Sciences, Simon Fraser University, British Columbia, Canada
- Healthy Heart Program, St. Paul's Hospital, Providence Health Care, British Columbia, Canada
| | - Gavin Arthur
- Heart and Stroke Foundation of Canada, Toronto, Canada
| | | | - Samantha Petrin
- Faculty of Health Sciences, Simon Fraser University, British Columbia, Canada
- Healthy Heart Program, St. Paul's Hospital, Providence Health Care, British Columbia, Canada
| | - Tara Sedlak
- Vancouver Coastal Health Authority, British Columbia, Canada
| | - Scott A. Lear
- Faculty of Health Sciences, Simon Fraser University, British Columbia, Canada
- Healthy Heart Program, St. Paul's Hospital, Providence Health Care, British Columbia, Canada
| |
Collapse
|
18
|
Plakht Y, Gilutz H, Shiyovich A. Excess long-term mortality among hospital survivors of acute myocardial infarction. Soroka Acute Myocardial Infarction (SAMI) project. Public Health 2016; 143:25-36. [PMID: 28159024 DOI: 10.1016/j.puhe.2016.09.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 09/25/2016] [Accepted: 09/27/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES We evaluated long-term survival after acute myocardial infarction (AMI) in unselected 'real life' patients according to the various risk groups, and it's persistence with time after AMI as compared with the matched general population. STUDY DESIGN Retrospective study. METHODS Data were collected from 2671 AMI hospital survivors (tertiary medical centre in Israel), which included demographics, clinical characteristics of AMI, comorbidities, interventions and test results. All-cause mortality during the 10-year follow-up period was compared with age-, sex- and ethnicity/religion-matched general population using standardized mortality ratios (SMRs). RESULTS Overall mortality of AMI patients (48.6%) was higher than the general population (SMR, 2.2; P < 0.001). Mortality rates and SMRs tended to be greater in higher risk strata of patients, Jews vs Muslims, women vs men, non-ST-elevation acute myocardial infarction (NSTEMI) vs ST-elevation acute myocardial infarction (STEMI), non-invasive treatment vs invasive treatment, and recurrent vs first AMI. Mortality rates increased with age, but SMRs were highest in the youngest group. Through the follow-up period, SMR was highest during the first year after discharge (SMR, 4.85; P < 0.001) and higher in 7th-10th years compared with 2nd-6th years. CONCLUSION Patients who survived hospital admission with AMI continue to be at higher (approximately twice) risk of death compared with the general population for at least 10-year follow-up period and especially throughout the first and 7th-10th years after AMI, young women, high-risk patients, Jews, NSTEMI, non-invasively treated and recurrent AMI. These findings can assist healthcare providers and decision makers prioritizing targets of secondary prevention and allocation of resources.
Collapse
Affiliation(s)
- Y Plakht
- Nursing Research Unit, Soroka University Medical Center, Beer-Sheva, Israel; Recanati School for Community Health Professions, Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - H Gilutz
- Department of Cardiology, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - A Shiyovich
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| |
Collapse
|
19
|
|
20
|
Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN, Lindley KJ, Vaccarino V, Wang TY, Watson KE, Wenger NK. Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation 2016; 133:916-47. [PMID: 26811316 DOI: 10.1161/cir.0000000000000351] [Citation(s) in RCA: 763] [Impact Index Per Article: 95.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction.
Collapse
|
21
|
Eshtehardi P, Pamerla M, Mojadidi MK, Goodman-Meza D, Hovnanians N, Gupta A, Lupercio F, Mazurek JA, Zolty R. Addition of Angiotensin-Converting Enzyme Inhibitors to Beta-Blockers Has a Distinct Effect on Hispanics Compared With African Americans and Whites With Heart Failure and Reduced Ejection Fraction: A Propensity Score–Matching Study. J Card Fail 2015; 21:448-56. [DOI: 10.1016/j.cardfail.2015.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 11/25/2022]
|
22
|
Campbell P, Ventura HO. Impact of Ethnicity and Race on Response to Angiotensin-Converting Enzyme Inhibitors in Heart Failure. J Card Fail 2015; 21:457-9. [DOI: 10.1016/j.cardfail.2015.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 05/01/2015] [Accepted: 05/01/2015] [Indexed: 11/17/2022]
|
23
|
Melton KD, Foli KJ, Yehle KS, Griggs RR. Heart Failure in Hispanic Americans: Improving Cultural Awareness. J Nurse Pract 2015. [DOI: 10.1016/j.nurpra.2014.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
24
|
Do gender and race/ethnicity influence acute myocardial infarction quality of care in a hospital with a large Hispanic patient and provider representation? Cardiol Res Pract 2013; 2013:975393. [PMID: 24490100 PMCID: PMC3893801 DOI: 10.1155/2013/975393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 10/17/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Disparities in acute myocardial infarction (AMI) care for women and minorities have been extensively reported in United States but with limited information on Hispanics. Methods. Medical records of 287 (62%) Hispanic and 176 (38%) non-Hispanic white (NHW) patients and 245 women (53%) admitted with suspected AMI to a southern California nonprofit community hospital with a large Hispanic patient and provider representation were reviewed. Baseline characteristics, outcomes (mortality, CATH, PCI, CABG, and use of pertinent drug therapy), and medical insurance were analyzed according to gender, Hispanic and NHW race/ethnicity when AMI was confirmed. For categorical variables, 2 × 2 chi-square analysis was conducted. Odds ratio and 95% confidence interval for outcomes adjusted for gender, race/ethnicity, cardiovascular risk factors, and insurance were obtained. Results. Women and Hispanics had similar drug therapy, CATH, PCI, and mortality as men and NHW when AMI was confirmed (n = 387). Hispanics had less private insurance than NHW (31.4% versus 56.3%, P < 0.001); no significant differences were found according to gender. Conclusions. No differences in quality measures and outcomes were found for women and between Hispanic and NHW in AMI patients admitted to a facility with a large Hispanic representation. Disparities in medical insurance showed no influence on these findings.
Collapse
|
25
|
Stevens S, Thomas SP. Recovery of Midlife Women From Myocardial Infarction. Health Care Women Int 2012; 33:1096-113. [DOI: 10.1080/07399332.2012.684815] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
26
|
Flotta D, Rizza P, Coscarelli P, Pileggi C, Nobile CGA, Pavia M. Appraising hospital performance by using the JCHAO/CMS quality measures in Southern Italy. PLoS One 2012; 7:e48923. [PMID: 23145023 PMCID: PMC3492134 DOI: 10.1371/journal.pone.0048923] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 10/02/2012] [Indexed: 11/19/2022] Open
Abstract
Objectives The main objective of the present study was to estimate the uptake to quality indicators that reflect the current evidence-based recommendations and guidelines. Methods A retrospective review of medical records of patients admitted to two hospitals in the South of Italy was conducted. For the purposes of the analysis, a sets of quality indicators has been used from the Joint Commission on Accreditation of Hospital Organizations and Centers for Medicare & Medicaid Services. Four areas of care were selected: acute myocardial infarction (AMI), heart failure (HF), pneumonia (PN), and surgical care improvement project (SCIP). Frequency or median was calculated, as appropriate, for each indicator. A composite score was calculated to estimate the overall performance for each area of care. Results A total of 1772 medical records were reviewed. The adherence rates showed a wide-ranging variability among the selected indicators. The use of aspirin and angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) for AMI, the use of ACEI or ARB for HF, the use of appropriate thromboembolism prophylaxis and appropriate hair removal for surgical patients almost approached optimal adherence. At the other extreme, rates regarding adherence to smoking-cessation counseling in AMI and HF patients, discharge instructions in HF patients, and influenza and pneumococcal vaccination in pneumonia patients were noticeably intangible. Overall, the recommended processes of care among eligible patients were provided in 70% for AMI, in 32.4% for HF, in 46.4% for PN, and in 46% for SCIP. Conclusions The results show that there is still substantial work that lies ahead on the way to improve the uptake to evidence-based processes of care. Improvement initiatives should be focused more on domains of healthcare than on specific conditions, especially on the area of preventive care.
Collapse
Affiliation(s)
- Domenico Flotta
- Department of Health Sciences, University of Catanzaro ‘Magna Græcia’, Catanzaro, Italy
| | - Paolo Rizza
- Department of Health Sciences, University of Catanzaro ‘Magna Græcia’, Catanzaro, Italy
| | - Pierluigi Coscarelli
- Department of Health Sciences, University of Catanzaro ‘Magna Græcia’, Catanzaro, Italy
| | - Claudia Pileggi
- Department of Health Sciences, University of Catanzaro ‘Magna Græcia’, Catanzaro, Italy
| | - Carmelo G. A. Nobile
- Department of Health Sciences, University of Catanzaro ‘Magna Græcia’, Catanzaro, Italy
| | - Maria Pavia
- Department of Health Sciences, University of Catanzaro ‘Magna Græcia’, Catanzaro, Italy
- * E-mail:
| |
Collapse
|
27
|
Davidson PM, Meleis AI, McGrath SJ, DiGiacomo M, Dharmendra T, Puzantian HV, Song M, Riegel B. Improving women's cardiovascular health: a position statement from the International Council on Women's Health Issues. Health Care Women Int 2012; 33:943-55. [PMID: 22946595 DOI: 10.1080/07399332.2011.646375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cardiovascular disease (CVD) is the number one killer of women worldwide, and it remains the primary cause of death and disability in both developed and developing countries. The International Council on Women's Health Issues is an international nonprofit association dedicated to the goals of promoting the health, health care, and the well-being of women. Based on the outcomes of a facilitated discussion at its 18th biannual meeting, delegates aim to raise awareness about the potent influence of gender-specific factors on the development, progression, and outcomes of CVD. Key recommendations for decreasing the burden of CVD are also discussed.
Collapse
Affiliation(s)
- Patricia M Davidson
- Centre for Cardiovascular and Chronic Care, University of Technology, Broadway, New South Wales, Australia.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Nicklett EJ. Sex, Health Behaviors and Social Support: Functional Decline among Older Diabetics. AMERICAN MEDICAL JOURNAL 2012; 3:10.3844/amjsp.2012.82.92. [PMID: 24358419 PMCID: PMC3866132 DOI: 10.3844/amjsp.2012.82.92] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PROBLEM STATEMENT Men and women experience pronounced differences in functional decline as they age. The mechanisms behind these differences remain unclear, particularly among chronically ill populations. Drawing on the theory of the disablement process, this research examines sex differences in functional decline, focusing on two mechanisms suggested by the literature to partially mediate these disparities: health behaviors and social support. APPROACH Data from diabetics aged 50 and older from the Health and Retirement Study (n = 2,493) were examined for change in functional status over a 10-year period. Multivariate longitudinal multi-level models were conducted to analyze (1) health behavior (2) social support; and (3) a full model with health behavior and social support together, followed by a separate analysis using sex interaction terms. RESULTS Women and men both experienced functional decline over time. In the models that examined health behaviors and social support separately, women experienced steeper rates of decline. In the full model (which included health behaviors and social support together), men experienced a steeper rate of decline relative to women. The analyses suggest that it is the combination of health and social characteristics (largely through engagement in socially supportive activities that promote health) that are protective against functional decline. CONCLUSION/RECOMMENDATIONS As diabetic men experienced a steeper rate of functional decline than diabetic women once health behaviors and social support were both held constant, future research must examine (a) how these protective factors operate in tandem to protect against disablement of women with diabetes; and (b) how clinical and social policy can promote multi-pronged interventions to improve health behaviors in supportive contexts. Such research will benefit from multi-disciplinary collaborations.
Collapse
Affiliation(s)
- Emily Joy Nicklett
- School of Social Work, University of Michigan, 1080 South University Avenue, 3772, Ann Arbor, MI 48109
| |
Collapse
|
29
|
Welch LC, Lutfey KE, Gerstenberger E, Grace M. Gendered uncertainty and variation in physicians' decisions for coronary heart disease: the double-edged sword of "atypical symptoms". JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2012; 53:313-28. [PMID: 22933590 PMCID: PMC3695479 DOI: 10.1177/0022146512456026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Nonmedical factors and diagnostic certainty contribute to variation in clinical decision making, but the process by which this occurs remains unclear. We examine how physicians' interpretations of patient sex-gender affect diagnostic certainty and, in turn, decision making for coronary heart disease. Data are from a factorial experiment of 256 physicians who viewed 1 of 16 video vignettes with different patient-actors presenting the same symptoms of coronary heart disease. Physician participants completed a structured interview and provided a narrative about their decision-making processes. Quantitative analysis showed that diagnostic uncertainty reduces the likelihood that physicians will order tests and medications appropriate for an urgent cardiac condition in particular. Qualitative analysis revealed that a subset of physicians applied knowledge that women have "atypical symptoms" as a generalization, which engendered uncertainty for some. Findings are discussed in relation to social-psychological processes that underlie clinical decision making and the social framing of medical knowledge.
Collapse
Affiliation(s)
- Lisa C Welch
- New England Research Institutes, Watertown, MA 02472, USA.
| | | | | | | |
Collapse
|
30
|
Vivo RP, Krim SR, Krim NR, Zhao X, Hernandez AF, Peterson ED, Piña IL, Bhatt DL, Schwamm LH, Fonarow GC. Care and outcomes of Hispanic patients admitted with heart failure with preserved or reduced ejection fraction: findings from get with the guidelines-heart failure. Circ Heart Fail 2012; 5:167-75. [PMID: 22414939 DOI: 10.1161/circheartfailure.111.963546] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although individuals of Hispanic ethnicity are at high risk for developing heart failure (HF), little is known about differences between Hispanic HF patients stratified by left ventricular ejection fraction (EF). We compared characteristics, quality of care, and outcomes between Hispanic and non-Hispanic white patients hospitalized for HF with preserved EF (PEF) or reduced EF (REF). METHODS AND RESULTS From 247 hospitals in Get With The Guidelines-Heart Failure between 2005-2010, 6117 Hispanics were compared with 71 859 non-Hispanic whites. Forty-six percent of Hispanics had PEF (EF >40%), whereas 54% had REF (EF <40%); 55% and 45% of non-Hispanic whites had PEF and REF, respectively. Relative to non-Hispanic whites, Hispanics with PEF or REF were more likely to be younger and to have diabetes, hypertension, and overweight/obesity. In multivariate analysis, a lower mortality risk was observed among Hispanics with PEF (odds ratio, 0.50; 95% confidence interval, 0.31-0.81; P=0.005) but not in Hispanics with REF (odds ratio, 0.94; 95% confidence interval, 0.62-1.43; P=0.784) compared with non-Hispanic whites. In all groups, composite performance improved within the study period (Hispanics PEF: 75.2-95.1%; non-Hispanic whites PEF: 79.0-92.7%; Hispanics REF: 67.7-88.4%; non-Hispanic whites REF: 60.8-85.6%, P<0.0001). CONCLUSIONS Hispanic HF patients with PEF had better in-hospital survival than non-Hispanic whites with PEF. Inpatient mortality was similar between groups with REF. Quality of care was similar and improved over time irrespective of ethnicity, highlighting the potential benefit of performance improvement programs in promoting equitable care.
Collapse
Affiliation(s)
- Rey P Vivo
- University of Texas Medical Branch, Galveston, and Methodist DeBakey Heart and Vascular Center, Houston, TX 77555-0144, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Peterson PN, Campagna EJ, Maravi M, Allen LA, Bull S, Steiner JF, Havranek EP, Dickinson LM, Masoudi FA. Acculturation and outcomes among patients with heart failure. Circ Heart Fail 2012; 5:160-6. [PMID: 22247483 DOI: 10.1161/circheartfailure.111.963561] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acculturation to US society among minority patients may-beyond race and ethnicity alone-influence health outcomes beyond race and ethnicity alone. In particular, those who are foreign-born and who do not speak English as their primary language may have greater challenges interacting with the health care system and thus be at greater risk for adverse outcomes. METHODS AND RESULTS We studied patients hospitalized with a principal discharge diagnosis of heart failure between January 2000 and December 2007 in an integrated delivery system that cares for minority patients. Individuals were defined as having low acculturation if their primary language was not English and their country of birth was outside of the United States. Multivariable logistic regression and Cox proportional hazards regression were used to determine the independent risk of 30-day rehospitalization and 1-year mortality, respectively. Candidate adjustment variables included demographics (age, sex, race/ethnicity), coexisting illnesses, laboratory values, left ventricular systolic function, and characteristics of the index admission. Of 1268 patients, 30% (n=379) were black, 39% (n=498) were Hispanic, and 27% (n=348) were white. Eighteen percent (n=228) had low acculturation. After adjustment, low acculturation was associated with a higher risk of readmission at 30 days (odds ratio, 1.70; 95% confidence interval, 1.07-2.68) but not 1-year all-cause mortality (hazard ratio, 0.69; 95% confidence interval, 0.42-1.14). CONCLUSIONS Patients with heart failure who are foreign-born and do not speak English as their primary language have a greater risk of rehospitalization, independent of clinical factors and race/ethnicity. Future studies should evaluate whether culturally concordant interventions focusing on such patients may improve outcomes for this patient population.
Collapse
|
32
|
Davidson PM, DiGiacomo M, McGrath SJ. The Feminization of Aging: How Will This Impact on Health Outcomes and Services? Health Care Women Int 2011; 32:1031-45. [DOI: 10.1080/07399332.2011.610539] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
33
|
Lifetime medical expenditures among hypertensive men and women in the United States. Womens Health Issues 2011; 21:246-53. [PMID: 21521625 DOI: 10.1016/j.whi.2010.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 12/25/2010] [Accepted: 12/27/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Our objective was to estimate lifetime medical expenditures that can be attributed to hypertension, by gender, in the United States, given important gender differences in both survival and medical expenditures. METHODS We estimated lifetime medical expenditures among hypertensive and nonhypertensive men and women aged 20 and older. Expenditures were estimated from the 2001 to 2004 Medical Expenditure Panel Survey and life expectancies were estimated from the 1986 to 2002 National Health Interview Survey Linked Mortality Files. Assuming that medical technology, the cost of health care services, the incidence of disease, and survival were fixed, the cross-sectional age-specific expenditures and the survival profiles were used to estimate the lifetime expenditures from ages 20 to older than 85. PRINCIPAL FINDINGS The estimated lifetime expenditure for an average life table individual at age 20 was $188,300 for hypertensive men and $254,910 for hypertensive women; however, a greater share of lifetime expenditures can be attributed to hypertension among men ($88,033) than among women ($40,960). CONCLUSION Although hypertensive women had greater lifetime expenditures than hypertensive men, hypertension was associated with a greater increase in lifetime expenditures for men than for women. Gender differences in both survival and health care utilization have important implications for gender differences in lifetime medical expenditures.
Collapse
|
34
|
Rodriguez F, Joynt KE, López L, Saldaña F, Jha AK. Readmission rates for Hispanic Medicare beneficiaries with heart failure and acute myocardial infarction. Am Heart J 2011; 162:254-261.e3. [PMID: 21835285 DOI: 10.1016/j.ahj.2011.05.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hispanics are the fastest growing segment of the US population and have a higher prevalence of cardiovascular risk factors than non-Hispanic whites. However, little is known about whether elderly Hispanics have higher readmission rates for heart failure (HF) and acute myocardial infarction (AMI) than whites and whether this is due to site of care. METHODS We examined hospitalizations for Medicare patients with a primary discharge diagnosis of HF and AMI in 2006 to 2008. We categorized hospitals in the top decile of proportion of Hispanic patients as "Hispanic serving" and used logistic regression to examine the relationship between patient ethnicity, hospital Hispanic-serving status, and readmissions. RESULTS Hispanic patients had higher risk-adjusted readmission rates than whites for both HF (27.9% vs 25.9%, odds ratio [OR] 1.11, 95% CI 1.07-1.14, P < .001) and AMI (23.0% vs 21.0%, OR 1.12, 95% CI 1.07-1.18, P < .001). Similarly, Hispanic-serving hospitals had higher readmission rates than non-Hispanic-serving hospitals for both HF (27.4% vs 25.8%, OR 1.09, 95% CI 1.06-1.12, P < .001) and AMI (23.0% vs 20.8%, OR 1.13, 95% CI 1.09-1.18, P < .001). In analyses considering ethnicity and site of care simultaneously, both Hispanics and whites had higher readmission rates at Hispanic-serving hospitals. CONCLUSIONS Elderly Hispanic patients are more likely to be readmitted for HF and AMI than whites, partly due to the hospitals where they receive care. Our findings suggest that targeting the site of care and these high-risk patients themselves will be necessary to reduce disparities in readmissions for this growing group of patients.
Collapse
|
35
|
Vimalananda VG, Miller DR, Palnati M, Christiansen CL, Fincke BG. Gender Disparities in Lipid-Lowering Therapy Among Veterans With Diabetes. Womens Health Issues 2011; 21:S176-81. [DOI: 10.1016/j.whi.2011.04.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 04/18/2011] [Accepted: 04/18/2011] [Indexed: 10/28/2022]
|
36
|
Gender Differences in Smoking and Smoking Cessation Treatment: An Examination of the Organizational Features Related to Care. Womens Health Issues 2011; 21:S182-9. [DOI: 10.1016/j.whi.2011.04.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 04/18/2011] [Accepted: 04/20/2011] [Indexed: 11/20/2022]
|
37
|
Rost K, Hsieh YP, Xu S, Harman J. Gender differences in hospitalization after emergency room visits for depressive symptoms. J Womens Health (Larchmt) 2011; 20:719-24. [PMID: 21417934 DOI: 10.1089/jwh.2010.2396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depressed women have greater than three times the odds of hospitalization as clinically comparable men. The objective of this study is to understand if these gender differences emerge in admissions decisions after depressed individuals' arrival at the emergency room (ER). METHODS We used multivariate logistic regression to examine gender differences in hospitalization after 6266 ER visits for depressive symptoms in the nationally representative 1998-2007 National Hospital Ambulatory Care Medical Survey. RESULTS ER visits by depressed women have only 0.82 the odds of hospitalization (95% confidence interval [CI] 0.70-0.96, p=0.02) in models adjusted for sociodemographic, clinical, and system covariates. Sensitivity analyses demonstrate gender differences in visits by patients with no injury but not in visits by patients with self-inflicted injury. CONCLUSIONS These findings suggest that admission decisions after ER visits are not responsible for the increased risk of hospitalization previously reported in depressed women, as ER visits by women with depressive symptoms actually have lower odds of hospitalization than visits by men. We encourage further research to explore the causes and consequences of this practice pattern to move toward rational delivery systems committed to providing comparable treatment to clinically comparable individuals regardless of gender.
Collapse
Affiliation(s)
- Kathryn Rost
- Department of Medical Humanities and Social Sciences, Florida State University College of Medicine, Tallahassee, FL 32306-4300, USA.
| | | | | | | |
Collapse
|
38
|
Ventura HO, Piña I. Heart failure in Hispanic patients: coming together? CONGESTIVE HEART FAILURE (GREENWICH, CONN.) 2010; 16:187-188. [PMID: 20662873 DOI: 10.1111/j.1751-7133.2010.00160.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Hector O Ventura
- Department of Cardiology John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
| | | |
Collapse
|
39
|
Godfrey JR, Wenger NK. Toward Optimal Health: Advances in the Cardiovascular Care of Women. J Womens Health (Larchmt) 2010; 19:659-64. [DOI: 10.1089/jwh.2010.1957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
40
|
Evangelista L, Ter-Galstanyan A, Moser DK, Dracup K. Smoking among women following heart transplantation: should we be concerned? ACTA ACUST UNITED AC 2010; 24:119-23. [PMID: 20002335 DOI: 10.1111/j.1751-7117.2009.00049.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The serious detrimental effects of smoking after heart transplantation (HTX) are well established, but data that demonstrate the effects on female HTX recipients are scarce. The purpose of this study was to describe tobacco use, exposure to second hand smoke (ESHS), and health perceptions of female HTX recipients and examine relationships between these variables of interest and demographic and clinical characteristics of women following HTX. Seventy-two women (mean age, 54.3+/-12.7 years; mean time since transplant, 5.5+/-4.5 years) were enrolled from a single HTX center. Demographic and clinical data, tobacco use, ESHS, and health perceptions were obtained through self-report and chart reviews. Tobacco use was verified by measurement of urine cotinine levels. Twenty-four women were nonsmokers before and after HTX. Eighteen (37.5%) of the 48 women who were former smokers before HTX had returned to tobacco abuse. Only 4 of the 18 accurately reported their smoking behaviors. Forty percent of nonsmokers reported ESHS. Tobacco use and ESHS were highest among African American women. Forty percent of the sample perceived their health status as fair-poor; the remaining 60% reported good-excellent health. In a multivariate analysis, current tobacco use (odds ratio [OR], 5.20; confidence interval [CI], 3.83-9.13) and ESHS (OR, 1.82; CI, 1.17-2.82) were independent predictors of lower health perceptions. Although a majority of the female recipients who used tobacco ceased smoking before HTX, a substantial proportion demonstrated recurrent tobacco use after HTX. Our findings suggest the need for aggressive screening and risk factor interventions to promote smoking cessation before and after HTX in this unique population of female HTX recipients.
Collapse
|
41
|
Plakht Y, Gilutz H, Shiyovich A, Zahger D, Weitzman S. Gender and ethnic disparities in outcome following acute myocardial infarction among Bedouins and Jews in southern Israel. Eur J Public Health 2010; 21:74-80. [PMID: 20197314 DOI: 10.1093/eurpub/ckq012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous studies have documented gender-ethnic disparities in outcomes following acute myocardial infarction (AMI). This study evaluates such disparities in the Negev, Israel, and reviews potentially responsible mechanisms. METHODS Patients discharged with AMI were classified into young (<70 years), elders (≥70 years) and gender-ethnicity groups: Female Bedouins (FB), Female Jews (FJ), Male Bedouins (MB) and Male Jews (MJ). The primary outcome was 1-year all-cause mortality. Prognosis was assessed using Kaplan-Meier approach. Multivariable analyses assessing hazard ratios (HRs) for mortality were performed using the Cox proportional hazards regression models in two steps controlling for (i) the Ontario Acute Myocardial Infarction Mortality Prediction Rules (OAMIMPRs) and (ii) the OAMIMPR and additional potential confounders. RESULTS Of 2669 subjects, 45.8% were elders, 66.2% male and 10.9% Bedouin. The mortality rate was 12.3% (young 4.6%, elders 22%). Survival was significantly lower in FB compared with MB in the elderly stratum (P = 0.025). Multivariate analyses demonstrated similar risks for dying among the young. In the elders, the first multivariate analysis showed greater risk for mortality in FB. Using FB as the reference group, the HRs were as follows: HR((MB)) = 0.36 [95% confidence interval (CI): 0.14-0.9]; HR((FJ)) = 0.5 (95% CI: 0.27-0.9) and HR((MJ)) = 0.5 (95% CI: 0.28-0.91). In the second analysis, the HRs were as follows: HR((MB)) = 0.37 (95% CI: 0.14-0.93); HR((FJ)) = 0.58 (95% CI: 0.32-1.07) and HR((MJ)) = 0.56 (95% CI: 0.31-1.03). CONCLUSIONS Elderly FB have poor 1-year prognosis following AMI compared with MB, MJ and FJ when controlling for the OAMIMPR model, yet when controlling for other potential confounders the differences are of borderline significance in relation to Jewish subjects. A culturally and economically sensitive programme focusing on tertiary prevention in these patients is warranted.
Collapse
Affiliation(s)
- Ygal Plakht
- Unit of Nursing Research, Soroka University Medical Center, Beer-Sheva, Israel.
| | | | | | | | | |
Collapse
|
42
|
Ariza MA, Vimalananda VG, Rosenzweig JL. The economic consequences of diabetes and cardiovascular disease in the United States. Rev Endocr Metab Disord 2010; 11:1-10. [PMID: 20191325 DOI: 10.1007/s11154-010-9128-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Diabetes-related care and complications constitute a significant proportion of the United States' (US) health care expenditure. Of these complications, cardiovascular disease (CVD) is a major component. Higher morbidity and mortality rates translate to higher costs of care in patients with diabetes compared to those who do not have the disease. Minorities bear a disproportionate burden of diabetes and CVD. We review this disparity and examine potential etiologies for it in Hispanics and African-Americans, the two largest minority groups in the US. We examine strategies in these populations that may improve outcomes in diabetes and CVD, potentially decreasing health care costs.
Collapse
Affiliation(s)
- Miguel A Ariza
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University School of Medicine, 88 East Newton Street, Evans 201, Boston, MA 02118, USA
| | | | | |
Collapse
|
43
|
Basu R, Franzini L, Krueger PM, Lairson DR. Gender Disparities in Medical Expenditures Attributable to Hypertension in the United States. Womens Health Issues 2010; 20:114-25. [DOI: 10.1016/j.whi.2009.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2009] [Revised: 08/22/2009] [Accepted: 12/02/2009] [Indexed: 12/24/2022]
|
44
|
Tabenkin H, Eaton CB, Roberts MB, Parker DR, McMurray JH, Borkan J. Differences in cardiovascular disease risk factor management in primary care by sex of physician and patient. Ann Fam Med 2010; 8:25-32. [PMID: 20065275 PMCID: PMC2807384 DOI: 10.1370/afm.1071] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate differences in the management of cardiovascular disease (CVD) risk factors based upon the sex of the patient and physician and their interaction in primary care practice. METHODS We evaluated CVD risk factor management in 4,195 patients cared for by 39 male and 16 female primary care physicians in 30 practices in southeastern New England. RESULTS Many of the sex-based differences in CVD risk factor management on crude analysis are lost once adjusted for confounding factors found at the level of the patient, physician, and practice. In multilevel adjusted analyses, styles of CVD risk factor management differed by the sex of the physician, with more female physicians documenting diet and weight loss counseling for hypertension (odds ratio [OR] = 2.22; 95% confidence interval [CI], 1.12-4.40) and obesity (OR = 2.14; 95% CI, 1.30-3.51) and more physical activity counseling for obesity (OR = 2.03; 95% CI, 1.30-3.18) and diabetes (OR = 6.55; 95% CI, 2.01-21.33). Diabetes management differed by the sex of the patient, with fewer women receiving glucose-lowering medications (OR = 0.49; 95% CI, 0.25-0.94), angiotensin-converting enzyme inhibitor therapy (OR = 0.39; 95% CI, 0.22-0.72), and aspirin prophylaxis (OR = 0.30; 95% CI, 0.15-0.58). CONCLUSION Quality of care as measured by patients meeting CVD risk factors treatment goals was similar regardless of the sex of the patient or physician. Selected differences were found in the style of CVD risk factor management by sex of physician and patient.
Collapse
Affiliation(s)
- Hava Tabenkin
- Department of Family Medicine, HaEmek Medical Center, Afula, Israel
| | | | | | | | | | | |
Collapse
|
45
|
Mwachofi AK, Broyles R, Khaliq A. Factors Affecting Vocational Rehabilitation Intervention Outcomes. JOURNAL OF DISABILITY POLICY STUDIES 2009. [DOI: 10.1177/1044207309338670] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vocational rehabilitation (VR) services are designed to help individuals with disabilities achieve gainful employment. This study examines VR’s effectiveness in assisting minorities achieve gainful employment. The study uses case management data from 617,149 cases closed by VR in 2006 in all states. It examines differences in access, employment, and earnings for White and ethnic minority clients. Multivariate techniques are used to assess factors that influence competitive employment outcomes, hourly earnings, and hours worked. Findings show significant differences in employment and earnings outcomes for minority and majority clients, with minorities faring worse. VR intervention length and per capita expenditures for services significantly influence employment and earnings outcomes. VR is more effective with White than with minority clients. There is a need to implement policies or practices that ensure equity in access to services that might translate into more equitable employment and earnings outcomes.
Collapse
Affiliation(s)
| | | | - Amir Khaliq
- University of Oklahoma Health Sciences Center
| |
Collapse
|
46
|
Zilbert NR, Stamell EF, Ezon I, Schlager A, Ginsburg HB, Nadler EP. Management and outcomes for children with acute appendicitis differ by hospital type: areas for improvement at public hospitals. Clin Pediatr (Phila) 2009; 48:499-504. [PMID: 19252102 DOI: 10.1177/0009922809332586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Access to health care is a well-recognized issue in health policy, but use once patients have entered the health care system is uncommonly addressed. METHODS We performed a retrospective review of children between 2 and 17 years of age with pathologically confirmed appendicitis at our public city hospital and private university hospital and compared management and outcomes. RESULTS Among patients with acute appendicitis, the median length of stay was a day longer in the public hospital (2 days vs 1 day, P = <.001) despite a similar complication rate (12% vs 11%). More computed tomography (CT) scans were performed at the public hospital (36% vs 21%, P = .02) with a trend toward less use of ultrasound (US) (54% vs 65%, P = .13). CONCLUSIONS Children at the public city hospital have a longer length of stay and undergo more expensive imaging. These findings may provide areas for improvement to optimize the care of children with appendicitis at government-funded institutions.
Collapse
Affiliation(s)
- Nathan R Zilbert
- Division of Pediatric Surgery, Department of Surgery, NYU School of Medicine, New York, New York, USA
| | | | | | | | | | | |
Collapse
|
47
|
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
|
48
|
Greene Jackson D, Hamilton P, Hutchinson S, Huber J. The effect of patients' race on provider treatment choices in coronary care: a literature review for model development. Policy Polit Nurs Pract 2009; 10:40-63. [PMID: 19383618 DOI: 10.1177/1527154409331395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This selective literature review provides insight into the depth and breadth of the problem of unequal medical treatment of Blacks compared with Whites, with particular focus on coronary heart disease. Poor health outcomes among Blacks, when compared with Whites, are well documented, and these disparities are linked to lower quality of and less aggressive medical treatment. It is not clear why these disparities in treatment occur. This review provides theoretical frameworks that attempt to explain the effect of race on treatment and presents an analysis of the quality and strength of existing evidence of racial disparity related to coronary care. Based on the review, implications for policy makers and providers are identified.
Collapse
|
49
|
Heart Failure in Hispanics. J Am Coll Cardiol 2009; 53:1167-75. [DOI: 10.1016/j.jacc.2008.12.037] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 10/31/2008] [Accepted: 12/01/2008] [Indexed: 11/21/2022]
|
50
|
Doroodchi H, Abdolrasulnia M, Foster JA, Foster E, Turakhia MP, Skelding KA, Sagar K, Casebeer LL. Knowledge and attitudes of primary care physicians in the management of patients at risk for cardiovascular events. BMC FAMILY PRACTICE 2008; 9:42. [PMID: 18611255 PMCID: PMC2474612 DOI: 10.1186/1471-2296-9-42] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 07/08/2008] [Indexed: 11/18/2022]
Abstract
Background Adherence to clinical practice guidelines for management of cardiovascular disease (CVD) is suboptimal. The purposes of this study were to identify practice patterns and barriers among U.S. general internists and family physicians in regard to cardiovascular risk management, and examine the association between physician characteristics and cardiovascular risk management. Methods A case vignette survey focused on cardiovascular disease risk management was distributed to a random sample of 12,000 U.S. family physicians and general internists between November and December 2006. Results Responses from a total of 888 practicing primary care physicians who see 60 patients per week were used for analysis. In an asymptomatic patient at low risk for cardiovascular event, 28% of family physicians and 37% of general internists made guideline-based preventive choices for no antiplatelet therapy (p < .01). In a patient at high risk for cardiovascular event, 59% of family physicians and 56% of general internists identified the guideline-based goal for serum fasting LDL level (< 100 mg/dl). Guideline adherence was inversely related to years in practice and volume of patients seen. Cost of medications (87.7%), adherence to medications (74.1%), adequate time for counseling (55.7%), patient education tools (47.1%), knowledge and skills to recommend dietary changes (47.8%) and facilitate patient adherence (52.0%) were cited as significant barriers to CVD risk management. Conclusion Despite the benefits demonstrated for managing cardiovascular risks, gaps remain in primary care practitioners' management of risks according to guideline recommendations. Innovative educational approaches that address barriers may facilitate the implementation of guideline-based recommendations in CVD risk management.
Collapse
|