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Schmidt FP, Geyer M, Sotiriou E, Ardic Y, Sadegh P, Schulz E, Münzel T, von Bardeleben RS. Guideline-endorsed follow-up after percutaneous valve therapies-non-attendance of TAVI and MitraClip patients. Herz 2024:10.1007/s00059-024-05245-2. [PMID: 38743296 DOI: 10.1007/s00059-024-05245-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Percutaneous valve therapies (PVT) are performed on a large number of patients. With increasing procedural volume, the need for follow-up has also increased. Follow-up in the heart valve clinic is endorsed by recent guidelines but utilization is unknown, making resource allocation in the clinic difficult. Central follow-up in valve centers may not be feasible for all patients in the future. METHODS In our center, follow-up for PVT patients is scheduled at 1 month and 12 months after the index procedure. Patients are reminded of their appointment by invitation letters or phone calls. We analyzed 150 consecutive patients who underwent transcutaneous aortic valve implantation (TAVI) and MitraClip implantation (n = 300) at our center. RESULTS At 1 month, 72.7% of patients attended their follow-up, while at 12 months the rate dropped to 58%. Patients who underwent TAVI were older than the MitraClip patients (82.7 vs. 76.1 years) but had lower mean logEuroSCORE (22.6% vs. 25.9%). There was no significant difference in 1‑year mortality between TAVI and MitraClip patients (20% vs. 17.3%). By contrast, the rate of missed follow-up visits was higher for TAVI compared to MitraClip patients (52% vs. 33.3%; p = 0.002). Female patients less frequently attended follow-up (p = 0.005), whereas age, EuroSCORE, NYHA class, ejection fraction, and health status (EQ-5DVAS) were not predictors of attendance in multivariable analysis. Although the result of the EQ-5D assessment was not associated with mortality or attendance, completing the questionnaire was associated with overall survival (p < 0.001). CONCLUSION In our heart valve clinic, we observed a high percentage of missed follow-up appointments (42% at 12 months) despite a structured follow-up plan. Factors significantly associated with non-attendance in multivariable analysis were female gender and having a TAVI rather than MitraClip. Future follow-up concepts should take such findings into account, and decentralized approaches need to be explored.
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Affiliation(s)
- Frank Patrick Schmidt
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany.
- Inneren Medizin 3, Klinikum Mutterhaus der Borromäerinnen, Feldstr. 16, 54290, Trier, Germany.
| | - Martin Geyer
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Efthymios Sotiriou
- Inneren Medizin 3, Klinikum Mutterhaus der Borromäerinnen, Feldstr. 16, 54290, Trier, Germany
| | - Yasemin Ardic
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Pantea Sadegh
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | | | - Thomas Münzel
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
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Martín-Román ÁL, Moral A, Pinillos-Franco S. Are women breaking the glass ceiling? A gendered analysis of the duration of sick leave in Spain. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2024; 24:107-134. [PMID: 37095293 PMCID: PMC10124936 DOI: 10.1007/s10754-023-09351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 03/17/2023] [Indexed: 05/03/2023]
Abstract
We study the gender gap in the duration of sick leave in Spain by splitting this duration into two types of days - those which are related to biological characteristics and those derived from behavioral reasons. Using the Statistics of Accidents at Work for 2011-2019, we found that women presented longer standard durations (i.e., purely attached to physiological reasons) compared to men. However, when estimating individuals' efficiency as the ratio between actual and standard durations, we found that women were more inefficient at lower levels of income, whereas in case of men, this occurred at higher levels of income. These results were reinforced when considering that men and women do not recover from the same injury at the same rate. Women were more efficient than men across all the compensation distribution, especially at higher income levels.
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Affiliation(s)
- Ángel L Martín-Román
- Dpto. Análisis Económico, Facultad de Ciencias Sociales Jurídicas Y de La Comunicación, Universidad de Valladolid, Plaza Universidad, 40005, Segovia, Spain.
| | - Alfonso Moral
- Dpto. Análisis Económico, Facultad de Ciencias Sociales Jurídicas Y de La Comunicación, Universidad de Valladolid, Plaza Universidad, 40005, Segovia, Spain
| | - Sara Pinillos-Franco
- Dpto. Análisis Económico, Facultad de Ciencias Económicas Y Empresariales, Universidad Autónoma de Madrid, Calle Francisco Tomás Y Valiente 5, 28049, Madrid, Spain
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Zhu C, Tran PM, Leifheit EC, Spatz ES, Dreyer RP, Nyhan K, Wang SY, Lichtman JH. Association of marital/partner status and patient-reported outcomes following myocardial infarction: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead018. [PMID: 36942107 PMCID: PMC10023828 DOI: 10.1093/ehjopen/oead018] [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: 01/09/2023] [Revised: 02/07/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
AIMS Little is known about the relationship between marital/partner status and patient-reported outcome measures (PROMs) following myocardial infarction (MI). We conducted a systematic review/meta-analysis and explored potential sex differences. METHODS AND RESULTS We searched five databases (Medline, Web of Science, Scopus, EMBASE, and PsycINFO) from inception to 27 July 2022. Peer-reviewed studies of MI patients that evaluated marital/partner status as an independent variable and reported its associations with defined PROMs were eligible for inclusion. Results for eligible studies were classified into four pre-specified outcome domains [health-related quality of life (HRQoL), functional status, symptoms, and personal recovery (i.e. self-efficacy, adherence, and purpose/hope)]. Study quality was appraised using Newcastle-Ottawa Scale, and data were synthesized by outcome domains. We conducted subgroup analysis by sex. We included 34 studies (n = 16 712), of which 11 were included in meta-analyses. Being married/partnered was significantly associated with higher HRQoL {six studies [n = 2734]; pooled standardized mean difference, 0.37 [95% confidence interval (CI), 0.12-0.63], I 2 = 51%} but not depression [three studies (n = 2005); pooled odds ratio, 0.72 (95% CI, 0.32-1.64); I 2 = 65%] or self-efficacy [two studies (n = 356); pooled β, 0.03 (95% CI, -0.09 to 0.14); I 2 = 0%]. The associations of marital/partner status with functional status, personal recovery outcomes, and symptoms of anxiety and fatigue were mixed. Sex differences were not evident due to mixed results from the available studies. CONCLUSIONS Married/partnered MI patients had higher HRQoL than unpartnered patients, but the associations with functional, symptom, and personal recovery outcomes and sex differences were less clear. Our findings inform better methodological approaches and standardized reporting to facilitate future research on these relationships.
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Affiliation(s)
- Cenjing Zhu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT 06510, USA
| | - Phoebe M Tran
- Department of Public Health, University of Tennessee, 1914 Andy Holt Ave, Knoxville, TN 37996, USA
| | - Erica C Leifheit
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT 06510, USA
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale School of Medicine, 195 Church St., 5th Floor, New Haven, CT 06510, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Rachel P Dreyer
- Department of Biostatistics, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA
- Department of Emergency Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, 333 Cedar St, New Haven, CT 06510, USA
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA
| | - Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT 06510, USA
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Hasan EM, Calma CL, Tudor A, Vernic C, Palade E, Tudorache E, Oancea C, Papava I. Gender Differences in Coping, Depression, and Anxiety in Patients with Non-Metastatic Lung Cancer. Cancer Manag Res 2022; 14:2041-2052. [PMID: 35757160 PMCID: PMC9231683 DOI: 10.2147/cmar.s368992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/08/2022] [Indexed: 01/10/2023] Open
Abstract
Background Depression and anxiety are prevalent issues amongst individuals suffering from thoracic cancer. Gender differences in coping with thoracic cancer have a serious impact upon the management of emotional distress. The purpose of our study has been to assess sex variations in handling anxiety and depression, including the use of coping mechanisms and their relationship with respect to anxiety and depression. Methods This cross-sectional study registered 18 women and 22 men with non-metastatic lung cancer and operated upon. Pre-operatively and at one month post-operatively, the patients were assessed by means of scales (COPE, GAD-7 and PHQ-9). Results Post-operatively, the intensity of depression and anxiety was substantially greater in males than in females (p = 0.049, p = 0.042). Male individuals tended to use coping mechanisms of humour (p = 0.009) and restraint (p = 0.029) significantly more frequently than women. Moreover, in women, depression correlated significantly with denial and behavioural deactivation (rho = 0.465, p = 0.029, respectively, rho = 0.562, p = 0.006); whilst anxiety, similarly, correlated with positive interpretation, behavioural deactivation, and use of social-emotional support (rho = 0.484, p = 0.022, respectively, rho = 0.590, p = 0.004 and rho = 0.502, p = 0.017). Furthermore, in males, depression correlated significantly with mental deactivation, use of social-instrumental and social-emotional support (rho = 0.702, p = 0.001, respectively, rho = 0.505, p=0.033, and rho = 0.773 with p < 0.001), whilst anxiety correlated significantly with mental deactivation, denial, and use of social-emotional support (rho = 0.597, p = 0.009, respectively, rho = 0.553 with p = 0.017 and rho = 0.755, p < 0.001). Conclusion There were gender divergences in the use of coping mechanisms and the level of post-surgical anxiety and depression. We found significant positive relationships between some coping mechanisms and depression/anxiety. The patient’s gender governs the coping style, which in turn has bearing upon the post-operative evolution.
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Affiliation(s)
| | - Crenguta Livia Calma
- Department of Functional Sciences, Center of Immuno-Physiology (CIFBIOTEH), "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Anca Tudor
- Department of Functional Sciences, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Corina Vernic
- Department of Functional Sciences, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Emanuel Palade
- Department of Cardiovascular and Thoracic Surgery, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Thoracic Surgery, "Leon Daniello" Pneumophtysiology Hospital, Cluj-Napoca, Romania
| | - Emanuela Tudorache
- Department of Infectious Diseases, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Cristian Oancea
- Department of Infectious Diseases, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Ion Papava
- Department of Neuroscience, NEUROPSY - COG Center for Cognitive Research in Neuropsychiatric Pathology, "Victor Babes," University of Medicine and Pharmacy, Timișoara, Romania
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Efectos de la rehabilitación cardiaca en el paciente cardiovascular con ansiedad y depresión. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
BACKGROUND Illness perception is composed of thoughts, ideas, and beliefs about illness, and a negative illness perception is known to be associated with poor outcomes. Among men and women, clinical outcomes after heart valve surgery are known to differ, but knowledge about differences in illness perception is sparse. OBJECTIVES The aim of this study is to describe the differences in illness perception among men and women after open heart valve surgery and to identify sociodemographic and clinical characteristics associated with worse illness perception in men and women. METHODS In a national cross-sectional study combined with register-based clinical and sociodemographic information, data on illness perception were collected with the Brief Illness Perception Questionnaire. Worse illness perception was defined as the worst quartile of each item of the Brief Illness Perception Questionnaire. Multiple logistic regression analyses were conducted to explore characteristics associated with worse illness perception. RESULTS Of 1084 eligible patients, 32% (n = 349) completed the questionnaire (67% men; mean age, 68 years). Compared with men, women reported significantly worse scores of illness perception in 6 of 8 items. Furthermore, being female, age, length of stay, and comorbidity were associated with worse illness perception (worse quartile of scores). Age, higher educational level, and comorbidity were found to be associated with worse illness perception for men and length of stay for women. CONCLUSION After open heart valve surgery, illness perception differs among men and women, with women having worse illness perception. Among the total population, being female, age, a longer length of stay, and comorbidity were also associated with worse illness perception.
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Bechtel AJ, Huffmyer JL. Gender Differences in Postoperative Outcomes After Cardiac Surgery. Anesthesiol Clin 2020; 38:403-415. [PMID: 32336392 DOI: 10.1016/j.anclin.2020.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Women presenting for cardiac surgery tend to be older and have hypertension, diabetes, and overweight or underweight body mass index than men. Despite improvements in surgical techniques and medications, women have increased risk for morbidity and mortality after multiple types of cardiac surgery. Women presenting for transcatheter aortic valve replacement are older and frailer than men, and have increased risk of intraoperative complications, but lower mortality at mid- and long-term ranges compared with men. Adherence to recovery and rehabilitation from cardiac surgery is challenging for women. Solutions should focus on increased family support, and use of group exercise and activities.
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Affiliation(s)
- Allison J Bechtel
- Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA 22908-0710, USA
| | - Julie L Huffmyer
- Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA 22908-0710, USA.
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Rodrigues HF, Furuya RK, Dantas RAS, Rodrigues AJ, Dessotte CAM. Association of preoperative anxiety and depression symptoms with postoperative complications of cardiac surgeries. Rev Lat Am Enfermagem 2018; 26:e3107. [PMID: 30517589 PMCID: PMC6280174 DOI: 10.1590/1518-8345.2784.3107] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 10/08/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE to investigate the associations of preoperative anxiety and depression symptoms with postoperative complications and with sociodemographic and clinical characteristics of patients submitted to the first coronary artery bypass graft. METHOD observational, analytical and longitudinal study. A consecutive non-probabilistic sample consisted of patients submitted to coronary artery bypass graft. To evaluate the symptoms, the Hospital Anxiety and Depression Scale was used. tracheal intubation for more than 48 hours, hemodynamic instability, sensorineural deficit, agitation, hyperglycemia, infection, nausea, vomiting, pain and death were classified as complications. The Mann-Whitney and Spearman Correlation tests were used, with a significance level of 0.05. RESULTS a total of 75 patients participated. The group that presented hemodynamic instability in the postoperative period had a greater median for the anxiety symptoms (p = 0.012), as well as the women (p = 0.028). The median of the depression symptoms was higher in the group presenting nausea (p = 0.002), agitation (p <0.001), tracheal intubation for more than 48 hours (p = 0.018) and sensorineural deficit (p = 0.016). CONCLUSION there was association of the symptoms of preoperative anxiety with hemodynamic instability in the postoperative period and with the female gender, as well as association of depression symptoms with the following complications: nausea, agitation, time of intubation in the postoperative period and sensorineural deficit.
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Affiliation(s)
| | | | - Rosana Aparecida Spadoti Dantas
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Alfredo José Rodrigues
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil
| | - Carina Aparecida Marosti Dessotte
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
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Jaworska S, Ryan K. Gender and the language of pain in chronic and terminal illness: A corpus-based discourse analysis of patients' narratives. Soc Sci Med 2018; 215:107-114. [DOI: 10.1016/j.socscimed.2018.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 08/30/2018] [Accepted: 09/03/2018] [Indexed: 11/26/2022]
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Psychological Profile in Coronary Artery By-Pass Graft Patients vs. Valve Replacement Patients Entering Cardiac Rehabilitation after Surgery. Sci Rep 2018; 8:14381. [PMID: 30258180 PMCID: PMC6158272 DOI: 10.1038/s41598-018-32696-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/13/2018] [Indexed: 11/16/2022] Open
Abstract
Anxiety and depression are thought to influence the genesis of ischemic diseases and not of valvular diseases, but little is known on the psychological profile of cardiac patients after surgery. Aim of this study was to investigate differences in disease experience and mood between patients undergoing cardiac rehabilitation after coronary artery by-pass graft (CABG) or after valve replacement (VR). We studied 1,179 CABG and 737 VR patients who completed the Illness Behaviour Questionnaire and the Hospital Anxiety and Depression Scale after surgery. We tested the independent effect of the type of surgery by multivariate analysis and between-group differences in prevalence of clinically relevant scores. Relevant scores in the psychosomatic concern scale were more frequent in CABG than in VR patients. After correction by age, sex, education and marital status, scores of disease conviction and psychosomatic concern were higher in CABG patients, scores of denial were higher in VR patients. Unexpectedly, anxiety and depression scores did not differ between groups. Results suggest providing psychological support for anxiety and depression to both VR and CABG patients during cardiac rehabilitation, and planning differentiated interventions of cardiac rehabilitation and secondary prevention tailored to the specific psychological reactions of CABG and VR patients.
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Yu J, Baber U, Mastoris I, Dangas G, Sartori S, Steg PG, Cohen DJ, Giustino G, Chandrasekhar J, Ariti C, Witzenbichler B, Henry TD, Kini AS, Krucoff MW, Gibson CM, Chieffo A, Moliterno DJ, Colombo A, Pocock S, Mehran R. Sex-Based Differences in Cessation of Dual-Antiplatelet Therapy Following Percutaneous Coronary Intervention With Stents. JACC Cardiovasc Interv 2017; 9:1461-9. [PMID: 27478113 DOI: 10.1016/j.jcin.2016.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to compare the incidence and impact of cessation of dual-antiplatelet therapy (DAPT) in women and men treated with percutaneous coronary intervention. BACKGROUND Nonadherence to cardiovascular medications and female sex are associated with worse outcomes. However, the patterns and impact of DAPT cessation in women compared with men following percutaneous coronary intervention have not been studied. METHODS Baseline characteristics, patterns of DAPT cessation, and 2-year clinical outcomes were compared in 5,031 patients (1,279 women, 3,739 men) enrolled following successful percutaneous coronary intervention with stents in the PARIS (Patterns of Non-Adherence to Antiplatelet Regimens in Stented Patients) study. DAPT cessation was adjudicated as physician-guided discontinuation, interruption for surgery, or disruption due to bleeding or noncompliance. Clinical endpoints were major adverse cardiac events (a composite of cardiac death, definite or probable stent thrombosis, spontaneous myocardial infarction, or clinically indicated target lesion revascularization), a second restricted definition of major adverse cardiac events excluding target lesion revascularization, and bleeding. RESULTS DAPT cessation was more common in women than men (59.1% vs. 55.9%, p = 0.007) and comprised increased rates of discontinuation, disruption for bleeding, and disruption due to noncompliance. The impact of DAPT cessation was similar regardless of sex and varied according the mode; in particular, disruption was associated with increased risk for both ischemic and bleeding events. After adjusting for differences in baseline and treatment characteristics as well as DAPT cessation events, female sex remained an independent predictor of bleeding but not of ischemic events. CONCLUSIONS DAPT cessation was more common in women, but its impact was similar in women and men. Female sex was an independent predictor of bleeding but not of ischemic events after adjustment for differences in DAPT cessation and baseline and treatment characteristics.
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Affiliation(s)
- Jennifer Yu
- Prince of Wales Clinical School, University of New South Wales, Randwick, Australia; Icahn School of Medicine at Mount Sinai, New York, New York
| | - Usman Baber
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - George Dangas
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - David J Cohen
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | | | | | - Cono Ariti
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Timothy D Henry
- Minneapolis Heart Institute Foundation, University of Minnesota, Minneapolis, Minnesota
| | | | | | | | | | | | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York.
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Saeidi M, Komasi S, Heydarpour B, Momeni K, Zakiei A. Those Who Perceive Their Disease as a Physiological or Psychological Risk Factor Experience More Anxiety at the Beginning of the Cardiac Rehabilitation Program. Res Cardiovasc Med 2016; 5:e29291. [PMID: 28203550 PMCID: PMC5297864 DOI: 10.5812/cardiovascmed.29291] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 05/06/2015] [Accepted: 05/06/2015] [Indexed: 11/30/2022] Open
Abstract
Background: In a cardiac patient, anxiety is the result of the individual’s perception of the treatment and is characterized by inability to predict, control, or achieve the desired treatment outcomes. Objectives: This study was carried out to investigate the extent of clinical anxiety in patients who underwent a cardiac rehabilitation program with different attitudes toward the disease risk factors. Patients and Methods: The administrative data of this retrospective study were obtained from the database of the cardiac rehabilitation department of a hospital in Iran. The demographic and clinical information of 603 patients from April 2006 to April 2011 was collected using compiled forms of this database, the Beck anxiety inventory, and the structured clinical interview for axis I disorders. The univariate analysis of variance and the Bonferroni post-hoc analysis were used for data analysis. Results: After controlling for gender and educational level, we observed statistically significant differences in the modified means between the patients who considered the behavioral risk factors and those who considered the physiological risk factors (P = 0.012, MD = 5.03) and between the patients who regarded the behavioral risk factors and those who regarded the psychological risk factors (P = 0.0005, MD = 5.32) as the underlying cause of their cardiac condition, which means that the level of anxiety in the physiological and psychological groups was higher than that in the behavioral group. Conclusions: The anxiety of patients can be controlled through alteration in their attitudes toward the disease risk factors on the grounds that psychological or physiological factors per se do not trigger the occurrence of the disease, whereas behavioral risk factors, as the controlling agent, significantly influence its occurrence.
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Affiliation(s)
- Mozhgan Saeidi
- Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Saeid Komasi
- Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
- Corresponding author: Saeid Komasi, Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Shahid Beheshti Blvd., Kermanshah, IR Iran. Tel: +98-8338380698, Fax: +98-8338360043, E-mail:
| | - Behzad Heydarpour
- Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Khodamorad Momeni
- Department of Psychology, Kermanshah Razi University, Kermanshah, IR Iran
| | - Ali Zakiei
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
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Meyer G, Badenhoop K, Linder R. Addison's disease with polyglandular autoimmunity carries a more than 2·5-fold risk for adrenal crises: German Health insurance data 2010-2013. Clin Endocrinol (Oxf) 2016; 85:347-53. [PMID: 26896640 DOI: 10.1111/cen.13043] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 01/23/2016] [Accepted: 02/16/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Adrenal crises are potentially life-threatening complications in patients with adrenal insufficiency (AI). Our objective was to investigate the frequency of adrenal crises in different forms of AI. DESIGN/PATIENTS The Statutory Health Insurance (SHI) database of the Techniker Krankenkasse - covering more than 12% of the German population - was analysed for diagnostic codes from 1 January 2010 to 31 December 2013. MEASUREMENTS By analysis of routine data from a large healthcare provider. Diagnoses of AI were recorded and classified in primary AI, secondary AI and autoimmune polyglandular syndrome (APS). The ICD-code E27·2 (AC) was retrieved in all cohorts. RESULTS We found a prevalence of 222/million for secondary and 126/million for primary AI. AC was documented with a frequency of 4·8/100 patient years. Crises were significantly more frequent in patients with primary (7·6/100 patient years) compared to those with secondary AI (3·2/100 patient years; P < 0·0001). Prevalence of crises was higher in individuals with APS (10·9/100 patient years) and highest in patients with primary AI and type 1 diabetes (12·5/100 patient years). CONCLUSIONS Applying a SHI database comprising more than 9 million individuals, we identified robust data about the risk of AC in different groups of patients with AI. Our data confirm and extend the clinical observation that patients with APS are at highest risk for AC. Approximately 1 of 8 patients with primary AI and type 1 diabetes suffers from an AC each year. Specific targeting of efforts aiming at the prevention of AC is necessary.
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Affiliation(s)
- Gesine Meyer
- Department of Medicine 1 - Endocrinology, Goethe-University Hospital, Frankfurt, Germany
| | - Klaus Badenhoop
- Department of Medicine 1 - Endocrinology, Goethe-University Hospital, Frankfurt, Germany
| | - Roland Linder
- WINEG, Scientific Institute of the TK for Benefit and Efficiency in Health Care, Hamburg, Germany
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Grady KL, Sherri Wissman, Naftel DC, Myers S, Gelijins A, Moskowitz A, Pagani FD, Young JB, Spertus JA, Kirklin JK. Age and gender differences and factors related to change in health-related quality of life from before to 6 months after left ventricular assist device implantation: Findings from Interagency Registry for Mechanically Assisted Circulatory Support. J Heart Lung Transplant 2016; 35:777-88. [PMID: 27068037 DOI: 10.1016/j.healun.2016.01.1222] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 12/11/2015] [Accepted: 01/28/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Gaps in the literature exist regarding health-related quality of life (HRQOL) early after left ventricular assist device (LVAD) surgery. The purposes of our study were to describe HRQOL over time, by age and gender, and identify risk factors for poor HRQOL early after LVAD implant. METHODS Patients (n = 7,353) from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database received a continuous-flow LVAD as a primary implant at 133 United States hospitals. Of these, 5,640 patients had pre-LVAD HRQOL data, 3,353 patients had 6-month post-LVAD HRQOL data, and 2,748 patients had data at both times. HRQOL was measured using the EQ-5D-3L (Euro-Qol) instrument. Data were collected pre-implant and 3 and 6 months post-operatively. Statistical analyses included chi-square test, t-test, Pearson correlation coefficients, and multiple regression analysis. RESULTS Overall HRQOL and dimensions of HRQOL improved from before to 6 months after device implant when examined by age and gender. However, younger patients and women reported significantly more problems regarding all dimensions before implant and significantly more problems regarding pain/discomfort and anxiety/depression at 3 and 6 months after implant. An increase in overall HRQOL from before to 6 months after implant was related to pre-implant INTERMACS Level 1. Factors related to a decrease in HRQOL from before to 6 months after implant were listed for heart transplant before surgery, comorbidities, better preoperative HRQOL, adverse events within 6 months after implant, bridge to transplant moderately likely and unlikely, and New York Heart Association Functional Classification IV at 6 months after LVAD (R(2) = 41%). CONCLUSIONS Overall HRQOL and dimensions of HRQOL improve in sub-groups of patients from before to 6 months after surgery, although differences in improvement exist. Adverse events are risk factors for decreased HRQOL across time and support the ongoing need to improve device technology with the aim of reducing adverse events.
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Affiliation(s)
- Kathleen L Grady
- Division of Cardiac Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Sherri Wissman
- Comprehensive Transplant Center, Ohio State University Medical Center, Columbus, Ohio
| | - David C Naftel
- Department of Surgery, University of Alabama, Birmingham, Birmingham, Alabama
| | - Susan Myers
- Department of Surgery, University of Alabama, Birmingham, Birmingham, Alabama
| | - Annetine Gelijins
- Department of Population Health Science and Policy, Mount Sinai Medical Center, New York, New York
| | - Alan Moskowitz
- Departments of Medicine and Population Health Science and Policy, Mount Sinai Medical Center, New York, New York
| | - Francis D Pagani
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - James B Young
- Department of Medicine, Cleveland Clinic Foundation Lerner College of Medicine, Cleveland, Ohio
| | - John A Spertus
- Division of Cardiovascular Research, St. Luke's Mid America Heart Institute, St. Luke's Mid America Heart Institute and University of Missouri Kansas City, Kansas City, Missouri
| | - James K Kirklin
- Department of Surgery, University of Alabama, Birmingham, Birmingham, Alabama
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Saeidi M, Komasi S, Heydarpour B, Karim H, Nalini M, Ezzati P. Predictors of Clinical Anxiety Aggravation at the End of a Cardiac Rehabilitation Program. Res Cardiovasc Med 2015; 5:e30091. [PMID: 26937419 PMCID: PMC4750222 DOI: 10.5812/cardiovascmed.30091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 06/13/2015] [Accepted: 06/29/2015] [Indexed: 11/20/2022] Open
Abstract
Background: Anxiety is one of the most primary and common reactions to a cardiac event can lead to hypertension, tachycardia, and high cardiac output. Objectives: To investigate the predictors of clinical anxiety aggravation at the end of a cardiac rehabilitation (CR) program. Patients and Methods: This retrospective study used a database of a CR ward of a hospital in Iran. The demographic and clinical information of 574 patients participating in the CR program from April 2005 through April 2010 were analyzed. In order to determine the predictors of anxiety, binary logistic regression was performed. Results: After adjustment for gender, age and education, the results showed that 16.7% of the patients completed their CR program with increased levels of clinical anxiety. The following study variables were independently predictive of increased anxiety at the end of the CR program: male gender (OR = 2.04, 95% CI = 1.11 to 3.33, P = 0.048), no history of diabetes (OR = 4.24, 95% CI = 172 to 10.44, P = 0.002), family history of cardiac disease (OR = 2.63, 95% CI = 1.03 to 6.74, P = 0.043), and not quitting smoking (OR = 3.29, 95% CI = 1.38 to 7.85, P = 0.007). These variables could explain 9% - 15% of the variance in the dependent variable. Conclusions: It is possible to predict higher anxiety levels at the end of the CR program and implement preventive measures to control anxiety by considering certain demographic and clinical variables. Future studies should assess the predictive power of other variables.
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Affiliation(s)
- Mozhgan Saeidi
- Department of Clinical Psychology, Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Saeid Komasi
- Department of Clinical Psychology, Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
- Corresponding author: Saeid Komasi, Department of Clinical Psychology, Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran., Tel.: +98-8338380698, Fax: +98-8338360043, E-mail:
| | - Behzad Heydarpour
- Department of Clinical Psychology, Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Hossein Karim
- Department of Cardiovascular Surgery, Imam Ali Heart Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Mehdi Nalini
- Heart Researches Center, Imam Ali Heart Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Parvin Ezzati
- Department of Clinical Psychology, Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
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Abstract
BACKGROUND It is a struggle to identify the most adaptive coping strategies with disease-mediated stress. Here, we hypothesize that intensity of coping strategies, including denial, in patients with end-stage renal disease (ESRD), varies with type of renal replacement therapy (RRT). MATERIAL AND METHODS We enrolled 60 in-center hemodialyzed patients (HD) and 55 patients treated with continuous ambulatory peritoneal dialysis (CAPD). We administered the Coping Inventory with Stressful Situation, Profile of Mood States, and Stroop Anxiety Inventory to measure patient coping strategies in the context of their ESRD. Denial defense mechanism was measured via the IBS-R/ED. The Nottingham Health Profile was used to evaluate self-perceived quality of life. Serum potassium, urea, creatinine, phosphorus, calcium, albumin, and hematocrit were utilized as the measurements of adequacy of dialysis. RESULTS HD patients had higher self-reported intensity of denial mechanism and avoidance-oriented strategies versus CAPD patients. Because a single strategy is almost never employed, we conducted cluster analysis. We identify 3 patterns of coping strategies using cluster analysis. "Repressors" employed denial and avoidance strategies and were predominant in HD. The second cluster consists of subjects employing predominantly task-oriented strategies with equal distribution among dialyzed patients. The third cluster encompassed a small group of patients who shared higher intensity of both denial and task-oriented strategies. Health-related outcome, anxiety, and mood profile were similar across all patients. CONCLUSIONS HD patients predominantly used "repressive" strategies. Patients on RRT utilized denial and avoidance-based strategies to achieve satisfactory outcome in terms of perceived quality of life. We conclude that these coping mechanisms that were previously thought to be inferior are beneficial to patient compliance with RRT.
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Affiliation(s)
- Zbigniew Nowak
- Department of Nephrology and Dialysotherapy, Military Institute of Medicine, Warsaw, Poland
| | - Zofia Wańkowicz
- Department of Nephrology and Dialysotherapy, Military Institute of Medicine, Warsaw, Poland
| | - Krzysztof Laudanski
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
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