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Kotini-Shah P, Pobee R, Karfunkle BL, Granado MN, Vanden Hoek TL, Buhimschi IA, Li J. Sex Hormone Trajectories and Association to Outcomes After Out-of-Hospital Cardiac Arrest. Resuscitation 2024:110356. [PMID: 39127123 DOI: 10.1016/j.resuscitation.2024.110356] [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: 04/29/2024] [Revised: 08/05/2024] [Accepted: 08/05/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Outcomes and susceptibility to out-of-hospital cardiac arrest (OHCA) are known to differ by sex, yet little is known about changes in sex hormones after OHCA. We sought to determine the trajectory of sex hormones after OHCA and their association to survival and neurological outcome. METHODS Plasma samples were collected from those that survived to hospital admission at four time points (1, 6, 24, and 48 hours) and estrone, estradiol, progesterone, and testosterone concentrations were quantified via liquid chromatography-mass spectrometry. Trends in hormones were plotted over time by sex and outcomes. The association between sex, hormone levels with survival and neurological outcome (cerebral performance category 1-2 indicating good outcome and 3-5 for poor outcome) were determined using generalized estimating equation models. RESULTS Of the 94 OHCA patients, 50 were males and 44 females, with a mean age of 61.3 (+15.7) years. Despite older age and lower BCPR in females compared to males, females had higher proportion of good neurological outcome compared to males. Over the 48 hours, estrone increased, testosterone decreased, and estradiol and progesterone remained flat. Survivors had lower levels of estrone at all time points but only at early time points for estradiol, progesterone and testosterone. Lower estrone level predicted survival at discharge, even after adjusting for time, sex, age, and hormones independently (β=-3.38, 95% CI= -5.71, -0.85). Females had better neurological scores compared to males after adjusting for estrone (β=1.27, 95% CI= 0.01, 2.53) and estradiol (β=2.92, 95% CI= 1.13, 4.70). CONCLUSIONS Survivors and those with favorable neurological outcome had lower trend in estrone. The sex hormone estrone, present in both males and females, may be a predictor of survival. When adjusted for estrogens, female sex had better neurological recovery compared to males. The difference in neurological outcome by sex is not explained by estrogens. However, these finding open the door for exploration of other sex-specific pathways in resuscitation after OHCA.
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Affiliation(s)
| | - Ruth Pobee
- Emergency Medicine, University of Illinois Chicago College of Medicine
| | | | - Misha N Granado
- University of Texas Health Houston, McGovern School of Medicine
| | - Terry L Vanden Hoek
- Emergency Medicine, University of Illinois Chicago College of Medicine; Center for Advanced Resuscitation Medicine, University of Illinois Chicago College of Medicine
| | - Irina A Buhimschi
- Obstetrics & Gynecology, University of Illinois Chicago College of Medicine
| | - Jing Li
- Emergency Medicine, University of Illinois Chicago College of Medicine; Center for Advanced Resuscitation Medicine, University of Illinois Chicago College of Medicine
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Coll-Vinent B, Sugranyes G. Sex and gender need to be integrated into emergency medicine. Recommendations for research and clinical practice. Eur J Emerg Med 2024:00063110-990000000-00140. [PMID: 39037732 DOI: 10.1097/mej.0000000000001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Affiliation(s)
- Blanca Coll-Vinent
- Comissió Clínica de Sexe i Gènere en Salut, Hospital Clínic
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
- Emergency Department, Hospital Clínic
| | - Gisela Sugranyes
- Comissió Clínica de Sexe i Gènere en Salut, Hospital Clínic
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
- Department of Child and Adolescent Psychiatry and Psychology Institute of Neuroscience, Hospital Clínic, Barcelona
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G04, Madrid, Spain
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Bijman LAE, Alotaibi R, Jackson CA, Clegg G, Halbesma N. Association between sex and survival after out-of-hospital cardiac arrest: A systematic review and meta-analysis. J Am Coll Emerg Physicians Open 2023; 4:e12943. [PMID: 37128297 PMCID: PMC10148381 DOI: 10.1002/emp2.12943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 05/03/2023] Open
Abstract
The current literature on sex differences in 30-day survival following out-of-hospital cardiac arrest (OHCA) is conflicting, with 3 recent systematic reviews reporting opposing results. To address these contradictions, this systematic literature review and meta-analysis aimed to synthesize the literature on sex differences in survival after OHCA by including only population-based studies and through separate meta-analyses of crude and adjusted effect estimates. MEDLINE and Embase databases were systematically searched from inception to March 23, 2022 to identify observational studies reporting sex-specific 30-day survival or survival until hospital discharge after OHCA. Two meta-analyses were conducted. The first included unadjusted effect estimates of the association between sex and survival (comparing males vs females), whereas the second included effect estimates adjusted for possible mediating and/or confounding variables. The PROSPERO registration number was CRD42021237887, and the search identified 6712 articles. After the screening, 164 potentially relevant articles were identified, of which 26 were included. The pooled estimate for crude effect estimates (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.22-1.66) indicated that males have a higher chance of survival after OHCA than females. However, the pooled estimate for adjusted effect estimates shows no difference in survival after OHCA between males and females (OR, 0.93; 95% CI, 0.84-1.03). Both meta-analyses involved high statistical heterogeneity between studies: crude pooled estimate I2 = 95.7%, adjusted pooled estimate I2 = 91.3%. There does not appear to be a difference in survival between males and females when effect estimates are adjusted for possible confounding and/or mediating variables in non-selected populations.
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Affiliation(s)
| | | | | | - Gareth Clegg
- Usher InstituteUniversity of EdinburghEdinburghUK
- Resuscitation Research GroupThe University of EdinburghEdinburghUK
| | - Nynke Halbesma
- Usher InstituteUniversity of EdinburghEdinburghUK
- Resuscitation Research GroupThe University of EdinburghEdinburghUK
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Wagner MK, Christensen AV, Hassager C, Stenbæk DS, Ekholm O, Borregaard B, Thrysoee L, Rasmussen TB, Thorup CB, Mols RE, Juel K, Berg SK. Sex Differences in Patient-Reported Outcomes in the Immediate Recovery Period After Resuscitation: Findings From the Cross-sectional DenHeart Survey. J Cardiovasc Nurs 2023; 38:279-287. [PMID: 37027133 PMCID: PMC10090329 DOI: 10.1097/jcn.0000000000000914] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND A paucity of resuscitation studies have examined sex differences in patient-reported outcomes upon hospital discharge. It remains unclear whether male and female patients differ in health outcomes in their immediate responses to trauma and treatment after resuscitation. OBJECTIVES The aim of this study was to examine sex differences in patient-reported outcomes in the immediate recovery period after resuscitation. METHODS In a national cross-sectional survey, patient-reported outcomes were measured by 5 instruments: symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), illness perception (Brief Illness Perception Questionnaire [B-IPQ]), symptom burden (Edmonton Symptom Assessment Scale [ESAS]), quality of life (Heart Quality of Life Questionnaire), and perceived health status (12-Item Short Form Survey). RESULTS Of 491 eligible survivors of cardiac arrest, 176 (80% male) participated. Compared with male, resuscitated female reported worse symptoms of anxiety (Hospital Anxiety and Depression Scale-Anxiety score ≥8) (43% vs 23%; P = .04), emotional responses (B-IPQ) (mean [SD], 4.9 [3.12] vs 3.7 [2.99]; P = .05), identity (B-IPQ) (mean [SD], 4.3 [3.10] vs 4.0 [2.85]; P = .04), fatigue (ESAS) (mean [SD], 5.26 [2.48] vs 3.92 [2.93]; P = .01), and depressive symptoms (ESAS) (mean [SD], 2.60 [2.68] vs 1.67 [2.19]; P = .05). CONCLUSIONS Between sexes, female survivors of cardiac arrest reported worse psychological distress and illness perception and higher symptom burden in the immediate recovery period after resuscitation. Attention should focus on early symptom screening at hospital discharge to identify those in need of targeted psychological support and rehabilitation.
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Dadon Z, Fridel T, Einav S. The association between CPR quality of In-hospital resuscitation and sex: A hypothesis generating, prospective observational study. Resusc Plus 2022; 11:100280. [PMID: 35935175 PMCID: PMC9352447 DOI: 10.1016/j.resplu.2022.100280] [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: 03/27/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction The relationship between sex and cardiopulmonary resuscitation (CPR) outcomes remains unclear. Particularly, questions remain regarding the potential contribution of unmeasured confounders. We aimed to examine the differences in the quality of chest compression delivered to men and women. Methods Prospective study of observational data recorded during consecutive resuscitations occurring in a single tertiary center (Feb-1-2015 to Dec-31-2018) with real-time follow-up to hospital discharge. The studied variables included time in CPR, no-flow-time and fraction, compression rate and depth and release velocity. The primary study endpoint was the unadjusted association between patient sex and the chest compression quality (depth and rate). The secondary endpoint was the association between the various components of chest compression quality, sex, and survival to hospital discharge/neurologically intact survival. Results Overall 260 in-hospital resuscitations (57.7% male patients) were included. Among these 100 (38.5%) achieved return of spontaneous circulation (ROSC) and 35 (13.5%) survived to hospital discharge. Female patients were significantly older. Ischemic heart disease and ventricular arrhythmias were more prevalent among males. Compression depth was greater in female vs male patients (54.9 ± 11.3 vs 51.7 ± 10.9 mm; p = 0.024). Other CPR quality-metrics were similar. The rates of ROSC, survival to hospital discharge and neurologically intact survival did not differ between males and females. Univariate analysis revealed no association between sex, quality metrics and outcomes. Discussion Women received deeper chest compressions during in-hospital CPR. Our findings require corroboration in larger cohorts but nonetheless underscore the need to maintain high-quality CPR in all patients using real-time feedback devices. Future studies should also include data on ventilation rates and volumes which may contribute to survival outcomes.
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Verghese D, Harsha Patlolla S, Cheungpasitporn W, Doshi R, Miller VM, Jentzer JC, Jaffe AS, Holmes DR, Vallabhajosyula S. Sex Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction in the United States. Resuscitation 2022; 172:92-100. [DOI: 10.1016/j.resuscitation.2022.01.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/16/2022] [Accepted: 01/24/2022] [Indexed: 02/08/2023]
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Bjertnæs LJ, Hindberg K, Næsheim TO, Suborov EV, Reierth E, Kirov MY, Lebedinskii KM, Tveita T. Rewarming From Hypothermic Cardiac Arrest Applying Extracorporeal Life Support: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:641633. [PMID: 34055829 PMCID: PMC8155640 DOI: 10.3389/fmed.2021.641633] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/04/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: This systematic review and meta-analysis aims at comparing outcomes of rewarming after accidental hypothermic cardiac arrest (HCA) with cardiopulmonary bypass (CPB) or/and extracorporeal membrane oxygenation (ECMO). Material and Methods: Literature searches were limited to references with an abstract in English, French or German. Additionally, we searched reference lists of included papers. Primary outcome was survival to hospital discharge. We assessed neurological outcome, differences in relative risks (RR) of surviving, as related to the applied rewarming technique, sex, asphyxia, and witnessed or unwitnessed HCA. We calculated hypothermia outcome prediction probability score after extracorporeal life support (HOPE) in patients in whom we found individual data. P < 0.05 considered significant. Results: Twenty-three case observation studies comprising 464 patients were included in a meta-analysis comparing outcomes of rewarming with CPB or/and ECMO. One-hundred-and-seventy-two patients (37%) survived to hospital discharge, 76 of 245 (31%) after CPB and 96 of 219 (44 %) after ECMO; 87 and 75%, respectively, had good neurological outcomes. Overall chance of surviving was 41% higher (P = 0.005) with ECMO as compared with CPB. A man and a woman had 46% (P = 0.043) and 31% (P = 0.115) higher chance, respectively, of surviving with ECMO as compared with CPB. Avalanche victims had the lowest chance of surviving, followed by drowning and people losing consciousness in cold environments. Assessed by logistic regression, asphyxia, unwitnessed HCA, male sex, high initial body temperature, low pH and high serum potassium (s-K+) levels were associated with reduced chance of surviving. In patients displaying individual data, overall mean predictive surviving probability (HOPE score; n = 134) was 33.9 ± 33.6% with no significant difference between ECMO and CPB-treated patients. We also surveyed 80 case reports with 96 victims of HCA, who underwent resuscitation with CPB or ECMO, without including them in the meta-analysis. Conclusions: The chance of surviving was significantly higher after rewarming with ECMO, as compared to CPB, and in patients with witnessed compared to unwitnessed HCA. Avalanche victims had the lowest probability of surviving. Male sex, high initial body temperature, low pH, and high s-K+ were factors associated with low surviving chances.
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Affiliation(s)
- Lars J. Bjertnæs
- Anesthesia and Critical Care Research Group, University of Tromsø (UiT), The Arctic University of Norway, Tromsø, Norway
| | - Kristian Hindberg
- K. G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø (UiT), The Arctic University of Norway, Tromsø, Norway
| | - Torvind O. Næsheim
- Cardiovascular Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø (UiT), The Arctic University of Norway, Tromsø, Norway
| | - Evgeny V. Suborov
- The Nikiforov Russian Federation Center of Emergency and Radiation Medicine, St. Petersburg, Russia
| | - Eirik Reierth
- Science and Health Library, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Mikhail Y. Kirov
- Department of Anesthesiology and Intensive Care, Northern State Medical University, Arkhangelsk, Russia
| | - Konstantin M. Lebedinskii
- Department of Anesthesiology and Intensive Care, North-Western State Medical University Named After I. I. Mechnikov, St. Petersburg, Russia
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Torkjel Tveita
- Anesthesia and Critical Care Research Group, University of Tromsø (UiT), The Arctic University of Norway, Tromsø, Norway
- Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway
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8
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Feng D, Li C, Yang X, Wang L. Gender differences and survival after an out-of-hospital cardiac arrest: a systematic review and meta-analysis. Intern Emerg Med 2021; 16:765-775. [PMID: 33174152 DOI: 10.1007/s11739-020-02552-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/23/2020] [Indexed: 11/26/2022]
Abstract
Patients who experience out-of-hospital cardiac arrest (OHCA) have unacceptably high mortality rates. It remains unclear whether gender has an association with survival in this regard. Hence, we aimed to investigate the association between gender and survival by conducting a systematic review and meta-analysis. The databases of PubMed, Embase, and Cochrane Database of Systematic Reviews were searched from inception to 17 March, 2020. Studies assessing the association between gender and survival to discharge or 30-day survival after OHCA were included. Two reviewers independently assessed the eligibility of the identified studies. The random-effects model was used to pool data, and the outcome was reported as odds ratios (ORs) and 95% confidence intervals, as the relative measure of association. Twenty-three eligible studies enrolling 897,805 patients were included in this systematic review. Overall, women were older and less likely to experience arrest in public places. When arrest occurred, women had less initial shockable rhythm, were less likely to be witnessed by bystanders, and were less likely provided with CPR compared with men. After admission, women underwent less coronary angiography, percutaneous coronary angiography, and targeted temperature management therapy. Eleven studies with ORs were pooled, showing a significant survival benefit in women (OR = 1.08, p < 0.05, I2 = 52.3%). In the subgroup analysis, both premenopausal women (< 50 years) (OR = 1.42, p < 0.001, I2 = 0%) and postmenopausal women (≥ 50 years) (OR = 1.07, p < 0.05, I2 = 16.4%) had higher odds of survival compared with age-matched men. Despite the unfavorable factors, the pooled results showed a significant survival benefit in women after OHCA, especially in premenopausal women.
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Affiliation(s)
- Dejing Feng
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong-Ti South Road, Beijing, 10020, China
| | - Chuang Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong-Ti South Road, Beijing, 10020, China
| | - Xinchun Yang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong-Ti South Road, Beijing, 10020, China
| | - Lefeng Wang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong-Ti South Road, Beijing, 10020, China.
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Vallabhajosyula S, Verghese D, Desai VK, Sundaragiri PR, Miller VM. Sex differences in acute cardiovascular care: a review and needs assessment. Cardiovasc Res 2021; 118:667-685. [PMID: 33734314 PMCID: PMC8859628 DOI: 10.1093/cvr/cvab063] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/16/2021] [Accepted: 03/03/2021] [Indexed: 12/17/2022] Open
Abstract
Despite significant progress in the care of patients suffering from cardiovascular disease, there remains a persistent sex disparity in the diagnosis, management, and outcomes of these patients. These sex disparities are seen across the spectrum of cardiovascular care, but, are especially pronounced in acute cardiovascular care. The spectrum of acute cardiovascular care encompasses critically ill or tenuous patients with cardiovascular conditions that require urgent or emergent decision-making and interventions. In this narrative review, the disparities in the clinical course, management, and outcomes of six commonly encountered acute cardiovascular conditions, some with a known sex-predilection will be discussed within the basis of underlying sex differences in physiology, anatomy, and pharmacology with the goal of identifying areas where improvement in clinical approaches are needed.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA.,Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Dhiran Verghese
- Department of Medicine, Amita Health Saint Joseph Hospital, Chicago, IL, USA
| | - Viral K Desai
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Pranathi R Sundaragiri
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Virginia M Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Blom MT, Oving I, Berdowski J, van Valkengoed IGM, Bardai A, Tan HL. Women have lower chances than men to be resuscitated and survive out-of-hospital cardiac arrest. Eur Heart J 2020; 40:3824-3834. [PMID: 31112998 PMCID: PMC6911168 DOI: 10.1093/eurheartj/ehz297] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/15/2019] [Accepted: 04/24/2019] [Indexed: 12/13/2022] Open
Abstract
Aims Previous studies on sex differences in out-of-hospital cardiac arrest (OHCA) had limited scope and yielded conflicting results. We aimed to provide a comprehensive overall view on sex differences in care utilization, and outcome of OHCA. Methods and results We performed a population-based cohort-study, analysing all emergency medical service (EMS) treated resuscitation attempts in one province of the Netherlands (2006–2012). We calculated odds ratios (ORs) for the association of sex and chance of a resuscitation attempt by EMS, shockable initial rhythm (SIR), and in-hospital treatment using logistic regression analysis. Additionally, we provided an overview of sex differences in overall survival and survival at successive stages of care, in the entire study population and in patients with SIR. We identified 5717 EMS-treated OHCAs (28.0% female). Women with OHCA were less likely than men to receive a resuscitation attempt by a bystander (67.9% vs. 72.7%; P < 0.001), even when OHCA was witnessed (69.2% vs. 73.9%; P < 0.001). Women who were resuscitated had lower odds than men for overall survival to hospital discharge [OR 0.57; 95% confidence interval (CI) 0.48–0.67; 12.5% vs. 20.1%; P < 0.001], survival from OHCA to hospital admission (OR 0.88; 95% CI 0.78–0.99; 33.6% vs. 36.6%; P = 0.033), and survival from hospital admission to discharge (OR 0.49, 95% CI 0.40–0.60; 33.1% vs. 51.7%). This was explained by a lower rate of SIR in women (33.7% vs. 52.7%; P < 0.001). After adjustment for resuscitation parameters, female sex remained independently associated with lower SIR rate. Conclusion In case of OHCA, women are less often resuscitated by bystanders than men. When resuscitation is attempted, women have lower survival rates at each successive stage of care. These sex gaps are likely explained by lower rate of SIR in women, which can only partly be explained by resuscitation characteristics. ![]()
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Affiliation(s)
- Marieke T Blom
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Iris Oving
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Jocelyn Berdowski
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Irene G M van Valkengoed
- Department of Public Health, Amsterdam UMC, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Abdenasser Bardai
- Department of Clinical Genetics, Amsterdam UMC, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
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Zachariasse JM, Borensztajn DM, Nieboer D, Alves CF, Greber-Platzer S, Keyzer-Dekker CMG, Maconochie IK, Steyerberg EW, Smit FJ, Moll HA. Sex-specific differences in children attending the emergency department: prospective observational study. BMJ Open 2020; 10:e035918. [PMID: 32948551 PMCID: PMC7500294 DOI: 10.1136/bmjopen-2019-035918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the role of sex in the presentation and management of children attending the emergency department (ED). DESIGN The TrIAGE project (TRiage Improvements Across General Emergency departments), a prospective observational study based on curated electronic health record data. SETTING Five diverse European hospitals in four countries (Austria, The Netherlands, Portugal, UK). PARTICIPANTS All consecutive paediatric ED visits of children under the age of 16 during the study period (8-36 months between 2012 and 2015). MAIN OUTCOME MEASURES The association between sex (male of female) and diagnostic tests and disease management in general paediatric ED visits and in subgroups presenting with trauma or musculoskeletal, gastrointestinal and respiratory problems and fever. Results from the different hospitals were pooled in a random effects meta-analysis. RESULTS 116 172 ED visits were included of which 63 042 (54%) by boys and 53 715 (46%) by girls. Boys accounted for the majority of ED visits in childhood, and girls in adolescence. After adjusting for age, triage urgency and clinical presentation, girls had more laboratory tests compared with boys (pooled OR 1.10, 95% CI 1.05 to 1.15). Additionally, girls had more laboratory tests in ED visits for respiratory problems (pooled OR 1.15, 95% CI 1.04 to 1.26) and more imaging in visits for trauma or musculoskeletal problems (pooled OR 1.10, 95% CI 1.01 to 1.20) and respiratory conditions (pooled OR 1.14, 95% CI 1.05 to 1.24). Girls with respiratory problems were less often treated with inhalation medication (pooled OR 0.76, 95% CI 0.70 to 0.83). There was no difference in hospital admission between the sexes (pooled OR 0.99, 95% CI 0.95 to 1.04). CONCLUSION In childhood, boys represent the majority of ED visits and they receive more inhalation medication. Unexpectedly, girls receive more diagnostic tests compared with boys. Further research is needed to investigate whether this is due to pathophysiological differences and differences in disease course, whether girls present signs and symptoms differently, or whether sociocultural factors are responsible.
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Affiliation(s)
- Joany M Zachariasse
- Department of General Paediatrics, Erasmus MC- Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dorine M Borensztajn
- Department of General Paediatrics, Erasmus MC- Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
| | - Claudio F Alves
- Department of Paediatrics, Emergency Unit, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | | | | | - Ian K Maconochie
- Department of Pediatric Emergency Medicine, Imperial College NHS Healthcare Trust, London, UK
| | - Ewout W Steyerberg
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Frank J Smit
- Department of Paediatrics, Maasstad Hospital, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of General Paediatrics, Erasmus MC- Sophia Children's Hospital, Rotterdam, The Netherlands
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12
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Goto Y, Funada A, Maeda T, Okada H, Goto Y. Sex-specific differences in survival after out-of-hospital cardiac arrest: a nationwide, population-based observational study. Crit Care 2019; 23:263. [PMID: 31345244 PMCID: PMC6659261 DOI: 10.1186/s13054-019-2547-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/18/2019] [Indexed: 11/14/2022] Open
Abstract
Background It remains unclear whether men have more favorable survival outcomes after out-of-hospital cardiac arrest (OHCA) than women. Methods We reviewed a total of 386,535 patients aged ≥ 18 years with OHCA who were included in the Japanese registry from 2013 to 2016. The study endpoints were the rates of 1-month survival and neurologically intact survival (Cerebral Performance Category Scale score = 1 or 2). Based on age, the reviewed patients were categorized into the following eight groups: < 30, 30–39, 40–49, 50–59, 60–69, 70–79, 80–89, and ≥ 90 years. The survival outcomes in men and women were compared using hierarchical propensity score matching. Results The crude survival rate was significantly higher in men than in women in five groups: 30–39, 40–49, 50–59, 60–69, and 70–79 years (all P < 0.001). Similarly, the crude neurologically intact survival rate was significantly higher in men than in women in seven groups: < 30, 30–39, 40–49, 50–59, 60–69, 70–79, and 80–89 years (all P < 0.005). However, multivariate logistic regression analysis of each group revealed no significant sex-specific differences in 1-month survival outcomes (all P > 0.02). Moreover, after hierarchical propensity score matching, the survival outcomes did not significantly differ between both sexes (all P > 0.05). Conclusions No significant sex-specific differences were found in the rates of 1-month survival and neurologically intact survival after OHCA. Electronic supplementary material The online version of this article (10.1186/s13054-019-2547-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yoshikazu Goto
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Takaramachi 13-1, Kanazawa, 920-8640, Japan.
| | - Akira Funada
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Takaramachi 13-1, Kanazawa, 920-8640, Japan
| | - Tetsuo Maeda
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Takaramachi 13-1, Kanazawa, 920-8640, Japan
| | - Hirofumi Okada
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Takaramachi 13-1, Kanazawa, 920-8640, Japan
| | - Yumiko Goto
- Department of Cardiology, Yawata Medical Center, Yawata I 12-7, Komatsu, 923-8551, Japan
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13
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Heyer JH, Cao NA, Amdur RL, Rao RR. Postoperative Complications Following Orthopedic Spine Surgery: Is There a Difference Between Men and Women? Int J Spine Surg 2019; 13:125-131. [PMID: 31131211 DOI: 10.14444/6017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Patient sex is known to affect outcomes following surgery. Prior studies have not specifically examined sex-stratified outcomes following spine surgery. The objective is to determine the differences between men and women in terms of 30-day complications following spine surgery. Methods The National Surgical Quality Improvement Program database was queried for patients undergoing spine surgery from 2005 to 2014. Postoperative data were analyzed to determine the differences between men and women with regard to 30-day complications. Results A total of 41 315 patients (49.0% women, 51% men) were analyzed. Men were more likely to have diabetes (P = .004) and be active smokers (P < .001). Women were more likely to be taking steroids for chronic conditions (P < .001). Postoperatively, women were at increased risk for superficial surgical site infection, urinary tract infection, transfusions, and longer length of stay, whereas men were at increased risk of pneumonia and reintubation. On multivariate analysis, women were associated with urinary tract infections (odds ratio = 2.17) and transfusions (odds ratio = 1.63). Conclusions Differences in complications are evident between men and women following spine surgery. These differences should be considered during preoperative planning and when consenting patients for surgery. Level of Evidence 4.
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Affiliation(s)
- Jessica H Heyer
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC
| | - N A Cao
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC
| | - Richard L Amdur
- Medical Faculty Associates, Department of Surgery, George Washington University, Washington, DC
| | - Raj R Rao
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC
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14
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Jarman AF, Mumma BE, Perman SM, Kotini-Shah P, McGregor AJ. When the Female Heart Stops: Sex and Gender Differences in Out-of-Hospital Cardiac Arrest Epidemiology and Resuscitation. Clin Ther 2019; 41:1013-1019. [PMID: 31053294 DOI: 10.1016/j.clinthera.2019.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/21/2019] [Accepted: 03/27/2019] [Indexed: 11/16/2022]
Abstract
Sex- and gender-based differences are emerging as clinically significant in the epidemiology and resuscitation of patients with out-of-hospital cardiac arrest (OHCA). Female patients tend to be older, experience arrest in private locations, and have fewer initial shockable rhythms (ventricular fibrillation/ventricular tachycardia). Despite standardized algorithms for the management of OHCA, women are less likely to receive evidence-based interventions, including advanced cardiac life support medications, percutaneous coronary intervention, and targeted temperature management. While some data suggest a protective mechanism of estrogen in the heart, brain, and kidney, its role is incompletely understood. Female patients experience higher mortality from OHCA, prompting the need for sex-specific research.
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Affiliation(s)
- Angela F Jarman
- Department of Emergency Medicine, University of California-Davis, Sacramento, CA, USA.
| | - Bryn E Mumma
- Department of Emergency Medicine, University of California-Davis, Sacramento, CA, USA
| | - Sarah M Perman
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Alyson J McGregor
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
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15
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Jeong JS, Kong SY, Shin SD, Ro YS, Song KJ, Hong KJ, Park JH, Kim TH. Gender disparities in percutaneous coronary intervention in out-of-hospital cardiac arrest. Am J Emerg Med 2019; 37:632-638. [DOI: 10.1016/j.ajem.2018.06.068] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/05/2018] [Accepted: 06/29/2018] [Indexed: 11/30/2022] Open
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16
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Nehme Z, Andrew E, Bernard S, Smith K. Sex differences in the quality-of-life and functional outcome of cardiac arrest survivors. Resuscitation 2019; 137:21-28. [DOI: 10.1016/j.resuscitation.2019.01.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/17/2019] [Accepted: 01/26/2019] [Indexed: 11/28/2022]
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17
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Dicker B, Conaglen K, Howie G. Gender and survival from out-of-hospital cardiac arrest: a New Zealand registry study. Emerg Med J 2018; 35:367-371. [DOI: 10.1136/emermed-2017-207176] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/07/2018] [Accepted: 03/21/2018] [Indexed: 11/03/2022]
Abstract
ObjectiveTo determine the relationships between survival from all-cause out-of-hospital cardiac arrest (OHCA) and gender in New Zealand.MethodsA retrospective observational study was conducted using data compliant with the Utstein guidelines from the St John New Zealand OHCA Registry for adult patients who were treated for an OHCA between 1 October 2013 and 30 September 2015. Univariate logistic regression was used to investigate factors associated with return of spontaneous circulation sustained to handover at hospital and survival to 30 days. Multivariate logistic regression models were used to investigate outcome differences in survival according to gender at 30 days postevent.ResultsWomen survived to hospital handover in 29% of cases, which was not significantly different from men (31%). When adjusted for age, location, aetiology, initial rhythm and witnessed status, there was no significant difference in 30-day survival between men (16%) and women (13%) (adjusted OR 1.22, 95% CI (0.96 to 1.55), p=0.11).ConclusionNo statistical differences were found in 30-day survival between genders when adjustments for unfavourable Utstein variables were accounted for.
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18
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Hansoti B, Aluisio AR, Barry MA, Davey K, Lentz BA, Modi P, Newberry JA, Patel MH, Smith TA, Vinograd AM, Levine AC. Global Health and Emergency Care: Defining Clinical Research Priorities. Acad Emerg Med 2017; 24:742-753. [PMID: 28103632 DOI: 10.1111/acem.13158] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/03/2017] [Accepted: 01/07/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Despite recent strides in the development of global emergency medicine (EM), the field continues to lag in applying a scientific approach to identifying critical knowledge gaps and advancing evidence-based solutions to clinical and public health problems seen in emergency departments (EDs) worldwide. Here, progress on the global EM research agenda created at the 2013 Academic Emergency Medicine Global Health and Emergency Care Consensus Conference is evaluated and critical areas for future development in emergency care research internationally are identified. METHODS A retrospective review of all studies compiled in the Global Emergency Medicine Literature Review (GEMLR) database from 2013 through 2015 was conducted. Articles were categorized and analyzed using descriptive quantitative measures and structured data matrices. The Global Emergency Medicine Think Tank Clinical Research Working Group at the Society for Academic Emergency Medicine 2016 Annual Meeting then further conceptualized and defined global EM research priorities utilizing consensus-based decision making. RESULTS Research trends in global EM research published between 2013 and 2015 show a predominance of observational studies relative to interventional or descriptive studies, with the majority of research conducted in the inpatient setting in comparison to the ED or prehospital setting. Studies on communicable diseases and injury were the most prevalent, with a relative dearth of research on chronic noncommunicable diseases. The Global Emergency Medicine Think Tank Clinical Research Working Group identified conceptual frameworks to define high-impact research priorities, including the traditional approach of using global burden of disease to define priorities and the impact of EM on individual clinical care and public health opportunities. EM research is also described through a population lens approach, including gender, pediatrics, and migrant and refugee health. CONCLUSIONS Despite recent strides in global EM research and a proliferation of scholarly output in the field, further work is required to advocate for and inform research priorities in global EM. The priorities outlined in this paper aim to guide future research in the field, with the goal of advancing the development of EM worldwide.
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Affiliation(s)
- Bhakti Hansoti
- Department of Emergency Medicine; Johns Hopkins University School of Medicine; Baltimore MD
| | - Adam R. Aluisio
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
| | - Meagan A. Barry
- Department of Medicine; Section of Emergency Medicine; Baylor College of Medicine; Houston TX
| | - Kevin Davey
- Department of Emergency Medicine; University of California San Francisco; San Francisco CA
| | - Brian A. Lentz
- Department of Emergency Medicine; Johns Hopkins University School of Medicine; Baltimore MD
| | - Payal Modi
- Department of Emergency Medicine; University of Massachusetts Medical School; Worcester MA
| | | | - Melissa H. Patel
- Department of Emergency Medicine; Johns Hopkins University School of Medicine; Baltimore MD
| | - Tricia A. Smith
- Department of Emergency Medicine; University of Connecticut School of Medicine; San Francisco CA
| | - Alexandra M. Vinograd
- Department of Emergency Medicine; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA
| | - Adam C. Levine
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
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19
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Bosson N, Kaji AH, Fang A, Thomas JL, French WJ, Shavelle D, Niemann JT. Sex Differences in Survival From Out-of-Hospital Cardiac Arrest in the Era of Regionalized Systems and Advanced Post-Resuscitation Care. J Am Heart Assoc 2016; 5:JAHA.116.004131. [PMID: 27633392 PMCID: PMC5079051 DOI: 10.1161/jaha.116.004131] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate sex differences in out-of-hospital cardiac arrest (OHCA) characteristics, interventions, and outcomes. METHODS AND RESULTS This is a retrospective analysis from a regionalized cardiac arrest system. Data on patients treated for OHCA are reported to a single registry, from which all adult patients were identified from 2011 through 2014. Characteristics, treatment, and outcomes were evaluated with stratification by sex. The adjusted odds ratio (OR) for survival with good neurological outcome (cerebral performance category 1 or 2) was calculated for women compared to men. There were 5174 out-of-hospital cardiac arrests (OHCAs; 3080 males and 2094 females). Women were older, median 71 (interquartile range [IQR], 59-82) versus 66 years (IQR, 55-78). Despite similar frequency of witnessed arrest, women were less likely to present with a shockable rhythm (22% vs 35%; risk difference [RD], 13%; 95% CI, 11-15), have ST-segment elevation myocardial infarction (23% vs 32%; RD, 13%; 95% CI, 7-11), or receive coronary angiography (11% vs 25%; RD, 14%; 95% CI, 12-16), percutaneous coronary intervention (5% vs 14%; RD, 9%; 95% CI, 7-11), or targeted temperature management (33% vs 40%; RD, 7%; 95% CI, 4-10). Women had decreased survival to discharge (33% vs 40%; RD, 7%; 95% CI, 4-10) and a lower proportion of good neurological outcome (16% vs 24%; RD, 8%; 95% CI, 6-10). In multivariable modeling, female sex was not associated with decreased survival with good neurological outcome (OR, 0.9; 95% CI, 0.8-1.1). CONCLUSIONS Sex-related differences in OHCA characteristics and treatment are predictors of survival outcome disparities. With adjustment for these factors, sex was not associated with survival or neurological outcome after OHCA.
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Affiliation(s)
- Nichole Bosson
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, CA Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA The David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Amy H Kaji
- Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA The David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Joseph L Thomas
- Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA The David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - William J French
- Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA The David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - David Shavelle
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - James T Niemann
- Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA The David Geffen School of Medicine at UCLA, Los Angeles, CA
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20
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Greenberg MR, Safdar B, Choo EK, McGregor AJ, Becker LB, Cone DC. Future directions in sex- and Gender-specific Emergency Medicine. Acad Emerg Med 2014; 21:1339-42. [PMID: 25421874 DOI: 10.1111/acem.12520] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/01/2014] [Indexed: 12/30/2022]
Abstract
The 2014 Academic Emergency Medicine (AEM) consensus conference "Gender-Specific Research in Emergency Medicine: Investigate, Understand, and Translate How Gender Affects Patient Outcomes" convened a diverse group of stakeholders to target gaps in emergency medicine (EM) sex- and gender-specific research and identify research priorities. At the close of the conference, the executive committee sought feedback from group leaders and conference attendees about the next critical steps in EM sex- and gender-specific research, goals for their own future research, and anticipated barriers in pursuing this research. This article summarizes this feedback on the future directions in sex- and gender-specific research in emergency care and strategies to overcome barriers.
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Affiliation(s)
- Marna R. Greenberg
- Department of Emergency Medicine; Lehigh Valley Health Network/USF Morsani College of Medicine; Allentown PA
| | - Basmah Safdar
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - Esther K. Choo
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
| | - Alyson J. McGregor
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
| | - Lance B. Becker
- Department of Emergency Medicine; Perelman School of Medicine; University of Pennsylvania; Philadelphia PA
| | - David C. Cone
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
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21
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McGregor AJ, Frank Peacock W, Marie Chang A, Safdar B, Diercks D. Sex- and gender-specific research priorities for the emergency management of heart failure and acute arrhythmia: proceedings from the 2014 Academic Emergency Medicine Consensus Conference Cardiovascular Research Workgroup. Acad Emerg Med 2014; 21:1361-9. [PMID: 25422074 DOI: 10.1111/acem.12526] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 08/11/2014] [Accepted: 08/29/2014] [Indexed: 12/27/2022]
Abstract
The emergency department (ED) is the point of first contact for patients with acute heart failure and arrhythmias, with 1 million annual ED visits in the United States. Although the total numbers of men and women living with heart failure are similar, female patients are underrepresented in clinical studies, with current knowledge predominantly based on data from male patients. This has led to an underappreciation of the sex-specific differences in clinical characteristics and pathophysiology-based management of heart failure. Similar disparities have been found in management of acute arrhythmias, especially atrial arrhythmias that lead to an increased risk of stroke in women. Additionally, peripartum and postpartum cardiomyopathy represent a diagnostic and treatment dilemma. This article is the result of a breakout session in the cardiovascular and resuscitation work group of the 2014 Academic Emergency Medicine consensus conference "Gender-Specific Research in Emergency Medicine: Investigate, Understand, and Translate How Gender Affects Patient Outcomes." A nominal group technique was used to identify and prioritize themes and research questions using electronic mail, monthly conference calls, in-person meetings, and Web-based surveys between June 2013 and May 2014. Consensus was achieved through three rounds of nomination followed by the meeting on May 13, 2014, and resulted in seven priority themes that are essential to the common complex clinical syndrome of heart failure for both men and women and include the areas of pathophysiology; presentation and symptomatology; and diagnostic strategies using biomarkers, treatment, and mortality, with special consideration to arrhythmia management and pregnancy.
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Affiliation(s)
- Alyson J. McGregor
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
| | - W. Frank Peacock
- Department of Emergency Medicine; Baylor College of Medicine; Portland OR
| | - Anna Marie Chang
- Section of Emergency Medicine; Oregon Health and Science University; Portland OR
| | - Basmah Safdar
- Department of Emergency Medicine; Yale University; New Haven CT
| | - Deborah Diercks
- Department of Emergency Medicine; UC Davis Medical Center; Davis CA
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