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Damluji AA, Myerburg RJ, Chongthammakun V, Feldman T, Rosenberg DG, Schrank KS, Keroff FM, Grossman M, Cohen MG, Moscucci M. Improvements in Outcomes and Disparities of ST-Segment–Elevation Myocardial Infarction Care. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.117.004038. [DOI: 10.1161/circoutcomes.117.004038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Abdulla A. Damluji
- From the Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, MD (A.A.D., M.M.); Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.D.); Cardiovascular Division (R.J.M., V.C., D.G.R., M.G.C.) and Division of Emergency Medicine (K.S.S.), University of Miami Miller School of Medicine, FL; Wertheim College of Medicine, Miami Cardiac and Vascular Institute, Baptist Health and Florida International University (T.F.); Department of Emergency Medicine, Memorial
| | - Robert J. Myerburg
- From the Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, MD (A.A.D., M.M.); Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.D.); Cardiovascular Division (R.J.M., V.C., D.G.R., M.G.C.) and Division of Emergency Medicine (K.S.S.), University of Miami Miller School of Medicine, FL; Wertheim College of Medicine, Miami Cardiac and Vascular Institute, Baptist Health and Florida International University (T.F.); Department of Emergency Medicine, Memorial
| | - Vasutakarn Chongthammakun
- From the Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, MD (A.A.D., M.M.); Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.D.); Cardiovascular Division (R.J.M., V.C., D.G.R., M.G.C.) and Division of Emergency Medicine (K.S.S.), University of Miami Miller School of Medicine, FL; Wertheim College of Medicine, Miami Cardiac and Vascular Institute, Baptist Health and Florida International University (T.F.); Department of Emergency Medicine, Memorial
| | - Theodore Feldman
- From the Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, MD (A.A.D., M.M.); Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.D.); Cardiovascular Division (R.J.M., V.C., D.G.R., M.G.C.) and Division of Emergency Medicine (K.S.S.), University of Miami Miller School of Medicine, FL; Wertheim College of Medicine, Miami Cardiac and Vascular Institute, Baptist Health and Florida International University (T.F.); Department of Emergency Medicine, Memorial
| | - Donald G. Rosenberg
- From the Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, MD (A.A.D., M.M.); Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.D.); Cardiovascular Division (R.J.M., V.C., D.G.R., M.G.C.) and Division of Emergency Medicine (K.S.S.), University of Miami Miller School of Medicine, FL; Wertheim College of Medicine, Miami Cardiac and Vascular Institute, Baptist Health and Florida International University (T.F.); Department of Emergency Medicine, Memorial
| | - Kathleen S. Schrank
- From the Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, MD (A.A.D., M.M.); Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.D.); Cardiovascular Division (R.J.M., V.C., D.G.R., M.G.C.) and Division of Emergency Medicine (K.S.S.), University of Miami Miller School of Medicine, FL; Wertheim College of Medicine, Miami Cardiac and Vascular Institute, Baptist Health and Florida International University (T.F.); Department of Emergency Medicine, Memorial
| | - Frederick M. Keroff
- From the Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, MD (A.A.D., M.M.); Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.D.); Cardiovascular Division (R.J.M., V.C., D.G.R., M.G.C.) and Division of Emergency Medicine (K.S.S.), University of Miami Miller School of Medicine, FL; Wertheim College of Medicine, Miami Cardiac and Vascular Institute, Baptist Health and Florida International University (T.F.); Department of Emergency Medicine, Memorial
| | - Marc Grossman
- From the Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, MD (A.A.D., M.M.); Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.D.); Cardiovascular Division (R.J.M., V.C., D.G.R., M.G.C.) and Division of Emergency Medicine (K.S.S.), University of Miami Miller School of Medicine, FL; Wertheim College of Medicine, Miami Cardiac and Vascular Institute, Baptist Health and Florida International University (T.F.); Department of Emergency Medicine, Memorial
| | - Mauricio G. Cohen
- From the Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, MD (A.A.D., M.M.); Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.D.); Cardiovascular Division (R.J.M., V.C., D.G.R., M.G.C.) and Division of Emergency Medicine (K.S.S.), University of Miami Miller School of Medicine, FL; Wertheim College of Medicine, Miami Cardiac and Vascular Institute, Baptist Health and Florida International University (T.F.); Department of Emergency Medicine, Memorial
| | - Mauro Moscucci
- From the Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, MD (A.A.D., M.M.); Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.D.); Cardiovascular Division (R.J.M., V.C., D.G.R., M.G.C.) and Division of Emergency Medicine (K.S.S.), University of Miami Miller School of Medicine, FL; Wertheim College of Medicine, Miami Cardiac and Vascular Institute, Baptist Health and Florida International University (T.F.); Department of Emergency Medicine, Memorial
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Mortality Among Black Men in the USA. J Racial Ethn Health Disparities 2017; 5:50-61. [PMID: 28236289 DOI: 10.1007/s40615-017-0341-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 02/07/2023]
Abstract
IMPORTANCE Black men have the lowest life expectancy of all major ethnic-sex populations in the USA, yet no recent studies have comprehensively examined black male mortality. OBJECTIVE The purpose of this study was to analyze recent mortality trends for black men, including black to white (B to W) disparities. DESIGN The study design was national mortality surveillance for 2000 to 2014. SETTING The setting was the USA. POPULATION All black non-Hispanic males aged ≥15 years old in the USA, including institutionalized persons, were included. EXPOSURE The 15 leading causes of death were analyzed. MAIN OUTCOMES AND MEASURES Linear regression of log-transformed annual age-adjusted death rates was used to calculate average annual percent change (AAPC) in mortality. Black to white (B to W) disparity rate ratios (RR) and 95% confidence intervals (CI) were compared for 2000 and 2014. The most recent available social and economic profile data were obtained from the U.S. Census of Population. RESULTS The top five causes of death for black men in 2014, with percentage of total deaths, were (1) heart disease (24.8%), (2) cancer (23.0%), (3) unintentional injuries (5.8%), (4) stroke (5.1%), and (5) homicide (4.3%). Significant mortality declines for 12 of the 15 leading causes occurred through 2014, with the strongest decline for HIV/AIDS (AAPC -8.0, 95% CI -8.8 to -7.1). Only Alzheimer's disease, ranked #15, significantly increased (AAPC +2.5, 95% CI +1.4 to +3.7). Significant black disadvantage persisted for 10 of the 15 leading causes in 2014, including homicide (RR = 10.43, 95% CI 9.98 to 10.89), HIV/AIDS (RR = 8.01, 95% CI 7.50 to 8.54), diabetes (RR = 1.88, 95% CI 1.82 to 1.93), and stroke (RR = 1.61, 95% CI 1.57 to 1.65). The B to W disparity did not improve for heart disease (RR 1.24 in 2000 vs. RR 1.23 in 2014), but did improve for cancer (RR 1.39 in 2000 vs. 1.20 in 2014). Death rates were significantly lower in black men for five causes, including unintentional injuries (RR = 0.83, 95% CI 0.80 to 0.84), chronic lower respiratory diseases (RR = 0.75, 95% CI 0.73 to 0.78), and suicide (RR = 0.37, 95% CI 0.35 to 0.39). CONCLUSIONS AND RELEVANCE Total mortality significantly declined for black men from 2000 to 2014, and the overall B to W disparity narrowed to RR = 1.21 (95% CI 1.20 to 1.23) in 2014. However, significant black disadvantages relative to white men persisted for 10 leading causes of death.
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Tisminetzky M, Erskine N, Chen HY, Gore J, Gurwitz J, Yarzebski J, Joffe S, Shaw P, Goldberg R. Changing Trends in, and Characteristics Associated with, Not Undergoing Cardiac Catheterization in Elderly Adults Hospitalized with ST-Segment Elevation Acute Myocardial Infarction. J Am Geriatr Soc 2015; 63:925-31. [PMID: 25940950 PMCID: PMC4439287 DOI: 10.1111/jgs.13399] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe decade- long trends (1999-2009) in the rates of not undergoing cardiac catheterization and percutaneous coronary intervention (PCI) in individuals aged 65 and older presenting with an ST-segment elevation acute myocardial infarction (STEMI) and factors associated with not undergoing these procedures. DESIGN Observational population-based study. SETTING Worcester, Massachusetts, metropolitan area. PARTICIPANTS Individuals aged 65 and older hospitalized for an STEMI in six biennial periods between 1999 and 2009 at 11 central Massachusetts medical centers (N=960). MEASUREMENTS Analyses were conducted to examine the characteristics of people who did not undergo cardiac catheterization overall and stratified into two age strata (65-74, ≥75). RESULTS Between 1999 and 2009, dramatic declines (from 59.4% to 7.5%) were observed in the proportion of older adults who did not undergo cardiac catheterization at all greater Worcester hospitals. These declines were observed in individuals aged 65 to 74 (58.4-6.7%) and in those aged 75 and older (69.4-13.5%). The proportion of individuals not undergoing PCI after undergoing cardiac catheterization decreased from 36.6% in 1999 to 6.5% in 2009. Women, individuals with a prior MI, those with do-not-resuscitate orders, and those with various comorbidities were less likely to have undergone these procedures than comparison groups. CONCLUSION Older adults who develop an STEMI are increasingly likely to undergo cardiac catheterization and PCI, but several high-risk groups remain less likely to undergo these procedures.
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Affiliation(s)
- Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nathaniel Erskine
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Han-Yang Chen
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Joel Gore
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jerry Gurwitz
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Samuel Joffe
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Peter Shaw
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Robert Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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Forsyth CJ, Pathak EB, Strom JA. De Facto regionalization of care for ST-elevation myocardial infarction in Florida, 2001-2009. Am Heart J 2012; 164:681-8. [PMID: 23137498 DOI: 10.1016/j.ahj.2012.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 06/22/2012] [Indexed: 11/18/2022]
Abstract
ACC/AHA guidelines recommend STEMI patients receive percutaneous coronary intervention (PCI) at high volume hospitals performing ≥400 procedures/year. The objective of this study was to evaluate changes in the organization and implementation of care for STEMI patients in Florida. We assessed trends and predictors of STEMI patients first hospitalized at high PCI volume hospitals in Florida from 2001-2009. This is the first study to examine statewide trends in hospital admission for all STEMI patients. We classified Florida hospitals by PCI volume (high, medium, low, non-PCI) for each quarter from January, 2001 through June, 2009. Using hospital discharge data, we determined the percent of STEMI patients who went to each type of hospital and analyzed multiple predictors. From 2001-2009 the proportion of STEMI patients first hospitalized at high PCI volume hospitals rose from 62.4 to 89.7%, while admissions to non-PCI hospitals declined from 31% to 4.9%. Persistent barriers to high PCI volume hospital admission were age ≥85 years (OR 0.56, 95% CI 0.50-0.62), female gender (OR 0.85, 95% CI 0.79-0.91), and residence in a major metropolitan county. Through the efforts of local coalitions throughout Florida, by 2009 almost 90% of Florida STEMI patients were first admitted to high PCI volume hospitals. Greater hospital competition may explain lower admission rates to high PCI volume hospitals in major metropolitan counties. The age and gender disadvantage we observed requires further research to determine potential causes.
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Affiliation(s)
- Colin J Forsyth
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL 33612, USA.
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Nash MC, Strom JA, Pathak EB. Prevalence of major infections and adverse outcomes among hospitalized. ST-elevation myocardial infarction patients in Florida, 2006. BMC Cardiovasc Disord 2011; 11:69. [PMID: 22108297 PMCID: PMC3252246 DOI: 10.1186/1471-2261-11-69] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 11/22/2011] [Indexed: 11/24/2022] Open
Abstract
Background ST-elevation myocardial infarction (STEMI) patients have risk factors and co-morbidities and require procedures predisposing to healthcare acquired infections (HAIs). As few data exist on the extent and consequences of infections among these patients, the prevalence, predictors, and potential complications of major infections among hospitalized STEMI patients at all Florida acute care hospitals during 2006 were analyzed. Methods Sociodemographic characteristics, risk factors, co-morbidities, procedures, complications, and mortality were analyzed from hospital discharge data for 11, 879 STEMI patients age ≥18 years. We used multivariable logistic regression modeling to examine and adjust for multiple potential predictors of any infection, bloodstream infection (BSI), pneumonia, surgical site infection (SSI), and urinary tract infection (UTI). Results There were 2, 562 infections among 16.6% of STEMI patients; 6.2% of patients had ≥2 infections. The most prevalent HAIs were UTIs (6.0%), pneumonia (4.6%), SSIs (4.1%), and BSIs (2.6%). Women were at 29% greater risk, Blacks had 23% greater risk, and HAI risk increased 11% with each 5 year increase in age. PCI was the only protective major procedure (OR 0.81, 95% CI, 0.69-0.95, p < .05). HAI lengthened hospital stays. STEMI patients with a BSI were almost 5 times more likely (31.3% vs. 6.5%, p < .0001), and those with pneumonia were 3 times more likely (19.6% vs. 6.5%, p < .0001) to die before discharge. Conclusions The protective effect of PCI on risk of infection is likely mediated by its many benefits, including reduced length of hospitalizations.
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Affiliation(s)
- Michelle C Nash
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B, Downs Blvd., Tampa, FL 33612, USA.
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