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McClain AK, Monteleone PP, Zoldan J. Sex in cardiovascular disease: Why this biological variable should be considered in in vitro models. SCIENCE ADVANCES 2024; 10:eadn3510. [PMID: 38728407 PMCID: PMC11086622 DOI: 10.1126/sciadv.adn3510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/09/2024] [Indexed: 05/12/2024]
Abstract
Cardiovascular disease (CVD), the world's leading cause of death, exhibits notable epidemiological, clinical, and pathophysiological differences between sexes. Many such differences can be linked back to cardiovascular sexual dimorphism, yet sex-specific in vitro models are still not the norm. A lack of sex reporting and apparent male bias raises the question of whether in vitro CVD models faithfully recapitulate the biology of intended treatment recipients. To ensure equitable treatment for the overlooked female patient population, sex as a biological variable (SABV) inclusion must become commonplace in CVD preclinical research. Here, we discuss the role of sex in CVD and underlying cardiovascular (patho)physiology. We review shortcomings in current SABV practices, describe the relevance of sex, and highlight emerging strategies for SABV inclusion in three major in vitro model types: primary cell, stem cell, and three-dimensional models. Last, we identify key barriers to inclusive design and suggest techniques for overcoming them.
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Affiliation(s)
- Anna K. McClain
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78751, USA
| | - Peter P. Monteleone
- Ascension Texas Cardiovascular, Austin, TX 78705, USA
- Dell School of Medicine, The University of Texas at Austin, Austin, TX 78712, USA
| | - Janet Zoldan
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78751, USA
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2
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Hu X, Fanous E, Jackson NJ, Daso GI, Liang I, McCullough LB, Cooper RJ, Horwich TB, Watson KE, Shah JB, Shahandeh N, Calfon Press MA. Impact of COVID-19 Pandemic on Sex and Racial Disparities in Chest Pain Presentation and Management Through the Emergency Department. Cardiol Res 2024; 15:90-98. [PMID: 38645824 PMCID: PMC11027781 DOI: 10.14740/cr1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/04/2023] [Indexed: 04/23/2024] Open
Abstract
Background Sex and racial disparities in the presentation and management of chest pain persist, however, the impact of coronavirus disease 2019 (COVID-19) on these disparities have not been studied. We sought to determine whether the COVID-19 pandemic contributed to pre-existing sex and racial disparities in the presentation, management, and outcomes of patients presenting to the emergency department (ED) with chest pain. Methods We conducted an observational cohort study with retrospective data collection of patients between January 1, 2016, and May 1, 2022. This was a single study conducted at a quaternary academic medical center of all patients who presented to the ED with a complaint of chest pain or chest pain equivalent symptoms. Patient were further segregated into different groups based on sex (male, female), race, ethnicity (Asian, Black, Hispanic, White, and other), and age (18 - 40, 41 - 65, > 65). We compared diagnostic evaluations, treatment decisions, and outcomes during prespecified time points before, during, and after the COVID-19 pandemic. Results This study included 95,764 chest pain encounters. Total chest pain presentations to the ED fell about 38% during the early pandemic months. Females presented significantly less than males during initial COVID-19 (48% vs. 52%, P < 0.001) and Asian females were least likely to present. There was an increase in the total number of troponins and echocardiograms ordered during peak COVID-19 across both sexes, but females were still less likely to have these tests ordered across all timepoints. The number of coronary angiograms did not increase during peak COVID-19, and females were less likely to undergo coronary angiogram during all timepoints. Finally, females with chest pain were less likely to be diagnosed with acute myocardial infarction (AMI) during all timepoints, while in-hospital deaths were similar between males and females during all timepoints. Conclusions During COVID-19, females, especially Asian females, were less likely to present to the ED for chest pain. Non-White patients were less likely to present to the ED compared to White patients prior to and during the pandemic. Disparities in management and outcomes of chest pain encounters remained similar to pre-COVID-19, with females receiving less cardiac workup and AMI diagnoses than males, but in-hospital mortality remaining similar between groups and timepoints.
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Affiliation(s)
- Xuchen Hu
- Department of Medicine - Cardiology, University of California, Los Angeles, CA 90095, USA
| | - Elias Fanous
- Department of Medicine - Cardiology, University of California, Los Angeles, CA 90095, USA
| | - Nicholas J. Jackson
- Department of Medicine - Statistics, University of California, Los Angeles, CA 90095, USA
| | - Gabrielle I. Daso
- Department of Medicine - Cardiology, University of California, Los Angeles, CA 90095, USA
| | - Icy Liang
- Department of Medicine - Cardiology, University of California, Los Angeles, CA 90095, USA
| | - Lynnell B. McCullough
- Department of Emergency Medicine, University of California, Los Angeles, CA 90095, USA
| | - Richelle J. Cooper
- Department of Emergency Medicine, University of California, Los Angeles, CA 90095, USA
| | - Tamara B. Horwich
- Department of Medicine - Cardiology, University of California, Los Angeles, CA 90095, USA
| | - Karol E. Watson
- Department of Medicine - Cardiology, University of California, Los Angeles, CA 90095, USA
| | - Janki B. Shah
- Department of Medicine - Cardiology, University of California, Los Angeles, CA 90095, USA
| | - Negeen Shahandeh
- Department of Medicine - Cardiology, University of California, Los Angeles, CA 90095, USA
| | - Marcella A. Calfon Press
- Department of Medicine - Cardiology, University of California, Los Angeles, CA 90095, USA
- UCLA Cardiovascular Center, Los Angeles, CA 90095, USA
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Angeli F, Ricci F, Moscucci F, Sciomer S, Bucciarelli V, Bianco F, Mattioli AV, Pizzi C, Gallina S. Sex- and gender-related disparities in chest pain syndromes: the feminine mystique of chest pain. Curr Probl Cardiol 2024; 49:102457. [PMID: 38342350 DOI: 10.1016/j.cpcardiol.2024.102457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024]
Abstract
Chest pain syndromes encompass a wide range of different clinical conditions, being coronary artery disease one of the most important and feared aetiology. Sex and gender disparities have been reported in pathophysiology, clinical presentations, diagnostic work-up and outcomes of patients admitted for chest pain. Biological differences in sexual hormones and neurological pain procession pathways have been proposed as contributors to disparities between men and women; however, gender-related disparities in socio-economic and psychological status have emerged as additional factors involved in these conditions. A better understanding of gender- and sex-related disparities will lead to improved clinical care and management of chest pain syndromes in both men and women. In this comprehensive review, we describe the existing knowledge regarding sex and gender-based differences in management and outcomes of chest pain syndromes in order to stimulate and promote the development of a more sex- and gender-oriented approach to these conditions.
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Affiliation(s)
- Francesco Angeli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Federica Moscucci
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, Viale del Policlinico n. 155, 00161 Rome, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, 'Sapienza', Rome University, Viale dell'Università, 37, 00185, Rome, Italy
| | - Valentina Bucciarelli
- Cardiovascular Sciences Department-Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Francesco Bianco
- Cardiovascular Sciences Department-Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Anna Vittoria Mattioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via Giuseppe Massarenti 9, 40138, Bologna, Italy.
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
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Lu H, Hatfield LA, Al-Azazi S, Bakx P, Banerjee A, Burrack N, Chen YC, Fu C, Gordon M, Heine R, Huang N, Ko DT, Lix LM, Novack V, Pasea L, Qiu F, Stukel TA, Uyl-de Groot CA, Weinreb G, Landon BE, Cram P. Sex-Based Disparities in Acute Myocardial Infarction Treatment Patterns and Outcomes in Older Adults Hospitalized Across 6 High-Income Countries: An Analysis From the International Health Systems Research Collaborative. Circ Cardiovasc Qual Outcomes 2024; 17:e010144. [PMID: 38328914 DOI: 10.1161/circoutcomes.123.010144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 10/27/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Sex differences in acute myocardial infarction treatment and outcomes are well documented, but it is unclear whether differences are consistent across countries. The objective of this study was to investigate the epidemiology, use of interventional procedures, and outcomes for older females and males hospitalized with ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation myocardial infarction (NSTEMI) in 6 diverse countries. METHODS We conducted a serial cross-sectional cohort study of 1 508 205 adults aged ≥66 years hospitalized with STEMI and NSTEMI between 2011 and 2018 in the United States, Canada, England, the Netherlands, Taiwan, and Israel using administrative data. We compared females and males within each country with respect to age-standardized hospitalization rates, rates of cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft surgery within 90 days of hospitalization, and 30-day age- and comorbidity-adjusted mortality. RESULTS Hospitalization rates for STEMI and NSTEMI decreased between 2011 and 2018 in all countries, although the hospitalization rate ratio (rate in males/rate in females) increased in virtually all countries (eg, US STEMI ratio, 1.58:1 in 2011 and 1.73:1 in 2018; Israel NSTEMI ratio, 1.71:1 in 2011 and 2.11:1 in 2018). Rates of cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft surgery were lower for females than males for STEMI in all countries and years (eg, US cardiac catheterization in 2018, 88.6% for females versus 91.5% for males; Israel percutaneous coronary intervention in 2018, 76.7% for females versus 84.8% for males) with similar findings for NSTEMI. Adjusted mortality for STEMI in 2018 was higher for females than males in 5 countries (the United States, Canada, the Netherlands, Israel, and Taiwan) but lower for females than males in 5 countries for NSTEMI. CONCLUSIONS We observed a larger decline in acute myocardial infarction hospitalizations for females than males between 2011 and 2018. Females were less likely to receive cardiac interventions and had higher mortality after STEMI. Sex disparities seem to transcend borders, raising questions about the underlying causes and remedies.
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Affiliation(s)
- Hannah Lu
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX (H.L., P.C.)
| | - Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, MA (L.A.H., C.F., G.W., B.E.L.)
- Division of General Medicine, Beth Israel Deaconess Medical Center (L.A.H., B.E.L.)
| | - Saeed Al-Azazi
- George & Fay Yee Centre for Healthcare Innovation (S.A.-A., L.M.L.), University of Manitoba, Winnipeg, Canada
| | - Pieter Bakx
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands (P.B., R.H., C.A.U.G.)
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, United Kingdom (A.B., L.P.)
- Consultant in Cardiology, University College London Hospitals, United Kingdom (A.B.)
| | - Nitzan Burrack
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel (N.B., M.G., V.N.)
| | - Yu-Chin Chen
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan (Y.-C.C., N.H.)
| | - Christina Fu
- Department of Health Care Policy, Harvard Medical School, Boston, MA (L.A.H., C.F., G.W., B.E.L.)
| | - Michal Gordon
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel (N.B., M.G., V.N.)
| | - Renaud Heine
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands (P.B., R.H., C.A.U.G.)
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan (Y.-C.C., N.H.)
| | - Dennis T Ko
- ICES, Toronto, ON (D.T.K., F.Q., T.A.S., P.C.)
- Schulich Heart Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada (D.T.K.)
- Faculty of Medicine (D.T.K., P.C.), University of Toronto, ON, Canada
| | - Lisa M Lix
- George & Fay Yee Centre for Healthcare Innovation (S.A.-A., L.M.L.), University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences (L.M.L.), University of Manitoba, Winnipeg, Canada
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel (N.B., M.G., V.N.)
| | - Laura Pasea
- Institute of Health Informatics, University College London, United Kingdom (A.B., L.P.)
| | - Feng Qiu
- ICES, Toronto, ON (D.T.K., F.Q., T.A.S., P.C.)
| | - Therese A Stukel
- ICES, Toronto, ON (D.T.K., F.Q., T.A.S., P.C.)
- Institute for Health Management Policy and Evaluation (T.A.S.), University of Toronto, ON, Canada
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands (P.B., R.H., C.A.U.G.)
| | - Gabe Weinreb
- Department of Health Care Policy, Harvard Medical School, Boston, MA (L.A.H., C.F., G.W., B.E.L.)
| | - Bruce E Landon
- Department of Health Care Policy, Harvard Medical School, Boston, MA (L.A.H., C.F., G.W., B.E.L.)
- Division of General Medicine, Beth Israel Deaconess Medical Center (L.A.H., B.E.L.)
| | - Peter Cram
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX (H.L., P.C.)
- ICES, Toronto, ON (D.T.K., F.Q., T.A.S., P.C.)
- Faculty of Medicine (D.T.K., P.C.), University of Toronto, ON, Canada
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5
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Norris CM, Mullen KA, Foulds HJ, Jaffer S, Nerenberg K, Gulati M, Parast N, Tegg N, Gonsalves CA, Grewal J, Hart D, Levinsson AL, Mulvagh SL. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 7: Sex, Gender, and the Social Determinants of Health. CJC Open 2024; 6:205-219. [PMID: 38487069 PMCID: PMC10935698 DOI: 10.1016/j.cjco.2023.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/31/2023] [Indexed: 03/17/2024] Open
Abstract
Women vs men have major differences in terms of risk-factor profiles, social and environmental factors, clinical presentation, diagnosis, and treatment of cardiovascular disease. Women are more likely than men to experience health issues that are complex and multifactorial, often relating to disparities in access to care, risk-factor prevalence, sex-based biological differences, gender-related factors, and sociocultural factors. Furthermore, awareness of the intersectional nature and relationship of sociocultural determinants of health, including sex and gender factors, that influence access to care and health outcomes for women with cardiovascular disease remains elusive. This review summarizes literature that reports on under-recognized sex- and gender-related risk factors that intersect with psychosocial, economic, and cultural factors in the diagnosis, treatment, and outcomes of women's cardiovascular health.
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Affiliation(s)
- Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kerri-Anne Mullen
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather J.A. Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shahin Jaffer
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kara Nerenberg
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Centre, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Nazli Parast
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Nicole Tegg
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jasmine Grewal
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna Hart
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | | | - Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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6
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Code J. At the Heart of Resilience: Empowering Women's Agency in Navigating Cardiovascular Disease. CJC Open 2024; 6:473-484. [PMID: 38487058 PMCID: PMC10935683 DOI: 10.1016/j.cjco.2023.12.013] [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: 09/11/2023] [Accepted: 12/13/2023] [Indexed: 03/17/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death among women globally, emphasizing the need for a healthcare approach that empowers women through agency. This review focuses on the critical role of women's agency in navigating CVD, integrating insights from various fields, including medicine, education, psychology, and sociology. The review highlights the shift toward patient-centred care, a framework in which women are recognized as key decision-makers, a crucial change given the historical underemphasis on women's health issues in medical practice. The diagnosis of CVD in women often involves emotional and psychological challenges. Unexpected diagnoses significantly disrupt perceived well-being, and prolonged diagnostic processes lead to professional skepticism and neglect of symptoms, resulting in delayed or inaccurate diagnoses and strained healthcare relationships. Effective management of CVD necessitates continuous self-management and a holistic approach to care, particularly for those with trauma who are at increased risk of cardiac incidents. Empowerment for women with CVD involves promoting self-confidence, autonomy, and active patient participation in healthcare. Implementing comprehensive care models is crucial for improving chronic CVD management, highlighting the need for healthcare systems that prioritize patient agency and empowerment. From the perspective of a woman with lived experience, this article examines the impact of CVD on women's agency throughout the diagnostic journey. By highlighting women's agency rather than particular behavioural changes, this review offers a comprehensive analysis that can shape policy, stimulate new research, and foster a more equitable, efficient, and empathetic healthcare system for women with CVD.
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Affiliation(s)
- Jillianne Code
- Woman with Lived Experience, Victoria, British Columbia, Canada
- HeartLife Foundation of Canada, Vancouver, British Columbia, Canada
- Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
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7
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Stamm B, Royan R, Madsen TE. Association of Prior Stroke With Health Care Perceptions of Adequate Emergency Care in Women. Stroke 2024; 55:301-304. [PMID: 37929566 DOI: 10.1161/strokeaha.123.044967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Women with a history of stroke represent a vulnerable patient population due to their extant disability, morbidity, and risk of recurrence. The association between prior stroke with patient experience and perception of emergency medical care is unknown. METHODS We utilized data from the Health Care Experiences and Perception cross-sectional, online survey from the American Heart Association Research Goes Red Registry. Ordinal logistic regression models were performed to assess the association between a self-reported history of stroke in the prior 10 years and the perception of not receiving adequate care in an emergency department because of gender or race. Models were adjusted for age at the time of enrollment, race/ethnicity, myocardial infarction within 10 years, and current smoking status. RESULTS A total of 3498 women participants met inclusion criteria: 89 participants with a history of stroke in the past 10 years (mean age, 49.4 years; 10.1% Black participants and 5.6% Hispanic participants) and 3409 participants without such history (mean age, 45.8 years; 7.8% Black participants and 7.0% Hispanic participants). In multivariate logistic regression models, stroke history was significantly associated with greater odds of answering "to a great extent" that "I will not receive adequate care in an emergency room based on my gender" (odds ratio, 3.23 [95% CI, 1.69-6.17]) and "…race/ethnicity" (odds ratio, 3.88 [95% CI, 1.45-10.39]). Similar results were seen for secondary outcomes. CONCLUSIONS Women patients with a stroke history felt less likely to receive adequate emergency care based on gender and race/ethnicity. Whether these negative health perceptions are associated with delays in presentation for stroke or other time-sensitive conditions should be the focus of future studies, given that these populations are known to less frequently receive advanced therapies for stroke, in part due to delays in presentation.
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Affiliation(s)
- Brian Stamm
- National Clinician Scholars Program and Department of Neurology (B.S.), University of Michigan, Ann Arbor
- Lieutenant Colonel Charles S. Kettles VA Medical Center, Ann Arbor, MI (B.S.)
| | - Regina Royan
- Department of Emergency Medicine (R.R.), University of Michigan, Ann Arbor
| | - Tracy E Madsen
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.)
- Department of Epidemiology, Brown University School of Public Health, Providence, RI (T.E.M.)
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8
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Bouchard K, Lalande K, Coutinho T, Mulvagh S, Pacheco C, Liu S, Saw J, So D, Reed JL, Chiarelli A, Stragapede E, Robert H, Lappa N, Sun L, Wells G, Tulloch H. Spontaneous Coronary Artery Dissection Across the Health Care Pathway: A National, Multicenter, Patient-Informed Investigation. J Am Heart Assoc 2023; 12:e032141. [PMID: 38084731 PMCID: PMC10863752 DOI: 10.1161/jaha.123.032141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/15/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Clinical practice guidelines for the management and convalescence of patients with spontaneous coronary artery dissection (SCAD) have yet to be developed. The targeted content, delivery, and outcomes of interventions that benefit this population remain unclear. Patient-informed data are required to substantiate observational research and provide evidence to inform and standardize clinical activities. METHODS AND RESULTS Patients diagnosed with SCAD (N=89; 86.5% women; mean age, 53.2 years) were purposively selected from 5 large tertiary care hospitals. Patients completed sociodemographic and medical questionnaires and participated in an interview using a patient-piloted semistructured interview guide. Interviews were transcribed and subjected to framework analysis using inductive and then deductive coding techniques. Approximately 1500 standard transcribed pages of interview data were collected. Emotional distress was the most commonly cited precipitating factor (56%), with an emphasis on anxiety symptoms. The awareness and detection of SCAD as a cardiac event was low among patients (35%) and perceived to be moderate among health care providers (55%). Health care providers' communication of the prognosis and self-management of SCAD were perceived to be poor (79%). Postevent psychological disorders among patients were evident (30%), and 73% feared recurrence. Short- and longer-term follow-up that was tailored to patients' needs was desired (72%). Secondary prevention programming was recommended, but there were low completion rates of conventional cardiac rehabilitation (48%), and current programming was deemed inadequate. CONCLUSIONS This early-stage, pretrial research has important implications for the acute and long-term management of patients with SCAD. Additional work is required to validate the hypotheses generated from this patient-oriented research.
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Affiliation(s)
- Karen Bouchard
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | | | - Thais Coutinho
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Sharon Mulvagh
- Division of CardiologyDalhousie UniversityHalifaxNova ScotiaCanada
| | - Christine Pacheco
- Department of CardiologyUniversity of Montréal Hospital CentreMontréalQuebecCanada
| | - Shuangbo Liu
- Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
| | - Jacqueline Saw
- Division of CardiologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Derek So
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Jennifer L. Reed
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | | | - Elisa Stragapede
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Helen Robert
- Patient Partner, University of Ottawa Heart InstituteOttawaOntarioCanada
| | - Nadia Lappa
- Patient Partner, University of Ottawa Heart InstituteOttawaOntarioCanada
| | - Louise Sun
- Stanford MedicineStanford UniversityStanfordCAUSA
| | - George Wells
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Heather Tulloch
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
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9
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Siddika A, Malik FTN, Kalimuddin M, Hasan N, Ahmed N, Badiuzzaman M, Ahmed MN, Dutta A, Ishraquzzaman M, Chowdhury MS. Severity of Coronary Artery Diseases Among Pre- and Postmenopausal Women With Acute Coronary Syndrome: A Hospital-Based Study in Bangladesh. Cureus 2023; 15:e50514. [PMID: 38222197 PMCID: PMC10787577 DOI: 10.7759/cureus.50514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Postmenopausal women present with more severe coronary artery disease (CAD) in addition to multiple comorbidities. However, there are limited data available to compare the risk factors, clinical characteristics, and angiographic severity of CAD between pre- and postmenopausal women with the acute coronary syndrome (ACS). AIM This study aimed to assess and compare the severity of CAD in pre- and postmenopausal women with ACS. METHODS This cross-sectional observational study was conducted at the Department of Cardiology of NHFH RI. A total of 140 female patients with ACS were enrolled and then divided into Group I (premenopausal) and Group II (postmenopausal) on the basis of menopause history. Clinical data and coronary angiographic severity were compared between both groups. RESULTS The mean age of the premenopausal group was 41.53 ± 5.45 years, and that of the postmenopausal group was 57.23 ± 7.45 years. Family history of premature CAD was significantly more common in the premenopausal group than in the postmenopausal group (35(50%) vs. 23(32.9%); p=0.017)). DM and smokeless tobacco were more prevalent in the postmenopausal group (48(68.6%) vs. 28(40%); p=0.001 and 14(20%) vs. 2(2.9%); p=0.002). Atypical presentation was more common in the premenopausal group (21(30%) vs. 9(12.9%); p=0.013). Most of the patients in both groups presented with unstable angina followed by NSTEMI and STEMI. Mean left ventricular ejection fraction was lower in the postmenopausal group than in the premenopausal group (50.71 ± 8.38% vs. 53.74 ± 7.46%; p=0.026). Normal coronary angiogram and single-vessel disease were more prevalent in the premenopausal group (22(31.4%) vs. 12(17.1%); p=0.04) and (22(31.4%) vs. 11(15.7%); p=0.002), whereas triple-vessel disease was more prevalent in the postmenopausal group (34(48.6% vs. 14(20%); p=0.001). The left anterior descending artery was the most commonly involved vessel in the postmenopausal group (67(95.7%) vs. 60(85.7%); p=0.04). Finally, the mean Gensini score was higher in the postmenopausal group than in the premenopausal group (56.1 ± 43.4 vs. 33.5 ± 36.9; p=0.001). CONCLUSION Family history of premature CAD and atypical presentation were common in premenopausal ACS patients. DM and smokeless tobacco use were more prevalent in the postmenopausal group than in the premenopausal group. Normal coronary angiogram and single-vessel disease were more prevalent in the premenopausal group, and triple-vessel disease was more common in the postmenopausal group. CAD was more severe in the postmenopausal group.
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Affiliation(s)
- Ayesha Siddika
- Internal Medicine, Bangladesh College of Physician and Surgeon, Dhaka, BGD
- Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
| | | | - Md Kalimuddin
- Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
| | - Nahidul Hasan
- Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
| | - Nazir Ahmed
- Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
| | | | | | - Ashok Dutta
- Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
| | - Mir Ishraquzzaman
- Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
| | - Md Shamim Chowdhury
- Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
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10
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Theofilis P, Vlachakis PK, Mantzouranis E, Sakalidis A, Chrysohoou C, Leontsinis I, Lazaros G, Dimitriadis K, Drakopoulou M, Vordoni A, Oikonomou E, Tsioufis K, Tousoulis D. Acute Coronary Syndromes in Women: A Narrative Review of Sex-Specific Characteristics. Angiology 2023:33197231218331. [PMID: 37995282 DOI: 10.1177/00033197231218331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Acute coronary syndromes (ACSs) encompass a spectrum of life-threatening cardiovascular conditions, including unstable angina (UA) and myocardial infarction. While significant progress has been made in the understanding and management of ACS over the years, it has become increasingly evident that sex-based differences play a pivotal role in the pathophysiology, presentation, and outcomes of these conditions. Despite this recognition, the majority of clinical research in the field has historically focused on male populations, leading to a significant knowledge gap in understanding the unique aspects of ACS in women. This review article aims to comprehensively explore and synthesize the current body of literature concerning the sex-specific characteristics of ACS, shedding light on the epidemiology, risk factors, clinical presentation, diagnostic challenges, treatment strategies, and prognosis in women. By elucidating the distinct aspects of ACS in women, this review intends to foster greater awareness and improved clinical management, ultimately contributing to enhanced cardiovascular care for female patients.
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Affiliation(s)
- Panagiotis Theofilis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayotis K Vlachakis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Mantzouranis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Sakalidis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Chrysohoou
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Leontsinis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Lazaros
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriakos Dimitriadis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Drakopoulou
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Vordoni
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, "Sotiria" Chest Disease Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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11
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Su J, Xiong JM, Ke QQ, Yu HY, Zhao ZR, Yang QH. Experiences and perceptions of acute myocardial infarction patients with a prolonged decision-making phase of treatment seeking: A meta-synthesis. J Clin Nurs 2023; 32:7891-7908. [PMID: 37353965 DOI: 10.1111/jocn.16802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023]
Abstract
AIMS To describe the experiences and perceptions of acute myocardial infarction (AMI) patients with a prolonged decision-making phase of treatment-seeking. BACKGROUND Previous attempts to reduce the treatment-seeking time of AMI have been less than optimal. Due to the coronavirus disease 2019 (COVID-19) pandemic, the situation of prehospital delay is possibly worse. Decisions to seek treatment are influenced by multiple factors and need individualised interventions. Understanding patients' external and internal experiences and psychological perceptions is essential. DESIGN Meta-synthesis. DATA SOURCES We searched PubMed, Embase, Cochrane Library, Web of Science, Scopus and four Chinese databases from inception to April 2022. METHODS We screened the retrieved articles with predetermined inclusion and exclusion criteria, and reviewed articles using Thomas and Harden's (BMC Medical Research Methodology, 2008 8, 45) qualitative thematic synthesis approach. The Joanna Briggs Institute critical appraisal tool for qualitative research was used to assess the quality of studies. RESULTS Twenty-one studies were included, identifying four themes and nine sub-themes. The four primary themes were difficulty recognising and attributing symptoms, attempt to act, unwillingness to change and self-sacrifice. CONCLUSION Deciding to seek treatment is a complex social and psychological process, which needs comprehensive interventions considering personal and sociocultural factors and factors related to the COVID-19 pandemic. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Details of interventions for decisions to seek treatment in AMI patients need to be further designed and evaluated. IMPACT Results would help healthcare professionals to implement individualised management of decision-making of treatment-seeking among AMI patients, and improve medical records of patients' prehospital experiences. REPORTING METHOD The Preferred Reporting Items for Systematic Reviews 2020 checklist was used to report the findings. PATIENT OR PUBLIC CONTRIBUTION Two AMI patients contributed to the data synthesis by giving simple feedback about the final themes.
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Affiliation(s)
- Jin Su
- School of Nursing, Jinan University, Guangzhou, China
| | | | - Qi-Qi Ke
- School of Nursing, Jinan University, Guangzhou, China
| | - Hong-Yu Yu
- School of Nursing, Jinan University, Guangzhou, China
| | - Zhuo-Rui Zhao
- School of Nursing, Jinan University, Guangzhou, China
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12
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Chan JCY, Man HSJ, Asghar UM, McRae K, Zhao Y, Donahoe LL, Wu L, Granton J, de Perrot M. Impact of sex on outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant 2023; 42:1578-1586. [PMID: 37422146 DOI: 10.1016/j.healun.2023.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND The impact of sex on long-term outcomes after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (PH) remains unclear. We therefore examined the early and long-term outcome after PEA to determine whether sex had an impact on the risk of residual PH and need for targeted PH medical therapy. METHODS Retrospective study of 401 consecutive patients undergoing PEA at our institution between August 2005 and March 2020 was performed. Primary outcome was the need for targeted PH medical therapy postoperatively. Secondary outcomes included survival and measures of hemodynamic improvement. RESULTS Females (N = 203, 51%) were more likely to have preoperative home oxygen therapy (29.6% vs 11.6%, p < 0.01), and to present with segmental and subsegmental disease compared to males (49.2% vs 21.2%, p < 0.01). Despite similar preoperative values, females had higher postoperative pulmonary vascular resistance (final total pulmonary vascular resistance after PEA, 437 Dynes∙s∙cm-5 vs 324 Dynes∙s∙cm-5 in males, p < 0.01). Although survival at 10 years was not significantly different between sexes (73% in females vs 84% in males, p = 0.08), freedom from targeted PH medical therapy was lower in females (72.9% vs 89.9% in males at 5 years, p < 0.001). Female sex remained an independent factor affecting the need for targeted PH medical therapy after PEA in multivariate analysis (HR 2.03, 95%CI 1.03-3.98, p = 0.04). CONCLUSIONS Although outcomes are excellent for both sexes, females had greater need for targeted PH medical therapy in the long-term. Early reassessment and long-term follow-up of these patients are important. Further investigations into possible mechanisms to explain the differences are warranted.
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Affiliation(s)
- Justin C Y Chan
- Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada; Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - H S Jeffrey Man
- Department of Respirology and Critical Care Medicine, University Health Network, Toronto, Ontario, Canada; Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Usman M Asghar
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Karen McRae
- Department of Anaesthesia and Pain Medicine, University Health Network, Toronto, Ontario, Canada
| | - Yidan Zhao
- Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Laura L Donahoe
- Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Licun Wu
- Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - John Granton
- Department of Respirology and Critical Care Medicine, University Health Network, Toronto, Ontario, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada.
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13
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Chen J, Oshima T, Kondo T, Tomita T, Fukui H, Shinzaki S, Miwa H. Non-cardiac Chest Pain in Japan: Prevalence, Impact, and Consultation Behavior - A Population-based Study. J Neurogastroenterol Motil 2023; 29:446-454. [PMID: 37814435 PMCID: PMC10577468 DOI: 10.5056/jnm22184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/05/2023] [Accepted: 01/25/2023] [Indexed: 10/11/2023] Open
Abstract
Background/Aims Non-cardiac chest pain (NCCP) is defined as recurring angina-like retrosternal chest pain of non-cardiac origin. Information about the epidemiology of NCCP in Japan is lacking. We aim to determine the prevalence and characteristics of NCCP in the Japanese general population. Methods Two internet-based surveys were conducted among the general population in March 2017. Questions investigated the characteristics of symptoms associated with chest pain and consultation behavior. Quality of life, anxiety, depression, and gastroesophageal reflux disease were analyzed. Results Five percent of the survey respondents reported chest pain. Subjects with chest pain showed higher frequencies of anxiety and depression and lower quality of life. Among subjects with chest pain, approximately 30% had sought medical attention for their symptoms. Among all consulters, 70% were diagnosed with NCCP. Females were less likely to seek consultations for chest pain than males. Further, severity and frequency of chest pain, lower physical health component summary score, and more frequent gastroesophageal reflux disease were associated with consultation behavior. Subjects with NCCP and cardiac chest pain experienced similar impacts on quality of life, anxiety, and depression. Among subjects with NCCP, 82% visited a primary-care physician and 15% were diagnosed with reflux esophagitis. Conclusions The prevalence of chest pain in this sample of a Japanese general population was 5%. Among all subjects with chest pain, less than one-third consulted physicians, approximately 70% of whom were diagnosed with NCCP. Sex and both the severity and frequency of chest pain were associated with consultation behavior.
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Affiliation(s)
- Junji Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Tadayuki Oshima
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Takashi Kondo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Toshihiko Tomita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Hirokazu Fukui
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Shinichiro Shinzaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Hiroto Miwa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
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14
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Kaur G, Oliveira-Gomes DD, Rivera FB, Gulati M. Chest Pain in Women: Considerations from the 2021 AHA/ACC Chest Pain Guideline. Curr Probl Cardiol 2023; 48:101697. [PMID: 36921653 DOI: 10.1016/j.cpcardiol.2023.101697] [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: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
Chest pain is a common concern of women evaluated in both the inpatient and outpatient setting. There are significant differences in pathophysiology when comparing coronary artery disease (CAD) in women and men, including a higher prevalence of non-obstructive CAD. Furthermore, significant sex disparities exist in the care of women with acute coronary syndromes that stem from factors such as delays in diagnosis and inconsistencies in treatment. The 2021 AHA/ACC/Multisociety Guideline for the Evaluation and Diagnosis of Chest Pain is an important document comprised of recommendations for the assessment of acute and stable chest pain. In this review, we discuss key points from the guideline in the context of evaluating chest pain in women. We discuss the similarities and differences of chest pain presentation between the sexes, evaluation of chest pain in patients with known nonobstructive CAD and ischemia with no obstructive coronary arteries, and considerations for cardiac imaging during pregnancy.
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Affiliation(s)
- Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | | | | | - Martha Gulati
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA.
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15
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Yu HY, Liu AK, Qiu WY, Su J, Zhou XY, Gong N, Yang QH. 'I'm still young… it doesn't matter' - A qualitative study on the neglect of prodromal myocardial infarction symptoms among young- and middle-aged adults. J Adv Nurs 2023; 79:332-342. [PMID: 36300715 DOI: 10.1111/jan.15474] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022]
Abstract
AIM To explore why young- and middle-aged adults ignore prodromal myocardial infarction symptoms from a life course and sociocultural perspective. DESIGN A qualitative descriptive study. METHODS We applied purposeful sampling to recruit participants from a tertiary hospital in Guangzhou from July to November 2021. Face-to-face interviews were performed. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis methods. RESULTS Twenty-four young- and middle-aged adults diagnosed with acute myocardial infarction participated in this study. Analysis revealed three main themes: I'm still young, it will not happen to me; to be somebody and different roles, multiple pressures. Age-related self-confidence led to inappropriate perceptions and responses to prodromal symptoms among young- and middle-aged adults. These individuals strived to align their behaviours and attention with social expectations and self-expectations, underestimating the importance of perceiving the warning signs of acute myocardial infarction and seeking medical treatment. Pressure from social roles also prevented them from paying enough attention to prodromal symptoms. CONCLUSION Targeted social support, public education and technologies should be provided to these individuals since they are pillars of the family and society. We also highlight how nurses can function these strategies appropriately. IMPACTS This study contributes to a better understanding of the neglect of prodromal symptoms among young- and middle-aged adults. Its results enhance our understanding of the perception of and coping with prodromal symptoms among this population, which will help avoid the burden caused by acute myocardial infarction. PATIENT OR PUBLIC CONTRIBUTION The patients involved in our study shared their experiences and insights to provide new perspectives regarding the neglect of prodromal myocardial infarction symptoms among young- and middle-aged adults.
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Affiliation(s)
- Hong-Yu Yu
- School of Nursing, Jinan University, Guangzhou, China
| | - An-Kang Liu
- School of Nursing, Jinan University, Guangzhou, China
| | - Wei-Yu Qiu
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Jin Su
- School of Nursing, Jinan University, Guangzhou, China
| | - Xin-Yi Zhou
- School of Nursing, Jinan University, Guangzhou, China
| | - Ni Gong
- School of Nursing, Jinan University, Guangzhou, China
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16
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Muacevic A, Adler JR. Knowledge and Attitude of General People Towards Symptoms of Heart Attack and the Impact of Delay Time in Riyadh, Saudi Arabia. Cureus 2022; 14:e32758. [PMID: 36561329 PMCID: PMC9767791 DOI: 10.7759/cureus.32758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cardiovascular disease is prevalent worldwide. The goal of this research is to evaluate the knowledge of Riyadh, Saudi Arabia, population about heart attack symptoms and risk factors. METHODOLOGY A one-year cross-sectional study was carried out. The study was conducted on 385 individuals in Riyadh, Saudi Arabia. We used the Acute Coronary Syndrome Response Index, with additional questions added, such as risk factors of heart attack and physical activity time. An anonymous self-administered online questionnaire was used to collect the data. RESULTS We collected data from 440 participants, but only 385 were included in the analysis. Males represented 41.4% of the participants. In terms of participant knowledge of heart attack symptoms, we found that chest pain or pressure was the most common (80.5%), followed by shortness of breath (77%) and weakness and fatigue (72.0%). In addition, 90.2% and 90.7% of the participants knew that smoking and obesity were risk factors for heart attacks. Furthermore, 46% of participants said they "would not be at all certain" of identifying the symptoms and indicators of a heart attack in another person and 45.7% "in themselves." We found that males were more likely than females to have low knowledge (RR: 1.84, 95% CI: 1.24:2.72, P = 0.002). CONCLUSION Our findings suggest that there is a lack of awareness of the heart attack warning signs and symptoms. We propose that future local campaigns focus on increasing awareness and recognition of heart attack symptoms.
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Afgani FJ, Brenna CTA, Hanneman K, Holzapfel S, Burton C, Harvey PJ, Nguyen ET. Cardiac Link: a retrospective cohort study evaluating a clinical pathway for expedited cardiology referral. CMAJ Open 2022; 10:E1000-E1007. [PMID: 36379587 PMCID: PMC9671298 DOI: 10.9778/cmajo.20210317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Outpatients presenting with chest pain often face long wait times for cardiology consultation and subsequent investigation for obstructive coronary artery disease (CAD), during which adverse cardiovascular events may occur. Our objective was to describe the design of Cardiac Link, a coronary computed tomography angiogram (CCTA)-guided rapid-access program, and evaluate its effect on cardiology consultation wait times in patients who present to primary care physicians with stable chest pain. METHODS We conducted a retrospective cohort study at Women's College Hospital, Toronto, Ontario, Canada, between 2017 and 2020 involving eligible patients from the Family Practice Health Centre who underwent CCTA after presenting with stable chest pain or equivalent symptoms. Referring primary care physicians decided on a patient-by-patient basis to opt into the Cardiac Link program when requesting CCTA. Our primary outcome was measure of time from CCTA to cardiology consultation, and our secondary outcomes were measures of time to diagnosis from primary care consultation and CCTA booking time. RESULTS Our analysis included 148 patients (Cardiac Link n = 98, non-Cardiac Link n = 50). Mean age of the patients was 58.4 (SD 11.2) years and 72% (107/148) were women. We found that the Cardiac Link group had a shorter time from CCTA to cardiology consultation (median 7 [interquartile range {IQR} 6-20] d v. median 100 [IQR 40-138] d; p = 0.01), shorter time to diagnosis (median 33 [IQR 22-55] d v. median 86 [IQR 40-112] d; p < 0.001) and shorter CCTA booking time (median 18 [IQR 11-31] d v. median 65 [IQR 24-92] d; p < 0.001) compared with the non-Cardiac Link group. INTERPRETATION We determined that the Cardiac Link program reduced cardiology consultation wait times for symptomatic patients who were suspected of having CAD. Our study shows the viability of CCTA-guided rapid-access programs to expedite specialist consultation and reduce unnecessary referral for patients presenting to primary care physicians with stable chest pain.
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Affiliation(s)
- Fahmeen J Afgani
- Women's College Research Institute (Afgani, Holzapfel, Burton, Harvey), Women's College Hospital; Postgraduate Medical Education (Brenna), University of Toronto; Joint Department of Medical Imaging (Hanneman, Burton, Nguyen), Toronto General Hospital; Departments of Medical Imaging (Hanneman, Nguyen), Family and Community Medicine (Holzapfel) and Medicine (Harvey), University of Toronto, Toronto, Ont
| | - Connor T A Brenna
- Women's College Research Institute (Afgani, Holzapfel, Burton, Harvey), Women's College Hospital; Postgraduate Medical Education (Brenna), University of Toronto; Joint Department of Medical Imaging (Hanneman, Burton, Nguyen), Toronto General Hospital; Departments of Medical Imaging (Hanneman, Nguyen), Family and Community Medicine (Holzapfel) and Medicine (Harvey), University of Toronto, Toronto, Ont
| | - Kate Hanneman
- Women's College Research Institute (Afgani, Holzapfel, Burton, Harvey), Women's College Hospital; Postgraduate Medical Education (Brenna), University of Toronto; Joint Department of Medical Imaging (Hanneman, Burton, Nguyen), Toronto General Hospital; Departments of Medical Imaging (Hanneman, Nguyen), Family and Community Medicine (Holzapfel) and Medicine (Harvey), University of Toronto, Toronto, Ont
| | - Stephen Holzapfel
- Women's College Research Institute (Afgani, Holzapfel, Burton, Harvey), Women's College Hospital; Postgraduate Medical Education (Brenna), University of Toronto; Joint Department of Medical Imaging (Hanneman, Burton, Nguyen), Toronto General Hospital; Departments of Medical Imaging (Hanneman, Nguyen), Family and Community Medicine (Holzapfel) and Medicine (Harvey), University of Toronto, Toronto, Ont
| | - Corwin Burton
- Women's College Research Institute (Afgani, Holzapfel, Burton, Harvey), Women's College Hospital; Postgraduate Medical Education (Brenna), University of Toronto; Joint Department of Medical Imaging (Hanneman, Burton, Nguyen), Toronto General Hospital; Departments of Medical Imaging (Hanneman, Nguyen), Family and Community Medicine (Holzapfel) and Medicine (Harvey), University of Toronto, Toronto, Ont
| | - Paula J Harvey
- Women's College Research Institute (Afgani, Holzapfel, Burton, Harvey), Women's College Hospital; Postgraduate Medical Education (Brenna), University of Toronto; Joint Department of Medical Imaging (Hanneman, Burton, Nguyen), Toronto General Hospital; Departments of Medical Imaging (Hanneman, Nguyen), Family and Community Medicine (Holzapfel) and Medicine (Harvey), University of Toronto, Toronto, Ont
| | - Elsie T Nguyen
- Women's College Research Institute (Afgani, Holzapfel, Burton, Harvey), Women's College Hospital; Postgraduate Medical Education (Brenna), University of Toronto; Joint Department of Medical Imaging (Hanneman, Burton, Nguyen), Toronto General Hospital; Departments of Medical Imaging (Hanneman, Nguyen), Family and Community Medicine (Holzapfel) and Medicine (Harvey), University of Toronto, Toronto, Ont.
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Ghelfi AM, Staffieri GJ. Hipertensión arterial en la mujer en edad fértil no gestante. Med Clin (Barc) 2022; 159:101-105. [DOI: 10.1016/j.medcli.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 11/15/2022]
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Bruno F, Moirano G, Budano C, Lalloni S, Ciccone G, Verardi R, Andreis A, Montabone A, De Filippo O, Gallone G, Gilardetti M, D'Ascenzo F, De Ferrari GM. Incidence trends and long-term outcomes of myocardial infarction in young adults: Does gender matter? Int J Cardiol 2022; 357:134-139. [PMID: 35301075 DOI: 10.1016/j.ijcard.2022.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/09/2022] [Accepted: 03/07/2022] [Indexed: 11/05/2022]
Abstract
AIMS Data about long-term clinical outcomes of young patients experiencing an acute myocardial infarction (MI) and about the potential impact of gender on juvenile MI incidence and prognosis are scant. METHODS AND RESULTS Hospital Discharge Register records of Piedmont region (Italy) from 2007 to 2018 were interrogated to identify incident juvenile MI cases and MI recurrences. Patients were considered young if the first MI occurred before or at 47 years of age (5th percentile). Incidence of first juvenile MI event and overall survival were the primary outcomes. Gender differences and survival rate after an MI recurrence were secondary outcomes. Out of 114.816 hospitalizations due to MI, 4482 (3.9%) occurred in people aged ≤47. Average incidence rate of juvenile MI over the study period was 24.5 (23.8-25.2) per 100.000 person-years, with a decline among men and a stable trend among women through the years. The risk of in hospital death was higher for women (1.9% vs. 0.9%, p = 0.02), while the survival rate at 10 years after the first MI was 94.8%, without gender differences (HR 1.05: 0.69-1.60). MI recurrence occurred in 348 (7.8%) and was less common in women (HR 0.72: 0.52-0.99). After multivariate adjustment, MI recurrence was associated with a significantly higher risk of death at follow-up as compared with a single MI episode (HR 3.05: 1.9-4.80, all CI 95%). CONCLUSION Among young patients with MI, women had a higher in-hospital mortality compared to men, but long-term prognosis after hospital discharge did not differ. MI recurrences were associated with increased mortality at follow up.
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Affiliation(s)
- Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Giovenale Moirano
- Epidemiology Unit, Department of Medical Sciences, University of Turin, Italy
| | - Carlo Budano
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Stefania Lalloni
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Giovannino Ciccone
- Clinical Epidemiology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Roberto Verardi
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy; Division of Cardiology, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, Italy
| | - Alessandro Andreis
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy.
| | - Andrea Montabone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Marco Gilardetti
- Clinical Epidemiology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
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20
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Symptoms of Infarction in Women: Is There a Real Difference Compared to Men? A Systematic Review of the Literature with Meta-Analysis. J Clin Med 2022; 11:jcm11051319. [PMID: 35268411 PMCID: PMC8910933 DOI: 10.3390/jcm11051319] [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: 02/04/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Context: The management of acute coronary syndrome (ACS) is based on a rapid diagnosis. The aim of this study was to focus on the ACS symptoms differences according to gender, in order to contribute to the improvement of knowledge regarding the clinical presentation in women. (2) Methods: We searched for relevant literature in two electronic databases, and analyzed the symptom presentation for patients with suspected ACS. Fifteen prospective studies were included, with a total sample size of 10,730. (3) Results: During a suspected ACS, women present more dyspnea, arm pain, nausea and vomiting, fatigue, palpitations and pain at the shoulder than men, with RR (95%CI) of 1.13 [1.10; 1.17], 1.30 [1.05; 1.59], 1,40 [1.26; 1.56], 1.08 [1.01; 1.16], 1.67 [1.49; 1.86], 1.78 [1.02; 3.13], respectively. They are older by (95%CI) 4.15 [2.28; 6.03] years compared to men. The results are consistent in the analysis of the ACS confirmed subgroup. (4) Conclusions: We have shown that there is a gender-based symptomatic difference and a female presentation for ACS. The “typical” or “atypical” semiology of ACS symptoms should no longer be used.
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21
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Chang TE, Goldstein LB, Leifheit EC, Howard VJ, Lichtman JH. Cardiovascular Risk Factor Profiles, Emergency Department Visits, and Hospitalizations for Women and Men with a History of Stroke or Transient Ischemic Attack: A Cross-Sectional Study. J Womens Health (Larchmt) 2022; 31:834-841. [PMID: 35148481 DOI: 10.1089/jwh.2021.0471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: The relationship between cardiovascular disease risk factors (CVD-RFs) and health care utilization may differ by sex. We determined whether having more CVD-RFs was associated with all-cause emergency department (ED) visits and all-cause hospitalizations for women and men with prior stroke/transient ischemic attack (TIA). Materials and Methods: In this cross-sectional study, we used nationally representative Medical Expenditure Panel Survey (2012-2015) data for persons aged ≥18 years with a prior stroke/TIA. CVD-RF summary scores include six self-reported factors (hypertension, diabetes, high cholesterol, physical inactivity, smoking, and obesity). Sex-specific covariate-adjusted logistic regression models assessed associations between CVD-RF scores and having one or more all-cause ED visits and one or more all-cause hospitalizations. Results: The weighted sample represents 9.1 million individuals (mean age 66.6 years; 54.3% women). Prevalence of low (0-1 risk factors), intermediate (2-3), and high (4-6) CVD-RF scores was 19.4%, 60.5%, and 20.1% for women and 14.6%, 60.2%, and 25.2% for men, respectively. Women having intermediate and high scores had a 1.58-fold (95% confidence interval [CI], 1.14-2.18) and 2.21-fold (95% CI, 1.50-3.25) increased odds of ED visits compared with women with low scores. Women with high CVD-RF scores had a 2.18-fold (95% CI, 1.42-3.34) increased odds of hospitalizations, but there was no association for women with intermediate CVD-RF profiles. There was no association between CVD-RF scores and either outcome for men. Conclusions: Women, but not men, with high and intermediate CVD-RF profiles had increased odds of all-cause ED visits; women with high CVD-RF profiles had increased odds of all-cause hospitalizations. The burden of CVD-RFs may be a sex-specific predictor of higher health care utilization in women with a history of stroke/TIA.
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Affiliation(s)
- Tiffany E Chang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Larry B Goldstein
- Department of Neurology, KY Neuroscience Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Erica C Leifheit
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Judith H Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
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22
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Gender and Social Inequalities in Awareness of Coronary Artery Disease in European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031388. [PMID: 35162415 PMCID: PMC8835179 DOI: 10.3390/ijerph19031388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 12/13/2022]
Abstract
Coronary artery disease (CAD) is the single leading cause of death in Europe and the most common form of cardiovascular disease. Little is known about awareness in the European population. A cross-sectional telephone survey of 2609 individuals from six European countries was conducted to gather information on perceptions of CAD, risk factors, preventive measures, knowledge of heart attack symptoms and ability to seek emergency medical care. Level of awareness was compared according to gender, age, socioeconomic status (SES) and educational level. Women were approximately five times less likely than men to consider heart disease as a main health issue or leading cause of death (OR = 0.224, 95% CI: 0.178–0.280, OR = 0.196, 95% CI: 0.171–0.226). Additionally, women were significantly less likely to have ever had a cardiovascular screening test (OR = 0.515, 95% CI: 0.459–0.578). Only 16.3% of men and 15.3% of women were able to spontaneously identify the main symptoms of a heart attack. Almost half of the sample failed to state that they would call emergency services in case of a cardiac event. Significant differences according to age, SES and education were found for many indicators amongst both men and women. Development of a European strategy targeting improved awareness of CAD and reduced gender and social inequalities within the European population is warranted.
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23
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Weininger D, Cordova JP, Wilson E, Eslava DJ, Alviar CL, Korniyenko A, Bavishi CP, Hong MK, Chorzempa A, Fox J, Tamis-Holland JE. Delays to Hospital Presentation in Women and Men with ST-Segment Elevation Myocardial Infarction: A Multi-Center Analysis of Patients Hospitalized in New York City. Ther Clin Risk Manag 2022; 18:1-9. [PMID: 35018099 PMCID: PMC8742618 DOI: 10.2147/tcrm.s335219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/23/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Previous studies have shown longer delays from symptom onset to hospital presentation (S2P time) in women than men with acute myocardial infarction. The aim of this study is to understand the reasons for delays in seeking care among women and men presenting with an ST-Segment Elevation Myocardial Infarction (STEMI) through a detailed assessment of the thoughts, perceptions and patterns of behavior. Patients/Methods and Results A total of 218 patients with STEMI treated with primary angioplasty at four New York City Hospitals were interviewed (24% female; Women: 68.7 ± 13.1 years and men: 60.7 ± 13.8 years) between January 2009 and August 2012. A significantly larger percentage of women than men had no chest pain (62% vs 36%, p<0.01). Compared to men, a smaller proportion of women thought they were having a myocardial infarction (15% vs 34%, p=0.01). A larger proportion of women than men had S2P time >90 minutes (72% of women vs 54% of men, p= 0.03). Women were more likely than men to hesitate before seeking help, and more women than men hesitated because they did not think they were having an AMI (91% vs 83%, p=0.04). Multivariate regression analysis showed that female sex (Odds Ratio: 2.46, 95% CI 1.10–5.60 P=0.03), subjective opinion it was not an AMI (Odds Ratio 2.44, 95% CI 1.20–5.0, P=0.01) and level of education less than high school (Odds ratio 7.21 95% CI 1.59–32.75 P=0.01) were independent predictors for S2P >90 minutes. Conclusion Women with STEMI have longer pre-hospital delays than men, which are associated with a higher prevalence of atypical symptoms and a lack of belief in women that they are having an AMI. Greater focus should be made on educating women (and men) regarding the symptoms of STEMI, and the importance of a timely response to these symptoms.
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Affiliation(s)
| | | | | | | | - Carlos L Alviar
- NYU Medical Center and Bellevue Hospital Center, New York, NY, USA
| | | | | | - Mun K Hong
- Bassett Healthcare Network, Cooperstown, NY, USA
| | | | - John Fox
- Mount Sinai Beth Israel Hospital, New York, NY, USA
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24
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Blakeman JR, Prasun MA. Perceived personal risk and vulnerability in recognizing and responding to symptoms of acute coronary syndrome: an integrative review. Eur J Cardiovasc Nurs 2021; 21:405-413. [PMID: 34893826 DOI: 10.1093/eurjcn/zvab112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/20/2021] [Accepted: 11/05/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Simply knowing the common symptoms of acute coronary syndrome (ACS) is not sufficient to ensure prompt care-seeking when these symptoms occur. Factors other than symptom knowledge contribute to prompt care-seeking behaviours and correct symptom attribution to the heart. OBJECTIVES To explore how perceived personal risk and perceived personal vulnerability towards ACS affect a person's ACS symptom recognition and attribution and also how this perception affects a person's response to ACS symptoms. DESIGN An integrative review, using Whittemore and Knafl's approach. DATA SOURCES PubMed, Academic Search Complete, CINAHL Complete, APA PsycINFO, and APA PsycARTICLES. ELIGIBILITY CRITERIA FOR STUDY SELECTION We included studies that (i) were original human-subjects research or secondary analyses of human-subjects research, (ii) provided information about how perceptions of risk or perceptions of vulnerability towards ACS or heart disease affect symptom recognition, attribution, and/or response to symptoms, and (iii) were published in English. RESULTS Thirteen articles were included. Studies were conducted in nine different countries and were descriptive or exploratory in nature. The existing evidence suggests that perceived personal risk or vulnerability towards heart disease may promote earlier care-seeking for ACS symptoms and facilitates attribution of symptoms to the heart. CONCLUSION The designs of the included studies limit causal attribution, and additional prospective and intervention-based research is needed to determine how perceived risk/vulnerability may affect care-seeking and ACS symptom attribution. Increasing perceptions of vulnerability towards heart disease may reduce care seeking delay.
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Affiliation(s)
- John R Blakeman
- Mennonite College of Nursing, Illinois State University, Campus Box 5810, Normal, IL 61790-5810, USA
| | - Marilyn A Prasun
- Mennonite College of Nursing, Illinois State University, Campus Box 5810, Normal, IL 61790-5810, USA
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25
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Mehta PK, Wei J, Shufelt C, Quesada O, Shaw L, Bairey Merz CN. Gender-Related Differences in Chest Pain Syndromes in the Frontiers in CV Medicine Special Issue: Sex & Gender in CV Medicine. Front Cardiovasc Med 2021; 8:744788. [PMID: 34869650 PMCID: PMC8635525 DOI: 10.3389/fcvm.2021.744788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/13/2021] [Indexed: 12/30/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of morbidity and mortality among both women and men, yet women continue to have delays in diagnosis and treatment. The lack of recognition of sex-specific biological and socio-cultural gender-related differences in chest pain presentation of CAD may, in part, explain these disparities. Sex and gender differences in pain mechanisms including psychological susceptibility, the autonomic nervous system (ANS) reactivity, and visceral innervation likely contribute to chest pain differences. CAD risk scores and typical/atypical angina characterization no longer appear relevant and should not be used in women and men. Women more often have ischemia with no obstructive CAD (INOCA) and myocardial infarction, contributing to diagnostic and therapeutic equipoise. Existing knowledge demonstrates that chest pain often does not relate to obstructive CAD, suggesting a more thoughtful approach to percutaneous coronary intervention (PCI) and medical therapy for chest pain in stable obstructive CAD. Emerging knowledge regarding the central and ANS and visceral pain processing in patients with and without angina offers explanatory mechanisms for chest pain and should be investigated with interdisciplinary teams of cardiologists, neuroscientists, bio-behavioral experts, and pain specialists. Improved understanding of sex and gender differences in chest pain, including biological pathways as well as sociocultural contributions, is needed to improve clinical care in both women and men.
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Affiliation(s)
- Puja K Mehta
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute and Emory Women's Heart Center, Emory University School of Medicine, Atlanta, GA, United States
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Chrisandra Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart Institute, Cincinnati, OH, United States
| | - Leslee Shaw
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
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26
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Vargas K, Messman A, Levy PD. Nuances in the Evaluation of Chest Pain in Women. JACC Case Rep 2021; 3:1793-1797. [PMID: 34917956 PMCID: PMC8642734 DOI: 10.1016/j.jaccas.2021.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/21/2021] [Indexed: 12/03/2022]
Abstract
Although chest pain is the most common presenting symptom for both men and women who ultimately receive diagnoses of acute coronary syndrome, there in are important differences in coronary artery disease pathophysiology that can affect patient care. Using a case-based approach, we provide insight into these and other important considerations that every clinician should think of when treating women with chest pain. (Level of Difficulty: Intermediate.)
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Key Words
- ACS, acute coronary syndrome
- AMI, acute myocardial infarction
- CAD, coronary artery disease
- HEART score, History, ECG, Age, Risk factors, Troponin score
- MACE, major acute coronary event
- MINOCA, myocardial infarction with nonobstructive coronary arteries
- PCI, percutaneous coronary intervention
- SCAD, spontaneous coronary artery dissection
- acute coronary syndrome
- chest pain
- myocardial infarction
- women
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Affiliation(s)
- Kelsey Vargas
- Department of Emergency Medicine, Cleveland Clinic Foundation/Case Western Reserve University, Cleveland, Ohio, USA
| | - Anne Messman
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
| | - Phillip D Levy
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA.,Integrative Biosciences Center, Wayne State University, Detroit, Michigan, USA
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27
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Nguyen DD, Doll JA. Quality Improvement and Public Reporting in STEMI Care. Interv Cardiol Clin 2021; 10:391-400. [PMID: 34053625 DOI: 10.1016/j.iccl.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mortality rates for patients with ST-segment elevation myocardial infarction (STEMI) remain high despite development of novel drugs and interventions over the past several decades. There is significant variability between hospitals in use of evidence-based treatments, and substantial opportunities exist to optimize care pathways and reduce disparities in care delivery. Quality improvement interventions implemented at local, regional, and national levels have improved care processes and patient outcomes. This article reviews evidence for quality improvement interventions along the spectrum of STEMI care, describes existing systems for quality measurement, and examines local and national policy interventions, with special attention to public reporting programs.
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Affiliation(s)
- Dan D Nguyen
- Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Jacob A Doll
- Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA; VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA.
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28
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Vogel B, Acevedo M, Appelman Y, Bairey Merz CN, Chieffo A, Figtree GA, Guerrero M, Kunadian V, Lam CSP, Maas AHEM, Mihailidou AS, Olszanecka A, Poole JE, Saldarriaga C, Saw J, Zühlke L, Mehran R. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet 2021; 397:2385-2438. [PMID: 34010613 DOI: 10.1016/s0140-6736(21)00684-x] [Citation(s) in RCA: 475] [Impact Index Per Article: 158.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease is the leading cause of death in women. Decades of grassroots campaigns have helped to raise awareness about the impact of cardiovascular disease in women, and positive changes affecting women and their health have gained momentum. Despite these efforts, there has been stagnation in the overall reduction of cardiovascular disease burden for women in the past decade. Cardiovascular disease in women remains understudied, under-recognised, underdiagnosed, and undertreated. This Commission summarises existing evidence and identifies knowledge gaps in research, prevention, treatment, and access to care for women. Recommendations from an international team of experts and leaders in the field have been generated with a clear focus to reduce the global burden of cardiovascular disease in women by 2030. This Commission represents the first effort of its kind to connect stakeholders, to ignite global awareness of sex-related and gender-related disparities in cardiovascular disease, and to provide a springboard for future research.
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Affiliation(s)
- Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monica Acevedo
- Divisón de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yolande Appelman
- Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gemma A Figtree
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundations Trust, Newcastle Upon Tyne, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore; Cardiovascular Sciences Academic Clinical Programme, Duke-National University of Singapore, Singapore
| | - Angela H E M Maas
- Department of Women's Cardiac Health, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anastasia S Mihailidou
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia; Cardiovascular and Hormonal Research Laboratory, Kolling Institute, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Agnieszka Olszanecka
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jeanne E Poole
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Clara Saldarriaga
- Department of Cardiology and Heart Failure Clinic, Clinica CardioVID, University of Antioquia, Medellín, Colombia
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Liesl Zühlke
- Departments of Paediatrics and Medicine, Divisions of Paediatric and Adult Cardiology, Red Cross Children's and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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29
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Haller PM, Gyöngyösi M, Chacon-Alberty L, Hochman-Mendez C, Sampaio LC, Taylor DA. Sex-Based Differences in Autologous Cell Therapy Trials in Patients With Acute Myocardial Infarction: Subanalysis of the ACCRUE Database. Front Cardiovasc Med 2021; 8:664277. [PMID: 34124198 PMCID: PMC8187782 DOI: 10.3389/fcvm.2021.664277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Sex-based differences are under-studied in cardiovascular trials as women are commonly underrepresented in dual sex studies, even though major sex-based differences in epidemiology, pathophysiology, and outcomes of cardiovascular disease have been reported. We examined sex-based differences in patient characteristics, outcome, and BM-CD34+ frequency of the ACCRUE (Meta-Analysis of Cell-based CaRdiac studies) database involving patients with acute myocardial infarction (AMI) randomized to autologous cell-based or control treatment. Methods: We compared baseline characteristics and 1-year follow-up clinical data: composite major adverse cardiac and cerebrovascular events (primary endpoint), and changes in left ventricular ejection fraction (LVEF), end-diastolic (EDV), and end-systolic volumes (ESV) (secondary efficacy endpoint) in women and men (N = 1,252; 81.4% men). Secondary safety endpoints included freedom from hard clinical endpoints. Results: In cell-treated groups, women but not men had a lower frequency of stroke, AMI, and mortality than controls. The frequency of BM-CD34+ cells was significantly correlated with baseline EDV and ESV and negatively correlated with baseline LVEF in both sexes; a left shift in regression curve in women indicated a smaller EDV and ESV was associated with higher BM-CD34+ cells in women. Conclusions: Sex differences were found in baseline cardiovascular risk factors and cardiac function and in outcome responses to cell therapy.
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Affiliation(s)
- Paul M Haller
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Mariann Gyöngyösi
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | | | - Luiz C Sampaio
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas (UT) Health Science Center, Houston, TX, United States
| | - Doris A Taylor
- Regenerative Medicine Research, Texas Heart Institute, Houston, TX, United States
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30
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Soltani L, Ravari A, Mirzaie T, Bagherian B, Sabzevari S. Prodromal symptoms as unfamiliar feelings: Experiences of Iranian myocardial infarction patients. ARYA ATHEROSCLEROSIS 2021; 17:1-8. [PMID: 36338530 PMCID: PMC9635721 DOI: 10.22122/arya.v17i0.2076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/21/2020] [Indexed: 06/16/2023]
Abstract
BACKGROUND Patients affected by myocardial infarction (MI) report prodromal symptoms before heart attack. Deep understanding of these symptoms can increase the likelihood of early recognition and treatment of coronary heart disease (CHD). The purpose of this study was to describe the prodromal symptoms of MI experienced by Iranian adults. METHODS In this qualitative conventional content analysis, data was collected through an in-depth semi-structured interview with 14 men and women (aged 40-82 years). The patients were interviewed at the hospital 2 or 3 days after hospitalization due to MI. MAXQDA software was used for data analysis. RESULTS Data analysis led to the emergence of the 4 categories of 'Misperception of the symptoms', 'Reactions to the symptoms', 'Heart disease knowledge deficit', and 'Ideas and beliefs about heart disease'. The participants had not recognized the prodromal symptoms of MI and they attributed their symptoms to non-cardiac causes. They did not consider themselves at risk of heart disease, so they did not seek health services. CONCLUSION The participants were unaware of their prodromal symptoms. Clinicians should be attentive that men and women at risk of MI may experience a range of unfamiliar and vague prodromal symptoms, so they must give greater attention to their narratives. A greater understanding of the prodromal symptoms experienced may lead to a more truthful and timely interpretation of their symptoms and earlier detection by physicians.
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Affiliation(s)
- Lida Soltani
- Assistant Professor, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ali Ravari
- Associate Professor, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Tayebeh Mirzaie
- Associate Professor, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Behnaz Bagherian
- Associate Professor, Department of Medical Surgical Nursing, Razi School of Nursing and Midwifery, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Sakineh Sabzevari
- Associate Professor, Department of Medical Surgical Nursing, Razi School of Nursing and Midwifery, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
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Cushman M, Shay CM, Howard VJ, Jiménez MC, Lewey J, McSweeney JC, Newby LK, Poudel R, Reynolds HR, Rexrode KM, Sims M, Mosca LJ. Ten-Year Differences in Women's Awareness Related to Coronary Heart Disease: Results of the 2019 American Heart Association National Survey: A Special Report From the American Heart Association. Circulation 2021; 143:e239-e248. [PMID: 32954796 PMCID: PMC11181805 DOI: 10.1161/cir.0000000000000907] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND High awareness that cardiovascular disease is the leading cause of death (LCOD) among women is critical to prevention. This study evaluated longitudinal trends in this awareness among women. METHODS AND RESULTS Online surveys of US women (≥25 years of age) were conducted in January 2009 and January 2019. Data were weighted to the US population distribution of sociodemographic characteristics. Multivariable logistic regression was used to evaluate knowledge of the LCOD. In 2009, awareness of heart disease as the LCOD was 65%, decreasing to 44% in 2019. In 2019, awareness was greater with older age and increasing education and lower among non-White women and women with hypertension. The 10-year awareness decline was observed in all races/ethnicities and ages except women ≥65 years of age. The greatest declines were among Hispanic women (odds ratio of awareness comparing 2019 to 2009, 0.14 [95% CI, 0.07-0.28]), non-Hispanic Black women (odds ratio, 0.31 [95% CI, 0.19-0.49]), and 25- to 34-year-olds (odds ratio, 0.19 [95% CI, 0.10-0.34]). In 2019, women were more likely than in 2009 to incorrectly identify breast cancer as the LCOD (odds ratio, 2.59 [95% CI, 1.86-3.67]), an association that was greater in younger women. Awareness of heart attack symptoms also declined. CONCLUSIONS Awareness that heart disease is the LCOD among women declined from 2009 to 2019, particularly among Hispanic and non-Hispanic Black women and in younger women (in whom primordial/primary prevention may be most effective). An urgent redoubling of efforts by organizations interested in women's health is required to reverse these trends.
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Pendyal A, Rosenthal MS, Spatz ES, Cunningham A, Bliesener D, Keene DE. "When you're homeless, they look down on you": A qualitative, community-based study of homeless individuals with heart failure. Heart Lung 2021; 50:80-85. [PMID: 32792114 PMCID: PMC7738391 DOI: 10.1016/j.hrtlng.2020.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Outpatient heart failure (HF) care involves intensive self-management (SM). Effective HF SM is associated with improved outcomes. Homelessness poses challenges to successful SM. OBJECTIVES To identify the ways in which homelessness may impede successful SM of HF and engagement with the healthcare system. METHODS We conducted open-ended, semi-structured interviews with homeless adults with HF. Data were analyzed by a multidisciplinary team using a grounded theory approach. RESULTS We interviewed 19 participants, 11 (58%) of whom were homeless at the time of interview. Interviews revealed a combination of influences on HF SM. Major themes included instability and lack of routine, tradeoffs between basic necessities and HF SM, and stigmatization by healthcare providers. CONCLUSIONS Anticipatory guidance aimed at the unique challenges faced by homeless individuals with HF may aid successful SM. HF providers should simlpify medication regimes and engage in non-stigmatizing discourse. Larger-scale interventions include the creation of medical respite programs.
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Affiliation(s)
- Akshay Pendyal
- Novant Health Heart and Vascular Institute, Presbyterian Medical Center, 1718 E. 4th Street, Charlotte, NC 28204, USA; National Clinician Scholars Program, Yale School of Medicine, PO Box 208088, New Haven, CT 06520, USA.
| | - Marjorie S Rosenthal
- National Clinician Scholars Program, Yale School of Medicine, PO Box 208088, New Haven, CT 06520, USA; Department of Pediatrics, Yale School of Medicine, PO Box 208064, New Haven, CT 06520-8064, USA
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale School of Medicine, 1 Church Street, New Haven, CT 06510, USA; Section of Cardiovascular Medicine, Yale School of Medicine, PO Box 208017, New Haven, CT 06520-8017, USA
| | | | - Dawn Bliesener
- Community partner, Yale School of Medicine, PO Box 208088, New Haven, CT 06520, USA
| | - Danya E Keene
- National Clinician Scholars Program, Yale School of Medicine, PO Box 208088, New Haven, CT 06520, USA; Yale School of Public Health, P.O. Box 208034, New Haven, CT 06520-0834, USA
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Martin J, Coffey S, Whalley GA. Sex Disparity in Cardiovascular Disease Outcomes: Do Our Current Echocardiographic Reference Ranges Measure Up? Heart Lung Circ 2020; 30:e1-e5. [PMID: 33176982 DOI: 10.1016/j.hlc.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022]
Abstract
Reducing inequity in access to health care and disparity in health outcomes remain key objectives in cardiovascular medicine. Echocardiography is often the primary diagnostic tool used to detect cardiovascular disease (CVD), and relies on comparison with published reference ranges to appropriately detect pathology. Our understanding of the contribution of age, sex and ethnicity to quantification of cardiac size is improving, but cardiovascular disease management guidelines have yet to evolve. While recently, sex, age and ethnicity-specific reference values have been produced, treatment thresholds in many clinical guidelines do not differentiate between sexes. As a result, in order to reach management thresholds, women are often required to have more severe pathology. In order to reduce potential disadvantage to women, future research efforts should be directed to develop more personalised treatment approaches by identification of sex-appropriate management thresholds.
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Affiliation(s)
- Josh Martin
- Department of Cardiology, Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia.
| | - Sean Coffey
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gillian A Whalley
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Mehta PK, Bess C, Elias-Smale S, Vaccarino V, Quyyumi A, Pepine CJ, Bairey Merz CN. Gender in cardiovascular medicine: chest pain and coronary artery disease. Eur Heart J 2020; 40:3819-3826. [PMID: 31713592 DOI: 10.1093/eurheartj/ehz784] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/26/2019] [Accepted: 10/23/2019] [Indexed: 01/10/2023] Open
Abstract
Ischaemic heart disease (IHD) remains the leading cause of morbidity and mortality among women and men yet women are more often underdiagnosed, have a delay in diagnosis, and/or receive suboptimal treatment. An implicit gender-bias with regard to lack of recognition of sex-related differences in presentation of IHD may, in part, explain these differences in women compared with men. Indeed, existing knowledge demonstrates that angina does not commonly relate to obstructive coronary artery disease (CAD). Emerging knowledge supports an inclusive approach to chest pain symptoms in women, as well as a more thoughtful consideration of percutaneous coronary intervention for angina in stable obstructive CAD, to avoid chasing our tails. Emerging knowledge regarding the cardiac autonomic nervous system and visceral pain pathways in patients with and without obstructive CAD offers explanatory mechanisms for angina. Interdisciplinary investigation approaches that involve cardiologists, biobehavioural specialists, and anaesthesia/pain specialists to improve angina treatment should be pursued.
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Affiliation(s)
- Puja K Mehta
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road NE, Suite 505, Atlanta, GA, USA
| | - Courtney Bess
- J. Willis Hurst Internal Residency Program, Emory University, 49 Jesse Hill Jr Drive, FOB Building, 4th floor, Box #92, Atlanta, GA, USA
| | - Suzette Elias-Smale
- Department of Cardiology, Radboud University Medical Center, Geert grooteplein Zuid 10, GA Nijmegen, The Netherlands
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, CNR Building, Room 3041, Atlanta, GA, USA
| | - Arshed Quyyumi
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road NE, Suite 505, Atlanta, GA, USA
| | - Carl J Pepine
- Divsion of Cardiology, University of Florida, 1329 SW 6th Street, PO Box 100288, Gainesville, FL, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, 127 S. San Vicente Blvd, Suite A3600, Los Angeles, CA, USA
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Sex Disparities in Myocardial Infarction: Biology or Bias? Heart Lung Circ 2020; 30:18-26. [PMID: 32861583 DOI: 10.1016/j.hlc.2020.06.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/19/2020] [Accepted: 06/28/2020] [Indexed: 12/31/2022]
Abstract
Women have generally worse outcomes after myocardial infarction (MI) compared to men. The reasons for these disparities are multifactorial. At the beginning is the notion-widespread in the community and health care providers-that women are at low risk for MI. This can impact on primary prevention of cardiovascular disease in women, with lower use of preventative therapies and lifestyle counselling. It can also lead to delays in presentation in the event of an acute MI, both at the patient and health care provider level. This is of particular concern in the case of ST elevation MI (STEMI), where "time is muscle". Even after first medical contact, women with acute MI experience delays to diagnosis with less timely reperfusion and percutaneous coronary intervention (PCI). Compared to men, women are less likely to undergo invasive diagnostic testing or PCI. After being diagnosed with a STEMI, women receive less guideline-directed medical therapy and potent antiplatelets than men. The consequences of these discrepancies are significant-with higher mortality, major cardiovascular events and bleeding after MI in women compared to men. We review the sex disparities in pathophysiology, risk factors, presentation, diagnosis, treatment, and outcomes for acute MI, to answer the question: are they due to biology or bias, or both?
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36
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Kim JS, Kim GS, Kang SM, Chu SH. Symptom experience as a predictor of cardiac rehabilitation education programme attendance after percutaneous coronary intervention: A prospective questionnaire survey. Eur J Cardiovasc Nurs 2020; 20:183–191. [PMID: 33611353 DOI: 10.1177/1474515120940534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/17/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite evidence that participation in cardiac rehabilitation programmes after percutaneous coronary intervention is associated with better clinical outcomes, many patients with coronary artery disease do not participate in such programmes. A traditional educational approach is recommended to provide patients with information regarding the benefits of cardiac rehabilitation in relation to their underlying coronary artery disease and modification of risk factors. AIMS The purpose of this study was to examine the role of patient factors (symptom experience and health belief) on cardiac rehabilitation education programme attendance among Korean patients subjected to percutaneous coronary intervention. METHODS A prospective survey was conducted enrolling 173 patients who underwent percutaneous coronary intervention. Information on symptom experience, health belief (perceived susceptibility/severity/benefits/ barriers) and sociodemographic and clinical characteristics was collected at baseline (after percutaneous coronary intervention). Three to four weeks later, information on disease-related knowledge and health behaviour was compared between cardiac rehabilitation education programme attendees and non-attendees. RESULTS Eighty of 173 (46.2%) patients surveyed attended the cardiac rehabilitation education programme. Symptom experience before percutaneous coronary intervention was the most significant predictor of programme attendance (odds ratio=3.46; 95% confidence interval 1.45-8.27), followed by higher perceived socioeconomic status (odds ratio=2.90; 95% confidence interval 1.28-6.58), perceived susceptibility (odds ratio=1.22, 95% confidence interval 1.08-1.39), perceived benefits (odds ratio=1.09; 95% confidence interval 1.02-1.17) and perceived severity (odds ratio=1.04; 95% confidence interval 1.00-1.08). Better disease-related knowledge and health behaviour were significantly associated with cardiac rehabilitation education programme attendance. CONCLUSION This study provides evidence that educational programmes to help improve patients' perceptions of their disease susceptibility and severity, especially health behaviour benefits in patients without symptom experience before percutaneous coronary intervention, are necessary.
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Affiliation(s)
- Ji-Su Kim
- College of Nursing, Yonsei University, Korea
| | - Gwang S Kim
- College of Nursing, Yonsei University, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University, Korea
| | - Seok-Min Kang
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, College of Medicine, Yonsei University, Korea
| | - Sang H Chu
- College of Nursing, Yonsei University, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University, Korea
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Mendez SEA, Mendez-Luck CA, Nylund-Gibson K, Ng B. Mental Health Attribution for Mexican-Origin Latinx and Non-Latinx Older Adults: A Latent Class Analysis. Innov Aging 2020; 4:igaa028. [PMID: 34136663 PMCID: PMC8202504 DOI: 10.1093/geroni/igaa028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Providing appropriate and culturally sensitive care to the rapidly growing number of
U.S. Latinx older adults with psychiatric conditions presents a major public health
challenge. We know little about older Latinx adults’ perceived causes of mental health
problems, offering clinicians limited insight to guide successful and culturally
congruent treatment. Moreover, there is a paucity of mental health research examining
heterogeneity in how Latinx individuals may attribute mental health symptoms. The
present study sought to identify how Latinx and non-Latinx older adults attributed the
sources of their mental health problems and how these types of attributions differ by
ethnicity. Research Design and Methods This study analyzed data collected from a retrospective chart review and survey of 673
adults aged 55–95 years (430 Mexican origin and 244 non-Latinx) from a rural psychiatric
outpatient clinic near the California–Mexico border. We conducted stratified latent
class analysis (LCA) by race/ethnicity to explore the mental health attribution beliefs
of Mexican-origin and non-Latinx clinic patients. Results Different LCA patterns for Mexican-origin Latinx versus non-Latinx groups were found.
For non-Latinx adults, there was a class of individuals who attributed their mental
health issues to social and financial problems. For Mexican-origin adults, there was a
class of individuals who attributed their mental health issues to spiritual and/or
supernatural factors, unaffected by acculturation level, depressive symptom severity,
and time spent in the United States, but differing by gender. We found within-group
heterogeneity: Not all Mexican-origin or non-Latinx older adults were alike in how they
conceptualized their mental health. Discussion and Implications Mexican-origin Latinx and non-Latinx older adults attributed their mental health issues
to different causes. More Mexican-origin older adults attributed their symptoms to
spiritual causes, even after controlling for contextual factors. Further research is
needed to determine whether attribution beliefs are affected by specific mental health
diagnoses and other cultural factors not measured in this study.
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Affiliation(s)
- Stephanie E A Mendez
- University of Southern California, University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles
| | | | | | - Bernardo Ng
- Sun Valley Behavioral Research Center, Imperial, California
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38
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Sex-Based Considerations in the Evaluation of Chest Pain and Management of Obstructive Coronary Artery Disease. Curr Atheroscler Rep 2020; 22:39. [DOI: 10.1007/s11883-020-00855-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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39
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Simeone S, Guillari A, Pucciarelli G, Stile F, Gargiulo G, Esposito M, Alvaro R, Rea T. Sexual Health After Acute Myocardial Infarction: The Lived Experience of Women During the First-Year Post Discharge. SEXUALITY AND DISABILITY 2020. [DOI: 10.1007/s11195-020-09627-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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40
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Huang L, Zhang Y, Su E, Liu Y, Deng Y, Jin L, Chen Z, Li S, Zhao Y, He N. Eight biomarkers on a novel strip for early diagnosis of acute myocardial infarction. NANOSCALE ADVANCES 2020; 2:1138-1143. [PMID: 36133047 PMCID: PMC9419248 DOI: 10.1039/c9na00644c] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/09/2019] [Indexed: 05/07/2023]
Abstract
Accurate detection of markers in human serum is important in the early diagnosis of acute myocardial infarction (AMI). This work presents a novel eight biomarker strip, which combines dry chemistry with a fluorescence lateral flow assay. Eight AMI markers were employed simultaneously for sensitive detection, including cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C), uric acid (UA), myoglobin (Myo), creatine kinase-MB (CK-MB), and cardiac troponin I (cTnI). The strip offers the advantages of simple fabrication, convenience, time-saving detection and accurate assessment for AMI. Moreover, the strip possesses acceptable applicability for human serum. This proposed strategy establishes a remarkable platform for the construction of a multi-target detection strip that is feasible for accurate detection for real human serum samples.
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Affiliation(s)
- Li Huang
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University Nanjing 210096 China
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology Zhuzhou 412007 P. R. China
- Getein Biotechnology Co., Ltd. Nanjing 210000 China
| | | | - Enben Su
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology Zhuzhou 412007 P. R. China
- Getein Biotechnology Co., Ltd. Nanjing 210000 China
| | - Yuan Liu
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University Nanjing 210096 China
| | - Yan Deng
- Getein Biotechnology Co., Ltd. Nanjing 210000 China
| | - Lian Jin
- Getein Biotechnology Co., Ltd. Nanjing 210000 China
| | - Zhu Chen
- Getein Biotechnology Co., Ltd. Nanjing 210000 China
| | - Song Li
- Getein Biotechnology Co., Ltd. Nanjing 210000 China
| | - Yongxiang Zhao
- National Center for International Bio-targeting Theranostics, Guangxi Key Laboratory of Bio-targeting Theranostics, Collaborative Innovation Center for Targeting Tumor Theranostics, Guangxi Medical University Guangxi 530021 China
| | - Nongyue He
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University Nanjing 210096 China
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology Zhuzhou 412007 P. R. China
- National Center for International Bio-targeting Theranostics, Guangxi Key Laboratory of Bio-targeting Theranostics, Collaborative Innovation Center for Targeting Tumor Theranostics, Guangxi Medical University Guangxi 530021 China
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Song KY, Zhang XZ, Li F, Ji QR. Silencing of ATP2B1-AS1 contributes to protection against myocardial infarction in mouse via blocking NFKBIA-mediated NF-κB signalling pathway. J Cell Mol Med 2020; 24:4466-4479. [PMID: 32155320 PMCID: PMC7176878 DOI: 10.1111/jcmm.15105] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/14/2020] [Accepted: 01/31/2020] [Indexed: 12/17/2022] Open
Abstract
Myocardial infarction (MI) is an acute coronary syndrome that refers to tissue infarction of the myocardium. This study aimed to investigate the effect of long intergenic non‐protein‐coding RNA (lincRNA) ATPase plasma membrane Ca2+ transporting 1 antisense RNA 1 (ATP2B1‐AS1) against MI by targeting nuclear factor‐kappa‐B inhibitor alpha (NFKBIA) and mediating the nuclear factor‐kappa‐B (NF‐κB) signalling pathway. An MI mouse model was established and idenepsied by cardiac function evaluation. It was determined that ATP2B1‐AS1 was highly expressed, while NFKBIA was poorly expressed and NF‐κB signalling pathway was activated in MI mice. Cardiomyocytes were extracted from mice and introduced with a series of mouse ATP2B1‐AS1 vector, NFKBIA vector, siRNA‐mouse ATP2B1‐AS1 and siRNA‐NFKBIA. The expression of NF‐κBp50, NF‐κBp65 and IKKβ was determined to idenepsy whether ATP2B1‐AS1 and NFKBIA affect the NF‐κB signalling pathway, the results of which suggested that ATP2B1‐AS1 down‐regulated the expression of NFKBIA and activated the NF‐κB signalling pathway in MI mice. Based on the data from assessment of cell viability, cell cycle, apoptosis and levels of inflammatory cytokines, either silencing of mouse ATP2B1‐AS1 or overexpression of NFKBIA was suggested to result in reduced cardiomyocyte apoptosis and expression of inflammatory cytokines, as well as enhanced cardiomyocyte viability. Our study provided evidence that mouse ATP2B1‐AS1 silencing may have the potency to protect against MI in mice through inhibiting cardiomyocyte apoptosis and inflammation, highlighting a great promise as a novel therapeutic target for MI.
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Affiliation(s)
- Kai-You Song
- Department of Cardiology, Linyi People's Hospital, Linyi, China
| | - Xian-Zhao Zhang
- Department of Cardiology, Linyi People's Hospital, Linyi, China
| | - Feng Li
- Clinical Laboratory, The Third People's Hospital of Linyi, Linyi, China
| | - Qing-Rong Ji
- Department of Cardiology, Linyi People's Hospital, Linyi, China
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Gulati R, Behfar A, Narula J, Kanwar A, Lerman A, Cooper L, Singh M. Acute Myocardial Infarction in Young Individuals. Mayo Clin Proc 2020; 95:136-156. [PMID: 31902409 DOI: 10.1016/j.mayocp.2019.05.001] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/07/2019] [Accepted: 05/03/2019] [Indexed: 12/17/2022]
Abstract
Globally, cardiovascular disease remains a major cause of adverse outcomes in young individuals, unlike its decline in other age groups. This group is not well studied and has a unique risk profile with less traditional cardiovascular risk factors compared with older populations. Plaque rupture still remains the most common etiology of myocardial infarction, but unique syndromes such as plaque erosion, coronary microvascular dysfunction, spontaneous coronary artery dissection, and coronary spasm related to drug use are more prevalent in this age group. Such diversity of diagnosis and presentation, along with therapeutic implications, underscore the need to study the profile of myocardial infarction in young persons. We searched PubMed for articles published from 1980 to 218 using the terms acute myocardial infarction, young, plaque rupture, plaque erosion, spontaneous coronary artery dissection (SCAD), coronary vasospasm, variant or Prinzmetal angina, drug-induced myocardial infarction, myocarditis, coronary embolism, microvascular dysfunction, MINOCA, and myocardial infarction in pregnancy and reviewed all the published studies. With the data from this search, we aim to inform readers of the prevalence, risk factors, presentation, and management of acute myocardial infarction in young patients and elaborate on special subgroups with diagnostic and therapeutic challenges. We also outline a parsimonious method designed to simplify management of these complex patients.
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Affiliation(s)
- Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Jagat Narula
- Department of Medicine/Cardiology, Mount Sinai Hospital, New York, NY
| | | | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Leslie Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
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Tran P, Tran L. Influence of rurality on the awareness of myocardial infarction symptoms in the US. Ther Adv Cardiovasc Dis 2019; 13:1753944719891691. [PMID: 31797738 PMCID: PMC6893939 DOI: 10.1177/1753944719891691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Myocardial infarctions (MIs) are the leading cause of death in the United States (US). Differences in MI mortality rates exist between rural and urban areas in the US. Early recognition of MI symptoms can lead to receiving prompt lifesaving treatment. In this study, we identified the influence of living in a rural area, rurality, on disparities in MI symptom awareness across the US. METHODS We examined 2007 and 2009 Behavioral Risk Factor Surveillances System survey data using logistic regressions to model the impact of rurality on MI symptom awareness while controlling for sociodemographic and MI clinical factors. From the results of these models, we created a type of marginal probability, known as average adjusted predictions (AAPs) and the difference in AAPs, called average marginal effects (AMEs), to determine patterns of awareness for each MI symptom between rural, suburban, and urban areas. RESULTS We found that there were similar odds and probabilities of being aware of all five MI symptoms between rural, suburban, and urban areas, although rural residents consistently had a slightly higher odds and probability of being aware of all five MI symptoms compared with suburban and urban residents. Rural, suburban, and urban residents had the highest probability of being aware of chest pain/discomfort (95.5-96.1%) and the lowest probability of being aware of jaw/back/neck pain (68.6-72.0%). After adjustment, more than 25% of rural, suburban, and urban residents were found to be unaware that jaw/back/neck pain and feeling weak/light-headed/faint were symptoms of MI. AMEs were greatest for all areas for jaw/back/neck pain (-3.5% to -3.2%) and smallest for chest pain/discomfort (-0.6% to -0.2%). CONCLUSIONS The study's results highlight the need to increase awareness of the MI symptoms of jaw/back/neck pain and feeling weak/light-headed/faint to shorten hospital delay and time to treatment, especially for rural areas where cardiovascular disease mortality is high.
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Affiliation(s)
- Phoebe Tran
- Department of Chronic Disease Epidemiology, Yale University, 60 College Street, New Haven, CT 06510, USA
| | - Lam Tran
- Department of Biostatistics, Michigan School of Public Health, Ann Arbor, MI, USA
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Vautrin E, Jean ABP, Fourny M, Marlière S, Vanzetto G, Bouvaist H, Debaty G, Belle L, Danchin N, Labarère J. Sex differences in coronary artery lesions and in‐hospital outcomes for patients with ST‐segment elevation myocardial infarction under the age of 45. Catheter Cardiovasc Interv 2019; 96:1222-1230. [DOI: 10.1002/ccd.28627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/08/2019] [Accepted: 11/17/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Estelle Vautrin
- Department of Cardiology Grenoble Alpes University Hospital Grenoble France
| | | | - Magali Fourny
- Quality of Care Unit Grenoble Alpes University Hospital Grenoble France
| | - Stéphanie Marlière
- Department of Cardiology Grenoble Alpes University Hospital Grenoble France
| | - Gérald Vanzetto
- Department of Cardiology Grenoble Alpes University Hospital Grenoble France
| | - Hélène Bouvaist
- Department of Cardiology Grenoble Alpes University Hospital Grenoble France
| | - Guillaume Debaty
- TIMC, UMR 5525, CNRS Université Grenoble Alpes Grenoble France
- Department of Emergency Medicine Grenoble Alpes University Hospital Grenoble France
| | - Loïc Belle
- Department of Cardiology Annecy‐Genevois Hospital, Réseau nord alpin des urgences (RENAU) Annecy France
| | - Nicolas Danchin
- Department of Cardiology Hôpital Européen Georges Pompidou, Assistance Publique‐Hôpitaux de Paris Paris France
| | - José Labarère
- Quality of Care Unit Grenoble Alpes University Hospital Grenoble France
- TIMC, UMR 5525, CNRS Université Grenoble Alpes Grenoble France
- CIC 1406, INSERM Grenoble Alpes University Hospital Grenoble France
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45
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Bęćkowski M, Kowalik I, Jaworski K, Dąbrowski R, Gierlotka M, Gąsior M, Poloński L, Zdrojewski T, Karwowski J, Drygas W, Szwed H. Differences in Symptomatology and Clinical Course of Acute Coronary Syndromes in Women ≤45 Years of Age Compared to Older Women. Curr Probl Cardiol 2019; 46:100508. [PMID: 31898981 DOI: 10.1016/j.cpcardiol.2019.100508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/29/2019] [Accepted: 11/02/2019] [Indexed: 12/22/2022]
Abstract
Acute coronary syndromes (ACS) in young people are rare. The data regarding differences in symptoms in relation to age are scarce, which may have an influence on outcomes. The aim of this study was to evaluate the differences in the clinical course of ACS between younger women (≤45 years old) and older women (63-64 years old). We compared 7481 women with ACS from the Polish Registry of ACS between 2007 and 2014 (1834 women aged ≤45 years and 5647 women aged 63-64 years). The predominant symptom of ACS in both groups was chest pain, with a higher incidence occurring in younger women (90.4% vs 88.5%, P = 0.025). Prehospital cardiac arrest occurred more often in younger women (2.1% vs 0.8%, P < 0.001), and onset-to-balloon time was shorter (8.9 vs 15.2 hours, P < 0.0001) in this group. Younger women presented with a lower Killip class at admission (class I at admission: 92.7% vs 86.2%, P < 0.001). The dominant type of ACS in the younger cohort was ST-segment elevation myocardial infarction (STEMI) (42% vs 26.1%), localized mainly in the anterior wall (47.7% vs 36.1%, P < 0.001), with a higher percentage of total occlusion of infarct-related artery (TIMI 0, 45.2% vs 36.1%) and left anterior descending artery engagement for all (33.5% vs 26.5%, P < 0.001). Drug-eluting stents were often used in the younger patients (43.3% vs 38.2%, P = 0.003) without significant differences in percutaneous coronary intervention numbers. Pharmacotherapy was used less in younger women. The 30-day and 2-year mortality in young women was lower than in the older cohort. The clinical course of ACS in younger women differed in comparison to older women. Younger women had a higher occurrence of typical chest pain, STEMI, and left anterior descending artery engagement. Except STEMI patients young women received faster revascularization, however with no significant differences in invasive treatment. Pharmacotherapy was inadequate in younger women and that resulted in a lower usage of the beta-blockers, angiotensin-converting enzyme inhibitors, and statins in that group. Short- and long-term mortality was low, regardless of the type of ACS.
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Paramasivam G, Devasia T, Ubaid S, Shetty A, Nayak K, Pai U, Rao MS. In-stent restenosis of drug-eluting stents: clinical presentation and outcomes in a real-world scenario. Egypt Heart J 2019; 71:28. [PMID: 31773342 PMCID: PMC6879682 DOI: 10.1186/s43044-019-0025-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/01/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Drug-eluting stents (DES) have substantially reduced the incidence of coronary in-stent restenosis (ISR), but the problem persists. Clinical presentation and outcomes of DES-ISR in a real-world scenario remains underreported. RESULTS In this retrospective study, we examined medical records of 191 consecutive patients with DES-ISR (210 ISR lesions) hospitalized between January 2013 and December 2017. ISR clinical presentation was classified as acute coronary syndrome (ACS) or non-ACS. Clinical, angiographic features and 1-year outcomes [composite of death, myocardial infarction (MI) and repeat-target lesion revascularization] for these two groups were compared. The mean age of study population was 61 ± 10 years and 81.2% were males. ACS was the dominant clinical presentation mode occurring in 118 (61.8%) patients. MI was seen in 66 (34.6%) patients. Female gender (odds ratio, 2.71; 95% confidence interval [CI], 1.13-6.52; P = 0.026) and chronic kidney disease (odds ratio, 3.85; 95% CI, 1.05-14.20; P = 0.043) correlated significantly with ACS ISR presentation. A majority [104 (54.5%)] of patients underwent percutaneous coronary intervention (PCI), of whom 72 (69.2%) received a new DES. The rest either underwent CABG (26.2%) or received medical therapy (19.4%). Patients presenting with ACS had a significantly worse clinical outcome at 1-year follow-up (ACS versus non-ACS presentation: hazard ratio [HR], 2.66; 95% CI, 1.09-6.50; P = 0.032). CONCLUSIONS DES-ISR presents most commonly as ACS. Female gender and chronic kidney disease seem to be associated with ACS presentation. ACS presentation of ISR is associated with worse 1-year outcomes. Early identification of those with ACS risk and closer follow-up may improve outcomes.
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Affiliation(s)
- Ganesh Paramasivam
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Tom Devasia
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Shabeer Ubaid
- Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Ashwitha Shetty
- Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Krishnananda Nayak
- Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Umesh Pai
- Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Mugula Sudhakar Rao
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Zhukova NS, Shakhnovich RM, Merkulova IN, Sukhinina TS, Pevzner DV, Staroverov II. [Spontaneous Coronary Artery Dissection]. ACTA ACUST UNITED AC 2019; 59:52-63. [PMID: 31540576 DOI: 10.18087/cardio.2019.9.10269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 11/18/2022]
Abstract
During several recent decades spontaneous coronary artery dissection (SCAD) has been known as one of causes of development of acute coronary syndrome (ACS). It has been assumed that this condition is extremely rarely met and is associated with pregnancy and postpartum period. The use in clinical practice of high sensitivity troponin, coronary angiography (CAG) in early period of ACS, in conjunction with the growing awareness of doctors about this pathology led to a revision of the viewse on prevalence of the disease. At present SCAD is considered as one of the causes of ACS in young and middle-aged women. In this review we present results of studies of pathogenesis, diagnostics, and treatment of SCAD, describe various angiographic types of this disease, and discuss problems of choice of optimal strategy of management of patients with SCAD.
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Affiliation(s)
- N S Zhukova
- National Medical Research Center for Cardiology
| | | | | | | | - D V Pevzner
- National Medical Research Center for Cardiology
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48
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Biddle C, Fallavollita JA, Homish GG, Giovino GA, Orom H. Gender differences in symptom misattribution for coronary heart disease symptoms and intentions to seek health care. Women Health 2019; 60:367-381. [PMID: 31370742 DOI: 10.1080/03630242.2019.1643817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Women are more likely to delay seeking care for coronary heart disease (CHD) symptoms than men. We tested whether this was because they are more likely to misattribute CHD symptoms. Data were collected in December 2016. Participants were 714 Amazon's Mechanical Turk (crowdsourcing marketplace) workers with US Internet Protocol (IP) addresses; 52% female (ages 35-77 years) made judgments about patients of their same gender described in vignettes. We used adjusted multivariable logistic, ordinal, and linear regression to test our hypotheses. Women had a higher odds of misattributing the symptoms of the target in the vignettes to non-cardiac causes than men (adjusted odds ratio [AOR] = 2.08, p < .001), despite having higher mean knowledge scores about CHD (4.49 vs. 4.03, p < .001) and rating their CHD risk as higher (25% more likely to get CHD vs. 19%, p = .025) than men. Women were also less likely than men to intend to seek care at an emergency department (b = -0.33, p = .024), and if they did intend to seek care, they were more likely to intend to wait to seek care (AOR = 2.37, p = .003). Symptom misattribution may partially account for women's lower likelihood of intending to seek care from an emergency department, which would be especially critical in emergency situations.
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Affiliation(s)
- Caitlin Biddle
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, New York, USA
| | | | - Gregory G Homish
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, New York, USA
| | - Gary A Giovino
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, New York, USA
| | - Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, New York, USA
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49
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Fiorilli PN, Kolansky DM. Getting to the Right Place at the Right Time: Another Piece of the STEMI Puzzle. Circ Cardiovasc Interv 2019; 11:e006700. [PMID: 29716934 DOI: 10.1161/circinterventions.118.006700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paul N Fiorilli
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Daniel M Kolansky
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia.
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50
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Gupta T, Kolte D, Khera S, Agarwal N, Villablanca PA, Goel K, Patel K, Aronow WS, Wiley J, Bortnick AE, Aronow HD, Abbott JD, Pyo RT, Panza JA, Menegus MA, Rihal CS, Fonarow GC, Garcia MJ, Bhatt DL. Contemporary Sex-Based Differences by Age in Presenting Characteristics, Use of an Early Invasive Strategy, and Inhospital Mortality in Patients With Non-ST-Segment-Elevation Myocardial Infarction in the United States. Circ Cardiovasc Interv 2019; 11:e005735. [PMID: 29311289 DOI: 10.1161/circinterventions.117.005735] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 12/07/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prior studies have reported higher inhospital mortality in women versus men with non-ST-segment-elevation myocardial infarction. Whether this is because of worse baseline risk profile compared with men or sex-based disparities in treatment is not completely understood. METHODS AND RESULTS We queried the 2003 to 2014 National Inpatient Sample databases to identify all hospitalizations in patients aged ≥18 years with the principal diagnosis of non-ST-segment-elevation myocardial infarction. Complex samples multivariable logistic regression models were used to examine sex differences in use of an early invasive strategy and inhospital mortality. Of 4 765 739 patients with non-ST-segment-elevation myocardial infarction, 2 026 285 (42.5%) were women. Women were on average 6 years older than men and had a higher comorbidity burden. Women were less likely to be treated with an early invasive strategy (29.4% versus 39.2%; adjusted odds ratio, 0.92; 95% confidence interval, 0.91-0.94). Women had higher crude inhospital mortality than men (4.7% versus 3.9%; unadjusted odds ratio, 1.22; 95% confidence interval, 1.20-1.25). After adjustment for age (adjusted odds ratio, 0.96; 95% confidence interval, 0.94-0.98) and additionally for comorbidities, other demographics, and hospital characteristics, women had 10% lower odds of inhospital mortality (adjusted odds ratio, 0.90; 95% confidence interval, 0.89-0.92). Further adjustment for differences in the use of an early invasive strategy did not change the association between female sex and lower risk-adjusted inhospital mortality. CONCLUSIONS Although women were less likely to be treated with an early invasive strategy compared with men, the lower use of an early invasive strategy was not responsible for the higher crude inhospital mortality in women, which could be entirely explained by older age and higher comorbidity burden.
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Affiliation(s)
- Tanush Gupta
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Dhaval Kolte
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Sahil Khera
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Nayan Agarwal
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Pedro A Villablanca
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Kashish Goel
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Kavisha Patel
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Wilbert S Aronow
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Jose Wiley
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Anna E Bortnick
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Herbert D Aronow
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - J Dawn Abbott
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Robert T Pyo
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Julio A Panza
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Mark A Menegus
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Charanjit S Rihal
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Gregg C Fonarow
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Mario J Garcia
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Deepak L Bhatt
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.).
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