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Sola M, Mesenbring E, Glorioso TJ, Gualano S, Atkinson T, Duvernoy CS, Waldo SW. Sex Disparities in the Management of Acute Coronary Syndromes: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. J Am Heart Assoc 2024; 13:e034312. [PMID: 39206727 DOI: 10.1161/jaha.123.034312] [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: 02/22/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Previous work has demonstrated disparities in the management of cardiovascular disease among men and women. We sought to evaluate these disparities and their associations with clinical outcomes among patients admitted with acute coronary syndromes to the Veterans Affairs Healthcare System. METHODS AND RESULTS We identified all patients that were discharged with acute coronary syndromes within the Veterans Affairs Healthcare System from October 1, 2015 to September 30, 2022. Medical and procedural management of patients was subsequently assessed, stratified by sex. In doing so, we identified 76 454 unique admissions (2327 women, 3.04%), which after propensity matching created an analytic cohort composed of 6765 men (74.5%) and 2295 women (25.3%). Women admitted with acute coronary syndromes were younger with fewer cardiovascular comorbidities and a lower prevalence of preexisting prescriptions for cardiovascular medications. Women also had less coronary anatomic complexity compared with men (5 versus 8, standardized mean difference [SMD]=0.40), as calculated by the Veterans Affairs SYNTAX score. After discharge, women were significantly less likely to receive cardiology follow-up at 30 days (hazard ratio [HR], 0.858 [95% CI, 0.794-0.928]) or 1 year (HR, 0.891 [95% CI, 0.842-0.943]), or receive prescriptions for guideline-indicated cardiovascular medications. Despite this, 1-year mortality rates were lower for women compared with men (HR, 0.841 [95% CI, 0.747-0.948]). CONCLUSIONS Women are less likely to receive appropriate cardiovascular follow-up and medication prescriptions after hospitalization for acute coronary syndromes. Despite these differences, the clinical outcomes for women remain comparable. These data suggest an opportunity to improve the posthospitalization management of cardiovascular disease regardless of sex.
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Affiliation(s)
- Michael Sola
- Division of Cardiology, Department of Medicine University of Colorado Aurora CO USA
- Department of Medicine Rocky Mountain Veterans Affairs Medical Center Aurora CO USA
| | - Elise Mesenbring
- CART Program, Office of Quality and Patient Safety Veterans Health Administration Washington DC USA
- Denver Research institute Aurora CO USA
| | - Thomas J Glorioso
- CART Program, Office of Quality and Patient Safety Veterans Health Administration Washington DC USA
| | - Sarah Gualano
- VA Ann Arbor Healthcare System Ann Arbor MI USA
- University of Michigan Ann Arbor MI USA
| | - Tamara Atkinson
- Portland VA Medical Center Portland OR USA
- Knight Cardiovascular Institute, Oregon Health Sciences University Portland OR USA
| | - Claire S Duvernoy
- VA Ann Arbor Healthcare System Ann Arbor MI USA
- University of Michigan Ann Arbor MI USA
| | - Stephen W Waldo
- Division of Cardiology, Department of Medicine University of Colorado Aurora CO USA
- Department of Medicine Rocky Mountain Veterans Affairs Medical Center Aurora CO USA
- CART Program, Office of Quality and Patient Safety Veterans Health Administration Washington DC USA
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2
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Bikdeli B, Muriel A, Wang Y, Piazza G, Khairani CD, Rosovsky RP, Mehdipoor G, O'Donoghue ML, Madridano O, Lopez-Saez JB, Mellado M, Brasero AMD, Grandone E, Spagnolo PA, Lu Y, Bertoletti L, López-Jiménez L, Núñez MJ, Blanco-Molina Á, Gerhard-Herman M, Goldhaber SZ, Bates SM, Jimenez D, Krumholz HM, Monreal M. Sex-Related Differences in Patient Characteristics, Risk Factors, and Symptomatology in Older Adults with Pulmonary Embolism: Findings from the SERIOUS-PE Study. Semin Thromb Hemost 2023; 49:725-735. [PMID: 36868268 DOI: 10.1055/s-0043-1764231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Sex-specific factors are implicated in pulmonary embolism (PE) presentation in young patients, as indicated by increased risk in pregnancy. Whether sex differences exist in PE presentation, comorbidities, and symptomatology in older adults, the age group in which most PEs occur, remains unknown. We identified older adults (aged ≥65 years) with PE in a large international PE registry replete with information about relevant clinical characteristics (RIETE registry, 2001-2021). To provide national data from the United States, we assessed sex differences in clinical characteristics and risk factors of Medicare beneficiaries with PE (2001-2019). The majority of older adults with PE in RIETE (19,294/33,462, 57.7%) and in the Medicare database (551,492/948,823, 58.7%) were women. Compared with men, women with PE less frequently had atherosclerotic diseases, lung disease, cancer, or unprovoked PE, but more frequently had varicose veins, depression, prolonged immobility, or history of hormonal therapy (p < 0.001 for all). Women less often presented with chest pain (37.3 vs. 40.6%) or hemoptysis (2.4 vs. 5.6%) but more often with dyspnea (84.6 vs. 80.9%) (p < 0.001 for all). Measures of clot burden, PE risk stratification, and use of imaging modalities were comparable between women and men. PE is more common in elderly women than in men. Cancer and cardiovascular disease are more common in men, whereas transient provoking factors including trauma, immobility, or hormone therapy are more common in elderly women with PE. Whether such differences correlate with disparities in treatment or differences in short- or long-term clinical outcomes warrants further investigation.
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Affiliation(s)
- Behnood Bikdeli
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
- Cardiovascular Research Foundation (CRF), New York, New York
| | - Alfonso Muriel
- Department of Respiratory, Hospital Ramón y Cajal, Universidad de Alcalá (Instituto de Ramón y Cajal de Investigación Sanitaria), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP: Universidad de Alcalá, Madrid, Spain
| | - Yun Wang
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Gregory Piazza
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Candrika D Khairani
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rachel P Rosovsky
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ghazaleh Mehdipoor
- Cardiovascular Research Foundation (CRF), New York, New York
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Bronx, New York
| | - Michelle L O'Donoghue
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- TIMI Study Group, Brigham and Women's Hospital, Boston, Massachusetts
| | - Olga Madridano
- Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Juan Bosco Lopez-Saez
- Department of Internal Medicine, Hospital Universitario de Puerto Real, Cádiz, Spain
| | - Meritxell Mellado
- Department of Angiology and Vascular Surgery, Hospital del Mar, Barcelona, Spain
| | - Ana Maria Diaz Brasero
- Department of Internal Medicine, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Elvira Grandone
- Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. "Casa Sollievo della Sofferenza," Foggia, S. Giovanni Rotondo, Italy
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
- Department of Obstetrics Gynaecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Primavera A Spagnolo
- Mary Horrigan Connors Center for Women's Health & Gender Biology, Harvard Medical School, Boston, Massachusetts
| | - Yuan Lu
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
| | - Laurent Bertoletti
- Department of Psychiatry, Brigham and Women Hospital, Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France
| | | | - Manuel Jesús Núñez
- Department of Internal Medicine, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
| | | | - Marie Gerhard-Herman
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samuel Z Goldhaber
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shannon M Bates
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David Jimenez
- Department of Respiratory, Hospital Ramón y Cajal, Universidad de Alcalá (Instituto de Ramón y Cajal de Investigación Sanitaria), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Harlan M Krumholz
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
- Department of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Manuel Monreal
- Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain
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Sue-Ling CB, Jairath N. Predicting 31- to 60-Day Heart Failure Rehospitalization Among Older Women. Res Gerontol Nurs 2022; 15:179-191. [PMID: 35609260 DOI: 10.3928/19404921-20220518-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current study sought to identify social, hemodynamic, and comorbid risk factors associated with 31-to 60-day heart failure (HF) rehospitalization in African American and Caucasian older (aged >65 years) women. A non-equivalent, case-control, quantitative design study using secondary data analysis of medical records from a local community hospital in the Southeast region of the United States was performed over a 3-year period. Relationships between predictor variables and the outcome variable, 31- to 60-day HF rehospitalization, were explored. The full model containing all predictors was not able to distinguish between predictors (χ2[21, N = 188] = 35.77, p = 0.12). However, a condensed model showed that body mass index (BMI) level 1 (<25 kg/m2), BMI level 2 (>25 and <30 kg/m2), age 75 to 80 years, and those taking lipid-lowering agents were significant predictors. Subtype of HF (reduced or preserved) and race did not predict HF rehospitalization within the specified time period. Multiple comorbid risk factors failed to consistently predict rehospitalization, which may reflect dated HF-specific approaches and therapies. Future studies should evaluate contributions of current targeted post-discharge methods or therapies. [Research in Gerontological Nursing, xx(x), xx-xx.].
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4
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Warraich HJ, Kitzman DW, Nelson MB, Mentz RJ, Rosenberg PB, Lev Y, Whellan DJ. Older Patients With Acute Decompensated Heart Failure Who Live Alone: An Analysis From the REHAB-HF Trial. J Card Fail 2022; 28:161-163. [PMID: 34147611 PMCID: PMC8734952 DOI: 10.1016/j.cardfail.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Haider J Warraich
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Cardiology Section, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.
| | - Dalane W Kitzman
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - M Benjamin Nelson
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Robert J Mentz
- Department of Medicine, Cardiology Division, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Paul B Rosenberg
- Department of Medicine, Cardiology Division, Duke University School of Medicine, Durham, North Carolina
| | - Yair Lev
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - David J Whellan
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
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5
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Cholack G, Garfein J, Errickson J, Krallman R, Montgomery D, Kline-Rogers E, Eagle K, Rubenfire M, Bumpus S, Barnes GD. Early (0-7 day) and late (8-30 day) readmission predictors in acute coronary syndrome, atrial fibrillation, and congestive heart failure patients. Hosp Pract (1995) 2021; 49:364-370. [PMID: 34474638 DOI: 10.1080/21548331.2021.1976558] [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: 10/20/2022]
Abstract
OBJECTIVES Thirty-day readmission following hospitalization for acute coronary syndrome (ACS), atrial fibrillation (AF), or congestive heart failure (CHF) is common, and many occur within one week of discharge. Using a cohort of patients hospitalized for ACS, AF, or CHF, we sought to identify predictors of 30-day, early (0-7 day), and late (8-30 day) all-cause readmission. METHODS We identified 3531 hospitalizations for ACS, AF, or CHF at a large academic medical center between 2008 and 2018. Multivariable logistic regression models were created to identify predictors of 30-day, early, and late unplanned, all-cause readmission, adjusting for discharge diagnosis and other demographics and comorbidities. RESULTS Of 3531 patients hospitalized for ACS, AF, or CHF, 700 (19.8%) were readmitted within 30 days, and 205 (29.3%) readmissions were early. Of all 30-day readmissions, 34.8% of ACS, 16.8% of AF, and 26.0% of the CHF cohorts' readmissions occurred early. Higher hemoglobin was associated with lower 30-day readmission [adjusted (adj) OR 0.92, 95% CI 0.88-0.97] while patients requiring intensive care unit (ICU) admission were more likely readmitted within 30 days (adj OR 1.31, 95% CI 1.03-1.67). Among patients with a 30-day readmission, females (adj OR 1.73, 95% CI 1.22, 2.47) and patients requiring ICU admission (adj OR 2.03, 95% CI 1.27, 3.26) were more likely readmitted early than late. Readmission predictors did not vary substantively by discharge diagnosis. CONCLUSION Patients admitted to the ICU were more likely readmitted in the early and 30-day periods. Other predictors varied between readmission groups. Since outpatient follow-up often occurs beyond 1 week of discharge, early readmission predictors can help healthcare providers identify patients who may benefit from particular post-discharge services.
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Affiliation(s)
- George Cholack
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA.,Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Joshua Garfein
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Josh Errickson
- Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | - Rachel Krallman
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Daniel Montgomery
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Eva Kline-Rogers
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Kim Eagle
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Melvyn Rubenfire
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Sherry Bumpus
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA.,College of Health and Human Services, School of Nursing, Eastern Michigan University, Ypsilanti, MI, USA
| | - Geoffrey D Barnes
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
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6
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Tong B, Osborne C, Horwood CM, Hakendorf PH, Woodman RJ, Li JY. The prevalence, characteristics, and risk factors of frequently readmitted patients to an internal medicine service. Intern Med J 2021; 52:1561-1568. [PMID: 34031965 DOI: 10.1111/imj.15395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/07/2021] [Accepted: 04/24/2021] [Indexed: 11/28/2022]
Abstract
AIMS To determine the prevalence, characteristics and risk factors associated with frequent readmissions to an internal medicine service at a tertiary public hospital. METHOD A retrospective observational study was conducted at an internal medicine service in a tertiary teaching hospital between 1st January 2010 and the 30th June 2016. Frequent readmission was defined as four or more readmissions within 12 months of discharge from the index admission. Demographic and clinical characteristics, and potential risk factors were evaluated. RESULTS 50 515 patients were included, 1657 (3.3%) had frequent readmissions and were associated with nearly 2.5 times higher in 12-month mortality rates. They were older, had higher rates of Indigenous Australians (3.2%), more disadvantaged status (Index of Relative Socio-Economic Disadvantage decile of 5.3), and more comorbidities (mean Charlson comorbidity index 1.4) in comparison, to infrequent readmission group. The mean length of hospital stay during the index admission was 6 days for frequent readmission group (21.4% staying more than 7 days) with higher incidence of discharge against medical advice (2.0% higher). Intensive care unit admission rate was 6.6% for frequent readmission group compared to 3.9% for infrequent readmission group. Multivariate analysis showed mental disease and disorders, neoplastic, and alcohol/drug use and alcohol/drug induced organic mental disorders are associated with frequent readmission. CONCLUSION The risk factors associated with frequent readmission were older age, indigenous status, being socially disadvantaged, having higher comorbidities, and discharging against medical advice. Conditions that lead to frequent readmissions were mental disorders, alcohol/drug use and alcohol/drug induced organic mental disorders, and neoplastic disorders.
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Affiliation(s)
- Bcy Tong
- College of Medicine & Public Health, Flinders University, Adelaide, South Australia
| | - Cdi Osborne
- College of Medicine & Public Health, Flinders University, Adelaide, South Australia
| | - C M Horwood
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, South Australia
| | - P H Hakendorf
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, South Australia
| | - R J Woodman
- College of Medicine & Public Health, Flinders University, Adelaide, South Australia.,Centre for Epidemiology and Biostatistics, College of Medicine & Public Health, Flinders University, Adelaide, South Australia
| | - J Y Li
- College of Medicine & Public Health, Flinders University, Adelaide, South Australia.,Department of Renal Medicine, Flinders Medical Centre, Adelaide, South Australia
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7
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Kwan AC, Salto G, Cheng S. Bending Primordial Trajectories Away From Heart Failure. J Am Soc Echocardiogr 2021; 34:401-404. [PMID: 33453368 DOI: 10.1016/j.echo.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Alan C Kwan
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gerran Salto
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts.
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8
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Leeds R, Shechter A, Alcantara C, Aggarwal B, Usseglio J, Abdalla M, Moise N. Elucidating the Relationship Between Insomnia, Sex, and Cardiovascular Disease. GENDER AND THE GENOME 2020. [DOI: 10.1177/2470289720980018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sex differences in cardiovascular disease (CVD) mortality have been attributed to differences in pathophysiology between men and women and to disparities in CVD management that disproportionately affect women compared to men. Similarly, there has been investigation of differences in the prevalence and presentation of insomnia attributable to sex. Few studies have examined how sex and insomnia interact to influence CVD outcomes, however. In this review, we summarize the literature on sex-specific differences in the prevalence and presentation of insomnia as well as existing research regarding the relationship between insomnia and CVD outcomes as it pertains to sex. Research to date indicate that women are more likely to have insomnia than men, and there appear to be differential associations in the relation between insomnia and CVD by sex. We posit potential mechanisms of the relationship between sex, insomnia and CVD, discuss gaps in the existing literature, and provide commentary on future research needed in this area. Unraveling the complex relations between sex, insomnia, and CVD may help to explain sex-specific differences in CVD, and identify sex-specific strategies for promotion of cardiovascular health. Throughout this review, terms “men” and “women” are used as they are in the source literature, which does not differentiate between sex and gender. The implications of this are also discussed.
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Affiliation(s)
- Rebecca Leeds
- Center for Family and Community Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Brooke Aggarwal
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - John Usseglio
- Augustus C. Long Health Sciences Library, Columbia University Irving Medical Center, New York, NY, USA
| | - Marwah Abdalla
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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9
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Vinogradova NG, Polyakov DS, Fomin IV. Analysis of mortality in patients with heart failure after decompensation during long-term follow-up in specialized medical care and in real clinical practice. ACTA ACUST UNITED AC 2020; 60:91-100. [DOI: 10.18087/cardio.2020.4.n1014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/02/2020] [Indexed: 11/18/2022]
Abstract
Background Mortality from chronic heart failure (CHF) remains high and entails serious demographic losses worldwide. The most vulnerable group is patients after acute decompensated HF (ADHF) who have a high risk of unfavorable outcome.Aim To analyze risks of all-cause death (ACD), cardiovascular death (CVD), and death from recurrent ADHF in CHF patients during two years following ADHF in long-term follow-up with specialized medical care and in real-life clinical practice.Material and methods The study successively included 942 CHF patients after ADHF. 510 patients continued out-patient treatment in a specialized CHF treatment center (CHFTC) (group 1) and 432 patients refused of the management in the CHFTC and were managed in out-patient clinics at the place of patient’s residence (group 2). Causes of death were determined based on inpatient hospital records, postmortem reports, or outpatient medical records. Cases of ACD, CVD, death from ADHF, and a composite index (CVD and death from ADHF) were analyzed. Statistical analysis was performed with the software package Statistica 7.0 for Windows, SPSS, and statistical package R.Results Patients of group 2 were older, more frequently had functional class (FC) III CHF and less frequently FC I CHF compared to group 1. Women and patients with preserved left ventricular ejection fraction (LV EF) prevailed in both groups. Results of the Cox proportional hazards model for ACD, CVD, death from ADHF, and the composite mortality index showed that belonging to group 2 was an independent predictor for increased risk of death (р<0.001). An increase in CCS score by 1 also increased the risk of death (р<0.001). Baseline CHF FC and LV EF did not influence the mortality in any model. Female gender and a higher value of 6-min walk test (6MW) independently decreased the risk of all outcomes except for CVD. An increase in systolic BP by 10 mm Hg reduced risk of all fatal outcomes. At two years of follow-up in groups 2 and 1, ACD was 29.9 % and 10.2 %, (OR, 3.7; 95 % CI: 2.6–5.3; p <0.001), CVD was 10.4 % and 1.9 % (OR, 5.9; 95 % CI: 2.8–12.4; p<0.001), death from ADHF was 18.1 % and 6.0 % (OR, 3.5; 95 % CI: 2.2–5.5; p<0.001), and the composite mortality index was 25.2 % and 7.7 % (OR, 4.1; 95 % CI: 2.7–6.1; р<0.001). Analysis of all outcomes by follow-up period (3 and 6 months and 1 and 2 years) showed that the difference between groups 2 and 1 in risks of any fatal outcome was maximal during the first 6 months.Conclusion The follow-up in the system of specialized medical care reduces risks of ACD, CVD, and death from ADHF. The first 6 months following discharge from the hospital was a vulnerability period for patients after ADHF. The CCS score impaired the prognosis whereas baseline LV EF and CHF FC did not influence the long-term prognosis after ADHF. Protective factors included female gender and higher values of 6MW and systolic BP.
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Affiliation(s)
- N. G. Vinogradova
- 1 - Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation
Department of Therapy and Cardiology, PhD Associate Professor
2 - City Clinical Hospital No. 38 Nizhny Novgorod
Cardiologist, Head of the City Center for the Treatment of Heart Failure
| | - D. S. Polyakov
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation
Department of Therapy and Cardiology, PhD Associate Professor
| | - I. V. Fomin
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation
Associate Professor, Head of the Department of Hospital Therapy and General Medical Practice named after V.G. Vogralika
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10
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The importance of sex as a risk factor for hospital readmissions due to pulmonary diseases. BMC Public Health 2020; 20:53. [PMID: 31937272 PMCID: PMC6961397 DOI: 10.1186/s12889-019-8138-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/30/2019] [Indexed: 02/07/2023] Open
Abstract
Background Pulmonary diseases are a common and costly cause of 30-day readmissions. Few studies have focused on the difference in risk for rehospitalization between men and women in older patients. In this study we analyzed the association between sex and the risk of readmission in a cohort of patients admitted to the hospital for chronic obstructive pulmonary disease (COPD) exacerbation and other major pulmonary diseases. Methods This was a retrospective cohort study based on administrative data collected in the Veneto Region in 2016. We included 14,869 hospital admissions among residents aged ≥65 years for diagnosis related groups (DRGs) of the most common disorders of the respiratory system: bronchitis and asthma, pneumonia, pulmonary edema, respiratory failure, and COPD. Multilevel logistic regressions were performed to test the association between 30-day hospital readmission and sex, adjusting for confounding factors. Results For bronchitis and asthma, male patients had significantly higher odds of 30-day readmission than female patients (adjusted odds ratio (aOR), 2.07; 95% confidence interval (CI), 1.11–3.87). The odds of readmission for men were also significantly higher for pneumonia (aOR, 1.40; 95% CI, 1.13–1.72), for pulmonary edema and respiratory failure (aOR, 1.28; 95% CI, 1.05–1.55), and for COPD (aOR, 1.34; 95% CI, 1.00–1.81). Conclusions This study found that male sex is a major risk factors for readmission in patients aged more than 65 years with a primary pulmonary diagnosis. More studies are needed to understand the underlying determinants of this phenomena and to provide targets for future interventions.
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Tian J, Yan J, Zhang Q, Yang H, Chen X, Han Q, Han R, Ren J, Zhang Y, Han Q. Analysis Of Re-Hospitalizations For Patients With Heart Failure Caused By Coronary Heart Disease: Data Of First Event And Recurrent Event. Ther Clin Risk Manag 2019; 15:1333-1341. [PMID: 31814728 PMCID: PMC6861516 DOI: 10.2147/tcrm.s218694] [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] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 10/24/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The re-hospitalization rate of patients with heart failure remains at a high level, and studies of the subject have focused mainly on event-time outcomes. In addition to using re-hospitalization data with the outcomes of the event-time-count, this study introduces the conditional frailty model, which could help obtain more reasonable results. MATERIALS AND METHODS This prospective observational cohort study enrolled 1484 patients with heart failure caused by coronary heart disease. The outcomes of heart failure readmissions and the case report form data were collected. Based on the traditional Cox model with event-time outcomes, the mixed effects of a conditional frailty model were added to analyze the event-time-count longitudinal data. RESULTS The Cox regression model showed that non-manual work, diastolic dysfunction, and better medical compensation increased the risk of heart failure readmission, whereas treatment with beta-blockers decreased the risk. The conditional frailty model further revealed that age, female sex, non-manual work, better medical compensation, longer QRS duration, and treatment with percutaneous coronary intervention increased the risk of heart failure readmission. CONCLUSION This study obtained more reliable, reasonable results based on longitudinal data and a mixed model. The results could provide more clinical epidemiological evidence for the management of heart failure.
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Affiliation(s)
- Jing Tian
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Jingjing Yan
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Qing Zhang
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Hong Yang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Xinlong Chen
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Qiang Han
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Rui Han
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Jia Ren
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Yanbo Zhang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Qinghua Han
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
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12
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Caraballo C, Dharmarajan K, Krumholz HM. Síndrome poshospitalización. ¿Causa daño el estrés por hospitalización? Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2019.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
BACKGROUND Despite advancements in treatment, acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality in the elderly population. Previous research has highlighted long-standing sex disparities in the care of these patients. However, differences in the patterns of discharge are not well described. One key parameter is the destination of discharge, and in particular - discharge to skilled nursing facilities (SNFs), a factor associated with worse prognosis and greater costs to the healthcare system. Our aim, therefore, was to observe destination differences after AMI on the basis of sex and other baseline characteristics. MATERIALS AND METHODS From a cohort of 143 180 claims, we carried out an observational analysis of 6123 Medicare beneficiaries discharged following AMI during the first quarter of 2016. RESULTS For patients who were referred from SNF, the rates of in-hospital death are higher, even after adjustment for baseline characteristics (odds ratio: 1.78, 95% confidence interval: 1.17-2.70). Of those discharged to SNF or home, 36.33% of the female patients were discharged to an SNF versus 25.12% (P<0.01) of the male patients. After adjusting for baseline characteristics, discharge to SNF remained significantly higher among female patients (odds ratio: 1.57, 95% confidence interval: 1.27-1.94). CONCLUSION Discharge to SNF following AMI is more frequent for female patients, even after adjustment for risk factors. Our findings highlight the need to better characterize this unique patient population and understand the cycle of care that they receive following AMI.
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Aggarwal NR, Patel HN, Mehta LS, Sanghani RM, Lundberg GP, Lewis SJ, Mendelson MA, Wood MJ, Volgman AS, Mieres JH. Sex Differences in Ischemic Heart Disease: Advances, Obstacles, and Next Steps. Circ Cardiovasc Qual Outcomes 2019; 11:e004437. [PMID: 29449443 DOI: 10.1161/circoutcomes.117.004437] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Evolving knowledge of sex-specific presentations, improved recognition of conventional and novel risk factors, and expanded understanding of the sex-specific pathophysiology of ischemic heart disease have resulted in improved clinical outcomes in women. Yet, ischemic heart disease continues to be the leading cause of morbidity and mortality in women in the United States. The important publication by the Institute of Medicine titled "Women's Health Research-Progress, Pitfalls, and Promise," highlights the persistent disparities in cardiovascular disease burden among subgroups of women, particularly women who are socially disadvantaged because of race, ethnicity, income level, and educational attainment. These important health disparities reflect underrepresentation of women in research, with the resultant unfavorable impact on diagnosis, prevention, and treatment strategies in women at risk for cardiovascular disease. Causes of disparities are multifactorial and related to differences in risk factor prevalence, access to care, use of evidence-based guidelines, and social and environmental factors. Lack of awareness in both the public and medical community, as well as existing knowledge gap regarding sex-specific differences in presentation, risk factors, pathophysiology, and response to treatment for ischemic heart disease, further contribute to outcome disparities. There is a critical need for implementation of sex- and gender-specific strategies to improve cardiovascular outcomes. This review is tailored to meet the needs of a busy clinician and summarizes the contemporary trends, characterizes current sex-specific outcome disparities, delineates challenges, and proposes transformative solutions for improvement of the full spectrum of ischemic heart disease clinical care and research in women.
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Affiliation(s)
- Niti R Aggarwal
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.).
| | - Hena N Patel
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Laxmi S Mehta
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Rupa M Sanghani
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Gina P Lundberg
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Sandra J Lewis
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Marla A Mendelson
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Malissa J Wood
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Annabelle S Volgman
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Jennifer H Mieres
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
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15
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Caraballo C, Dharmarajan K, Krumholz HM. Post Hospital Syndrome: Is the Stress of Hospitalization Causing Harm? ACTA ACUST UNITED AC 2019; 72:896-898. [PMID: 31175070 DOI: 10.1016/j.rec.2019.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/30/2019] [Indexed: 12/29/2022]
Affiliation(s)
- César Caraballo
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States
| | - Kumar Dharmarajan
- Clover Health, Jersey City, NJ, United States; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States.
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16
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Polyakov DS, Fomin IV, Vaysberg AR. [EPOCHA-D-CHF: gender differences in the prognosis of patients with CHF af-ter acute decompensation (part 2*)]. ACTA ACUST UNITED AC 2019; 59:33-43. [PMID: 31131758 DOI: 10.18087/cardio.2654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 05/24/2019] [Indexed: 11/18/2022]
Abstract
AIM To study effects of gender differences in clinical and epidemiological factors on long-term prognosis for patients with acute decompensated heart failure (ADHF). MATERIALS AND METHODS A retrospective, observational analysis of a sample of patients (n=718) hospitalized with signs of ADHF with subsequent collecting information about the endpoint (all-cause death) at four years. RESULTS Age was a predictor of unfavorable outcome for both men and women (RR, 1.04, 95% CI, 1.02-1.06, p<0.001 and RR, 1.04, 95% CI, 1.03-1.06, p<0.001). Presence of lower extremity edema increased the risk of fatal outcome for men (RR, 2.03, 95% CI, 1.21-3.39, р=0.007) whereas for women, presence of ascites (RR, 3.43, 95% CI, 2.09-5.64, р<0.001) or orthopneic position on admission (RR, 1.51, 95% CI, 1.03-2.23, p=0.04) resulted in the increased risk. For both sexes, the prediction improved with every 10% increase in systolic BP on admission (RR, 0.87, 95% CI, 0.78-0.97, p=0.01 for men and RR, 0.84, 95% CI, 0.76-0.91, p<0.001 for women). Presence of diabetes mellitus affected the prediction only for women (RR, 1.80, 95% CI, 1.34-2.42, p<0.001). A history of myocardial infarction (RR, 1.40, 95% CI, 1.01-1.95, p=0.04 and RR, 1.44, 95% CI, 1.04-1.98, р=0.03), presence of communityacquired pneumonia (RR, 1.90, 95% CI, 1.32-2.74, p<0.001 and RR, 2.38, 95% CI, 1.55-3.68, p<0.001) adversely affected the prediction for men and women, respectively. At the end of study (4 years), the endpoint (all-cause death) was observed in 65.5% of men and 48.1% of women, median survival was 720 и 1168 days, respectively. CONCLUSIONS Te long-term prognosis was worse for men hospitalized for ADHF. Presence of congestion signs impaired the prediction for both men and women. Patients with higher systolic BP on admission were characterized with beter survival. A history of diabetes mellitus for women and myocardial infarction or community acquired pneumonia for both sexes worsened the long-term prediction.
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Affiliation(s)
| | - I V Fomin
- Privolzhsky Research Medical University
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17
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Lam L, Ahn HJ, Okajima K, Schoenman K, Seto TB, Shohet RV, Miyamura J, Sentell TL, Nakagawa K. Gender Differences in the Rate of 30-Day Readmissions after Percutaneous Coronary Intervention for Acute Coronary Syndrome. Womens Health Issues 2018; 29:17-22. [PMID: 30482594 DOI: 10.1016/j.whi.2018.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/27/2018] [Accepted: 09/06/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND It has been reported that women have higher 30-day readmission rates than men after acute coronary syndrome (ACS). However, readmission after percutaneous coronary intervention (PCI) for ACS is a distinct subset of patients in whom gender differences have not been adequately studied. METHODS Hawaii statewide hospitalization data from 2010 to 2015 were assessed to compare gender differences in 30-day readmission rates among patients hospitalized with ACS who underwent PCI during the index hospitalization. Readmission diagnoses were categorized using an aggregated version of the Centers for Medicare and Medicaid Services Condition Categories. Multivariable logistic regression was applied to evaluate the effect of gender on the 30-day readmission rate. RESULTS A total of 5,354 patients (29.4% women) who were hospitalized with a diagnosis of ACS and underwent PCI were studied. Overall, women were older, with more identified as Native Hawaiian, and had a higher prevalence of cardiovascular risk factors compared with men. The 30-day readmission rate was 13.9% in women and 9.6% in men (p < .0001). In the multivariable model, female gender (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.09-1.60), Medicaid (OR, 1.48; 95% CI, 1.07-2.06), Medicare (1.72; 95% CI, 1.35-2.19), heart failure (1.88; 95% CI, 1.53-2.33), atrial fibrillation (OR, 1.54; 95% CI-1.21-1.95), substance use (OR, 1.88; 95% CI, 1.27-2.77), history of gastrointestinal bleeding (OR, 2.43; 95% CI, 1.29-4.58), and chronic kidney disease (OR, 1.78; 95% CI, 1.42-2.22) were independent predictors of 30-day readmissions. Readmission rates were highest during days 1 through 6 (peak, day 3) after discharge. The top three cardiac causes of readmissions were heart failure, recurrent angina, and recurrent ACS. CONCLUSIONS Female gender is an independent predictor of 30-day readmission after ACS that requires PCI. Our finding suggests women are at a higher risk of post-ACS cardiac events such as heart failure and recurrent ACS, and further gender-specific intervention is needed to reduce 30-day readmission rate in women after ACS.
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Affiliation(s)
- Luke Lam
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii.
| | - Hyeong Jun Ahn
- Department of Complementary and Integrative Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Kazue Okajima
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Katie Schoenman
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Todd B Seto
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; The Queen's Medical Center, Honolulu, Hawaii
| | - Ralph V Shohet
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Jill Miyamura
- Hawaii Health Information Corporation, Honolulu, Hawaii
| | - Tetine L Sentell
- Office of Public Health Studies, University of Hawaii, Honolulu, Hawaii
| | - Kazuma Nakagawa
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; The Queen's Medical Center, Honolulu, Hawaii
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Risk factors for hospital readmission among Swedish older adults. Eur Geriatr Med 2018; 9:603-611. [PMID: 30294396 PMCID: PMC6153697 DOI: 10.1007/s41999-018-0101-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/21/2018] [Indexed: 11/12/2022]
Abstract
Introduction Hospital readmissions of older persons are common and often associated with complex health problems. The objectives were to analyze risk factors for readmission within 30 days from hospital discharge. Methods A prospective study with a multifactorial approach based on the population-based longitudinal Swedish Adoption/Twin Study of Aging (SATSA) was conducted. During 9 years of follow-up, information on hospitalizations, readmissions and associated diagnoses were obtained from national registers. Logistic regression models controlling for age and sex were conducted to analyze risk factors for readmissions. Results Of the 772 participants, [mean age 69.7 (± 11.1), 84 (63%)] were hospitalized and among these 208 (43%) had one or several readmissions within 30 days during the follow-up period. Most of the readmissions (57%) occurred within the first week; mean days from hospital discharge to readmission was 7.9 (± 6.2). The most common causes of admission and readmission were cardiovascular diseases and tumors. Only 8% of the readmissions were regarded as avoidable admissions. In a multivariate logistic regression, falling within the last 12 months (OR 0.57, p = 0.039) and being a male (OR 1.84, p = 0.006) increased the risk of readmission. Conclusions Most older persons that are readmitted return to hospital within the first week after discharge. Experiencing a fall was a particular risk factor of readmission. Preventive actions should preferably take place already at the hospital to reduce the numbers of readmission. Still, it should be remembered that most readmissions were considered to be necessary.
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Lindenauer PK, Dharmarajan K, Qin L, Lin Z, Gershon AS, Krumholz HM. Risk Trajectories of Readmission and Death in the First Year after Hospitalization for Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2018; 197:1009-1017. [PMID: 29206052 PMCID: PMC5909167 DOI: 10.1164/rccm.201709-1852oc] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/01/2017] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Characterization of the dynamic nature of posthospital risk in chronic obstructive pulmonary disease (COPD) is needed to provide counseling and plan clinical services. OBJECTIVES To analyze risk of readmission and death after discharge for COPD among Medicare beneficiaries aged 65 years and older and to determine the association between ventilator support and risk trajectory. METHODS We computed daily absolute risks of hospital readmission and death for 1 year after discharge for COPD, stratified by ventilator support. We determined the time required for risks to decline by 50% from maximum daily values after discharge and for daily risks to plateau. We compared risks with those found in the general elderly population. MEASUREMENTS AND MAIN RESULTS Among 2,340,637 hospitalizations, the readmission rate at 1 year was 64.2%, including 63.5%, 66.0%, and 64.1% among those receiving invasive, noninvasive, and no ventilation, respectively. Among 1,283,069 hospitalizations, mortality at 1 year was 26.2%, including 45.7%, 41.8%, and 24.4% among those same respective groups. Daily risk of readmission declined by 50% within 28, 39, and 43 days and plateaued at 46, 54, and 61 days among those receiving invasive, noninvasive, and no ventilation, respectively. Risk of death declined by 50% by 3, 4, and 17 days and plateaued by 21, 18, and 24 days in the same respective groups. Risks of hospitalization and death were significantly higher after discharge for COPD than among the general Medicare population. CONCLUSIONS Discharge from the hospital is associated with prolonged risks of readmission and death that vary with need for ventilator support. Interventions limited to the first month after discharge may be insufficient to improve longitudinal outcomes.
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Affiliation(s)
- Peter K. Lindenauer
- Institute for Healthcare Delivery and Population Science and
- Department of Medicine, University of Massachusetts Medical School–Baystate, Springfield, Massachusetts
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kumar Dharmarajan
- Clover Health, Jersey City, New Jersey
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
| | - Li Qin
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
| | - Zhenqiu Lin
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
| | - Andrea S. Gershon
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; and
| | - Harlan M. Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut
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Zuo Y, Pino EC, Vyliparambil M, Kalesan B. Sex Differences in Early Cardiovascular and All-Cause Hospitalization Outcomes After Surviving Firearm Injury. Am J Mens Health 2018. [PMID: 29540125 PMCID: PMC6131471 DOI: 10.1177/1557988318761989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The majority of the burden of firearm injury in the United States is on men as
compared to women. There is limited evidence regarding sex differences in
short-term hospitalization outcomes after surviving firearm injury. The risk of
cardiovascular and all-cause hospital readmission, length of stay (LOS), and
costs within 180 days after surviving an index firearm injury was compared
between males and females. A claims-based, retrospective, cohort study was
performed using Nationwide Readmission Database (2013–2014) to obtain a cohort
of patients who survived an index hospitalization of firearm injury. The
analysis was performed in August 2017. Cox proportional hazard regression models
were used to estimate hazard ratio (HR) and 95% confidence intervals (95% CIs).
Among 17,594 males and 2,289 females discharged alive after index firearm injury
hospitalization, 14.4% and 13.2% were readmitted within 180 days. Within 180
days, the risk of cardiovascular readmission was 3.3 times greater among males
versus females (HR = 3.34, 95% CI [1.18, 9.44]. Risk of all-cause readmission
among males was greater at 90 days (HR = 1.40, 95% CI [1.04, 1.87]. Patients
surviving a firearm injury have a substantial risk of subsequent
hospitalizations. Cardiovascular readmissions are greater among males than
females during the first 6 months after injury and may be indicative of a
continuing long-term risk of health and patient outcomes that contributes to the
overall burden of firearm injury.
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Affiliation(s)
- Yi Zuo
- 1 Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Elizabeth C Pino
- 1 Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - Bindu Kalesan
- 3 Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Sections of Preventive Medicine, Department of Medicine and Community Health Science, Boston University School of Medicine and Public Health, Boston, MA, USA
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