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Gonuguntla K, Badu I, Duhan S, Sandhyavenu H, Chobufo MD, Taha A, Thyagaturu H, Sattar Y, Keisham B, Ali S, Khan MZ, Latchana S, Naeem M, Shaik A, Balla S, Gulati M. Sex and Racial Disparities in Proportionate Mortality of Premature Myocardial Infarction in the United States: 1999 to 2020. J Am Heart Assoc 2024; 13:e033515. [PMID: 38842272 PMCID: PMC11255752 DOI: 10.1161/jaha.123.033515] [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: 11/16/2023] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The incidence of premature myocardial infarction (PMI) in women (<65 years and men <55 years) is increasing. We investigated proportionate mortality trends in PMI stratified by sex, race, and ethnicity. METHODS AND RESULTS CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) was queried to identify PMI deaths within the United States between 1999 and 2020, and trends in proportionate mortality of PMI were calculated using the Joinpoint regression analysis. We identified 3 017 826 acute myocardial infarction deaths, with 373 317 PMI deaths corresponding to proportionate mortality of 12.5% (men 12%, women 14%). On trend analysis, proportionate mortality of PMI increased from 10.5% in 1999 to 13.2% in 2020 (average annual percent change of 1.0 [0.8-1.2, P <0.01]) with a significant increase in women from 10% in 1999 to 17% in 2020 (average annual percent change of 2.4 [1.8-3.0, P <0.01]) and no significant change in men, 11% in 1999 to 10% in 2020 (average annual percent change of -0.2 [-0.7 to 0.3, P=0.4]). There was a significant increase in proportionate mortality in both Black and White populations, with no difference among American Indian/Alaska Native, Asian/Pacific Islander, or Hispanic people. American Indian/Alaska Natives had the highest PMI mortality with no significant change over time. CONCLUSIONS Over the last 2 decades, there has been a significant increase in the proportionate mortality of PMI in women and the Black population, with persistently high PMI in American Indian/Alaska Natives, despite an overall downtrend in acute myocardial infarction-related mortality. Further research to determine the underlying cause of these differences in PMI mortality is required to improve the outcomes after acute myocardial infarction in these populations.
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Affiliation(s)
| | - Irisha Badu
- Department of MedicineOnslow Memorial HospitalJacksonvilleNC
| | - Sanchit Duhan
- Department of MedicineSinai Hospital of BaltimoreBaltimoreMD
| | | | | | - Amro Taha
- Department of MedicineWeiss Memorial HospitalChicagoIL
| | | | - Yasar Sattar
- Department of CardiologyWest Virginia UniversityMorgantownWV
| | - Bijeta Keisham
- Department of MedicineSinai Hospital of BaltimoreBaltimoreMD
| | - Shafaqat Ali
- Department of Internal MedicineLouisiana State UniversityShreveportLA
| | | | - Sharaad Latchana
- American University of Integrative Sciences School of MedicineBridgetownBarbados
| | - Minahil Naeem
- Department of Internal MedicineKing Edward Medical UniversityLahorePakistan
| | - Ayesha Shaik
- Department of CardiologyHartford HospitalHartfordCT
| | - Sudarshan Balla
- Department of CardiologyWest Virginia UniversityMorgantownWV
| | - Martha Gulati
- Department of Cardiology, Barbra Streisand Women’s Heart CenterSmidt Heart Institute, Cedars Sinai Medical CenterLos AngelesCA
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Yan M, Shang H, Guo X, Hao L, Hou S, Zheng H. The diagnostic role of resting myocardial blood flow in STEMI patients after revascularization. Front Cardiovasc Med 2024; 11:1364772. [PMID: 38576422 PMCID: PMC10993732 DOI: 10.3389/fcvm.2024.1364772] [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] [Received: 01/03/2024] [Accepted: 02/27/2024] [Indexed: 04/06/2024] Open
Abstract
Background The value of semiquantitative resting myocardial perfusion imaging (MPI) in coronary artery disease (CAD) is limited. At present, quantitative MPI can be performed by a new cadmium zinc tellurium single-photon emission computed tomography (CZT-SPECT) scan. The quantitative index of resting myocardial blood flow (MBF) has received little attention, and its manifestations and clinical value in the presence of unstable coronary blood flow have not been clarified. Purpose In patients with ST-segment elevation myocardial infarction (STEMI), whether resting MBF can provide additional value of blood flow than semi-quantitative resting MPI is not sure. We also explored the influencing factors of resting MBF. Methods This was a retrospective clinical study. We included 75 patients with STEMI in the subacute phase who underwent resting MPI and dynamic scans after reperfusion therapy. General patient information, STEMI-related data, MPI, gated MPI (G-MPI), and resting MBF data were collected and recorded. According to the clinically provided culprit vessels, the resting MBF was divided into ischemic MBF and non-ischemic MBF. The paired Wilcoxon signed-rank test was used for resting MBF. The receiver operating characteristic (ROC) curves were used to determine the optimal threshold for ischemia, and multiple linear regression analysis was used to analyze the influencing factors of resting MBF. Results There was a statistically significant difference between the ischemic MBF and non-ischemic MBF [0.59 (0.47-0.72) vs. 0.76 (0.64-0.93), p < 0.0001]. The ROC curve analysis revealed that resting MBF could identify ischemia to a certain extent, with a cutoff value of 0.5975, area under the curve (AUC) = 0.666, sensitivity = 55.8%, and specificity = 68.7%. Male sex and summed rest score (SRS) were influencing factors for resting MBF. Conclusion To a certain extent, resting MBF can suggest residual ischemia after reperfusion therapy in patients with STEMI. There was a negative correlation between male sex, SRS, and ischemic MBF. A lower resting MBF may be associated with more severe myocardial ischemia.
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Affiliation(s)
- Ming Yan
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hua Shang
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaorui Guo
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Luping Hao
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shuang Hou
- Department of Electronic Science and Technology, School of Electronic and Information Engineering, Beijing Jiaotong University, Beijing, China
| | - Hongming Zheng
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Loutati R, Perel N, Marmor D, Maller T, Taha L, Amsalem I, Hitter R, Mohammed M, Levi N, Shrem M, Amro M, Shuvy M, Glikson M, Asher E. Artificial intelligence based prediction model of in-hospital mortality among females with acute coronary syndrome: for the Jerusalem Platelets Thrombosis and Intervention in Cardiology (JUPITER-12) Study Group. Front Cardiovasc Med 2024; 11:1333252. [PMID: 38500758 PMCID: PMC10944920 DOI: 10.3389/fcvm.2024.1333252] [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] [Received: 11/04/2023] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Despite ongoing efforts to minimize sex bias in diagnosis and treatment of acute coronary syndrome (ACS), data still shows outcomes differences between sexes including higher risk of all-cause mortality rate among females. Hence, the aim of the current study was to examine sex differences in ACS in-hospital mortality, and to implement artificial intelligence (AI) models for prediction of in-hospital mortality among females with ACS. Methods All ACS patients admitted to a tertiary care center intensive cardiac care unit (ICCU) between July 2019 and July 2023 were prospectively enrolled. The primary outcome was in-hospital mortality. Three prediction algorithms, including gradient boosting classifier (GBC) random forest classifier (RFC), and logistic regression (LR) were used to develop and validate prediction models for in-hospital mortality among females with ACS, using only available features at presentation. Results A total of 2,346 ACS patients with a median age of 64 (IQR: 56-74) were included. Of them, 453 (19.3%) were female. Female patients had higher prevalence of NSTEMI (49.2% vs. 39.8%, p < 0.001), less urgent PCI (<2 h) rates (40.2% vs. 50.6%, p < 0.001), and more complications during admission (17.7% vs. 12.3%, p = 0.01). In-hospital mortality occurred in 58 (2.5%) patients [21/453 (5%) females vs. 37/1,893 (2%) males, HR = 2.28, 95% CI: 1.33-3.91, p = 0.003]. GBC algorithm outscored the RFC and LR models, with area under receiver operating characteristic curve (AUROC) of 0.91 with proposed working point of 83.3% sensitivity and 82.4% specificity, and area under precision recall curve (AUPRC) of 0.92. Analysis of feature importance indicated that older age, STEMI, and inflammatory markers were the most important contributing variables. Conclusions Mortality and complications rates among females with ACS are significantly higher than in males. Machine learning algorithms for prediction of ACS outcomes among females can be used to help mitigate sex bias.
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Affiliation(s)
- Ranel Loutati
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Corna G, Golino M, Talasaz AH, Moroni F, Del Buono MG, Damonte JI, Chiabrando JG, Mbualungu J, Trankle CR, Thomas GK, Markley R, Canada JM, Turlington J, Agatiello CR, VAN Tassell B, Abbate A. Response to interleukin-1 blockade with anakinra in women and men with ST-segment elevation myocardial infarction. Minerva Cardiol Angiol 2024; 72:67-75. [PMID: 37987681 DOI: 10.23736/s2724-5683.23.06439-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Interleukin-1 blockade with anakinra reduces high-sensitivity C-reactive protein (hsCRP) levels and prevents heart failure (HF) events after ST-segment myocardial infarction (STEMI). Sex-based differences in STEMI patients have been reported, but no data are available regarding response to anakinra. METHODS We analyzed the systemic inflammation and composite end-point of new-onset HF or death in women and men with STEMI treated with anakinra from three different Virginia Commonwealth University Anakinra Response Trial (VCUART) randomized clinical trials. RESULTS We analyzed 139 patients, 29 (21%) were women while 110 (79%) were men. Baseline hsCRP was higher in women compared to men (8.9 [5.2-13.5] vs. 4.2 [2.1-7.7] mg/L, P<0.001). Eighty-four patients were treated with anakinra (22 [75%] women and 62 [56%] men). The area under the curve of hsCRP (hsCRP-AUC) after 14 days was numerically lower in patients receiving anakinra versus placebo both in men (86 [37-130] vs. 223 [119-374] mg day/L) and in women (73 [46-313] vs. 242 [102-988] mg day/L) (P<0.001 for multiple groups, P for interaction 0.22). The incidence of the composite endpoint was also numerically lower in the anakinra group compared to placebo, both in men (4 [6.4%] vs. 14 [29.1%]) and in women (3 [13.6%] vs. 2 [28.5%]) (P=0.019 for multiple groups, P for interaction 0.44). There were no statistically significant differences between women and men in hsCRP-AUC and death or HF events when comparing separately the anakinra and placebo groups (all P>0.05). CONCLUSIONS Women were underrepresented in the VCUART trials, they appeared to have higher hsCRP levels at time of presentation, yet to benefit similar to men by treatment with anakinra in STEMI.
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Affiliation(s)
- Giuliana Corna
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
- Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Michele Golino
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Azita H Talasaz
- Department of Pharmacotherapy and Outcomes Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Francesco Moroni
- Department of Internal Medicine, University of Virginia, Charlottesville, VA, USA
- Department of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Marco G Del Buono
- Department of Cardiovascular Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Juan I Damonte
- Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan G Chiabrando
- Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - James Mbualungu
- Division of Cardiology, Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, USA
| | - Cory R Trankle
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Georgia K Thomas
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Roshanak Markley
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Justin M Canada
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Jeremy Turlington
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Carla R Agatiello
- Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Benjamin VAN Tassell
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
- Department of Pharmacotherapy and Outcomes Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Antonio Abbate
- Division of Cardiology, Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, USA -
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Kaldal A, Tonstad S, Jortveit J. Sex differences in secondary preventive follow-up after coronary heart events. BMC Cardiovasc Disord 2023; 23:459. [PMID: 37710178 PMCID: PMC10502978 DOI: 10.1186/s12872-023-03483-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND AND AIMS Some studies point to sex differences in cardiovascular preventive practices. The aim of this study was to investigate differences in achievement of secondary preventive targets and long-term outcome in men and women after a coronary heart event. METHODS This study was a subanalysis from a randomized controlled trial of hospital-based versus primary care-based secondary preventive follow-up at Sorlandet Hospital, Norway, 2007-2022 and included both groups. The main outcome was achievement of treatment targets two years after the index event. Event-free survival was calculated based on the composite of mortality, coronary intervention, stroke, or myocardial infarction during follow-up. Participants were followed-up for up to 10 years after the index event through out-patient consultations. RESULTS In total, 337 women and 1203 men were eligible for the study. Due to loss of follow-up during the first two years after the index coronary event 106 (7%) participants were excluded from further analysis (53% withdrawal of consent, 12% death, and 35% other causes) leaving 307 (21%) women and 1127 (79%) men. After two years of follow-up we found no differences between women and men in achievement of blood pressure targets (61% vs. 59%; p = 0.57), LDL-cholesterol goals (64% vs. 69%; p = 0.15), HbA1c-goal in patients with diabetes (49% vs. 45%; p = 0.57), non-smoking (79% vs. 81%; p = 0.34), healthy diets (14% vs. 13%, p = 0.89), physical activity (55% vs. 58%; p = 0.38), use of acetylsalicylic acid (93% vs. 94%; p = 0.39), and use of lipid lowering therapy (92% vs. 94%; p = 0.15). After a median follow-up time of 5.0 [SD 3.2] years there were no differences between women and men regarding composite endpoint (89 [30.0%] vs. 345 [30.6]; p = 0.58), and composite endpoint-free survival did not differ between women and men (hospital-based follow-up HR for women versus men, 0.87, 95% CI 0.62-1.23; p = 0.44 and primary care service HR for women versus men 0.95, 95% CI 0.69-1.31; p = 0.78). CONCLUSIONS The study show no sex differences in achievement of secondary preventive targets or composite endpoint after coronary heart events. However, many women and men did not achieve treatment goals, and further improvement in secondary prevention is needed. TRIAL REGISTRATION The study is registered in ClinicalTrials.gov (NCT00679237).
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Affiliation(s)
- Anete Kaldal
- Department of Research, Sørlandet Hospital, Kristiansand S, Norway.
| | - Serena Tonstad
- Department of Endocrinology, Obesity and Preventive Medicine, Section of Preventive Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jarle Jortveit
- Department of Cardiology, Sorlandet Hospital, Arendal, Norway
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Ranasinghe S, Merz CNB, Khan N, Wei J, George M, Berry C, Chieffo A, Camici PG, Crea F, Kaski JC, Marzilli M, Gulati M. Sex Differences in Quality of Life in Patients with Ischemia with No Obstructive Coronary Artery Disease (INOCA): A Patient Self-Report Retrospective Survey from INOCA International. J Clin Med 2023; 12:5646. [PMID: 37685713 PMCID: PMC10488627 DOI: 10.3390/jcm12175646] [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: 07/03/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Women with obstructive coronary artery disease (CAD) have a relatively lower quality of life (QoL) compared to men, but our understanding of sex differences in QoL in ischemia with no obstructive coronary artery disease (INOCA) is limited. We conducted a survey of patient members of INOCA International with an assessment of self-reported health measures. Functional capacity was retrospectively estimated using the Duke Activity Status Index (DASI), assessing levels of activities performed before and after INOCA symptom onset. Of the 1579 patient members, the overall survey completion rate was 21%. Women represented 91% of the respondents. Estimated functional capacity, expressed as metabolic equivalents (METs), was higher before compared to after INOCA diagnosis comparably for both women and men. For every one MET decline in functional capacity, there was a significantly greater decline in QoL for men compared with women in physical health (4.0 ± 1.1 vs. 2.9 ± 0.3 days/month, p < 0.001), mental health (2.4 ± 1.2 vs. 1.8 ± 0.3 days/month, p = 0.001), and social health/recreational activities (4.1 ± 1.0 vs. 2.9 ± 0.3 days/month, p = 0.0001), respectively. In an international survey of patients living with INOCA, despite similar diagnoses, clinical comorbidities, and symptoms, INOCA-related functional capacity declines are associated with a greater adverse impact on QoL in men compared to women.
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Affiliation(s)
- Sachini Ranasinghe
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Najah Khan
- Houston Methodist Hospital, Houston, TX 77030, USA
| | - Janet Wei
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | | | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8QQ, UK
| | - Alaide Chieffo
- IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Department of Medicine, Vita Salute San Raffaele University, 20132 Milan, Italy
| | | | - Filippo Crea
- Department of Cardiology, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George’s University of London, London SW17 0RE, UK
| | - Mario Marzilli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-Cardiology Division, University of Pisa, 56126 Pisa, Italy
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Rodriguez CP, Ogunmoroti O, Minhas AS, Vaidya D, Kazzi B, Osibogun O, Whelton S, Kovell LC, Harrington CM, Honigberg MC, Thamman R, Stein JH, Shapiro MD, Michos ED. Female-specific risk factors of parity and menopause age and risk of carotid plaque: the multi-ethnic study of atherosclerosis. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2023; 13:222-234. [PMID: 37736349 PMCID: PMC10509453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/21/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Female-specific factors of grand multiparity (≥5 births) and early menopause age are associated with an increased risk of cardiovascular disease (CVD). However, mechanisms are incompletely understood. Carotid plaque is a marker of subclinical atherosclerosis and associated with increased CVD risk. We evaluated the association of female-specific factors with plaque burden. METHODS We included 2,313 postmenopausal women in the Multi-Ethnic Study of Atherosclerosis, free of clinical CVD, whose parity and menopause age were ascertained by questionnaires and carotid plaque measured by ultrasound at baseline and 10 years later. Parity was categorized as nulliparity (reference), 1-2, 3-4 and ≥5 live births. Menopause age was categorized as <45, 45-49, 50-54 (reference) and ≥55 years. Multivariable regression was performed to evaluate the association of parity and menopause age with carotid plaque presence (yes/no) and extent [carotid plaque score (CPS)]. RESULTS The mean age was 64±9 years; 52.3% had prevalent carotid plaque at baseline. Compared to nulliparity, grand multiparity was significantly associated with prevalent carotid plaque after adjustment for CVD risk factors (prevalence ratio 1.17 (95% CI 1.03-1.35)) and progression of CPS over 10 years [percent difference 13% (95% CI 3-23)]. There was not any significant association of menopause age with carotid plaque presence or progression in fully-adjusted models. CONCLUSION In a multiethnic cohort, grand multiparity was independently associated with carotid plaque presence and progression. Early menopause, a known risk factor for CVD, was not captured by carotid plaque in this study. These findings may have implications for refining CVD risk assessment in women.
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Affiliation(s)
- Carla P Rodriguez
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Oluseye Ogunmoroti
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Anum S Minhas
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Dhananjay Vaidya
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Brigitte Kazzi
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International UniversityMiami, FL, USA
| | - Seamus Whelton
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Lara C Kovell
- Division of Cardiology, University of Massachusetts Chan School of MedicineWorchester, MA, USA
| | - Colleen M Harrington
- Cardiology Division, Department of Medicine, Massachusetts General HospitalBoston, MA, USA
| | - Michael C Honigberg
- Cardiology Division, Department of Medicine, Massachusetts General HospitalBoston, MA, USA
| | - Ritu Thamman
- Division of Cardiology, University of PittsburghPittsburgh, PA, USA
| | - James H Stein
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of MedicineWinston-Salem, NC, USA
| | - Erin D Michos
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
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Sawano M, Lu Y, Caraballo C, Mahajan S, Dreyer R, Lichtman JH, D'Onofrio G, Spatz E, Khera R, Onuma O, Murugiah K, Spertus JA, Krumholz HM. Sex Difference in Outcomes of Acute Myocardial Infarction in Young Patients. J Am Coll Cardiol 2023; 81:1797-1806. [PMID: 37137590 DOI: 10.1016/j.jacc.2023.03.383] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Younger women experience worse health status than men after their index episode of acute myocardial infarction (AMI). However, whether women have a higher risk for cardiovascular and noncardiovascular hospitalizations in the year after discharge is unknown. OBJECTIVES The aim of this study was to determine sex differences in causes and timing of 1-year outcomes after AMI in people aged 18 to 55 years. METHODS Data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study, which enrolled young patients with AMI across 103 U.S. hospitals, were used. Sex differences in all-cause and cause-specific hospitalizations were compared by calculating incidence rates ([IRs] per 1,000 person-years) and IR ratios with 95% CIs. We then performed sequential modeling to evaluate the sex difference by calculating subdistribution HRs (SHRs) accounting for deaths. RESULTS Among 2,979 patients, at least 1 hospitalization occurred among 905 patients (30.4%) in the year after discharge. The leading causes of hospitalization were coronary related (IR: 171.8 [95% CI: 153.6-192.2] among women vs 117.8 [95% CI: 97.3-142.6] among men), followed by noncardiac hospitalization (IR: 145.8 [95% CI: 129.2-164.5] among women vs 69.6 [95% CI: 54.5-88.9] among men). Furthermore, a sex difference was present for coronary-related hospitalizations (SHR: 1.33; 95% CI: 1.04-1.70; P = 0.02) and noncardiac hospitalizations (SHR: 1.51; 95% CI: 1.13-2.07; P = 0.01). CONCLUSIONS Young women with AMI experience more adverse outcomes than men in the year after discharge. Coronary-related hospitalizations were most common, but noncardiac hospitalizations showed the most significant sex disparity.
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Affiliation(s)
- Mitsuaki Sawano
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - Yuan Lu
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - César Caraballo
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - Shiwani Mahajan
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - Rachel Dreyer
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Judith H Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Erica Spatz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - Oyere Onuma
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - Karthik Murugiah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - John A Spertus
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA.
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9
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Dreyer RP, Arakaki A, Raparelli V, Murphy TE, Tsang SW, D’Onofrio G, Wood M, Wright CX, Pilote L. Young Women With Acute Myocardial Infarction: Risk Prediction Model for 1-Year Hospital Readmission. CJC Open 2023; 5:335-344. [PMID: 37377522 PMCID: PMC10290947 DOI: 10.1016/j.cjco.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Background Although young women ( aged ≤ 55 years) are at higher risk than similarly aged men for hospital readmission within 1 year after an acute myocardial infarction (AMI), no risk prediction models have been developed for them. The present study developed and internally validated a risk prediction model of 1-year post-AMI hospital readmission among young women that considered demographic, clinical, and gender-related variables. Methods We used data from the US Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study (n = 2007 women), a prospective observational study of young patients hospitalized with AMI. Bayesian model averaging was used for model selection and bootstrapping for internal validation. Model calibration and discrimination were respectively assessed with calibration plots and area under the curve. Results Within 1-year post-AMI, 684 women (34.1%) were readmitted to the hospital at least once. The final model predictors included: any in-hospital complication, baseline perceived physical health, obstructive coronary artery disease, diabetes, history of congestive heart failure, low income ( < $30,000 US), depressive symptoms, length of hospital stay, and race (White vs Black). Of the 9 retained predictors, 3 were gender-related. The model was well calibrated and exhibited modest discrimination (area under the curve = 0.66). Conclusions Our female-specific risk model was developed and internally validated in a cohort of young female patients hospitalized with AMI and can be used to predict risk of readmission. Whereas clinical factors were the strongest predictors, the model included several gender-related variables (ie, perceived physical health, depression, income level). However, discrimination was modest, indicating that other unmeasured factors contribute to variability in hospital readmission risk among younger women.
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Affiliation(s)
- Rachel P. Dreyer
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Health Informatics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Andrew Arakaki
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Nursing, University of Alberta, Edmonton, Alberta, Canada
- University Centre for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Terrence E. Murphy
- Program on Aging, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sui W. Tsang
- Program on Aging, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gail D’Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Malissa Wood
- Massachusetts General Hospital Heart Centre, Boston, Massachusetts, USA
- Harvard School of Medicine, Boston, Massachusetts, USA
| | - Catherine X. Wright
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Louise Pilote
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
- Division of Clinical Epidemiology McGill University Health Centre Research Institute, Montreal, Quebec, Canada
- Division of General Internal Medicine, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
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10
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Gulanski BI, Butera NM, Krause-Steinrauf H, Lichtman JH, Harindhanavudhi T, Green JB, Suratt CE, AbouAssi H, Desouza C, Ahmann AJ, Wexler DJ, Aroda VR. Higher burden of cardiometabolic and socioeconomic risk factors in women with type 2 diabetes: an analysis of the Glycemic Reduction Approaches in Diabetes (GRADE) baseline cohort. BMJ Open Diabetes Res Care 2023; 11:e003159. [PMID: 37094945 PMCID: PMC10151943 DOI: 10.1136/bmjdrc-2022-003159] [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: 10/03/2022] [Accepted: 02/18/2023] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a powerful risk factor for cardiovascular disease (CVD), conferring a greater relative risk in women than men. We sought to examine sex differences in cardiometabolic risk factors and management in the contemporary cohort represented by the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). RESEARCH DESIGN AND METHODS GRADE enrolled 5047 participants (1837 women, 3210 men) with T2DM on metformin monotherapy at baseline. The current report is a cross-sectional analysis of baseline data collected July 2013 to August 2017. RESULTS Compared with men, women had a higher mean body mass index (BMI), greater prevalence of severe obesity (BMI≥40 kg/m2), higher mean LDL cholesterol, greater prevalence of low HDL cholesterol, and were less likely to receive statin treatment and achieve target LDL, with a generally greater prevalence of these risk factors in younger women. Women with hypertension were equally likely to achieve blood pressure targets as men; however, women were less likely to receive ACE inhibitors or angiotensin receptor blockers. Women were more likely to be divorced, separated or widowed, and had fewer years of education and lower incomes. CONCLUSIONS This contemporary cohort demonstrates that women with T2DM continue to have a greater burden of cardiometabolic and socioeconomic risk factors than men, particularly younger women. Attention to these persisting disparities is needed to reduce the burden of CVD in women. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT01794143).
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Affiliation(s)
- Barbara I Gulanski
- Department of Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Section of Endocrinology, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Nicole M Butera
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, Maryland, USA
| | - Heidi Krause-Steinrauf
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, Maryland, USA
| | - Judith H Lichtman
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Tasma Harindhanavudhi
- Division of Diabetes, Endocrinology and Metabolism, University of Minnesota Health, Minneapolis, Minnesota, USA
| | - Jennifer B Green
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina, USA
| | - Colleen E Suratt
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, Maryland, USA
| | - Hiba AbouAssi
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina, USA
| | - Cyrus Desouza
- Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andrew J Ahmann
- Division of Endocrinology Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, Oregon, USA
| | - Deborah J Wexler
- Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vanita R Aroda
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA
- MedStar Health Research Institute, Hyattsville, Maryland, USA
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11
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Dondo TB, Munyombwe T, Hall M, Hurdus B, Soloveva A, Oliver G, Aktaa S, West RM, Hall AS, Gale CP. Sex differences in health-related quality of life trajectories following myocardial infarction: national longitudinal cohort study. BMJ Open 2022; 12:e062508. [PMID: 36351712 PMCID: PMC9644325 DOI: 10.1136/bmjopen-2022-062508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To investigate sex-based differences in baseline values and longitudinal trajectories of health-related quality of life (HRQoL) in a large cohort of myocardial infarction (MI) survivors after adjusting for other important factors. DESIGN Longitudinal cohort study. SETTING Population-based longitudinal study the Evaluation of the Methods and Management of Acute Coronary Events study linked with national cardiovascular registry. Data were collected from 77 hospitals in England between 1 November 2011 and 24 June 2015. PARTICIPANTS 9551 patients with MI. Patients were eligible for the study if they were ≥18 years of age. PRIMARY AND SECONDARY OUTCOME MEASURES HRQoL was measured by EuroQol five-dimension, visual analogue scale (EQ-5D, EQ VAS) survey at baseline, 1, 6 and 12 months after discharge. Multi-level linear and logistic regression models coupled with inverse probability weighted propensity scoring were used to evaluate sex differences in HRQoL following MI. RESULTS Of the 9551 patients with MI and complete data on sex, 25.1% (2,397) were women. At baseline, women reported lower HRQoL (EQ VAS (mean (SD) 59.8 (20.4) vs 64.5 (20.9)) (median (IQR) 60.00 (50.00-75.00) vs 70.00 (50.00-80.00))) (EQ-5D (mean (SD) 0.66 (0.31) vs 0.74 (0.28)) (median (IQR) 0.73 (0.52-0.85) vs 0.81 (0.62-1.00))) and were more likely to report problems in each HRQoL domain compared with men. In the covariate balanced and adjusted multi-level model sex differences in HRQoL persisted during follow-up, with lower EQ VAS and EQ-5D scores in women compared with men (adjusted EQ VAS model sex coefficient: -4.41, 95% CI -5.16 to -3.66 and adjusted EQ-5D model sex coefficient: -0.07, 95% CI -0.08 to -0.06). CONCLUSIONS Women have lower HRQoL compared with men at baseline and during 12 months follow-up after MI. Tailored interventions for women following an MI could improve their quality of life. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT04598048, NCT01808027, NCT01819103.
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Affiliation(s)
- Tatendashe Bernadette Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Theresa Munyombwe
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Ben Hurdus
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds General Infirmary, Leeds, West Yorkshire, UK
| | - Anzhela Soloveva
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | | | - Suleman Aktaa
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds General Infirmary, Leeds, West Yorkshire, UK
| | - Robert M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alistair S Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds General Infirmary, Leeds, West Yorkshire, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds General Infirmary, Leeds, West Yorkshire, UK
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12
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Hellgren T, Blöndal M, Jortveit J, Ferenci T, Faxén J, Lewinter C, Eha J, Lõiveke P, Marandi T, Ainla T, Saar A, Veldre G, Andréka P, Halvorsen S, Jánosi A, Edfors R. Sex-related differences in the management and outcomes of patients hospitalized with ST-elevation myocardial infarction: a comparison within four European myocardial infarction registries. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac042. [PMID: 35919580 PMCID: PMC9283107 DOI: 10.1093/ehjopen/oeac042] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/17/2022] [Accepted: 06/30/2022] [Indexed: 12/18/2022]
Abstract
Aims Data on how differences in risk factors, treatments, and outcomes differ between sexes in European countries are scarce. We aimed to study sex-related differences regarding baseline characteristics, in-hospital managements, and mortality of ST-elevation myocardial infarction (STEMI) patients in different European countries. Methods and results Patients over the age of 18 with STEMI who were treated in hospitals in 2014–17 and registered in one of the national myocardial infarction registers in Estonia (n = 5817), Hungary (n = 30 787), Norway (n = 33 054), and Sweden (n = 49 533) were included. Cardiovascular risk factors, hospital treatment, and recommendation of discharge medications were obtained from the infarction registries. The primary outcome was mortality, in-hospital, after 30 days and after 1 year. Logistic and cox regression models were used to study the associations of sex and outcomes in the respective countries. Women were older than men (70–78 and 62–68 years, respectively) and received coronary angiography, percutaneous coronary intervention, left ventricular ejection fraction assessment, and evidence-based drugs to a lesser extent than men, in all countries. The crude mortality in-hospital rates (10.9–15.9 and 6.5–8.9%, respectively) at 30 days (13.0–19.9 and 8.2–10.9%, respectively) and at 1 year (20.3–28.1 and 12.4–17.2%, respectively) after hospitalization were higher in women than in men. In all countries, the sex-specific differences in mortality were attenuated in the adjusted analysis for 1-year mortality. Conclusion Despite improved awareness of the sex-specific inequalities on managing patients with acute myocardial infarction in Europe, country-level data from this study show that women still receive less guideline-recommended management.
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Affiliation(s)
- Tora Hellgren
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Nobels väg 6, Sweden
| | - Mai Blöndal
- Department of Cardiology, Heart Clinic, Tartu University Hospital, 8 L. Puusepa Street, Estonia
| | - Jarle Jortveit
- Department of Cardiology, Sorlandet Hospital, Arendal, Norway
| | - Tamas Ferenci
- John von Neumann Faculty of Informatics, Obuda University, 1034 Budapest, Hungary
| | - Jonas Faxén
- Department of Cardiology, Karolinska University Hospital, Eugeniavagen 23, 17165 Stockholm, Sweden
| | - Christian Lewinter
- Department of Cardiology, Karolinska University Hospital, Eugeniavagen 23, 17165 Stockholm, Sweden
| | - Jaan Eha
- Department of Cardiology, Heart Clinic, Tartu University Hospital, 8 L. Puusepa Street, Estonia
| | - Piret Lõiveke
- Department of Cardiology, University of Tartu, 8 L. Puusepa Street, 50406 Tartu, Estonia
| | - Toomas Marandi
- Department of Cardiology, University of Tartu, 8 L. Puusepa Street, 50406 Tartu, Estonia
| | - Tiia Ainla
- Department of Cardiology, University of Tartu, 8 L. Puusepa Street, 50406 Tartu, Estonia
| | - Aet Saar
- Centre of Cardiology, North Estonia Medical Centre, 19 J. Sutiste Street, 13419 Tallinn, Estonia
| | - Gudrun Veldre
- Department of Cardiology, University of Tartu, 8 L. Puusepa Street, 50406 Tartu, Estonia
| | - Péter Andréka
- Hungarian Myocardial Infarction Registry, Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo and University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
| | - András Jánosi
- Hungarian Myocardial Infarction Registry, Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
| | - Robert Edfors
- Bayer AG, Cardiovascular Studies & Pipeline, Pharmaceuticals, Building S102, 13342 Berlin, Germany
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13
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Gender differences in secondary prevention of coronary heart disease: Far from closing the gap. Int J Cardiol 2022; 355:52-53. [DOI: 10.1016/j.ijcard.2022.03.003] [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: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 11/18/2022]
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14
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Leopold JA, Antman EM. Ideal Cardiovascular Health in Young Adults With Established Cardiovascular Diseases. Front Cardiovasc Med 2022; 9:814610. [PMID: 35252395 PMCID: PMC8893279 DOI: 10.3389/fcvm.2022.814610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
There has been an increase in the prevalence of cardiovascular diseases among young adults in the United States that has been attributed, in part, to a rise in overweight and obesity, use of combustible tobacco and unhealthy diet and exercise patterns. These factors are influenced further by socioeconomic status and other social determinants of health. In the My Research Legacy study, we examined ideal cardiovascular health in young adults aged 18– <50 years with cardiovascular disease using the Life's Simple 7 survey and data from digital health devices. Young adults with cardiovascular disease (n = 349) were older, had a lower socioeconomic status, a higher prevalence of risk factors, and lower Life's Simple 7 Health Scores (6.4 ± 1.5 vs. 7.1 ± 1.5, p < 0.01) compared to young adults without cardiovascular disease (n = 696). Analysis of digital health device data revealed that young adults with cardiovascular disease performed a similar number of weekly minutes of moderate and vigorous exercise as those without disease leading to similar ideal activity scores. Young adults with cardiovascular disease also shared similarities in modifiable risk factors with adults aged ≥50 years with cardiovascular disease (n = 217), including weight, dietary habits, and weekly minutes of exercise. Latent class analysis identified two phenogroups of young adults with cardiovascular disease: phenogroup 1 was characterized by more advantageous cardiovascular health factors and behaviors resulting in higher Life's Simple 7 Health Scores than phenogroup 2 (7.4 ± 1.2 vs. 5.5 ± 1.1, p < 0.01). These findings in young adults with cardiovascular disease may inform the design of behavioral and therapeutic interventions in the future to decrease cardiovascular morbidity and mortality.
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15
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Hall TS, Ørn S, Zannad F, Rossignol P, Duarte K, Solomon SD, Atar D, Agewall S, Dickstein K, Girerd N. The Association of Smoking with Hospitalization and Mortality Differs According to Sex in Patients with Heart Failure Following Myocardial Infarction. J Womens Health (Larchmt) 2022; 31:310-320. [PMID: 35049355 DOI: 10.1089/jwh.2021.0326] [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: 11/13/2022] Open
Abstract
Background: Smoking has been associated with higher morbidity and mortality following myocardial infarction (MI), but reports of the impact on morbidity and mortality for females and elderly patients experiencing MI complicated with left ventricular dysfunction or overt heart failure are limited. Materials and Methods: In an individual patient data meta-analysis of high-risk MI patients, the association of smoking with hospitalizations and death were investigated. Weighted Cox proportional hazard modeling were used to study the risks of smoking on adjudicated endpoints among different sex and age categories. Results: Twenty-eight thousand seven hundred thirty-five patients from the CAPRICORN, EPHESUS, OPTIMAAL, and VALIANT trials were assessed. After weighting, smokers (N = 18,148) were unfrequently women (29.2%) and a minority were above ≥80 years (9.8%). Smoking was significantly more associated with all-cause hospitalizations in women (hazard ratio [HR] 1.24; 95% confidence interval [95% CI] 1.16-1.32) than in men (HR = 1.10; 95% CI 1.05-1.16) resulting in a significant interaction between smoking and sex (p = 0.005). Smoking was predictive of all-cause mortality homogenously across age categories (p for interaction = 0.25) and sex (p for interaction = 0.58). Conclusions: The influence of smoking on morbidity differed according to sex following high-risk MI. The deleterious impact of smoking on hospitalization appeared particularly potent in women, which should further reinforce preventive strategies in females.
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Affiliation(s)
- Trygve S Hall
- Department of Cardiology B, Oslo University Hospital, Oslo, Norway
| | - Stein Ørn
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | - Faiez Zannad
- INSERM, Centre d'Investigation Clinique-1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, Nancy, France.,Université de Lorraine, Faculté de Médecine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France
| | - Patrick Rossignol
- INSERM, Centre d'Investigation Clinique-1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, Nancy, France.,Université de Lorraine, Faculté de Médecine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France
| | - Kevin Duarte
- INSERM, Centre d'Investigation Clinique-1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, Nancy, France.,Université de Lorraine, Faculté de Médecine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Dan Atar
- Department of Cardiology B, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stefan Agewall
- Department of Cardiology B, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kenneth Dickstein
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Institute of Internal Medicine, University of Bergen, Bergen, Norway
| | - Nicolas Girerd
- INSERM, Centre d'Investigation Clinique-1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, Nancy, France.,Université de Lorraine, Faculté de Médecine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France
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16
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De Leon K, Winokur EJ. Examining Acute Coronary Syndrome Across Ethnicity, Sex, and Age. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Kerola AM, Palomäki A, Rautava P, Nuotio M, Kytö V. Sex Differences in Cardiovascular Outcomes of Older Adults After Myocardial Infarction. J Am Heart Assoc 2021; 10:e022883. [PMID: 34743564 PMCID: PMC9075375 DOI: 10.1161/jaha.121.022883] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Evidence on the impact of sex on prognoses after myocardial infarction (MI) among older adults is limited. We evaluated sex differences in long-term cardiovascular outcomes after MI in older adults. Methods and Results All patients with MI ≥70 years admitted to 20 Finnish hospitals during a 10-year period and discharged alive were studied retrospectively using a combination of national registries (n=31 578, 51% men, mean age 79). The primary outcome was combined major adverse cardiovascular event within 10-year follow-up. Sex differences in baseline features were equalized using inverse probability weighting adjustment. Women were older, with different comorbidity profiles and rarer ST-segment-elevation MI and revascularization, compared with men. Adenosine diphosphate inhibitors, anticoagulation, statins, and high-dose statins were more frequently used by men, and renin-angiotensin-aldosterone inhibitors and beta blockers by women. After balancing these differences by inverse probability weighting, the cumulative 10-year incidence of major adverse cardiovascular events was 67.7% in men, 62.0% in women (hazard ratio [HR], 1.17; CI, 1.13-1.21; P<0.0001). New MI (37.0% in men, 33.1% in women; HR, 1.16; P<0.0001), ischemic stroke (21.1% versus 19.5%; HR, 1.10; P=0.004), and cardiovascular death (56.0% versus 51.1%; HR, 1.18; P<0.0001) were more frequent in men during long-term follow-up after MI. Sex differences in major adverse cardiovascular events were similar in subgroups of revascularized and non-revascularized patients, and in patients 70 to 79 and ≥80 years. Conclusions Older men had higher long-term risk of major adverse cardiovascular events after MI, compared with older women with similar baseline features and evidence-based medications. Our results highlight the importance of accounting for confounding factors when studying sex differences in cardiovascular outcomes.
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Affiliation(s)
- Anne M Kerola
- Department of Internal Medicine Päijät-Häme Joint Authority for Health and Wellbeing Lahti Finland.,Preventive Cardio-Rheuma Clinic Division of Rheumatology and Research Diakonhjemmet Hospital Oslo Norway.,Faculty of Medicine University of Helsinki Helsinki Finland
| | - Antti Palomäki
- Centre for Rheumatology and Clinical Immunology Division of Medicine Turku University Hospital Turku Finland.,Department of Medicine University of Turku Turku Finland
| | - Päivi Rautava
- Department of Public Health University of Turku Turku Finland.,Turku Clinical Research Center Turku University Hospital Turku Finland
| | - Maria Nuotio
- Research Services and Department of Clinical Medicine Turku University Hospital Turku Finland.,Division of Geriatric Medicine University of Turku Turku Finland
| | - Ville Kytö
- Heart Center Turku University Hospital and University of Turku Turku Finland.,Research Center of Applied and Preventive Cardiovascular Medicine University of Turku Turku Finland.,Center for Population Health Research Turku University Hospital and University of Turku Turku Finland.,Administrative Center Hospital District of Southwest Finland Turku Finland.,Department of Public Health Faculty of Medicine University of Helsinki Helsinki Finland
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18
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Dreyer RP, Raparelli V, Tsang SW, D'Onofrio G, Lorenze N, Xie CF, Geda M, Pilote L, Murphy TE. Development and Validation of a Risk Prediction Model for 1-Year Readmission Among Young Adults Hospitalized for Acute Myocardial Infarction. J Am Heart Assoc 2021; 10:e021047. [PMID: 34514837 PMCID: PMC8649501 DOI: 10.1161/jaha.121.021047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Readmission over the first year following hospitalization for acute myocardial infarction (AMI) is common among younger adults (≤55 years). Our aim was to develop/validate a risk prediction model that considered a broad range of factors for readmission within 1 year. Methods and Results We used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study, which enrolled young adults aged 18 to 55 years hospitalized with AMI across 103 US hospitals (N=2979). The primary outcome was ≥1 all‐cause readmissions within 1 year of hospital discharge. Bayesian model averaging was used to select the risk model. The mean age of participants was 47.1 years, 67.4% were women, and 23.2% were Black. Within 1 year of discharge for AMI, 905 (30.4%) of participants were readmitted and were more likely to be female, Black, and nonmarried. The final risk model consisted of 10 predictors: depressive symptoms (odds ratio [OR], 1.03; 95% CI, 1.01–1.05), better physical health (OR, 0.98; 95% CI, 0.97–0.99), in‐hospital complication of heart failure (OR, 1.44; 95% CI, 0.99–2.08), chronic obstructive pulmomary disease (OR, 1.29; 95% CI, 0.96–1.74), diabetes mellitus (OR, 1.23; 95% CI, 1.00–1.52), female sex (OR, 1.31; 95% CI, 1.05–1.65), low income (OR, 1.13; 95% CI, 0.89–1.42), prior AMI (OR, 1.47; 95% CI, 1.15–1.87), in‐hospital length of stay (OR, 1.13; 95% CI, 1.04–1.23), and being employed (OR, 0.88; 95% CI, 0.69–1.12). The model had excellent calibration and modest discrimination (C statistic=0.67 in development/validation cohorts). Conclusions Women and those with a prior AMI, increased depressive symptoms, longer inpatient length of stay and diabetes may be more likely to be readmitted. Notably, several predictors of readmission were psychosocial characteristics rather than markers of AMI severity. This finding may inform the development of interventions to reduce readmissions in young patients with AMI.
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Affiliation(s)
- Rachel P Dreyer
- Center for Outcomes Research and Evaluation, Yale - New Haven Hospital New Haven CT.,Department of Emergency Medicine Yale School of Medicine New Haven CT
| | - Valeria Raparelli
- Department of Translational Medicine University of Ferrara Ferrara Italy.,Department of Nursing University of Alberta Edmonton Canada.,University Center for Studies on Gender Medicine University of Ferrara Ferrara Italy
| | - Sui W Tsang
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Gail D'Onofrio
- Department of Emergency Medicine Yale School of Medicine New Haven CT
| | - Nancy Lorenze
- Program on Aging Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Catherine F Xie
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Mary Geda
- Program on Aging Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Louise Pilote
- Centre for Outcomes Research and Evaluation McGill University Health Centre Research Institute Montreal Quebec Canada.,Divisions of Clinical Epidemiology and General Internal Medicine McGill University Health Centre Research Institute Montreal Quebec Canada
| | - Terrence E Murphy
- Program on Aging Department of Internal Medicine Yale School of Medicine New Haven CT
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19
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Lorca R, Pascual I, Aparicio A, Junco-Vicente A, Alvarez-Velasco R, Barja N, Roces L, Suárez-Cuervo A, Diaz R, Moris C, Hernandez-Vaquero D, Avanzas P. Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis. J Clin Med 2021; 10:1314. [PMID: 33806738 PMCID: PMC8004961 DOI: 10.3390/jcm10061314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Coronary artery disease (CAD) is the most frequent cause of ST-segment elevation myocardial infarction (STEMI). Etiopathogenic and prognostic characteristics in young patients may differ from older patients and young women may present worse outcomes than men. We aimed to evaluate the clinical characteristics and prognosis of men and women with premature STEMI. METHODS A total 1404 consecutive patients were referred to our institution for emergency cardiac catheterization due to STEMI suspicion (1 January 2014-31 December 2018). Patients with confirmed premature (<55 years old in men and <60 in women) STEMI (366 patients, 83% men and 17% women) were included (359 atherothrombotic and 7 spontaneous coronary artery dissection (SCAD)). RESULTS Premature STEMI patients had a high prevalence of classical cardiovascular risk factors. Mean follow-up was 4.1 years (±1.75 SD). Mortality rates, re-hospitalization, and hospital stay showed no significant differences between sexes. More than 10% of women with premature STEMI suffered SCAD. There were no significant differences between sexes, neither among cholesterol levels nor in hypolipemiant therapy. The global survival rates were similar to that expected in the general population of the same sex and age in our region with a significantly higher excess of mortality at 6 years among men compared with the general population. CONCLUSION Our results showed a high incidence of cardiovascular risk factors, a high prevalence of SCAD among young women, and a generally good prognosis after standardized treatment. During follow-up, 23% suffered a major cardiovascular event (MACE), without significant differences between sexes and observed survival at 1, 3, and 6 years of follow-up was 96.57% (95% CI 94.04-98.04), 95.64% (95% CI 92.87-97.35), and 94.5% (95% CI 91.12-97.66). An extra effort to prevent/delay STEMI should be invested focusing on smoking avoidance and optimal hypolipemiant treatment both in primary and secondary prevention.
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Affiliation(s)
- Rebeca Lorca
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Andrea Aparicio
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
| | - Alejandro Junco-Vicente
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
| | - Rut Alvarez-Velasco
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
| | - Noemi Barja
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
| | - Luis Roces
- Anestesiología, Reanimación y Terapéutica del Dolor, Completo Asistencial Universitario de Salamanca, 37007 Salamanca, Spain;
| | - Alfonso Suárez-Cuervo
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
| | - Rocio Diaz
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Cesar Moris
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Daniel Hernandez-Vaquero
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
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20
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Vallabhajosyula S, Verghese D, Desai VK, Sundaragiri PR, Miller VM. Sex differences in acute cardiovascular care: a review and needs assessment. Cardiovasc Res 2021; 118:667-685. [PMID: 33734314 PMCID: PMC8859628 DOI: 10.1093/cvr/cvab063] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/16/2021] [Accepted: 03/03/2021] [Indexed: 12/17/2022] Open
Abstract
Despite significant progress in the care of patients suffering from cardiovascular disease, there remains a persistent sex disparity in the diagnosis, management, and outcomes of these patients. These sex disparities are seen across the spectrum of cardiovascular care, but, are especially pronounced in acute cardiovascular care. The spectrum of acute cardiovascular care encompasses critically ill or tenuous patients with cardiovascular conditions that require urgent or emergent decision-making and interventions. In this narrative review, the disparities in the clinical course, management, and outcomes of six commonly encountered acute cardiovascular conditions, some with a known sex-predilection will be discussed within the basis of underlying sex differences in physiology, anatomy, and pharmacology with the goal of identifying areas where improvement in clinical approaches are needed.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA.,Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Dhiran Verghese
- Department of Medicine, Amita Health Saint Joseph Hospital, Chicago, IL, USA
| | - Viral K Desai
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Pranathi R Sundaragiri
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Virginia M Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Department of Surgery, Mayo Clinic, Rochester, MN, USA
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21
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Thakkar A, Agarwala A, Michos ED. Secondary Prevention of Cardiovascular Disease in Women: Closing the Gap. Eur Cardiol 2021; 16:e41. [PMID: 34815749 PMCID: PMC8591616 DOI: 10.15420/ecr.2021.24] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/24/2021] [Indexed: 12/16/2022] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of death in women globally. Younger women (<55 years of age) who experience MI are less likely to receive guideline-directed medical therapy (GDMT), have a greater likelihood of readmission and have higher rates of mortality than similarly aged men. Women have been under-represented in CVD clinical trials, which limits the generalisability of results into practice. Available evidence indicates that women derive a similar benefit as men from secondary prevention pharmacological therapies, such as statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, icosapent ethyl, antiplatelet therapy, sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists. Women are less likely to be enrolled in cardiac rehabilitation programs than men. Mitigating risk and improving outcomes is dependent on proper identification of CVD in women, using appropriate GDMT and continuing to promote lifestyle modifications. Future research directed at advancing our understanding of CVD in women will allow us to further develop and tailor CVD guidelines appropriate by sex and to close the gap between diagnoses, treatment and mortality.
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Affiliation(s)
- Aarti Thakkar
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, US
| | - Anandita Agarwala
- Division of Cardiology, Baylor Scott and White Health Heart Hospital Baylor PlanoPlano, TX, US
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, US
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22
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Asleh R, Manemann SM, Weston SA, Bielinski SJ, Chamberlain AM, Jiang R, Gerber Y, Roger VL. Sex Differences in Outcomes After Myocardial Infarction in the Community. Am J Med 2021; 134:114-121. [PMID: 32622868 PMCID: PMC7752831 DOI: 10.1016/j.amjmed.2020.05.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Prior studies observed that women experienced worse outcomes than men after myocardial infarction but did not convincingly establish an independent effect of female sex on outcomes, thus failing to impact clinical practice. Current data remain sparse and information on long-term nonfatal outcomes is lacking. To address these gaps in knowledge, we examined outcomes after incident myocardial infarction for women compared with men. METHODS We studied a population-based myocardial infarction incidence cohort in Olmsted County, Minnesota, between 2000 and 2012. Patients were followed for recurrent myocardial infarction, heart failure, and death. A propensity score was constructed to balance the clinical characteristics between men and women; Cox models were weighted using inverse probabilities of the propensity scores. RESULTS Among 1959 patients with incident myocardial infarction (39% women; mean age 73.8 and 64.2 for women and men, respectively), 347 recurrent myocardial infarctions, 464 heart failure episodes, 836 deaths, and 367 cardiovascular deaths occurred over a mean follow-up of 6.5 years. Women experienced a higher occurrence of each adverse event (all P <0.01). After propensity score weighting, women had a 28% increased risk of recurrent myocardial infarction (hazard ratio: 1.28, 95% confidence interval: 1.03-1.59), and there was no difference in risk for any other outcomes (all P >0.05). CONCLUSION After myocardial infarction, women experience a large excess risk of recurrent myocardial infarction but not of heart failure or death independently of clinical characteristics. Future studies are needed to understand the mechanisms driving this association.
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Affiliation(s)
- Rabea Asleh
- Department of Cardiovascular Diseases; Department of Cardiology, Hadassah University Medical Center, Jerusalem, Israel
| | - Sheila M Manemann
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Susan A Weston
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | | | | | - Ruoxiang Jiang
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Yariv Gerber
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Véronique L Roger
- Department of Cardiovascular Diseases; Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
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23
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Sex and gender aspects in vascular pathophysiology. Clin Sci (Lond) 2020; 134:2203-2207. [PMID: 32844996 DOI: 10.1042/cs20200876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease (CVD) is a leading cause of global mortality in men and women. The prevalence, pathophysiology, clinical manifestations and outcomes of CVD observed in these two populations is being increasingly recognized as distinct. In this editorial, we provide an overview of mechanisms related to differences in vascular pathophysiology between men and women and explore the contributions of both sex and gender.
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24
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Liu J, Elbadawi A, Elgendy IY, Megaly M, Ogunbayo GO, Krittanawong C, Tamis-Holland JE, Ballantyne CM, Khalid MU, Virani S, Gulati M, Albert M, Bozkurt B, Jneid H. Age-Stratified Sex Disparities in Care and Outcomes in Patients With ST-Elevation Myocardial Infarction. Am J Med 2020; 133:1293-1301.e1. [PMID: 32417118 DOI: 10.1016/j.amjmed.2020.03.059] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Women are undertreated and have worse clinical outcomes than men after acute myocardial infarction. It remains uncertain whether the sex disparities in treatments and outcomes persist in the contemporary era and whether they affect all age groups equally. METHODS Using the National Inpatient Sample (NIS) registry, we evaluated 1,260,200 hospitalizations for ST-elevation myocardial infarction (STEMI) between 2010 and 2016, of which 32% were for women. The age-stratified sex differences in care measures and mortality were examined. Stepwise multivariable adjustment models, including baseline comorbidities, hospital characteristics, and reperfusion and revascularization therapies, were used to compare measures and outcomes between women and men across different age subgroups. RESULTS Overall, women with STEMI were older than men and had more comorbidities. Women were less likely to receive fibrinolytic therapy, percutaneous coronary intervention (PCI), and coronary artery bypass surgery across all age subgroups. Women with STEMI overall experienced higher unadjusted in-hospital mortality (11.1% vs 6.8%; adjusted odds ratio [OR] = 1.039, 95% confidence interval [CI]: 1.003-1.077), which persisted after multivariable adjustments. However, when stratified by age, the difference in mortality became non-significant in most age groups after stepwise multivariable adjustment, except among the youngest patients 19-49 years of age with STEMI (women vs men: 3.9% vs 2.6%; adjusted odds ratio = 1.259, 95% confidence interval: 1.083-1.464). CONCLUSIONS Women with STEMI were less likely to receive reperfusion and revascularization therapies and had higher in-hospital mortality and complications compared with men. Younger women with STEMI (19-49 years of age) experienced higher in-hospital mortality that persisted after multivariable adjustment.
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Affiliation(s)
- Jing Liu
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Tex
| | - Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston
| | - Islam Y Elgendy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Michael Megaly
- Division of Cardiovascular Medicine, Minneapolis Heart Institute, Minneapolis, Minn
| | | | | | | | - Christie M Ballantyne
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Tex
| | - Mirza U Khalid
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Tex
| | - Salim Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, Tex; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Tex
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Tucson
| | - Michelle Albert
- Division of Cardiology, University of California, San Francisco
| | - Biykem Bozkurt
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Tex
| | - Hani Jneid
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Tex.
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25
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Song J, Murugiah K, Hu S, Gao Y, Li X, Krumholz HM, Zheng X. Incidence, predictors, and prognostic impact of recurrent acute myocardial infarction in China. Heart 2020; 107:heartjnl-2020-317165. [PMID: 32938773 PMCID: PMC7873426 DOI: 10.1136/heartjnl-2020-317165] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Incidence, predictors, and prognostic impact of recurrent acute myocardial infarction (AMI) after initial AMI remain poorly understood. Data on recurrent AMI in China is unknown. METHODS Using the China Patient-centred Evaluative Assessment of Cardiac Events (PEACE)-Prospective AMI Study, we studied 3387 patients admitted to 53 hospitals for AMI and discharged alive. The association of recurrent AMI with 1-year mortality was evaluated using time-dependent Cox regression. Recurrent AMI events were classified as early (1-30 days), late (31-180 days), and very late (181-365 days). Their impacts on 1-year mortality were estimated by Kaplan-Meier methodology and compared by the log-rank test. Multivariable modelling was used to identify factors associated with recurrent AMI. RESULTS The mean (SD) age was 60.7 (11.9) years and 783 (23.1%) were women. The observed 1-year recurrent AMI rate was 2.5% (95% CI 2.00 to 3.07) with 35.7% events occurring within the first 30 days. Recurrent AMI was associated with 1-year mortality with an adjusted HR of 25.42 (95% CI 15.27 to 42.34). Early recurrent AMI was associated with the highest 1-year mortality rate of 53.3% (log-rank p<0.001). Predictors of recurrent AMI included age 75-84, in-hospital percutaneous coronary intervention, heart rate >90 min/beats at initial admission, renal dysfunction, and not being prescribed any of guideline-based medications at discharge. CONCLUSIONS One-third of recurrent AMI events occurred early. Recurrent AMI is strongly associated with 1-year mortality, particularly if early. Heightened surveillance during this early period and improving prescription of recommended discharge medications may reduce recurrent AMI in China.
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Affiliation(s)
- Jiali Song
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Karthik Murugiah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut, United States
| | - Shuang Hu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Yan Gao
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xi Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut, United States
- Yale School of Public Health, Yale University School of Medicine, and Yale-New Haven Hospital, New Haven, Connecticut, United States
| | - Xin Zheng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
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26
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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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27
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Sun Y, Feng L, Li X, Gao R, Wu Y. The sex difference in 6-month MACEs and its explaining variables in acute myocardial infarction survivors: Data from CPACS-3 study. Int J Cardiol 2020; 311:1-6. [PMID: 32223960 DOI: 10.1016/j.ijcard.2020.03.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND We aimed to assess sex difference in developing major adverse cardiovascular events (MACEs) after discharge and factors associated with the gender disparity among AMI survivors. METHODS We selected the patients hospitalized with either NSTEMI or STEMI from 101 Chinese centers in the CPACS 3 study. We compared sex differences in MACEs and mortality in 6 months after discharge using a Cox proportional hazards model, following sequential adjustment for covariates. RESULTS 8958 patients with AMI were included and 30.3% were women. Overall, the crude rate of MACEs at 6 month for women were significantly higher than men (6.5% vs 4.5%; hazard ratio (HR) =1.47; 95% CI, 1.21-1.77). Women also had significantly higher total mortality compared to men (4.4% vs 2.7%; HR = 1.65; 95% CI, 1.30-2.09). Among possible explanatory factors, patients' cardiovascular risk profile might explain 53%, age 38%, low level of education and socioeconomic status 32%. Interestingly, medications at discharge did not contribute to the sex disparity in 6-month risk of MACEs. These factors could explain a similar proportion of the gender disparity in total death. All together, these factors could explain all the disparity in the risk of both MACEs (HR = 1.05,95% CI, 0.85-1.31) and total death (HR = 1.00,95% CI,0.76-1.30). CONCLUSIONS The gender disparity in MACEs and total death among AMI patients continues at 6 months after discharged surviving. Multiple factors could explain the higher risk for women, including poorer cardiovascular risk factor profile, older age and lower socioeconomic status. TRIAL REGISTRATION CPACS-3 was registered on www.clinicaltrails.gov, and the registration number is NCT01398228.
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Affiliation(s)
- Yihong Sun
- China-Japan Friendship Hospital, Beijing, China
| | - Lin Feng
- Peking University Clinical Research Institute, Beijing, China.
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China; Faculty of Medicine, University of New South Wales, Australia.
| | - Runlin Gao
- The Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Beijing, China; The George Institute for Global Health at Peking University Health Science Center, Beijing, China; Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China.
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Spaulding EM, Marvel FA, Lee MA, Yang WE, Demo R, Wang J, Xun H, Shah L, Weng D, Fashanu OE, Carter J, Sheidy J, McLin R, Flowers J, Majmudar M, Elgin E, Vilarino V, Lumelsky D, Bhardwaj V, Padula W, Allen JK, Martin SS. Corrie Health Digital Platform for Self-Management in Secondary Prevention After Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2020; 12:e005509. [PMID: 31043065 DOI: 10.1161/circoutcomes.119.005509] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Unplanned readmissions after hospitalization for acute myocardial infarction are among the leading causes of preventable morbidity, mortality, and healthcare costs. Digital health interventions could be an effective tool in promoting self-management, adherence to guideline-directed therapy, and cardiovascular risk reduction. A digital health intervention developed at Johns Hopkins-the Corrie Health Digital Platform (Corrie)-includes the first cardiology Apple CareKit smartphone application, which is paired with an Apple Watch and iHealth Bluetooth-enabled blood pressure cuff. Corrie targets: (1) self-management of cardiac medications, (2) self-tracking of vital signs, (3) education about cardiovascular disease through articles and animated videos, and (4) care coordination that includes outpatient follow-up appointments. METHODS AND RESULTS The 3 phases of the MiCORE study (Myocardial infarction, Combined-device, Recovery Enhancement) include (1) the development of Corrie, (2) a pilot study to assess the usability and feasibility of Corrie, and (3) a prospective research study to primarily compare time to first readmission within 30 days postdischarge among patients with Corrie to patients in the historical standard of care comparison group. In Phase 2, the feasibility of deploying Corrie in an acute care setting was established among a sample of 60 patients with acute myocardial infarction. Phase 3 is ongoing and patients from 4 hospitals are being enrolled as early as possible during their hospital stay if they are 18 years or older, admitted with acute myocardial infarction (ST-segment-elevation myocardial infarction or type I non-ST-segment-elevation myocardial infarction), and own a smartphone. Patients are either being enrolled with their own personal devices or they are provided an iPhone and/or Apple Watch for the duration of the study. Phase 3 started in October 2017 and we aim to recruit 140 participants. CONCLUSIONS This article will provide an in-depth understanding of the feasibility associated with implementing a digital health intervention in an acute care setting and the potential of Corrie as a self-management tool for acute myocardial infarction recovery.
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Affiliation(s)
- Erin M Spaulding
- Johns Hopkins University School of Nursing, Baltimore, MD (E.M.S., J.K.A.)
| | - Francoise A Marvel
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (F.A.M., O.E.F., S.S.M.)
| | - Matthias A Lee
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD (M.A.L., R.D., S.S.M.)
| | - William E Yang
- Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
| | - Ryan Demo
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (F.A.M., O.E.F., S.S.M.)
| | - Jane Wang
- Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
| | - Helen Xun
- Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
| | - Lochan Shah
- Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
| | - Daniel Weng
- Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
| | - Oluwaseun E Fashanu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (F.A.M., O.E.F., S.S.M.)
| | | | - Julie Sheidy
- Reading Hospital, West Reading, PA (J.S., R.M., J.F., E.E.)
| | - Renee McLin
- Reading Hospital, West Reading, PA (J.S., R.M., J.F., E.E.)
| | | | | | - Eric Elgin
- Reading Hospital, West Reading, PA (J.S., R.M., J.F., E.E.)
| | - Valerie Vilarino
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD (V.V., D.L.)
| | - David Lumelsky
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD (V.V., D.L.)
| | - Vinayak Bhardwaj
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (V.B., W.P., J.K.A.)
| | - William Padula
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (V.B., W.P., J.K.A.)
| | - Jerilyn K Allen
- Johns Hopkins University School of Nursing, Baltimore, MD (E.M.S., J.K.A.).,Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.).,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (V.B., W.P., J.K.A.)
| | - Seth S Martin
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (F.A.M., O.E.F., S.S.M.).,Whiting School of Engineering, Johns Hopkins University, Baltimore, MD (M.A.L., R.D., S.S.M.).,Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
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Li J, Dharmarajan K, Bai X, Masoudi FA, Spertus JA, Li X, Zheng X, Zhang H, Yan X, Dreyer RP, Krumholz HM. Thirty-Day Hospital Readmission After Acute Myocardial Infarction in China. Circ Cardiovasc Qual Outcomes 2020; 12:e005628. [PMID: 31092023 DOI: 10.1161/circoutcomes.119.005628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Readmission after acute myocardial infarction in low- and middle-income countries like China is not well characterized. Methods and Results We approached consecutive patients with acute myocardial infarction hospitalized within 24 hours of symptom onset and discharged alive from 53 geographically diverse hospitals in China. We described rates of unplanned 30-day readmission, their timing and admitting diagnoses, and fit Cox proportional hazards models to identify factors associated with readmission. Among 3387 patients, median (interquartile range) age was 61 (52-69) years, and 76.9% were men. The index median length of stay was 11 (8-14) days. Unplanned 30-day readmission occurred in 6.3% of the cohort; most readmissions (77.7%) were for cardiovascular diagnoses. Nearly half (41.9% of all-cause readmissions; 44.3% of cardiovascular readmissions) occurred within 5 days of discharge. Mini-Global Registry of Acute Coronary Events scores at admission (hazard ratio [HR], 1.15 for every 10-point increase; 95% CI, 1.05-1.25), longer length of stay (HR, 1.03; 95% CI, 1.00-1.06 for each extra day), and in-hospital recurrent angina (HR, 1.40; 95% CI, 1.04-1.89) were associated with higher unplanned all-cause readmission. Revascularization during the index hospitalization (70.2% of the cohort) was associated with lower risks of all-cause readmission (HR, 0.27; 95% CI, 0.18-0.42). In addition, left ventricular ejection fraction <0.4 (HR, 1.79; 95% CI, 1.05-3.07) and in-hospital complication (HR, 1.20; 95% CI, 1.03-1.39) were associated with higher risk of unplanned cardiovascular readmission, and ST-segment-elevation myocardial infarction (HR, 0.60; 95% CI, 0.36-0.98) was associated with lower risk of unplanned cardiovascular readmission. Sex, family income, depression, stress level, lower social support, disease-specific health status, and medications were not associated with readmission. Conclusions In China, most readmissions are for cardiovascular events, and almost half occur within 5 days of discharge. Clinical factors identify patients at higher and lower unplanned readmissions. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT01624909.
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Affiliation(s)
- Jing Li
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Kumar Dharmarajan
- Clover Health, Jersey City, NJ (K.D.).,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.D., R.P.D., H.M.K.).,Section of Cardiovascular Medicine (K.D., H.M.K.), Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Xueke Bai
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Frederick A Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (J.A.S.)
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Xin Zheng
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Haibo Zhang
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Xiaofang Yan
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Rachel P Dreyer
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.D., R.P.D., H.M.K.).,Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (R.P.D.)
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.D., R.P.D., H.M.K.).,Section of Cardiovascular Medicine (K.D., H.M.K.), Department of Internal Medicine, Yale School of Medicine, New Haven, CT.,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
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Sun D, Zhang Q, Li W, Wang H. Body Mass Index and 1-Year Unplanned Readmission in Chinese Patients with Acute Myocardial Infarction: A Retrospective Cohort Study. Cardiol Res Pract 2020; 2020:4158209. [PMID: 32148951 PMCID: PMC7049439 DOI: 10.1155/2020/4158209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/16/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Evidence regarding the relationship between body mass index (BMI) and 1-year unplanned readmission was limited. Therefore, the objective of this research is to investigate whether BMI was independently related to 1-year unplanned readmission in Chinese patients with acute myocardial infarction (AMI) after percutaneous transluminal coronary intervention (PCI) after adjusting for other covariates. METHODS The present study was a cohort study. A total of 214 participants with AMI after PCI were involved in a hospital in China from 1st January 2017 to 1st January 2018. The target independent variable and the dependent variable were BMI measured at baseline and 1-year unplanned readmission, respectively. Covariates involved in this study included age, gender, TC, triglyceride, HDL-C, LDL-C, PT, APTT, INR, creatinine, HGB, LVEF, discharge medication, marital status, educational level, COPD, diabetes mellitus, heart failure, history of ischemic stroke, history of hemorrhagic stroke, arrhythmia, and hypertension. RESULTS The average age of 172 selected participants was 60.2 ± 10.8 years old, and about 68.6% of them was male. The rate of readmission in patients with AMI was 26.14%. The result of fully adjusted binary logistic regression showed BMI was negatively associated with risk of readmission after adjusting confounders (hazard ratio (HR) = 1.1, 95% CI 0.93-1.29). Nonlinear relationship was detected between BMI and 1-year unplanned readmission, whose point was 29.3. The effect sizes and the confidence intervals of the left and right sides of inflection point were 0.9 (0.7-1.2, P for nonlinearity = 0.530) and 2.8 (1.3-5.8, P for nonlinearity = 0.530) and 2.8 (1.3-5.8. CONCLUSION BMI has a nonlinear relationship with 1-year unplanned readmission in patients with myocardial infarction. The 1-year unplanned readmission rate of overweight patients (BMI > 29.3 kg/m2) has increased significantly. Obesity paradox does not exist in terms of readmission of Chinese patients with myocardial infarction after PCI.
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Affiliation(s)
- Dandan Sun
- Department of Cardiology of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng District, Jining 272000, Shandong Province, China
| | - Qingyun Zhang
- Department of Cardiology of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng District, Jining 272000, Shandong Province, China
| | - Wei Li
- Nursing Department of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng District, Jining 272000, Shandong Province, China
| | - Haichen Wang
- Office of Party Committee of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng District, Jining 272000, Shandong Province, China
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31
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Raparelli V, Proietti M, Lenzi A, Basili S. Sex and Gender Differences in Ischemic Heart Disease: Endocrine Vascular Disease Approach (EVA) Study Design. J Cardiovasc Transl Res 2020; 13:14-25. [PMID: 30511337 PMCID: PMC7010648 DOI: 10.1007/s12265-018-9846-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/13/2018] [Indexed: 12/18/2022]
Abstract
Improvements in ischemic heart disease (IHD) management have been unbalanced between sexes, with coronary microvascular dysfunction considered the likely underlying reason. The Endocrine Vascular disease Approach (EVA) is an observational study (Clinicaltrial.gov NCT02737982) aiming to assess sex and gender interactions between coronary circulation, sexual hormones, and platelet function. Consecutive patients with IHD undergoing coronary angiography will be recruited: (1) to assess sex and gender differences in angiographic reperfusion indexes; (2) to evaluate the effects of estrogen/androgen on sex-related differences in myocardial ischemia; (3) to investigate the platelet biology differences between men and women with IHD; (4) to verify sex- and gender-driven interplay between response to percutaneous coronary intervention, platelets, sex hormones, and myocardial damage at baseline and its impact on 12-month outcomes. The integration of sex and gender in this translational project on IHD will contribute to the identification of new targets for further innovative clinical interventions.
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Affiliation(s)
- Valeria Raparelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC Canada
| | - Marco Proietti
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Stefania Basili
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
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Reza N, Adusumalli S, Saybolt MD, Silvestry FE, Sanghavi M, Lewey J, Ambrose M. Implementing a Women's Cardiovascular Health Training Program in a Cardiovascular Disease Fellowship: The MUCHACHA Curriculum. JACC Case Rep 2020; 2:164-167. [PMID: 34316988 PMCID: PMC8301516 DOI: 10.1016/j.jaccas.2019.11.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sex- and gender-specific training for cardiovascular clinicians is essential to enhance knowledge and quality of women’s cardiovascular health care. In 2016, the University of Pennsylvania cardiovascular fellowship program established a dedicated women’s cardiovascular health curriculum, motivated by the fellow-in-training desire to gain formal and focused training in this emerging field.
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Affiliation(s)
- Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Address for correspondence: Dr. Nosheen Reza, Perelman Center for Advanced Medicine, South Tower 11th Floor, Room 11-134, 3400 Civic Center Boulevard, Philadelphia, Pennsylvania 19104.
| | - Srinath Adusumalli
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew D. Saybolt
- Hackensack Meridian Health Jersey Shore University Medical Center, Neptune City, New Jersey
| | - Frank E. Silvestry
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Monika Sanghavi
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer Lewey
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marietta Ambrose
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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" Bridging the Gap" Everything that Could Have Been Avoided If We Had Applied Gender Medicine, Pharmacogenetics and Personalized Medicine in the Gender-Omics and Sex-Omics Era. Int J Mol Sci 2019; 21:ijms21010296. [PMID: 31906252 PMCID: PMC6982247 DOI: 10.3390/ijms21010296] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/21/2019] [Accepted: 12/30/2019] [Indexed: 02/06/2023] Open
Abstract
Gender medicine is the first step of personalized medicine and patient-centred care, an essential development to achieve the standard goal of a holistic approach to patients and diseases. By addressing the interrelation and integration of biological markers (i.e., sex) with indicators of psychological/cultural behaviour (i.e., gender), gender medicine represents the crucial assumption for achieving the personalized health-care required in the third millennium. However, ‘sex’ and ‘gender’ are often misused as synonyms, leading to frequent misunderstandings in those who are not deeply involved in the field. Overall, we have to face the evidence that biological, genetic, epigenetic, psycho-social, cultural, and environmental factors mutually interact in defining sex/gender differences, and at the same time in establishing potential unwanted sex/gender disparities. Prioritizing the role of sex/gender in physiological and pathological processes is crucial in terms of efficient prevention, clinical signs’ identification, prognosis definition, and therapy optimization. In this regard, the omics-approach has become a powerful tool to identify sex/gender-specific disease markers, with potential benefits also in terms of socio-psychological wellbeing for each individual, and cost-effectiveness for National Healthcare systems. “Being a male or being a female” is indeed important from a health point of view and it is no longer possible to avoid “sex and gender lens” when approaching patients. Accordingly, personalized healthcare must be based on evidence from targeted research studies aimed at understanding how sex and gender influence health across the entire life span. The rapid development of genetic tools in the molecular medicine approaches and their impact in healthcare is an example of highly specialized applications that have moved from specialists to primary care providers (e.g., pharmacogenetic and pharmacogenomic applications in routine medical practice). Gender medicine needs to follow the same path and become an established medical approach. To face the genetic, molecular and pharmacological bases of the existing sex/gender gap by means of omics approaches will pave the way to the discovery and identification of novel drug-targets/therapeutic protocols, personalized laboratory tests and diagnostic procedures (sex/gender-omics). In this scenario, the aim of the present review is not to simply resume the state-of-the-art in the field, rather an opportunity to gain insights into gender medicine, spanning from molecular up to social and psychological stances. The description and critical discussion of some key selected multidisciplinary topics considered as paradigmatic of sex/gender differences and sex/gender inequalities will allow to draft and design strategies useful to fill the existing gap and move forward.
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Sarma AA, Braunwald E, Cannon CP, Guo J, Im K, Antman EM, Gibson CM, Newby LK, Giugliano RP, Morrow DA, Wiviott SD, Sabatine MS, O’Donoghue ML. Outcomes of Women Compared With Men After Non–ST-Segment Elevation Acute Coronary Syndromes. J Am Coll Cardiol 2019; 74:3013-3022. [DOI: 10.1016/j.jacc.2019.09.065] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 09/18/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
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Okunrintemi V, Valero-Elizondo J, Patrick B, Salami J, Tibuakuu M, Ahmad S, Ogunmoroti O, Mahajan S, Khan SU, Gulati M, Nasir K, Michos ED. Gender Differences in Patient-Reported Outcomes Among Adults With Atherosclerotic Cardiovascular Disease. J Am Heart Assoc 2019; 7:e010498. [PMID: 30561253 PMCID: PMC6405598 DOI: 10.1161/jaha.118.010498] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Atherosclerotic cardiovascular disease (ASCVD) accounts for approximately one third of deaths in women. Although there is an established relationship between positive patient experiences, health‐related quality of life, and improved health outcomes, little is known about gender differences in patient‐reported outcomes among ASCVD patients. We therefore compared gender differences in patient‐centered outcomes among individuals with ASCVD. Methods and Results Data from the 2006 to 2015 Medical Expenditure Panel Survey, a nationally representative US sample, were used for this study. Adults ≥18 years with a diagnosis of ASCVD, ascertained by International Classification of Diseases, Ninth Revision (ICD‐9) codes and/or self‐reported data, were included. Linear and logistic regression were used to compare self‐reported patient experience, perception of health, and health‐related quality of life by gender. Models adjusted for demographics, socioeconomic status, and comorbidities. There were 21 353 participants included, with >10 000 (47%‐weighted) of the participants being women, representing ≈11 million female adults with ASCVD nationwide. Compared with men, women with ASCVD were more likely to experience poor patient–provider communication (odds ratio 1.25 [95% confidence interval 1.11–1.41]), lower healthcare satisfaction (1.12 [1.02–1.24]), poor perception of health status (1.15 [1.04–1.28]), and lower health‐related quality of life scores. Women with ASCVD also had lower use of aspirin and statins, and greater odds of ≥2 Emergency Department visits/y. Conclusions Women with ASCVD were more likely to report poorer patient experience, lower health‐related quality of life, and poorer perception of their health when compared with men. These findings have important public health implications and require more research towards understanding the gender‐specific differences in healthcare quality, delivery, and ultimately health outcomes among individuals with ASCVD.
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Affiliation(s)
- Victor Okunrintemi
- 1 Department of Internal Medicine East Carolina University Greenville NC
| | | | | | | | - Martin Tibuakuu
- 5 Department of Medicine St. Luke's Hospital Chesterfield MO.,6 Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD
| | - Saba Ahmad
- 7 Department of Cardiology Lankenau Medical Center Wynnewood PA
| | - Oluseye Ogunmoroti
- 6 Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD
| | - Shiwani Mahajan
- 2 Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT
| | | | - Martha Gulati
- 9 Division of Cardiology University of Arizona College of Medicine Phoenix AZ
| | - Khurram Nasir
- 2 Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,10 Division of Cardiology Yale School of Medicine New Haven CT
| | - Erin D Michos
- 6 Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD.,11 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
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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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de Oliveira LMSM, Costa IMNBDC, da Silva DG, Silva JRSS, Barreto-Filho JAS, Almeida-Santos MA, Oliveira JLM, Buarque MDBM, Vieira DADS, Sousa ACS. Readmission of Patients with Acute Coronary Syndrome and Determinants. Arq Bras Cardiol 2019; 113:42-49. [PMID: 31271598 PMCID: PMC6684196 DOI: 10.5935/abc.20190104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/23/2018] [Accepted: 11/01/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) is responsible for high rates of hospital admission and readmission, which are associated with increased costs for the patient and the health system, and increased in-hospital mortality rates. OBJECTIVE To evaluate readmission in patients with ACS and its determinants. METHODS This was a retrospective cohort study of adult and elderly patients with ACS, readmitted to public and private referral cardiology hospitals within one year after the first hospitalization for ACS. The occurrence of readmissions, the time elapsed from the first to the second admission, and the use of medications at admission were collected from the medical records. Associations between categorical variables were evaluated by the chi-square test or the Fisher's exact test. Multiple logistic regression was used to evaluate predictors for readmissions. A p < 0.05 was set as statistically significant. RESULTS Readmission rate was 21.5% (n = 115) and mean time between admissions was 122.7 ± 112.1 days. The patients were mostly men (64.0%), mean age of 63.15 ± 12.3 years. Among readmitted patients, 7% had a prognosis of "death", and 68.7% were readmitted more than once within a one-year period. The main reasons of readmission were cardiovascular diseases including ACS. Private health care and the diagnosis of congestive heart failure were associated with multiple logistic regression. CONCLUSION ACS was the main cause of readmission, with higher prevalence among users of supplemental health care. Readmissions were associated with previous diagnosis of congestive heart failure and the type of health care provided.
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Affiliation(s)
| | - Ingrid Maria Novais Barros de Carvalho Costa
- Universidade Federal de Sergipe - Departamento de
Pós-Graduação em Ciências da Saúde, São
Cristovão, SE - Brazil
- Instituto Federal de Educação Ciência e
Tecnologia de Sergipe, São Cristovão, SE - Brazil
| | | | | | - José Augusto Soares Barreto-Filho
- Universidade Federal de Sergipe - Departamento de
Pós-Graduação em Ciências da Saúde, São
Cristovão, SE - Brazil
- Universidade Federal de Sergipe - Departamento de Medicina,
São Cristovão, SE - Brazil
- Fundação São Lucas - Centro de Ensino e
Pesquisa, Aracaju, SE - Brazil
| | | | - Joselina Luzia Meneses Oliveira
- Universidade Federal de Sergipe - Departamento de
Pós-Graduação em Ciências da Saúde, São
Cristovão, SE - Brazil
- Universidade Federal de Sergipe - Departamento de Medicina,
São Cristovão, SE - Brazil
| | | | | | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe - Departamento de
Pós-Graduação em Ciências da Saúde, São
Cristovão, SE - Brazil
- Universidade Federal de Sergipe - Departamento de Medicina,
São Cristovão, SE - Brazil
- Fundação São Lucas - Centro de Ensino e
Pesquisa, Aracaju, SE - Brazil
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Zheng H, Foo LL, Tan HC, Richards AM, Chan SP, Lee CH, Low AF, Hausenloy DJ, Tan JW, Sahlen AO, Ho HH, Chai SC, Tong KL, Tan DS, Yeo KK, Chua TS, Lam CS, Chan MY. Sex Differences in 1-Year Rehospitalization for Heart Failure and Myocardial Infarction After Primary Percutaneous Coronary Intervention. Am J Cardiol 2019; 123:1935-1940. [PMID: 30979413 DOI: 10.1016/j.amjcard.2019.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
It is unclear whether universal access to primary percutaneous coronary intervention (pPCI) may reduce sex differences in 1-year rehospitalization for heart failure (HF) and myocardial infarction (MI) after ST-elevation myocardial infarction (STEMI). We studied 7,597 consecutive STEMI patients (13.8% women, n = 1,045) who underwent pPCI from January 2007 to December 2013. Cox regression models adjusted for competing risk from death were used to assess sex differences in rehospitalization for HF and MI within 1 year from discharge. Compared with men, women were older (median age 67.6 vs 56.0 years, p < 0.001) with higher prevalence of co-morbidities and multivessel disease. Women had longer median door-to-balloon time (76 vs 66 minutes, p < 0.001) and were less likely to receive drug-eluting stents (19.5% vs 24.1%, p = 0.001). Of the medications prescribed at discharge, fewer women received aspirin (95.8% vs 97.6%, p = 0.002) and P2Y12 antagonists (97.6% vs 98.5%, p = 0.039), but there were no significant sex differences in other discharge medications. After adjusting for differences in baseline characteristics and treatment, sex differences in risk of rehospitalization for HF attenuated (hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.79 to 1.40), but persisted for MI (HR 1.68, 95% CI 1.22 to 2.33), with greater disparity in patients aged ≥60 years (HR 1.83, 95% CI 1.18 to 2.85) than those aged <60 years (HR 1.45, 95% CI 0.84 to 2.50). In conclusion, in a setting of universal access to pPCI, the adjusted risk of 1-year rehospitalization for HF was similar in both sexes, but women had significantly higher adjusted risk of 1-year rehospitalization for MI, especially older women.
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Unplanned Readmissions After Acute Myocardial Infarction: 1-Year Trajectory Following Discharge From a Safety Net Hospital. Crit Pathw Cardiol 2019; 18:72-74. [PMID: 31094732 DOI: 10.1097/hpc.0000000000000170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Financial penalties rendered by the Centers for Medicare and Medicaid Services have brought about new challenges for safety net hospitals that serve a vulnerable patient population with risk factors associated with high readmission rates. Our goal was to determine the 1-year trajectory of unplanned readmissions in post-myocardial infarction (MI) patients, and to identify factors associated with readmission. METHODS A total of 261 acute MI patients admitted from April 2015 to April 2016 were evaluated in a multidisciplinary cardiology clinic within 10 days of hospital discharge and baseline characteristics and medical comorbidities were collected. Readmission and mortality data were obtained at 1 year through chart review and telephone follow-up. RESULTS At 1 year, there were 90 (34%) unplanned readmissions of which half were for noncardiac diagnoses. Of these, 69 patients (77%) were readmitted once, 16 (18%) were readmitted twice, 2 (2%) were readmitted 3 times, and 3 (3%) were readmitted 4 times over the subsequent year. Cardiac causes of 1-year readmission included recurrent MI in 23 (9%) and decompensated heart failure in 18 (7%) patients. Depressed left ventricular systolic function (hazard ratio, 2.23; 95% confidence interval, 2.00-2.44; P = 0.0003) and diabetes mellitus (hazard ratio, 1.60; 95% confidence interval, 1.38-1.82; P = 0.029) were associated with a significantly higher risk of readmission at 1 year. CONCLUSION Following acute MI, patients are readmitted for cardiac and noncardiac diagnoses well beyond the 30-day mark. This is likely a function of the vulnerability of the patient population rather than a reflection of the medical care provided. More frequent surveillance may attenuate this problem.
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Smolderen KG, Brush A, Dreyer RP. Psychosocial Factors and Recovery After Acute Myocardial Infarction in Younger Women. Curr Cardiol Rep 2019; 21:50. [PMID: 31020453 DOI: 10.1007/s11886-019-1140-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To explain sex and gender approaches to studying acute myocardial infarction (AMI) risk and outcomes in younger women (18-55 years). More specifically, by looking at the AMI care pathway-from AMI risk to receiving acute and follow-up outpatient care to longer term AMI outcomes-we will examine where potential psychosocial factors may be associated with inequalities in AMI care and outcomes in younger women. RECENT FINDINGS Despite recent declines in AMI incidence, morbidity, and mortality rates, younger women stand out as a group whose incidence has risen and who face worse outcomes following AMI, as compared with other groups. A focus on gender, rather than the binary, biological sex construct, allowed researchers to better understand potential pathways as to why younger women are facing this risk. Feminine traits and disproportionate exposures to psychosocial stressors in society at large may be correlated with inequalities in AMI care and further AMI outcomes in younger women. Psychosocial interventions in women with AMI that have proven to be successful have embraced this wider gender concept. Adopting a wider gender-concept to understand roles and demands that are placed on individuals that make them more at risk to experience psychosocial stressors and make it more challenging to organize self-care, get access to care, and equitable care may be needed.
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Affiliation(s)
- Kim G Smolderen
- Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO, 64111, USA.
- UMKC School of Medicine - Biomedical & Health Informatics, Kansas City, MO, 64108, USA.
| | - Anna Brush
- University of Virginia, Charlottesville, VA, USA
| | - Rachel P Dreyer
- Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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Hao Y, Liu J, Liu J, Yang N, Smith SC, Huo Y, Fonarow GC, Ge J, Taubert KA, Morgan L, Zhou M, Xing Y, Ma CS, Han Y, Zhao D. Sex Differences in In-Hospital Management and Outcomes of Patients With Acute Coronary Syndrome. Circulation 2019; 139:1776-1785. [PMID: 30667281 DOI: 10.1161/circulationaha.118.037655] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Yongchen Hao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Jing Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Jun Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Na Yang
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Sidney C Smith
- Division of Cardiology, University of North Carolina, Chapel Hill (S.C.S.)
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China (Y. Huo)
| | - Gregg C Fonarow
- Division of Cardiology, Geffen School of Medicine at University of California, Los Angeles (G.C.F.)
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, China (J.G.)
| | - Kathryn A Taubert
- Department of International Science, American Heart Association, Basel, Switzerland (K.A.T.)
| | - Louise Morgan
- International Quality Improvement Department, American Heart Association, Dallas, TX (L.M.)
| | - Mengge Zhou
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Yueyan Xing
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, China (C.- S.M.)
| | - Yaling Han
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Liaoning, China (Y. Han)
| | - Dong Zhao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
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Bullock‐Palmer RP, Shaw LJ, Gulati M. Emerging misunderstood presentations of cardiovascular disease in young women. Clin Cardiol 2019; 42:476-483. [PMID: 30793342 PMCID: PMC6712330 DOI: 10.1002/clc.23165] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/13/2019] [Accepted: 02/20/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) remains the leading cause of death for females in the United States accounting for over 412 000 female deaths in 2016. CVD mortality in young women <55 years old remains significantly high and greater than that in men. HYPOTHESIS There is a void with regards to awareness of CVD in women. Many traditional CVD risk estimate tools fail to identify the "at risk" female and is true for the young female patient. There needs to be a shift in focus from looking for the vulnerable plaque to looking for the "at risk" patient. METHODS This review outlines the emerging misunderstood presentations of CVD in young women which include certain categories of myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA), such as spontaneous coronary artery dissection (SCAD), as well as the more stable myocardial ischemia with non-obstructive coronary arteries (INOCA) category focusing on mental stress-induced myocardial ischemia (MSIMI). RESULTS The prevalence of MINOCA in patients presenting with MI is greater in women. In younger women with CVD, SCAD is an emerging misunderstood presentation in this group of patients with type 2 SCAD being the most common form. MSIMI, a form of INOCA, is more common in women with CVD. CONCLUSIONS There are emerging misunderstood factors that are prevalent in young women, such as SCAD and MSIMI. It is important to recognize their presentations in young women to prevent misdiagnosis, missed diagnosis as well as mismanagement of these patients to improve their clinical outcomes.
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Affiliation(s)
| | - Leslee J. Shaw
- Department of RadiologyWeill Cornell Medical CollegeNew YorkNew York
| | - Martha Gulati
- Department of CardiologyUniversity of Arizona College of MedicinePhoenixArizona
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Henry S, Bond R, Rosen S, Grines C, Mieres J. Challenges in Cardiovascular Risk Prediction and Stratification in Women. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2017.0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Chaudhari S, Cushen SC, Osikoya O, Jaini PA, Posey R, Mathis KW, Goulopoulou S. Mechanisms of Sex Disparities in Cardiovascular Function and Remodeling. Compr Physiol 2018; 9:375-411. [PMID: 30549017 DOI: 10.1002/cphy.c180003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Epidemiological studies demonstrate disparities between men and women in cardiovascular disease prevalence, clinical symptoms, treatments, and outcomes. Enrollment of women in clinical trials is lower than men, and experimental studies investigating molecular mechanisms and efficacy of certain therapeutics in cardiovascular disease have been primarily conducted in male animals. These practices bias data interpretation and limit the implication of research findings in female clinical populations. This review will focus on the biological origins of sex differences in cardiovascular physiology, health, and disease, with an emphasis on the sex hormones, estrogen and testosterone. First, we will briefly discuss epidemiological evidence of sex disparities in cardiovascular disease prevalence and clinical manifestation. Second, we will describe studies suggesting sexual dimorphism in normal cardiovascular function from fetal life to older age. Third, we will summarize and critically discuss the current literature regarding the molecular mechanisms underlying the effects of estrogens and androgens on cardiac and vascular physiology and the contribution of these hormones to sex differences in cardiovascular disease. Fourth, we will present cardiovascular disease risk factors that are positively associated with the female sex, and thus, contributing to increased cardiovascular risk in women. We conclude that inclusion of both men and women in the investigation of the role of estrogens and androgens in cardiovascular physiology will advance our understanding of the mechanisms underlying sex differences in cardiovascular disease. In addition, investigating the role of sex-specific factors in the development of cardiovascular disease will reduce sex and gender disparities in the treatment and diagnosis of cardiovascular disease. © 2019 American Physiological Society. Compr Physiol 9:375-411, 2019.
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Affiliation(s)
- Sarika Chaudhari
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Spencer C Cushen
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Oluwatobiloba Osikoya
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Paresh A Jaini
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Rachel Posey
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Keisa W Mathis
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Styliani Goulopoulou
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
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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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Dreyer RP, Zheng X, Xu X, Liu S, Li J, Ding Q, Du X, Li X, Zhang H, Masoudi FA, Spertus JA, Krumholz HM, Jiang L. Sex differences in health outcomes at one year following acute myocardial infarction: A report from the China Patient-Centered Evaluative Assessment of Cardiac Events prospective acute myocardial infarction study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 8:273-282. [PMID: 30270637 DOI: 10.1177/2048872618803726] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We examined sex differences in long-term health outcomes following acute myocardial infarction in China, including mortality, major adverse cardiac events and health status (symptoms, functioning, quality of life). METHODS A total of 3415 acute myocardial infarction patients (23.2% women) aged ⩾18 years were enrolled across 10 geographic regions in China (2012-2014) in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) study. Clinical data was abstracted from medical records. Generic (Euro-Quality of Life Scale) and disease-specific (Seattle Angina Questionnaire) health status was obtained through interviews at baseline and one year. RESULTS At one year, women with acute myocardial infarction had a higher risk of death from all causes ( p<0.001), but had similar rates of major adverse cardiac events ( p=0.2). Women had lower mean generic (Euro-Quality of Life Scale utility index score: 0.90±0.13 vs 0.94±0.11) and disease specific health scores indicating poorer functioning (Seattle Angina Questionnaire summary score: 75.3±11.4 vs 78.4±9.7) and higher rates of daily/weekly angina (Seattle Angina Questionnaire angina frequency score ⩽60 vs >60: 9.1% vs 4.7%; all p<0.001). In multivariable analysis, there was a significant association between female sex and mortality (β=0.45, standard error=0.21, p=0.03) but not for major adverse cardiac events (β=-0.02, standard error=0.14, p=0.89). The association between female sex and worse generic health status persisted (β=-0.02, standard error=0.01, p=0.003), but was no longer significant between sexes for disease-specific health status (β=-0.82, standard error=0.58, p=0.154) or daily/weekly angina (odds ratio=1.39; 95% confidence interval 0.88-2.21). CONCLUSION Women in China have higher crude rates of all-cause/cardiovascular death versus men, as well as worse generic/disease specific health status at one-year post-acute myocardial infarction. The association between female sex and worse generic health status persisted following adjustment.
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Affiliation(s)
- Rachel P Dreyer
- 1 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA.,2 Department of Emergency Medicine, Yale School of Medicine, USA
| | - Xin Zheng
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
| | - Xiao Xu
- 1 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA.,4 Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, USA
| | - Shuling Liu
- 1 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA
| | - Jing Li
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
| | - Qinglan Ding
- 1 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA
| | - Xue Du
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
| | - Xi Li
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
| | - Haibo Zhang
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
| | - Fredrick A Masoudi
- 5 Department of Medicine, University of Colorado Anschutz Medical Campus, USA
| | - John A Spertus
- 6 Saint Luke's Mid America Heart Institute, USA.,7 University of Missouri - Kansas City, USA
| | - Harlan M Krumholz
- 1 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA.,8 Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, USA.,9 Department of Health Policy and Management, Yale School of Public Health, USA
| | - Lixin Jiang
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
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Telephone-based mindfulness training to reduce stress in women with myocardial infarction: Rationale and design of a multicenter randomized controlled trial. Am Heart J 2018; 202:61-67. [PMID: 29864732 PMCID: PMC7432959 DOI: 10.1016/j.ahj.2018.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/13/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Elevated stress is associated with adverse cardiovascular disease outcomes and accounts in part for the poorer recovery experienced by women compared with men after myocardial infarction (MI). Psychosocial interventions improve outcomes overall but are less effective for women than for men with MI, suggesting the need for different approaches. Mindfulness-based cognitive therapy (MBCT) is an evidence-based intervention that targets key psychosocial vulnerabilities in women including rumination (i.e., repetitive negative thinking) and low social support. This article describes the rationale and design of a multicenter randomized controlled trial to test the effects of telephone-delivered MBCT (MBCT-T) in women with MI. METHODS We plan to randomize 144 women reporting elevated perceived stress at least two months after MI to MBCT-T or enhanced usual care (EUC), which each involve eight weekly telephone sessions. Perceived stress and a set of patient-centered health outcomes and potential mediators will be assessed before and after the 8-week telephone programs and at 6-month follow-up. We will test the hypothesis that MBCT-T will be associated with greater 6-month improvements in perceived stress (primary outcome), disease-specific health status, quality of life, depression and anxiety symptoms, and actigraphy-based sleep quality (secondary outcomes) compared with EUC. Changes in mindfulness, rumination and perceived social support will be evaluated as potential mediators in exploratory analyses. CONCLUSIONS If found to be effective, this innovative, scalable intervention may be a promising secondary prevention strategy for women with MI experiencing elevated perceived stress.
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Chandrasekhar J, Gill A, Mehran R. Acute myocardial infarction in young women: current perspectives. Int J Womens Health 2018; 10:267-284. [PMID: 29922097 PMCID: PMC5995294 DOI: 10.2147/ijwh.s107371] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Acute myocardial infarction (AMI) is the leading cause of death in women worldwide. Every year, in the USA alone, more than 30,000 young women <55 years of age are hospitalized with AMI. In recent decades, the incidence of AMI is increasing in younger women in the context of increasing metabolic syndrome, diabetes mellitus, and non-traditional risk factors such as stress, anxiety, and depression. Although women are classically considered to present with atypical chest pain, several observational data confirm that men and women experience similar rates of chest pain, with some differences in intensity, duration, radiation, and the choice of descriptors. Women also experience more number of symptoms and more prodromal symptoms compared with men. Suboptimal awareness, sociocultural and financial reasons result in pre-hospital delays in women and lower rates of access to care with resulting undertreatment with guideline-directed therapies. Causes of AMI in young women include plaque-related MI, microvascular dysfunction or vasospasm, and spontaneous coronary artery dissection. Compared with men, women have greater in-hospital, early and late mortality, as a result of baseline comorbidities. Post-AMI women have lower referral to cardiac rehabilitation with more dropouts, lower levels of physical activity, and poorer improvements in health status compared with men, with higher inflammatory levels at 1-year from index presentation. Future strategies should focus on primary and secondary prevention, adherence, and post-AMI health-related quality of life. This review discusses the current evidence in the epidemiology, diagnosis, and treatment of AMI in young women.
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Affiliation(s)
- Jaya Chandrasekhar
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amrita Gill
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY.,Saint Louis University, St Louis, MO, USA
| | - Roxana Mehran
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
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Hirayama A, Goto T, Faridi MK, Camargo CA, Hasegawa K. Age-related differences in the rate and diagnosis of 30-day readmission after hospitalization for acute ischemic stroke. Int J Stroke 2018; 13:717-724. [PMID: 29693505 DOI: 10.1177/1747493018772790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Little is known about the association between age and readmission within 30 days after hospitalization for acute ischemic stroke. Aim To examine the age-related differences in rate and principal reason of 30-day readmissions in patients hospitalized for acute ischemic stroke. Methods In this retrospective, population-based cohort study using State Inpatient Databases from eight US states, we identified all adults hospitalized for acute ischemic stroke. We grouped the patients into four age categories: < 65, 65-74, 75-84, and ≥85 years. Outcomes were any-cause readmission within 30 days of discharge from the index hospitalization for acute ischemic stroke and the principal diagnosis of 30-day readmission. Results We identified 620,788 hospitalizations for acute ischemic stroke. The overall 30-day readmission rate was 16.6% with an increase with advanced age. Compared to patients aged <65 years, the readmission rate was significantly higher in age 65-74 years (OR 1.19; 95% CI 1.16-1.21), in age 75-84 years (OR 1.29; 95% CI 1.27-1.31), and in ≥ 85 years (OR 1.24; 95% CI 1.22-1.27; all P<0.001). There was heterogeneity in the age-readmission rate association between men and women (Pinteraction < 0.001). Overall, 45.8% of readmissions were assigned stroke-related conditions or rehabilitation care. Compared to younger adults, older adults were more likely to present with non-stroke-related conditions (46.1% in < 65 years, 50.6% in 65-74 years, 57.1% in 75-84 years, and 62.9% in ≥ 85 years; P<0.001). Conclusions Advanced age was associated with a higher 30-day readmission rate after acute ischemic stroke. Compared with younger adults, older adults were more likely to be readmitted for non-stroke-related conditions.
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Affiliation(s)
- Atsushi Hirayama
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Tadahiro Goto
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Mohammad K Faridi
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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