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Vas P, Chockalingam N. Improving Physical, Physiological, and Psychological Health Outcomes in Patients with Diabetic Foot Ulcers - State of the Art. Clin Cosmet Investig Dermatol 2023; 16:3547-3560. [PMID: 38107668 PMCID: PMC10725647 DOI: 10.2147/ccid.s333660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
Diabetic foot disease is a complex and challenging complication of diabetes mellitus, which imposes a significant burden of disease on patients, their carers, and the wider health systems. Recurrence rates are high, and current evidence indicates a high mortality associated with it. While management algorithms have primarily focused on the physical aspects of healing, there is increasing recognition of the critical role played by psychological and biomechanical factors in the development and resolution of diabetic foot disease. Therefore, in this paper, we aim to explore how diabetic foot outcomes can be improved by addressing not only the physical but also the psychological and biomechanical aspects that are integral to the development of this condition and its optimal resolution. We explore new technologies that allow for non-invasive objective assessment of the diabetic foot at risk, and we also explore the role of understanding biomechanics, which is essential to determining risk of foot disease, but also the potential for recurrence. In addition, we discuss the evidence linking depression and cognitive impairment to diabetic foot disease and offer our insight on the research direction required before implementing novel information into front-line clinics.
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Affiliation(s)
- Prashanth Vas
- Department of Diabetes and Diabetic Foot, King’s College Hospital NHS Foundation Trust, London, UK
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
- Department of Diabetes and Endocrinology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
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Kofoed KF, Bosserdt M, Maurovich-Horvat P, Rieckmann N, Benedek T, Donnelly P, Rodriguez-Palomares J, Erglis A, Štěchovský C, Šakalytė G, Ađić F, Gutberlet M, Dodd JD, Diez I, Davis G, Zimmermann E, Kępka C, Vidakovic R, Francone M, Ilnicka-Suckiel M, Plank F, Knuuti J, Faria R, Schröder S, Berry C, Saba L, Ruzsics B, Kubiak C, Hansen KS, Müller-Nordhorn J, Merkely B, Jørgensen TS, Benedek I, Orr C, Valente FX, Zvaigzne L, Suchánek V, Zajančkauskienė L, Čanković M, Woinke M, Keane S, Lecumberri I, Thwaite E, Laule M, Kruk M, Neskovic AN, Mancone M, Kuśmierz D, Feuchtner G, Pietilä M, Ribeiro VG, Drosch T, Delles C, Loi B, Fisher M, Szilveszter B, Sigvardsen PE, Ratiu M, Kelly S, Garcia Del Blanco B, Rubio A, Drobni ZD, Kragelund C, Rodean I, Regan S, Calabria HC, Boussoussou M, Engstrøm T, Hodas R, Napp AE, Haase R, Feger S, Mohamed MMA, Serna-Higuita LM, Neumann K, Dreger H, Rief M, Wieske V, Estrella M, Martus P, Dewey M. Comparative effectiveness of initial computed tomography and invasive coronary angiography in women and men with stable chest pain and suspected coronary artery disease: multicentre randomised trial. BMJ 2022; 379:e071133. [PMID: 36261169 DOI: 10.1136/bmj-2022-071133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To assess the comparative effectiveness of computed tomography and invasive coronary angiography in women and men with stable chest pain suspected to be caused by coronary artery disease. DESIGN Prospective, multicentre, randomised pragmatic trial. SETTING Hospitals at 26 sites in 16 European countries. PARTICIPANTS 2002 (56.2%) women and 1559 (43.8%) men (total of 3561 patients) with suspected coronary artery disease referred for invasive coronary angiography on the basis of stable chest pain and a pre-test probability of obstructive coronary artery disease of 10-60%. INTERVENTION Both women and men were randomised 1:1 (with stratification by gender and centre) to a strategy of either computed tomography or invasive coronary angiography as the initial diagnostic test (1019 and 983 women, and 789 and 770 men, respectively), and an intention-to-treat analysis was performed. Randomised allocation could not be blinded, but outcomes were assessed by investigators blinded to randomisation group. MAIN OUTCOME MEASURES The primary endpoint was major adverse cardiovascular events (MACE; cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke). Key secondary endpoints were an expanded MACE composite (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, transient ischaemic attack, or major procedure related complication) and major procedure related complications. RESULTS Follow-up at a median of 3.5 years was available in 98.9% (1979/2002) of women and in 99.0% (1544/1559) of men. No statistically significant gender interaction was found for MACE (P=0.29), the expanded MACE composite (P=0.45), or major procedure related complications (P=0.11). In both genders, the rate of MACE did not differ between the computed tomography and invasive coronary angiography groups. In men, the expanded MACE composite endpoint occurred less frequently in the computed tomography group than in the invasive coronary angiography group (22 (2.8%) v 41 (5.3%); hazard ratio 0.52, 95% confidence interval 0.31 to 0.87). In women, the risk of having a major procedure related complication was lower in the computed tomography group than in the invasive coronary angiography group (3 (0.3%) v 21 (2.1%); hazard ratio 0.14, 0.04 to 0.46). CONCLUSION This study found no evidence for a difference between women and men in the benefit of using computed tomography rather than invasive coronary angiography as the initial diagnostic test for the management of stable chest pain in patients with an intermediate pre-test probability of coronary artery disease. An initial computed tomography scan was associated with fewer major procedure related complications in women and a lower frequency of the expanded MACE composite in men. TRIAL REGISTRATION NCT02400229ClinicalTrials.gov NCT02400229.
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Sex difference in clinical and procedural outcomes in patients undergoing coronary atherectomy: a systematic review and meta-analysis. Coron Artery Dis 2022; 33:634-642. [PMID: 36238981 DOI: 10.1097/mca.0000000000001187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rotational and orbital coronary atherectomy (CA) are commonly utilized to treat complex calcified coronary lesions. We conducted a meta-analysis to evaluate sex differences in procedural complications and clinical outcomes after CA. METHODS PubMed, Google Scholar, and Cochrane databases were searched for all studies comparing sex differences in procedural and clinical outcomes following CA. The outcomes of interest were procedural complications (coronary dissection, stroke, major bleeding, coronary perforation, cardiac tamponade, and slow or no flow in target vessel) and the clinical outcomes (including early mortality, mid-term all-cause mortality, stroke, myocardial infarction, and target vessel revascularization). Pooled risk ratios (RRs) with their corresponding 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel random-effects model. RESULTS Six observational studies with 3517 patients (2420 men and 1035 women) were included in this meta-analysis. While there was no significant difference in the early mortality (RR, 1.14; 95% CI, 0.37-3.53; P = 0.83) between men and women, at a mean follow-up of 2.9 years, all-cause mortality was significantly higher in women (RR, 1.29; 95% CI, 1.11-1.49; P = 0.0009). Women had an increased risk of procedure-related stroke (RR, 3.98; 95% CI, 1.06-14.90; P = 0.04), coronary dissection (RR, 2.10; 95% CI, 1.23-3.58; P = 0.006), and bleeding (RR, 2.26; 95% CI, 1.30-3.93; P = 0.004), whereas the rates of coronary perforation, cardiac tamponade, and the risk of slow or no flow in the revascularized artery were similar in both. CONCLUSION In our analysis, women undergoing CA are at increased risk of mid-term mortality and procedure-related complications including stroke, coronary dissection, and major bleeding.
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Khandelwal A, Bakir M, Bezaire M, Costello B, Gomez JMD, Hoover V, Nazir NT, Nichols K, Reisenberg A, Rao A, Sanghani R, Tracy M, Volgman AS. Managing Ischemic Heart Disease in Women: Role of a Women's Heart Center. Curr Atheroscler Rep 2021; 23:56. [PMID: 34345945 PMCID: PMC8331213 DOI: 10.1007/s11883-021-00956-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Heart centers for women (HCW) were developed due to the rising cardiovascular morbidity and mortality in women in the United States in the early 1990s. Our review encompasses the epidemiology, risk factors, diagnostic strategies, treatments, and the role of HCW in managing women with ischemic heart disease (IHD). RECENT FINDINGS HCW use a multidisciplinary team to manage women with IHD. Due to the paucity of randomized controlled trials investigating various manifestations of IHD, some treatments are not evidence-based such as those for coronary microvascular dysfunction and spontaneous coronary artery dissection. Sex-specific risk factors have been identified and multimodality cardiac imaging is improving in diagnosing IHD in women. Treatments are being studied to help improve symptoms and outcomes in women with IHD. There has been progress in the care of women with IHD. HCW can be instrumental in treating women with IHD, doing research, and being a source of research study participants.
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Affiliation(s)
- Abha Khandelwal
- Division of Cardiology, Women's Heart Health, Stanford University, Palo Alto, CA, USA
| | - May Bakir
- Division of Cardiology, Women's Heart Health Center, Loyola University, Chicago, IL, USA
| | - Meghan Bezaire
- Rush Heart Center for Women, Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Briana Costello
- Center for Women's Heart & Vascular Health, Texas Heart Institute, and Baylor St. Luke's Medical Center Hospital, Houston, TX, USA
| | | | - Valerie Hoover
- Department of Psychology, Stanford University, Palo Alto, CA, USA
| | - Noreen T Nazir
- Division of Cardiology, Department of Medicine, University of Illinois, Chicago, Chicago, USA
| | - Katherine Nichols
- Division of Cardiology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Amy Reisenberg
- Stanford Healthcare, Stanford University, Palo Alto, CA, USA
| | - Anupama Rao
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Rupa Sanghani
- Rush Heart Center for Women, Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Melissa Tracy
- Rush Heart Center for Women, Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Annabelle Santos Volgman
- Rush Heart Center for Women, Division of Cardiology, Rush University Medical Center, Chicago, IL, USA. .,, Chicago, USA.
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Patil S, Gonuguntla K, Rojulpote C, Kumar M, Nadadur S, Nardino RJ, Pickett C. Prevalence and Determinants of Atrial Fibrillation-Associated In-Hospital Ischemic Stroke in Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention. Am J Cardiol 2021; 144:1-7. [PMID: 33385356 DOI: 10.1016/j.amjcard.2020.12.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 01/19/2023]
Abstract
Atrial fibrillation (AF) is an established risk factor ischemic stroke (IS) and is commonly encountered in patient hospitalized with acute myocardial infarction (AMI). Uncommonly, IS can occur as a complication resulting from percutaneous coronary intervention (PCI). There is limited real world data regarding AF-associated in-hospital IS (IH-IS) in patients admitted with AMI undergoing PCI. We queried the National Inpatient Sample database from January 2010 to December 2014 to identify patients admitted with AMI who underwent PCI. In this cohort, we determined the prevalence of AF associated IH-IS and compared risk factors for IH-IS between patients with AF and without AF using multivariable logistic regression models. IH-IS was present in 0.46% (n = 5,938) of the patients with AMI undergoing PCI (n = 1,282,829). Prevalence of IH-IS in patients with AF was higher compared with patients without AF (1.05% vs 0.4%; adjusted odds ratio: 1.634, 95% confidence interval: 1.527 to 1.748, p <0.001). Regardless of AF status, prevalence and risk of IH-IS was higher in females and increased with advancing age. There was significant overlap among risk-factors associated with increased risk of IH-IS in AF and non-AF cohorts, except for obesity in AF patients (adjusted odds ratio: 1.268, 95% confidence interval: 1.023 to 1.572, p = 0.03) in contrast to renal disease, malignancy, and peripheral vascular disease in non-AF patients. In conclusion, IH-IS is a rare complication affecting patients undergoing PCI for AMI and is more likely to occur in AF patients, females, and older adults, with heterogeneity among risk factors in patients with and without AF.
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Affiliation(s)
- Shivaraj Patil
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut.
| | - Karthik Gonuguntla
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut
| | - Chaitanya Rojulpote
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania
| | - Manish Kumar
- Department of Cardiology, University of Connecticut, Farmington, Connecticut
| | - Srinivas Nadadur
- Department of Cardiology, University of Connecticut, Farmington, Connecticut
| | - Robert J Nardino
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut
| | - Christopher Pickett
- Department of Cardiology, University of Connecticut, Farmington, Connecticut
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Alkhouli M, Nanjundappa A, Annie F, Bates MC, Bhatt DL. Sex Differences in Case Fatality Rate of COVID-19: Insights From a Multinational Registry. Mayo Clin Proc 2020; 95:1613-1620. [PMID: 32753136 PMCID: PMC7256502 DOI: 10.1016/j.mayocp.2020.05.014] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To confirm whether a relationship exists between male sex and coronavirus disease 2019 (COVID-19) mortality and whether this relationship is age dependent. PATIENTS AND METHODS We queried the COVID-19 Research Network, a multinational database using the TriNetX network, to identify patients with confirmed COVID-19 infection. The main end point of the study was all-cause mortality. RESULTS A total of 14,712 patients were included, of whom 6387 (43%) were men. Men were older (mean age, 55.0±17.7 years vs 51.1±17.9 years; P<.001) and had a higher prevalence of hypertension, diabetes, coronary disease, obstructive pulmonary disease, nicotine dependence, and heart failure but a lower prevalence of obesity. Before propensity score matching (PSM), all-cause mortality rate was 8.8% in men and 4.3% in women (odds ratio, 2.15; 95% CI, 1.87 to 2.46; P<.001) at a median follow-up duration of 34 and 32 days, respectively. In the Kaplan-Meier survival analysis, the cumulative probability of survival was significantly lower in men than in women (73% vs 86%; log-rank, P<.001). After PSM, all-cause mortality remained significantly higher in men than in women (8.13% vs 4.60%; odds ratio, 1.81; 95% CI, 1.55 to 2.11; P<.001). In the Kaplan-Meier survival analysis, the cumulative probability of survival remained significantly lower in men than in women (74% vs 86%; log-rank, P<.001). The cumulative probability of survival remained significantly lower in propensity score-matched men than in women after excluding patients younger than 50 years and those who were taking angiotensin-converting enzyme inhibitor or angiotensin receptor blocker medications on admission. CONCLUSION Among patients with COVID-19 infection, men had a significantly higher mortality than did women, and this difference was not completely explained by the higher prevalence of comorbidities in men.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Aravinda Nanjundappa
- Department of Medicine, Division of Cardiology, Charleston Area Medical Center Institute (CAMC) for Academic Medicine and CAMC Health, Education and Research Institute, Charleston, WV; Department of Medicine, Division of Cardiology, West Virginia University, Charleston Division, Charleston, WV
| | - Frank Annie
- Department of Medicine, Division of Cardiology, Charleston Area Medical Center Institute (CAMC) for Academic Medicine and CAMC Health, Education and Research Institute, Charleston, WV
| | - Mark C Bates
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Medicine, Division of Cardiology, Charleston Area Medical Center Institute (CAMC) for Academic Medicine and CAMC Health, Education and Research Institute, Charleston, WV
| | - Deepak L Bhatt
- Department of Medicine, Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA
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Validation of Acute Ischemic Stroke Codes Using the International Classification of Diseases Tenth Revision. Am J Cardiol 2020; 125:1135. [PMID: 31955830 DOI: 10.1016/j.amjcard.2020.01.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/03/2020] [Indexed: 12/21/2022]
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