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Smith E, Tamis-Holland JE. Sex differences in the presentation and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock: a critical review of contemporary data and a look towards future directions. Curr Opin Crit Care 2024:00075198-990000000-00173. [PMID: 38841913 DOI: 10.1097/mcc.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Cardiogenic shock (CS) is a devasting complicating of acute myocardial infarction (AMI), associated with significant mortality. Prior studies have reported sex differences in the presentation, management and outcomes of patients with AMI and CS. These differences are likely due to a variety of factors influencing therapeutic decision-making and impacting survival. This review highlights the more contemporary studies exploring differences in women and men with AMI-CS, providing a critical perspective towards understanding the factors that might lead to these differences and outlining potential opportunities to reduce disparities in treatment and improve survival for women with AMI-CS. RECENT FINDINGS Recent reports demonstrate that women with AMI-CS are older than men and have more cardiovascular comorbidities. When examining an unselected population of patients with AMI-CS, women receive less aggressive treatment compared to men and have poorer outcomes. However, when examining a selected population of patients with AMI-CS treated with mechanical circulatory support (MCS) and/or admitted to centers that implement CS protocols to manage AMI-CS, these sex-based differences in outcomes are largely mitigated. SUMMARY Standardizing protocols for the diagnosis and treatment of patients with AMI-CS, with an emphasis on early revascularization and appropriate invasive therapies, can improve outcomes in women and narrow the gender gap.
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Affiliation(s)
- Emily Smith
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydnell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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2
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Nelson BD, McLaughlin CJ, Rivera OE, Kaul K, Ferdock AJ, Matuzsan ZM, Yazdanyar AR, Gopal JV, Patel AY, Chaska RM, Feldman BA, Jacoby JL. Implementation of a Novel Prehospital Clinical Decision Tool and ECG Transmission for STEMI Significantly Reduces Door-to-Balloon Time and Sex-Based Disparities. PREHOSP EMERG CARE 2024:1-10. [PMID: 38771723 DOI: 10.1080/10903127.2024.2357595] [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: 01/22/2024] [Accepted: 04/30/2024] [Indexed: 05/23/2024]
Abstract
Background: An important method employed to reduce door to balloon time (DTBT) for ST segment elevation Myocardial Infarctions (STEMIs) is a prehospital MI alert. The purpose of this retrospective study was to examine the effects of an educational intervention using a novel decision support method of STEMI notification and prehospital electrocardiogram (ECG) transmission on DTBT.Methods: An ongoing database (4/4/2000 - present) is maintained to track STEMI alerts. In 2007, an MI alert program began; emergency medicine physicians could activate a "prehospital MI alert". In October 2015, modems were purchased for Emergency Medical Services personnel to transmit ECGs. There was concurrent implementation of a decision support tool for identifying STEMI. Sex was assigned as indicated in the medical record. Data were analyzed in two groups: Pre-2016 (PRE) and 2016-2022 (POST).Results: In total, 3,153 patients (1,301 PRE; 1,852 POST) were assessed; the average age was 65.2 years, 32.6% female, 87.7% white with significant differences in age and race between the two cohorts. Of the total 3,153 MI alerts, 239 were false activations, leaving 2,914 for analysis. 2,115 (72.6%) had cardiac catheterization while 16 (6.7%) of the 239 had a cardiac catheterization. There was an overall decrease in DTBT of 27.5% PRE to POST of prehospital ECG transmission (p <0.001); PRE median time was 74.5 minutes vs. 55 minutes POST. There was no significant difference between rates of cardiac catheterization PRE and POST for all patients. After accounting for age, race, and mode of arrival, DTBT was 12.2% longer in women, as compared to men (p < 0.001) PRE vs. POST. DTBT among women was significantly shorter when comparing PRE to POST periods (median 77 minutes vs. 60 minutes; p = 0.0001). There was no significant sex difference in the proportion of those with cardiac catheterization between the two cohorts (62.5% vs. 63.5%; p = 0.73).Conclusion: Introduction of a decision support tool with prehospital ECG transmission with prehospital ECG transmission decreased overall DTBT by 20 minutes (27.5%). Women in the study had a 17-minute decrease in DTBT (22%), but their DTBT remained 12.2% longer than men for reasons that remain unclear.
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Affiliation(s)
- Bryan D Nelson
- Lehigh Valley Health Network, Heart and Vascular Institute/University of South Florida, Morsani College of Medicine; 1259 S. Cedar Crest Boulevard Suite 301, Allentown, PA 18103
| | - Conor J McLaughlin
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/University of South Florida, Morsani College of Medicine; Cedar Crest Boulevard & I-78, Allentown, PA 18103
| | - Orlando E Rivera
- Lehigh Valley Health Network, Heart and Vascular Institute/University of South Florida, Morsani College of Medicine; 1259 S. Cedar Crest Boulevard Suite 301, Allentown, PA 18103
- Hospital of Second Chances Health System, 1033 West Germantown Pike, Norristown, PA 19403
| | - Kashyap Kaul
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/University of South Florida, Morsani College of Medicine; Cedar Crest Boulevard & I-78, Allentown, PA 18103
| | - Andrew J Ferdock
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/University of South Florida, Morsani College of Medicine; Cedar Crest Boulevard & I-78, Allentown, PA 18103
| | - Zachary M Matuzsan
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/University of South Florida, Morsani College of Medicine; Cedar Crest Boulevard & I-78, Allentown, PA 18103
- University of South Florida, Morsani College of Medicine; Lehigh Valley Health Network Campus, Center for Health Care Education, 3900 Sierra Circle, Center Valley, PA 18034
| | - Ali R Yazdanyar
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/University of South Florida, Morsani College of Medicine; Cedar Crest Boulevard & I-78, Allentown, PA 18103
- Department of Medicine, Division of Hospital Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Jay V Gopal
- University of South Florida, Morsani College of Medicine; Lehigh Valley Health Network Campus, Center for Health Care Education, 3900 Sierra Circle, Center Valley, PA 18034
- Medical University of South Carolina, Department of Internal Medicine; 96 Jonathan Lucas Street, Charleston, SC 29425
| | - Ayushi Y Patel
- University of South Florida, Morsani College of Medicine; Lehigh Valley Health Network Campus, Center for Health Care Education, 3900 Sierra Circle, Center Valley, PA 18034
- Lehigh Valley Health Network, Department of Obstetrics and Gynecology/University of South Florida, Morsani College of Medicine; Cedar Crest Boulevard & I-78, Allentown, PA 18103
| | - Rachael M Chaska
- University of South Florida, Morsani College of Medicine; Lehigh Valley Health Network Campus, Center for Health Care Education, 3900 Sierra Circle, Center Valley, PA 18034
- Henry Ford Hospital, Department of Emergency Medicine; 2799 West Grand Boulevard, Detroit, MI 48202
| | - Bruce A Feldman
- Lehigh Valley Health Network, Heart and Vascular Institute/University of South Florida, Morsani College of Medicine; 1259 S. Cedar Crest Boulevard Suite 301, Allentown, PA 18103
| | - Jeanne L Jacoby
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/University of South Florida, Morsani College of Medicine; Cedar Crest Boulevard & I-78, Allentown, PA 18103
- University of South Florida, Morsani College of Medicine; Lehigh Valley Health Network Campus, Center for Health Care Education, 3900 Sierra Circle, Center Valley, PA 18034
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Mahowald MK, Esmail K, Ezzeddine FM, Choi C, Mieszczanska H, Velarde G. Sex Disparities in Cardiovascular Disease. Methodist Debakey Cardiovasc J 2024; 20:107-119. [PMID: 38495656 PMCID: PMC10941692 DOI: 10.14797/mdcvj.1328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/30/2024] [Indexed: 03/19/2024] Open
Abstract
Cardiovascular disease is the leading cause of death in women. It remains underdiagnosed, undertreated, and portends worse outcomes in women than men. Disparities exist in every stage of science, from bench research to the editorial board of major journals and in every cardiovascular subspecialty. This review summarizes differences in cardiovascular risk factors and disparities in management and outcomes of ischemic heart disease, heart failure, aortic stenosis, and atrial fibrillation. It also provides an overview of female representation as participants and leaders of clinical trials, editorial boards, and academic institutions. Strategies to overcome these disparities are proposed with examples of successful programs.
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Affiliation(s)
| | - Khadeeja Esmail
- University of Florida College of Medicine, Jacksonville, Florida, US
| | | | - Calvin Choi
- University of Florida College of Medicine, Jacksonville, Florida, US
| | | | - Gladys Velarde
- University of Florida College of Medicine, Jacksonville, Florida, US
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4
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Garatti L, Tavecchia G, Milani M, Rizzi I, Tondelli D, Bernasconi D, Maloberti A, Oliva F, Sacco A. Unveiling the gender gap in ST-elevation myocardial infarction: a retrospective analysis of a single Italian center gender disparities in STEMI-ACS. J Cardiovasc Med (Hagerstown) 2024; 25:239-242. [PMID: 38305123 DOI: 10.2459/jcm.0000000000001594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Affiliation(s)
- Laura Garatti
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Giovanni Tavecchia
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Martina Milani
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Ilaria Rizzi
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Daniele Tondelli
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza
| | - Davide Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Fabrizio Oliva
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Alice Sacco
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [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] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Jaffer S, Noble M, Pozgay A, Randhawa V, Gulati M, Mensour E, Parast N, Tegg N, Theberge E, Harchaoui EK, Mulvagh SL. The Development of a Chest-Pain Protocol for Women Presenting to the Emergency Department. CJC Open 2024; 6:517-529. [PMID: 38487055 PMCID: PMC10935692 DOI: 10.1016/j.cjco.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/02/2023] [Indexed: 03/17/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in women worldwide, and of premature death in women in Canada. Despite improvements in cardiovascular care over the past 15-20 years, acute coronary syndrome (ACS) and CVD mortality continue to increase among women in Canada. Chest pain is a common symptom leading to emergency department visits for both men and women. However, women with ACS experience worse outcomes. compared with those of men, due to misdiagnosis or lack of diagnosis resulting in delayed care and underuse of guideline-directed medical therapies. CVD mortality rates are highest in Indigenous and racialized women and those with a disproportionately high number of adverse social determinants of health. CVD remains underrecognized, underdiagnosed, undertreated, and underresearched in women. Moreover, a lack of awareness of unique symptoms, clinical presentations, and sex-and-gender specific CVD risk factors, by healthcare professionals, leads to outcome disparities. In response to this knowledge gap, in acute recognition and management of chest-pain syndromes in women, the Canadian Women's Heart Health Alliance performed a needs assessment and review of CVD risk factors and ACS pathophysiology, through a sex and gender lens, and then developed a unique chest-pain assessment protocol utilizing modified dynamic programming algorithmic methodology. The resulting algorithmic protocol is presented. The output is intended as a quick reference algorithm that could be posted in emergency departments and other acute-care settings. Next steps include protocol implementation evaluation and impact assessment on CVD outcomes in women.
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Affiliation(s)
- Shahin Jaffer
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Anita Pozgay
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Varinder Randhawa
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martha Gulati
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Emma Mensour
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Nazli Parast
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Nicole Tegg
- Faculty of Nursing, University of Alberta, Alberta, Ontario, Canada
| | - Emilie Theberge
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sharon L. Mulvagh
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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7
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Mulvagh SL, Colella TJ, Gulati M, Crosier R, Allana S, Randhawa VK, Bruneau J, Pacheco C, Jaffer S, Cotie L, Mensour E, Clavel MA, Hill B, Kirkham AA, Foulds H, Liblik K, Van Damme A, Grace SL, Bouchard K, Tulloch H, Robert H, Pike A, Benham JL, Tegg N, Parast N, Adreak N, Boivin-Proulx LA, Parry M, Gomes Z, Sarfi H, Iwegim C, Van Spall HG, Nerenberg KA, Wright SP, Limbachia JA, Mullen KA, Norris CM. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 9: Summary of Current Status, Challenges, Opportunities, and Recommendations. CJC Open 2024; 6:258-278. [PMID: 38487064 PMCID: PMC10935707 DOI: 10.1016/j.cjco.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/03/2023] [Indexed: 03/17/2024] Open
Abstract
This final chapter of the Canadian Women's Heart Health Alliance "ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women" presents ATLAS highlights from the perspective of current status, challenges, and opportunities in cardiovascular care for women. We conclude with 12 specific recommendations for actionable next steps to further the existing progress that has been made in addressing these knowledge gaps by tackling the remaining outstanding disparities in women's cardiovascular care, with the goal to improve outcomes for women in Canada.
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Affiliation(s)
- Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tracey J.F. Colella
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Cedars Sinai Heart Institute, Los Angeles, California, USA
| | - Rebecca Crosier
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | - Jill Bruneau
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Christine Pacheco
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Shahin Jaffer
- Department of Medicine, Division of Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Cotie
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
| | - Emma Mensour
- University of Western Ontario, London, Ontario, Canada
| | | | - Braeden Hill
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Amy A. Kirkham
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Heather Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kiera Liblik
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Andrea Van Damme
- University of Alberta Faculty of Graduate & Postdoctoral Studies, Edmonton, Alberta, Canada
| | - Sherry L. Grace
- York University and University Health Network, Toronto, Ontario, Canada
| | - Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Helen Robert
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - April Pike
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Jamie L. Benham
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Tegg
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nazli Parast
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Najah Adreak
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Zoya Gomes
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hope Sarfi
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | - Chinelo Iwegim
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Harriette G.C. Van Spall
- Departments of Medicine and Health Research Methods, Evidence, and Impact, Research Institute of St Joe’s, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kara A. Nerenberg
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Colleen M. Norris
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Kanaan CN, Kassis N, Nair RM, Kumar A, Huded CP, Kravitz K, Reed GW, Krishnaswamy A, Lincoff AM, Khatri J, Puri R, Ziada K, Nair R, Kapadia S, Khot U. Implementing a comprehensive STEMI protocol to improve care metrics and outcomes in patients with in-hospital STEMI: an observational cohort study. Open Heart 2024; 11:e002505. [PMID: 38290731 PMCID: PMC10828835 DOI: 10.1136/openhrt-2023-002505] [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: 09/26/2023] [Accepted: 12/08/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Patients who experience in-hospital ST-segment elevation myocardial infarction (iSTEMI) represent a uniquely high-risk cohort owing to delays in diagnosis, prolonged time to reperfusion and increased mortality. Quality initiatives aimed at improving the care of this vulnerable, yet understudied population are needed. METHODS This study included consecutive patients with iSTEMI treated with percutaneous coronary intervention (PCI) between 1 January 2011 and 15 July 2019 at a single, tertiary referral centre. A comprehensive iSTEMI protocol (CSP) was implemented on 15 July 2014, incorporating: (1) cardiology fellow activation of the catheterisation lab using standardised criteria, (2) nursing chest pain protocol, (3) improved electronic access to electrocardiographic studies, (4) checklist for initial triage and management, (5) 24/7/365 catheterisation lab readiness and (6) radial-first PCI approach. Key metrics and clinical outcomes were compared before and after CSP implementation. RESULTS Among 125 total subjects, the post-CSP cohort (n=81) was younger, had more males and were more likely to be hospitalised for cardiac-related reasons relative to the pre-CSP cohort (n=44) who were more likely hospitalised for operative-related aetiologies. After CSP adoption, median ECG-to-first-device-activation time decreased from 113 min to 64 min (p<0.001), goal ECG-to-first-device-activation time increased from 36% to 76% of patients (p<0.001), administration of guideline-directed medical therapy prior to PCI increased from 27.3% to 65.4% (p<0.001), trans-radial access increased from 16% to 70% (p<0.001) and rates of discharge home increased from 56.8% to 76.5% (p=0.04). Statistically insignificant numerical reductions were observed post-CSP in in-hospital mortality (18.2% vs 9.9%, p=0.30), 30-day mortality (15.9% vs 12.3%, p=0.78) and 1-year mortality (27.3% vs 21.0%, p=0.57). CONCLUSIONS The implementation of a CSP was associated with marked enhancements in key care metrics among patients with iSTEMI. Among a larger cohort, the use of a CSP yielded a significant reduction in ECG-to-first-device-activation time in a particularly vulnerable population at high risk of death.
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Affiliation(s)
| | - Nicholas Kassis
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Raunak M Nair
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | - Kathleen Kravitz
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | | | | - Khaled Ziada
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ravi Nair
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Umesh Khot
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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9
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Darabi M, Heidari Moghaddam R, Godarzi F, Karami S, Siabani S, Salehi N. Age and sex-related differences in epidemiology, treatment, and mortality of patients with ST-segment elevation myocardial infarction in Iran. J Cardiovasc Thorac Res 2023; 15:210-217. [PMID: 38357566 PMCID: PMC10862036 DOI: 10.34172/jcvtr.2023.32887] [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: 06/19/2023] [Accepted: 12/02/2023] [Indexed: 02/16/2024] Open
Abstract
Introduction Few studies have investigated the characteristics of patients with ST elevation myocardial infarction (STEMI) according to age and sex in Iran. This study aims to investigate the risk factors profile, treatment, and mortality of STEMI based on age and sex. Methods From 10th June 2016 to December 2019 a total of 2816, STEMI patients referred to the Imam Ali heart center of Kermanshah were included in the study. Profile of the risk factors, epidemiology, treatment and 30- day mortality for all cases in the age categories of 18-49, 50-64, and≥65 years were studied. Results There were 1256 (44.6%) middle-aged STEMI patients, and 2181 (77.45%) were male. The elderly had a longer median door-to-balloon and symptom-to-balloon time and received less primary PCI. In the absence of primary PCI, the rate of 30-day mortality in women was higher than in men, and the mortality rate increased with age. The risk of death in middle-aged women was higher than that of men. Also, in the middle-aged group, after multivariable adjustment, previous bypass surgery, diabetes, and Killip class≥2 was associated with significant increase in the risk of death. Conclusion The present study showed that young people with STEMI had a high risk of heart failure and anterior infarction compared to the older age groups. Women had more risk factors for STEMI and a higher mortality rate than men. Therefore, there is a need to educate young age groups and women to modify their lifestyles and intervene in the risk factors of heart diseases.
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Affiliation(s)
- Mehdi Darabi
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Heidari Moghaddam
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farzaneh Godarzi
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sahar Karami
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Soraya Siabani
- Department of Health Education and Health Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nahid Salehi
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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10
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Holtzman JN, Kaur G, Hansen B, Bushana N, Gulati M. Sex differences in the management of atherosclerotic cardiovascular disease. Atherosclerosis 2023; 384:117268. [PMID: 37723005 DOI: 10.1016/j.atherosclerosis.2023.117268] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/23/2023] [Accepted: 08/31/2023] [Indexed: 09/20/2023]
Abstract
Disparities between women and men persist in the diagnosis, treatment, and prognosis of atherosclerotic cardiovascular disease (ASCVD). Despite growing attention to sex-based differences in cardiovascular care, there are continued disparities in short- and long-term outcomes. Such disparities highlight the need to identify pathophysiologic differences in treatment patterns for stable ischemic heart disease, non-ST elevation myocardial infarction (NSTE-ACS), ST-elevation myocardial infarction (STEMI), and myocardial infarction with non-obstructive coronary arteries (MINOCA). The role of age as an effect modifier should also be considered given that young women diagnosed with ACS continue to experience increased rates of in-hospital mortality and major adverse cardiovascular events. Both patient-directed and systems-based approaches remain integral to improve outcomes in cardiovascular care. While inadequate representation of women in clinical trials remains a barrier to the implementation of evidence-based therapies, a growing body of data has established the efficacy and safety of medications in women across acute coronary syndromes. This review seeks to feature existing data on the differential treatment guidelines, care implementation, and cardiovascular outcomes between women and men, highlighting next directions for clinical investigation.
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Affiliation(s)
- Jessica N Holtzman
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Breanna Hansen
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Martha Gulati
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA.
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11
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Lebreton O, Fels A, Compagnon A, Lazareth I, Ghaffari P, Chatellier G, Emmerich J, Michon-Pasturel U, Priollet P, Yannoutsos A. Amputation-free survival in the long-term follow-up and gender-related characteristics in patients revascularized for critical limb ischemia. JOURNAL DE MEDECINE VASCULAIRE 2023; 48:105-115. [PMID: 37914455 DOI: 10.1016/j.jdmv.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/01/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Patients with Critical Limb Ischemia (CLI) present a high risk of cardiovascular events and death. Revascularization is the cornerstone of therapy to relieve ischemic pain and prevent limb loss. Literature data suggest that women tend to present with worse outcomes after revascularization. The aim of the present study is to determine amputation-free survival in a long-term follow-up in women and men following endovascular revascularization procedure for CLI. METHODS From November 2013 to December 2020, 357 consecutive patients were retrospectively included. Clinical and biological parameters were recorded at baseline before endovascular revascularization. During follow-up until February 2023, overall survival and amputation-free survival (freedom from major amputation) were analysed using the Kaplan-Meier method. Univariate and multivariate analyses were performed to study the parameters associated with amputation-free survival. A P<0.05 was considered as statistically significant. RESULTS A total of 357 consecutive patients were included, 189 men and 168 women with CLI, with a mean age of 78.6±12 years. Treated hypertension (79%), diabetes mellitus (48%), coronary artery disease (39%) and protein malnutrition (61%) were the most prevalent comorbidities. Women were older than men with a mean age of 82.4±11.4 years (versus 75.4±11 years in men) and presented more frequently with protein malnutrition (70% of women). Prevalence of diabetes, tobacco use and history of coronary heart disease were significantly higher in men. During the 10-year follow-up period, 241 patients had died (68%) and 38 (11%) underwent major amputation, of whom 22 patients were still alive on February 2023. Median survival was 35.5 months [IQR: 29.5; 43] in the overall population, 38.5 [32; 50.4] months in women and 33.5 months [24.7; 43.5] in men. No gender-related differences were noted according to peri-procedural complications, survival probability and amputation-free survival. In multivariate analysis for amputation-free survival, age, previous coronary heart disease, C-reactive protein level, left ventricular ejection fraction (LVEF)<60% and albumin level<35g/L were correlated with poor outcome. In particular, protein malnutrition, as a treatable risk factor, appears significantly correlated with poor outcome in both men and women (HR=2.50 [1.16;5.38], P=0.0196 in men; HR=1.77 [1.00;3.13], P=0.049 in women). CONCLUSION The present results highlight that mortality in patients after endovascular revascularization remains high with a mortality rate of 28% at 1 year, 40% at 2 years and 51% at 3 years. Women represented a distinct population, almost 10-year older than their male counterparts, with more prevalent protein malnutrition. However, no gender-related difference was noted according to amputation-free survival on the long-term follow-up. Associated risk factors are mainly age, a history of coronary heart disease, pre-procedural inflammatory syndrome and protein malnutrition. Correction of malnutrition could have the potential to improve functional and general long-term prognosis in patients with CLI together with optimal medical and interventional management.
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Affiliation(s)
- O Lebreton
- Vascular Medicine Department, groupe hospitalier Paris St-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - A Fels
- Clinical Research Center, groupe hospitalier Paris St-Joseph, Paris, France
| | - A Compagnon
- Vascular Medicine Department, groupe hospitalier Paris St-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - I Lazareth
- Vascular Medicine Department, groupe hospitalier Paris St-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - P Ghaffari
- Vascular Medicine Department, groupe hospitalier Paris St-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - G Chatellier
- Clinical Research Center, groupe hospitalier Paris St-Joseph, Paris, France
| | - J Emmerich
- Vascular Medicine Department, groupe hospitalier Paris St-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France; Université Paris Cité, Inserm CRESS UMR 1153, Paris, France
| | - U Michon-Pasturel
- Vascular Medicine Department, groupe hospitalier Paris St-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - P Priollet
- Vascular Medicine Department, groupe hospitalier Paris St-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - A Yannoutsos
- Vascular Medicine Department, groupe hospitalier Paris St-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France; Université Paris Cité, Inserm CRESS UMR 1153, Paris, France.
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12
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Lawless M, Brown S, Kunadian V. Raising awareness about cardiovascular disease in women. Eur Heart J 2023; 44:3110-3112. [PMID: 37528655 DOI: 10.1093/eurheartj/ehad452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Affiliation(s)
- Michael Lawless
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
| | - Sarah Brown
- Cardiovascular Care Partnership, British Cardiovascular Society, 9 Fitzroy Square, London W1T 5HW, UK
| | - Vijay Kunadian
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, High Heaton, Newcastle upon Tyne NE7 7DN, UK
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13
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Vogel B, Tycinska A, Sambola A. Cardiogenic shock in women - A review and call to action. Int J Cardiol 2023; 386:98-103. [PMID: 37211458 DOI: 10.1016/j.ijcard.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/13/2023] [Accepted: 05/05/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | - Antonia Sambola
- Acute Cardiac Care Unit, Department of Cardiology, University Hospital Vall d'Hebron, Barcelona, Spain
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14
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Stehli J. Have we reached equality in pre-hospital management for women and men with STEMI? Eur J Prev Cardiol 2023; 30:1054-1055. [PMID: 36728703 DOI: 10.1093/eurjpc/zwad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/16/2023] [Indexed: 02/03/2023]
Affiliation(s)
- Julia Stehli
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
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15
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Osho A, Fernandes MF, Poudel R, de Lemos J, Hong H, Zhao J, Li S, Thomas K, Kikuchi DS, Zegre-Hemsey J, Ibrahim N, Shah NS, Hollowell L, Tamis-Holland J, Granger CB, Cohen M, Henry T, Jacobs AK, Jollis JG, Yancy CW, Goyal A. Race-Based Differences in ST-Segment-Elevation Myocardial Infarction Process Metrics and Mortality From 2015 Through 2021: An Analysis of 178 062 Patients From the American Heart Association Get With The Guidelines-Coronary Artery Disease Registry. Circulation 2023; 148:229-240. [PMID: 37459415 DOI: 10.1161/circulationaha.123.065512] [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: 05/07/2023] [Accepted: 06/13/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Systems of care have been developed across the United States to standardize care processes and improve outcomes in patients with ST-segment-elevation myocardial infarction (STEMI). The effect of contemporary STEMI systems of care on racial and ethnic disparities in achievement of time-to-treatment goals and mortality in STEMI is uncertain. METHODS We analyzed 178 062 patients with STEMI (52 293 women and 125 769 men) enrolled in the American Heart Association Get With The Guidelines-Coronary Artery Disease registry between January 1, 2015, and December 31, 2021. Patients were stratified into and outcomes compared among 3 racial and ethnic groups: non-Hispanic White, Hispanic White, and Black. The primary outcomes were the proportions of patients achieving the following STEMI process metrics: prehospital ECG obtained by emergency medical services; hospital arrival to ECG obtained within 10 minutes for patients not transported by emergency medical services; arrival-to-percutaneous coronary intervention time within 90 minutes; and first medical contact-to-device time within 90 minutes. A secondary outcome was in-hospital mortality. Analyses were performed separately in women and men, and all outcomes were adjusted for age, comorbidities, acuity of presentation, insurance status, and socioeconomic status measured by social vulnerability index based on patients' county of residence. RESULTS Compared with non-Hispanic White patients with STEMI, Hispanic White patients and Black patients had lower odds of receiving a prehospital ECG and achieving targets for door-to-ECG, door-to-device, and first medical contact-to-device times. These racial disparities in treatment goals were observed in both women and men, and persisted in most cases after multivariable adjustment. Compared with non-Hispanic White women, Hispanic White women had higher adjusted in-hospital mortality (odds ratio, 1.39 [95% CI, 1.12-1.72]), whereas Black women did not (odds ratio, 0.88 [95% CI, 0.74-1.03]). Compared with non-Hispanic White men, adjusted in-hospital mortality was similar in Hispanic White men (odds ratio, 0.99 [95% CI, 0.82-1.18]) and Black men (odds ratio, 0.96 [95% CI, 0.85-1.09]). CONCLUSIONS Race- or ethnicity-based disparities persist in STEMI process metrics in both women and men, and mortality differences are observed in Hispanic White compared with non-Hispanic White women. Further research is essential to evolve systems of care to mitigate racial differences in STEMI outcomes.
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Affiliation(s)
- Asishana Osho
- Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Boston (A.O.)
| | | | - Ram Poudel
- American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)
| | - James de Lemos
- University of Texas Southwestern Medical Center, Dallas (J.d.L.)
| | - Haoyun Hong
- American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)
| | - Juan Zhao
- American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)
| | - Shen Li
- American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)
| | - Kathie Thomas
- American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)
| | - Daniel S Kikuchi
- Osler Medical Residency, Johns Hopkins Hospital, Baltimore, MD (D.S.K.)
| | | | - Nasrien Ibrahim
- Harvard T.H. Chan School of Public Health, Boston, MA (N.I.)
| | - Nilay S Shah
- Department of Medicine, Division of Cardiology, Northwestern University Medical School, Chicago, IL (N.S.S., C.W.Y.)
| | - Lori Hollowell
- American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)
| | | | | | | | - Timothy Henry
- The Christ Hospital Heart and Vascular Institute, Cincinnati, OH (T.H., J.G.J.)
| | | | - James G Jollis
- The Christ Hospital Heart and Vascular Institute, Cincinnati, OH (T.H., J.G.J.)
| | - Clyde W Yancy
- Department of Medicine, Division of Cardiology, Northwestern University Medical School, Chicago, IL (N.S.S., C.W.Y.)
| | - Abhinav Goyal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.)
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16
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Kalff MC, Dijksterhuis WPM, Wagner AD, Oertelt-Prigione S, Verhoeven RHA, Lemmens VEPP, van Laarhoven HWM, Gisbertz SS, van Berge Henegouwen MI. Sex differences in treatment allocation and survival of potentially curable gastroesophageal cancer: A population-based study. Eur J Cancer 2023; 187:114-123. [PMID: 37146505 DOI: 10.1016/j.ejca.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Although curative treatment options are identical for male and female gastroesophageal cancer patients, access to care and survival may vary. This study aimed to compare treatment allocation and survival between male and female patients with potentially curable gastroesophageal cancer. METHODS Nationwide cohort study including all patients with potentially curable gastroesophageal squamous cell or adenocarcinoma diagnosed between 2006 and 2018 registered in the Netherlands Cancer Registry. The main outcome, treatment allocation, was compared between male and female patients with oesophageal adenocarcinoma (EAC), oesophageal squamous cell carcinoma (ESCC), and gastric adenocarcinoma (GAC). Additionally, 5-year relative survival with relative excess risk (RER), that is, adjusted for the normal life expectancy, was compared. RESULTS Among 27,496 patients (68.8% men), most were allocated to curative treatment (62.8%), although rates dropped to 45.6%>70 years. Curative treatment rates were comparable among younger male and female patients (≤70 years) with gastroesophageal adenocarcinoma, while older females with EAC were less frequently allocated to curative treatment than males (OR = 0.85, 95% confidence interval [CI] 0.73-0.99). For those allocated to curative treatment, relative survival was superior for female patients with EAC (RER = 0.88, 95% CI 0.80-0.96) and ESCC (RER = 0.82, 95% CI 0.75-0.91), and comparable for males and females with GAC (RER = 1.02, 95% CI 0.94-1.11). CONCLUSIONS While curative treatment rates were comparable between younger male and female patients with gastroesophageal adenocarcinoma, treatment disparities were present between older patients. When treated, the survival of females with EAC and ESCC was superior to males. The treatment and survival gaps between male and female patients with gastroesophageal cancer warrant further exploration and could potentially improve treatment strategies and survival.
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Affiliation(s)
- Marianne C Kalff
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Cancer Center Amsterdam, de Boelelaan 1118, 1081 HV Amsterdam, The Netherlands.
| | - Willemieke P M Dijksterhuis
- Cancer Center Amsterdam, de Boelelaan 1118, 1081 HV Amsterdam, The Netherlands; Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, The Netherlands
| | - Anna D Wagner
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands; Sex, and Gender-Sensitive Medicine, Medical Faculty OWL, University of Bielefeld, Universitätsstraße 25, 33615 Bielefeld, Germany
| | - Rob H A Verhoeven
- Cancer Center Amsterdam, de Boelelaan 1118, 1081 HV Amsterdam, The Netherlands; Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, The Netherlands
| | - Valery E P P Lemmens
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, The Netherlands; Department of Public Health, Erasmus MC, Erasmus University, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Cancer Center Amsterdam, de Boelelaan 1118, 1081 HV Amsterdam, The Netherlands; Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Cancer Center Amsterdam, de Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Cancer Center Amsterdam, de Boelelaan 1118, 1081 HV Amsterdam, The Netherlands.
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17
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Thomas YT, Jarman AF, Faynshtayn NG, Buehler GB, Andrabi S, McGregor AJ. Achieving Equity in Emergency Medicine Quality Measures Requires a Sex and Gender Lens. J Emerg Med 2023; 65:e60-e65. [PMID: 37331918 PMCID: PMC10505242 DOI: 10.1016/j.jemermed.2023.03.063] [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: 09/27/2022] [Revised: 03/07/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Quality measures within Emergency Medicine (EM) were developed to standardize and improve care. Their development has been limited by lack of consideration of sex- and gender-based differences. Research has suggested that sex and gender can impact clinical care and treatment. Inclusion of sex and gender differences is needed to create EM quality measures that are equitable to all. OBJECTIVE The aim of the review is to provide a brief history of EM quality measures and the value of considering sex- and gender-based evidence in their development to ensure equity, using acute myocardial infarction (AMI) as an example. DISCUSSION Current quality measures related to AMI, such as time-to-electrocardiogram and door-to-balloon time in percutaneous coronary intervention, may have important and modifiable disparities when stratified by sex. Even when presenting with signs and symptoms of AMI, women experience delayed time to diagnosis and treatment. Few studies have considered interventions to mitigate these differences. However, the data available suggest that sex-based disparities can be minimized by implementation of strategies such as a quality control checklist. CONCLUSIONS Quality measures were created to deliver high-quality, evidence-based, and standardized care, but without the inclusion of sex and gender metrics, they may not advance care to an equitable level.
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Affiliation(s)
- Ynhi T Thomas
- Henry J.N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas.
| | - Angela F Jarman
- Department of Emergency Medicine, University of California-Davis, Sacramento, California
| | | | - Greg B Buehler
- Henry J.N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | - Sara Andrabi
- Henry J.N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | - Alyson J McGregor
- Department of Emergency Medicine, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville, South Carolina
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Qamar A, Bhatia K, Arora S, Hendrickson M, Gupta P, Fatima A, MP G, Bansal A, Batra V, Ricciardi MJ, Grines CL, Yusuf J, Mukhopadhyay S, Smith SC, Tyagi S, Bhatt DL, Gulati M, Gupta MD. Clinical Profiles, Outcomes, and Sex Differences of Patients With STEMI: Findings From the NORIN-STEMI Registry. JACC. ASIA 2023; 3:431-442. [PMID: 37396424 PMCID: PMC10308105 DOI: 10.1016/j.jacasi.2022.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/13/2022] [Accepted: 12/24/2022] [Indexed: 07/04/2023]
Abstract
Background Low- and middle-income countries account for most of the global burden of coronary artery disease. There is a paucity of data regarding epidemiology and outcomes for ST-segment elevation myocardial infarction (STEMI) patients in these regions. Objectives The authors studied the contemporary characteristics, practice patterns, outcomes, and sex differences in patients with STEMI in India. Methods NORIN-STEMI (North India ST-Segment Elevation Myocardial Infarction Registry) is an investigator-initiated prospective cohort study of patients presenting with STEMI at tertiary medical centers in North India. Results Of 3,635 participants, 16% were female patients, one-third were <50 years of age, 53% had a history of smoking, 29% hypertension, and 24% diabetes. The median time from symptom onset to coronary angiography was 71 hours; the majority (93%) presented first to a non-percutaneous coronary intervention (PCI)-capable facility. Almost all received aspirin, statin, P2Y12 inhibitors, and heparin on presentation; 66% were treated with PCI (98% femoral access) and 13% received fibrinolytics. The left ventricular ejection fraction was <40% in 46% of patients. The 30-day and 1-year mortality rates were 9% and 11%, respectively. Compared with male patients, female patients were less likely to receive PCI (62% vs 73%; P < 0.0001) and had a more than 2-fold greater 1-year mortality (22% vs 9%; adjusted HR: 2.1; 95% CI: 1.7-2.7; P < 0.001). Conclusions In this contemporary registry of patients with STEMI in India, female patients were less likely to receive PCI after STEMI and had a higher 1-year mortality compared with male patients. These findings have important public health implications, and further efforts are required to reduce these gaps.
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Affiliation(s)
- Arman Qamar
- Section of Interventional Cardiology & Vascular Medicine, Division of Cardiology, NorthShore University Health System, Evanston, Illinois, USA
| | - Kirtipal Bhatia
- Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, New York, USA
| | - Sameer Arora
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Michael Hendrickson
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Puneet Gupta
- Department of Cardiology, Janakpuri Superspeciality Hospital, New Delhi, India
| | - Amber Fatima
- Division of Cardiology, Loyola University Medical Center, Loyola Stritch School of Medicine, Maywood, Illinois, USA
| | - Girish MP
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Ankit Bansal
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Vishal Batra
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Mark J. Ricciardi
- Section of Interventional Cardiology & Vascular Medicine, Division of Cardiology, NorthShore University Health System, Evanston, Illinois, USA
| | - Cindy L. Grines
- Department of Cardiovascular Medicine, Northside Cardiovascular Institute, Atlanta, Georgia, USA
| | - Jamal Yusuf
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Saibal Mukhopadhyay
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Sidney C. Smith
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Sanjay Tyagi
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Deepak L. Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Mohit D. Gupta
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Kim SR, Bae S, Lee JY, Kim MS, Kim MN, Chung WJ, Bae JH, Lee J, Park SM. Gender disparities in prevalence by diagnostic criteria, treatment and mortality of newly diagnosed acute myocardial infarction in Korean adults. Sci Rep 2023; 13:4120. [PMID: 36914709 PMCID: PMC10011387 DOI: 10.1038/s41598-023-31014-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 03/06/2023] [Indexed: 03/14/2023] Open
Abstract
Acute myocardial infarction (AMI) is highly prevalent and remains the leading cause of mortality. Particularly in women, under-recognition and management of AMI have been raised. The aim of this study was to investigate the long-term trends of prevalence, treatment methodologies, and mortality of AMI by gender. The subjects of this study were patients hospitalized for AMI according to the Korean National Health Insurance Claims Database from 2002 to 2018. Total 633,097 AMI patients were hospitalized, 40% women. The incidence of AMI has been increasing since 2011, with a lower incidence in women. Overall, 53.1% of patients underwent CAG, with a lower tendency in women than in men (39.8% vs. 62.3%). Furthermore, fewer women underwent PCI than men (77.5% vs. 85.8% in 2018, p < 0.0001). Of the 336,463 AMI patients undergoing CAG, women were undertreated with a lower prescription rate of beta-blockers or statins at discharge. When adjusted for age, women showed higher 7-day mortality but lower 1-year mortality relative to men. According to the Korean National Health Insurance Claims Database, women with AMI have been under-recognized, underdiagnosed, and undertreated in terms of revascularization or medical therapy for years suggesting that efforts to close the gender gap are necessary.
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Affiliation(s)
- So Ree Kim
- Division of Cardiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - SungA Bae
- Division of Cardiology, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Ji Yoon Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Sun Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Mi-Na Kim
- Division of Cardiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Wook-Jin Chung
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Republic of Korea
| | - Jang-Ho Bae
- Division of Cardiology, Department of Internal Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seong-Mi Park
- Division of Cardiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea. .,Korea University Anam Hospital, Goryeodae-ro 73, Seongbuk-gu, Seoul, 02841, Republic of Korea.
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1023] [Impact Index Per Article: 1023.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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21
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Cader FA, Gavina C. Reducing Sex Disparities in STEMI Care and Outcomes: Turning the Tide for Women. Arq Bras Cardiol 2023; 120:e20220884. [PMID: 36790308 PMCID: PMC10389104 DOI: 10.36660/abc.20220884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- F. Aaysha Cader
- Departamento de CardiologiaIbrahim Cardiac Hospital & Research InstituteDhakaBangladeshDepartamento de Cardiologia - Ibrahim Cardiac Hospital & Research Institute, Dhaka – Bangladesh
| | - Cristina Gavina
- Departamento de Cardiologia e MedicinaHospital Pedro HispanoMatosinhosPortugalDepartamento de Cardiologia e Medicina - Hospital Pedro Hispano, ULS Matosinhos – Portugal
- Universidade do PortoPortoPortugalUniversidade do Porto, Porto - Portugal
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22
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Social Media and Cardiovascular Health: Implications for Women. Curr Atheroscler Rep 2022; 24:901-913. [PMID: 36441421 PMCID: PMC10017051 DOI: 10.1007/s11883-022-01069-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is the leading cause of mortality in adult women in the USA, yet CVD is underrecognized in women. Disparities in care are further pronounced in women of racial/ethnic minority backgrounds. In this review, we discuss the role of social media (SoMe) as a tool to (i) promote women's cardiovascular (CV) health and (ii) address and potentially reduce gaps in care, particularly in general cardiology (targeting atherosclerotic cardiovascular disease), cardio-oncology, and cardio-obstetrics. We also briefly discuss women's CV health as a common, although not unique, focus of women in cardiology on SoMe. RECENT FINDINGS Studies have suggested the utility of social media to help advance subspecialties of cardiology. Leaders within general cardiology, cardio-oncology, and cardio-obstetrics have curated social media strategies to advance their respective fields and call attention to cardiovascular health disparities in female populations and racial/ethnic minorities. In addition to these types of uses, women in cardiology also frequently use SoMe to encourage a career in cardiology and to share experiences, challenges, and resources for support and career advancement as healthcare professionals; men in cardiology and especially those who are allies for sex and racial/ethnic minorities also use SoMe for these means. Herein, we highlight the role and myriad applications of social media in the promotion of women's cardiovascular health. We discuss five primary roles of social media: increasing public awareness, disseminating medical literature in a rapid and accessible fashion, facilitating professional networking, serving as a platform for medical conferences, and empowering patients. These core strategies are discussed through the lens of general cardiology, cardio-oncology, and cardio-obstetrics. We also demonstrate how these applications can be leveraged to increase representation of women in cardiology, also supporting an increased focus on women's cardiovascular health.
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23
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Burgess SN, Mamas MA. Narrowing disparities in PCI outcomes in women; From risk assessment, to referral pathways and outcomes. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 24:100225. [PMID: 38560635 PMCID: PMC10978432 DOI: 10.1016/j.ahjo.2022.100225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 04/04/2024]
Abstract
This review evaluates published data regarding outcomes for women with ACS undergoing PCI. Data is discussed from a patient centred perspective and timeline, beginning with sex-based differences in perception of risk, time to presentation, time to treatment, access to angiography, access to angioplasty, the impact of incomplete revascularization, prescribing practices, under-representation of women in randomized controlled trials and in cardiology physician workforces. The objective of the review is to identify factors contributing to outcome disparities for women with ACS, and to discuss potential solutions to close this outcome gap.
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Affiliation(s)
- Sonya N. Burgess
- Department of Cardiology, Nepean Hospital, Sydney, Australia
- University of Sydney, NSW, Australia
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK
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24
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Jarman AF, Hwang AC, Schleimer JP, Fontenette RW, Mumma BE. Racial Disparities in Opioid Analgesia Administration Among Adult Emergency Department Patients with Abdominal Pain. West J Emerg Med 2022; 23:826-831. [PMID: 36409944 PMCID: PMC9683779 DOI: 10.5811/westjem.2022.8.55750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Racial disparities in pain management have been reported among emergency department (ED) patients. In this study we evaluated the association between patients' self-identified race/ethnicity and the administration of opioid analgesia among ED patients with abdominal pain, the most common chief complaint for ED presentations in the United States. METHODS This was a retrospective cohort study of adult (age ≥18 years) patients who presented to the ED of a single center with abdominal pain from January 1, 2019-December 31, 2020. We collected demographic and clinical information, including patients' race and ethnicity, from the electronic health record. The primary outcome was the ED administration of any opioid analgesic (binary). Secondary outcomes included the administration of non-opioid analgesia (binary) and administration of any analgesia (binary). We used logistic regression models to estimate odds ratios (OR) of the association between a patient's race/ethnicity and analgesia administration. Covariates included age, sex, initial pain score, Emergency Severity Index, and ED visits in the prior 30 days. Subgroup analyses were performed in non-pregnant patients, those who underwent any imaging study, were admitted to the hospital, and who underwent surgery within 24 hours of ED arrival. RESULTS We studied 7,367 patients: 45% (3,314) were non-Hispanic (NH) White; 28% (2,092) were Hispanic/Latinx; 19% (1,384) were NH Black, and 8% (577) were Asian. Overall, 44% (3,207) of patients received opioid analgesia. In multivariable regression models, non-White patients were less likely to receive opioid analgesia compared with White patients (OR 0.73, 95% CI 0.65-0.83 for Hispanic/Latinx patients; OR 0.62, 95% CI 0.54-0.72 for Black patients; and OR 0.64, 95% CI 0.52-0.78 for Asian patients). Black patients were also less likely to receive non-opioid analgesia, and Black and Hispanic/Latinx patients were less likely than White patients to receive any analgesia. The associations were similar across subgroups; however, the association was attenuated among patients who underwent surgery within 24 hours of ED arrival. CONCLUSION Hispanic/Latinx, Black, and Asian patients were significantly less likely to receive opioid analgesia than White patients when presenting to the ED with abdominal pain. Black patients were also less likely than White patients to receive non-opioid analgesia.
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Affiliation(s)
- Angela F. Jarman
- University of California, Davis School of Medicine, Department of Emergency Medicine, Davis, California
| | - Alexander C. Hwang
- University of California, Davis School of Medicine, Department of Emergency Medicine, Davis, California
- David Grant Medical Center, Travis Air Force Base, Fairfield, California
| | - Julia P. Schleimer
- University of California, Davis School of Medicine, Violence Prevention Research Program, Department of Emergency Medicine, Davis, California
- University of California, Davis, University of California Firearm Violence Research Center, Davis, California
| | - Roderick W. Fontenette
- University of California, Davis School of Medicine, Department of Emergency Medicine, Davis, California
- David Grant Medical Center, Travis Air Force Base, Fairfield, California
| | - Bryn E. Mumma
- University of California, Davis School of Medicine, Department of Emergency Medicine, Davis, California
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25
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Savage M, Hay K, Murdoch D, Walters DL, Denman R, Ranasinghe I, Raffel C. Sex differences in time to primary percutaneous coronary intervention and outcomes in patients presenting with ST-segment elevation myocardial infarction. Catheter Cardiovasc Interv 2022; 100:520-529. [PMID: 35971748 PMCID: PMC9804760 DOI: 10.1002/ccd.30357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/11/2022] [Accepted: 07/27/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We assessed sex differences in treatment and outcomes in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). BACKGROUND Historically, delays to timely reperfusion and poorer outcomes have been described in women who suffer STEMI. However, whether these sex discrepancies still exist with contemporary STEMI treatment remains to be evaluated. METHODS Consecutive STEMI patients treated with primary PCI patients over a 10-year period (January 1, 2010 to December 31, 2019) from a tertiary referral center were assessed. Comparisons were performed between patient's sex. Primary outcomes were 30-day and 1-year mortality. Secondary outcomes were STEMI performance measures. RESULTS Most patients (n = 950; 76%) were male. Females were on average older (66.8 vs. 61.4 years males; p < 0.001). Prehospital treatment delays did not differ between sexes (54 min [IQR: 44-65] females vs. 52 min [IQR: 43-62] males; p = 0.061). STEMI performance measures (door-to-balloon, first medical contact-to-balloon [FMCTB]) differed significantly with longer median durations in females and fewer females achieving FMCTB < 90 min (28% females vs. 39% males; p < 0.001). Women also experienced greater rates of initial radial arterial access failure (11.3% vs. 3.1%; p < 0.001). However, there were no significant sex differences in crude or adjusted mortality between sexes at 30-days (3.6% male vs. 5.1% female; p = 0.241, adjusted OR: 1.1, 95% CI: 0.5-2.2, p = 0.82) or at 1-year (4.8% male vs. 6.8% female; p = 0.190, adjusted OR: 1.0, (95% CI: 0.5-1.8; p = 0.96). CONCLUSION Small discrepancies between sexes in measures of timely reperfusion for STEMI still exist. No significant sex differences were observed in either 30-day or 1-year mortality.
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Affiliation(s)
- Michael L. Savage
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Karen Hay
- School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,QIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Dale J. Murdoch
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Darren L. Walters
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Russell Denman
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Isuru Ranasinghe
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Christopher Raffel
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
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26
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Acute Coronary Syndrome in Women. Emerg Med Clin North Am 2022; 40:629-636. [DOI: 10.1016/j.emc.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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27
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Moscucci F, Lavalle F, Politi C, Campanale A, Baggio G, Sciomer S. Acute coronary syndrome in women: a new and specific approach is needed. Eur J Prev Cardiol 2022; 29:e305-e308. [PMID: 35881512 DOI: 10.1093/eurjpc/zwac143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 12/20/2022]
Affiliation(s)
- Federica Moscucci
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Rome, Italy
| | - Franco Lavalle
- OMCEO (Provincial Order Council of Surgeons and Dentists), Bari, Italy
- G.I.S.e G. (Gender and Health Italian Group), Italy
| | - Cecilia Politi
- Internal Medicine Department, Gender Medicine Area F.A.D.O.I., Isernia, Italy
| | - Antonella Campanale
- Medical Device and Pharmaceutical Service-Italian Ministry of Health, Rome, Italy
| | - Giovanella Baggio
- Department of Medicine, University of Padua, Padua, Italy
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Rome, Italy
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Rome, Italy
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Brinkley TE, Stites SD, Hunsberger HC, Karvonen-Gutierrez CA, Li M, Shaaban CE, Thorpe RJ, Kritchevsky SB. Research Centers Collaborative Network Workshop on Sex and Gender Differences in Aging. Innov Aging 2022; 6:igac055. [PMID: 36267320 PMCID: PMC9579719 DOI: 10.1093/geroni/igac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Indexed: 02/03/2023] Open
Abstract
Aging affects men and women differently; however, the impact of sex and gender on the aging process is not well understood. Moreover, these 2 concepts are often conflated, which further contributes to a lack of clarity on this important issue. In an effort to better understand the relevance of sex and gender in aging research, the Research Centers Collaborative Network sponsored a 1.5-day conference on sex and gender differences in aging that brought together key thought leaders from the 6 National Institute on Aging center programs. The meeting included sessions on comparing males and females, pathophysiological differences, sex/gender in clinical care, and gender and health in the social context. Presenters from a wide array of disciplines identified opportunities for multidisciplinary research to address current gaps in the field and highlighted the need for a more systematic approach to understanding the how and why of sex/gender differences, as well as the health implications of these differences and the sex/gender biases that affect clinical treatment and outcomes. This article summarizes the proceedings of the workshop and provides several recommendations to move the field forward, such as better data collection tools to assess the intersection of sex and gender in epidemiological research; a life course perspective with attention to fetal/developmental origins and key life stages; innovative animal models to distinguish contributions from sex hormones versus sex chromosomes; and integration of sex/gender into teaching and clinical practice. Ultimately, successful implementation of these recommendations will require thoughtful investigations across the translational spectrum and increased collaborations among those with expertise in sex and gender differences.
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Affiliation(s)
- Tina E Brinkley
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Shana D Stites
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Holly C Hunsberger
- Department of Foundational Science and Humanities, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | | | - Mengting Li
- School of Nursing, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - C Elizabeth Shaaban
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Zhang LM, Geater AF, McNeil EB, Lin YP, Liu SC, Luo H, Wang YZ, Wen SC. Health Inequalities of STEMI Care Before Implementation of a New Regional Network: A Prefecture-Level Analysis of Social Determinants of Healthcare in Yunnan, China. Int J Health Policy Manag 2022; 11:1413-1424. [PMID: 34060274 PMCID: PMC9808331 DOI: 10.34172/ijhpm.2021.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 03/16/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND As one of the most serious types of coronary heart disease, ST-elevation myocardial infarction (STEMI) faces huge challenges in the equal management and care of patients due to its life-threatening and time-critical condition. Health inequalities such as sex and age differences in STEMI care have been reported from developed countries. However, limited outcomes have been investigated and the major drivers of inequality are still unclear, especially in under-developed areas. This study aimed to explore the major drivers of health inequalities in STEMI care before implementation of a new regional network in the south-west of China. METHODS Prefecture-level data of STEMI patients before the implementation of a regional network were analysed retrospectively. Drivers of inequality were identified from six social determinants of health, namely area of residence, ethnicity, sex, age, education and occupation. Outcomes of STEMI care included timely presentation, reperfusion therapy, timely reperfusion therapy, heart failure, inpatient mortality, length of hospital stay, hospital costs, and various intervals of ischaemic time. RESULTS A total of 376 STEMI patients in the research area before implementation of the STEMI network were included. Compared with urban residents, rural patients were significantly less likely to have timely presentation (odds ratio [OR]=0.47, 95% CI: 0.28-0.80, P=.004) and timely reperfusion therapy (OR=0.32, 95% CI: 0.14-0.70, P=.005). Rural residents were less likely to present to hospital promptly than urban residents (HR=0.65, 95% CI=0.52-0.82, P<.001). In the first 3 hours of percutaneous coronary intervention (PCI) reperfusion delay and first 6 hours of total ischaemic time, rural patients had a significantly lower probability to receive prompt PCI (hazard ratio [HR]=0.40, 95% CI: 0.29-0.54, P<.001) and reperfusion therapy (HR=0.37, 95% CI: 0.25-0.56, P<.001) compared to urban patients. CONCLUSION Rural residents were a major vulnerable group before implementation of the regional STEMI network. No obvious inequalities in ethnicity, sex, age, education or occupation existed in STEMI care in Chuxiong Prefecture of China.
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Affiliation(s)
- Li Mei Zhang
- Department of Cardiology, People’s Hospital of Chuxiong Prefecture, Yunnan, China
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Alan Frederick Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Edward B. McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Yun Peng Lin
- Department of Cardiology, People’s Hospital of Chuxiong Prefecture, Yunnan, China
| | - Si Chen Liu
- Faculty of Dentistry, Prince of Songkla University, Hat Yai, Thailand
| | - Heng Luo
- People’s Hospital of Chuxiong Prefecture, Yunnan, China
- Executive Office, Alliance of Chuxiong Prefecture Chest Pain Centres, Yunnan, China
| | - Yuan Zhang Wang
- Department of Cardiology, People’s Hospital of Chuxiong Prefecture, Yunnan, China
- Executive Office, Alliance of Chuxiong Prefecture Chest Pain Centres, Yunnan, China
| | - Shao Chang Wen
- Department of Cardiology, People’s Hospital of Chuxiong Prefecture, Yunnan, China
- Executive Office, Alliance of Chuxiong Prefecture Chest Pain Centres, Yunnan, China
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Biology, Bias, or Both? The Contribution of Sex and Gender to the Disparity in Cardiovascular Outcomes Between Women and Men. Curr Atheroscler Rep 2022; 24:701-708. [PMID: 35773564 PMCID: PMC9399064 DOI: 10.1007/s11883-022-01046-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2022] [Indexed: 11/24/2022]
Abstract
Purpose of Review Cardiovascular disease (CVD) is the leading cause of mortality and morbidity worldwide for both men and women. However, CVD is understudied, underdiagnosed, and undertreated in women. This bias has resulted in women being disproportionately affected by CVD when compared to men. The aim of this narrative review is to explore the contribution of sex and gender on CVD outcomes in men and women and offer recommendations for researchers and clinicians. Recent Findings Evidence demonstrates that there are sex differences (e.g., menopause and pregnancy complications) and gender differences (e.g., socialization of gender) that contribute to the inequality in risk, presentation, and treatment of CVD in women. Summary To start addressing the CVD issues that disproportionately impact women, it is essential that these sex and gender differences are addressed through educating health care professionals on gender bias; offering patient-centered care and programs tailored to women’s needs; and conducting inclusive health research.
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Boivin-Proulx LA, Pacheco C, Matteau A, Mansour S, Potter BJ. Pre-Hospital STEMI Referral Systems and Sex-Related Bias in Canada: A National Survey. CJC Open 2022; 4:829-832. [PMID: 36254323 PMCID: PMC9568687 DOI: 10.1016/j.cjco.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/26/2022] [Indexed: 11/25/2022] Open
Abstract
Background Prehospital electrocardiographic ST-elevation myocardial infarction (STEMI) diagnosis and prehospital cardiac catheterization laboratory activation have been shown to significantly reduce average treatment delay, and further standardization of such systems may help reduce sex-related treatment and outcome gaps. However, what types of prehospital STEMI activation systems are in place across Canada, and to what extent sex-based STEMI treatment disparities are tracked, is unknown. Methods We conducted a national survey of catheterization laboratory directors between October 11 and December 25, 2021. Seventeen catheterization laboratory directors representing 6 community and 11 academic centres completed the survey (40% response rate). Results : All responding centres use a prehospital STEMI diagnosis and cardiac catheterization laboratory activation system, and the majority (59%) rely on real-time physician oversight. Slightly less than half (47%) of percutaneous coronary intervention centres reported prospectively tracking sex-related differences in STEMI care, and only one respondent believed that a significant systemic sex-related bias was present in their prehospital STEMI referral system. Patient factors (symptom description or time to presentation; 23.5%) and limitations of electrocardiogram diagnosis of STEMI in women (23.5%) were cited most frequently as contributing to sex-related bias in STEMI referral systems. In contrast, implicit bias in the referral algorithm, prehospital provider bias, and physician bias were not considered important contributing factors. Conclusions Although all responding centres employ prehospital activation systems, less than half tracked sex-related differences, and most respondents believed that no sex-related bias existed in their prehospital STEMI system.
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Gottfried S. Women: Diet, Cardiometabolic Health, and Functional Medicine. Phys Med Rehabil Clin N Am 2022; 33:621-645. [DOI: 10.1016/j.pmr.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gaudino M, Di Franco A, Cao D, Giustino G, Bairey Merz CN, Fremes SE, Kirtane AJ, Kunadian V, Lawton JS, Masterson Creber RM, Sandner S, Vogel B, Zwischenberger BA, Dangas GD, Mehran R. Sex-Related Outcomes of Medical, Percutaneous, and Surgical Interventions for Coronary Artery Disease: JACC Focus Seminar 3/7. J Am Coll Cardiol 2022; 79:1407-1425. [PMID: 35393023 DOI: 10.1016/j.jacc.2021.07.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022]
Abstract
Biological and sociocultural differences between men and women are complex and likely account for most of the variations in the epidemiology and treatment outcomes of coronary artery disease (CAD) between the 2 sexes. Worse outcomes in women have been described following both conservative and invasive treatments of CAD. For example, increased levels of residual platelet reactivity during treatment with antiplatelet drugs, higher rates of adverse cardiovascular outcomes following percutaneous coronary revascularization, and higher operative and long-term mortality after coronary bypass surgery have been reported in women compared with in men. Despite the growing recognition of sex-specific determinants of outcomes, representation of women in clinical studies remains low and sex-specific management strategies are generally not provided in guidelines. This review summarizes the current evidence on sex-related differences in patients with CAD, focusing on the differential outcomes following medical therapy, percutaneous coronary interventions, and coronary artery bypass surgery.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Stephen E Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ajay J Kirtane
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center and the Cardiovascular Research Foundation, New York, New York, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jennifer S Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brittany A Zwischenberger
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Stehli J, Dinh D, Dagan M, Dick R, Oxley S, Brennan A, Lefkovits J, Duffy SJ, Zaman S. Sex differences in treatment and outcomes of patients with in-hospital ST-elevation myocardial infarction. Clin Cardiol 2022; 45:427-434. [PMID: 35253228 PMCID: PMC9019891 DOI: 10.1002/clc.23797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/21/2022] [Accepted: 02/03/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND AND HYPOTHESIS Two cohorts face high mortality after ST-elevation myocardial infarction (STEMI): females and patients with in-hospital STEMI. The aim of this study was to evaluate sex differences in ischemic times and outcomes of in-hospital STEMI patients. METHODS Consecutive STEMI patients treated with percutaneous coronary intervention (PCI) were prospectively recruited from 30 hospitals into the Victorian Cardiac Outcomes Registry (2013-2018). Sex discrepancies within in-hospital STEMIs were compared with out-of-hospital STEMIs. The primary endpoint was 12-month all-cause mortality. Secondary endpoints included symptom-to-device (STD) time and 30-day major adverse cardiovascular events (MACE). To investigate the relationship between sex and 12-month mortality for in-hospital versus out-of-hospital STEMIs, an interaction analysis was included in the multivariable models. RESULTS A total of 7493 STEMI patients underwent PCI of which 494 (6.6%) occurred in-hospital. In-hospital versus out-of-hospital STEMIs comprised 31.9% and 19.9% females, respectively. Female in-hospital STEMIs were older (69.5 vs. 65.9 years, p = .003) with longer adjusted geometric mean STD times (104.6 vs. 94.3 min, p < .001) than men. Female versus male in-hospital STEMIs had no difference in 12-month mortality (27.1% vs. 20.3%, p = .92) and MACE (22.8% vs. 19.3%, p = .87). Female sex was not independently associated with 12-month mortality for in-hospital STEMIs which was consistent across the STEMI cohort (OR: 1.26, 95% CI: 0.94-1.70, p = .13). CONCLUSIONS In-hospital STEMIs are more frequent in females relative to out-of-hospital STEMIs. Despite already being under medical care, females with in-hospital STEMIs experienced a 10-min mean excess in STD time compared with males, after adjustment for confounders. Adjusted 12-month mortality and MACE were similar to males.
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Affiliation(s)
- Julia Stehli
- Nursing and Health Sciences, Faculty of MedicineMonash UniversityMelbourneVictoriaAustralia
- Epworth HealthCareRichmondVictoriaAustralia
| | - Diem Dinh
- School of Public Health and Preventive Medicine, Centre of Cardiovascular Research and Education in TherapeuticsMonash UniversityMelbourneVictoriaAustralia
| | - Misha Dagan
- Department of General MedicineThe Alfred HospitalMelbourneVictoriaAustralia
| | - Ron Dick
- Epworth HealthCareRichmondVictoriaAustralia
| | | | - Angela Brennan
- School of Public Health and Preventive Medicine, Centre of Cardiovascular Research and Education in TherapeuticsMonash UniversityMelbourneVictoriaAustralia
| | - Jeffrey Lefkovits
- Nursing and Health Sciences, Faculty of MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of CardiologyRoyal Melbourne HospitalMelbourneVictoriaAustralia
| | - Stephen J. Duffy
- Nursing and Health Sciences, Faculty of MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of CardiologyThe Alfred HospitalMelbourneVictoriaAustralia
| | - Sarah Zaman
- School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVictoriaAustralia
- Westmead Applied Research CentreUniversity of SydneySydneyNew South WalesAustralia
- Department of CardiologyWestmead HospitalSydneyNew South WalesAustralia
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Shah T, Kapadia S, Lansky AJ, Grines CL. ST-Segment Elevation Myocardial Infarction: Sex Differences in Incidence, Etiology, Treatment, and Outcomes. Curr Cardiol Rep 2022; 24:529-540. [PMID: 35286662 DOI: 10.1007/s11886-022-01676-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Although there have been marked improvements in the standard of care for treatment of ST-elevation myocardial infarction, women, especially younger women, continue to have significantly worse outcomes than men. RECENT FINDINGS This review highlights the current sex differences in presentation, etiology, treatment, and outcomes among these patients in order to make providers aware of the heterogeneous entities that cause ST-elevation myocardial infarction particularly in women and of disparities in treatment that lead to poorer outcomes in women. Furthermore, it emphasizes evidence-based strategies including standardized protocols for early revascularization, mechanical circulatory support, and access methodology that can reduce sex-based disparities in treatments and outcomes.
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Affiliation(s)
- Tayyab Shah
- Yale University School of Medicine, New Haven, CT, USA
| | | | | | - Cindy L Grines
- Northside Hospital Cardiovascular Institute, Atlanta, GA, USA.
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Xi Z, Qiu H, Guo T, Wang Y, Li J, Li Y, Zheng J, Gao R. Contemporary sex differences in mortality among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis. BMJ Open 2022; 12:e053379. [PMID: 35264344 PMCID: PMC8915368 DOI: 10.1136/bmjopen-2021-053379] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess the effect of sex differences on short-term and long-term mortality among patients with ST-segment elevation myocardial infarction (STEMI). DESIGN Systematic review and meta-analysis of contemporary available evidence. SETTING PubMed, Embase and Cochrane Library were searched for relevant studies reporting sex-specific outcomes among patients with STEMI published between 1 January 2010 and 1 August 2020. Risk ratios (RRs) and 95% CIs were measured using DerSimonian and Laird random-effects model. Sensitivity analyses were performed and publication bias was also checked. All statistical analyses were performed using STATA V.15.0. PARTICIPANTS Studies providing data about short-term or long-term mortality stratified by sex in patients with STEMI were included. Only study conducted in last 10 years were included. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was all-cause death at short-term (in-hospital or 30 days) and long-term (at least 12 months) follow-up. RESULTS A total of 15 studies involving 128 585 patients (31 706 (24.7%) female and 96 879 (75.3%) male) were included. In the unadjusted analyses, female were at a higher risk of short-term mortality (RR, 1.73; 95% CI 1.53 to 1.96, p<0.001, I2=77%) but not long-term mortality (RR, 1.23; 95% CI 0.89 to 1.69, p=0.206, I2=77.5%). When adjusted effect estimates from individual studies were used in meta-analysis, the association between female and higher risk of short-term mortality remained significant (RR, 1.24; 95% CI 1.11 to 1.38, p<0.001, I2=39.6%). And adjusted long-term mortality was also similar between female and male (RR, 1.11; 95% CI 0.42 to 1.80, p=0.670, I2=74.5%). CONCLUSIONS An increased short-term but not long-term mortality was found in female with STEMI. After adjustment for baseline cardiovascular risk factors and clinical profiles, short-term mortality remains higher in female with STEMI compared with male, indicating the need for further improvements in management in female patients.
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Affiliation(s)
- Ziwei Xi
- Department of Cardiology, Coronary artery disease center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Qiu
- Department of Cardiology, Coronary artery disease center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tingting Guo
- Thrombosis Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Wang
- Department of Cardiology, Coronary artery disease center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianan Li
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Beijing, China
| | - Yang Li
- Department of Cardiology, Coronary artery disease center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianfeng Zheng
- Department of Cardiology, Coronary artery disease center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - R Gao
- Department of Cardiology, Coronary artery disease center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Greenberg E, Schultz E, Cobb E, Philpott S, Schrader M, Parker J. Racial Variations in Emergency Department Management of Chest Pain in a Community-based Setting. Spartan Med Res J 2022; 7:32582. [PMID: 35291706 PMCID: PMC8873438 DOI: 10.51894/001c.32582] [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: 11/15/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Chest pain is one of the most common chief presenting complaints occurring in most Emergency Departments. The HEART score is a validated risk stratification tool commonly used to evaluate chest pain. Prior research has demonstrated the existence of complex racial variations in health care, specifically in what tests are ordered (or accepted by patients) during evaluation and treatment of cardiac disease. The authors hypothesized that chest pain management (i.e., disposition to hospital/observation unit and rates of stress testing) patterns and longitudinal outcomes (i.e., death and 30-day readmission) would occur differently in African Americans despite systematic use of the HEART score. METHODS Funded by the Statewide Campus System, this study was comprised of a retrospective chart review of a sample of eligible patients presenting with chest pain to the authors' 345-bed community-based Michigan hospital. RESULTS Of the 1,412 eligible sample patients, 886 (63%) reported their racial affiliation as White, 473 (33%) African-American, and 53 (4%) "Other". The average HEART score in Whites was 3.92 (SD = 1.89) compared to 3.31 (SD = 1.79) in African-Americans, (p < 0.01, 95% CI: 0.40-0.82). However, White patients' odds of admission to observation or inpatient was 1.49 times higher (95% CI: 1.04 - 2.15), with every unit increase in HEART score increasing the odds ratio of admission by 3.24 times (95% CI: 2.79 - 3.76). White patients were also 2.37 times more likely to receive (or accept) stress tests than African American patients (95% CI: 1.41 - 3.88). Only five (0.01%) of 458 White patients with HEART score between 4 and 6 experienced 30-day readmission or death whereas seven (0.04%) of 193 African-American patients experienced these outcomes (p = 0.04 with OR 3.40, 95% CI: 1.07 - 10.9). CONCLUSIONS Although the authors were unable to precisely distinguish the provider (e.g., desire to order testing) and patient-driven (e.g., desire to accept testing) factors likely to contribute to measured differences, these results suggest continued complex racial variations concerning hospital admission and stress testing in chest pain patients. Further studies are needed to analyze potential systems or subject-level factors influencing the multi-dimensional phenomenon of chest pain management across racial affiliation.
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Affiliation(s)
| | - Elle Schultz
- Resident Physician, Spectrum Health Lakeland Emergency Medicine Residency
| | - Emily Cobb
- Resident Physician, Spectrum Health Lakeland Emergency Medicine Residency
| | - Shelia Philpott
- Core Faculty, Spectrum Health Lakeland Emergency Medicine Residency
| | - Megan Schrader
- Core Faculty, Spectrum Health Lakeland Emergency Medicine Residency
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Reynolds HR, Merz CNB, Berry C, Samuel R, Saw J, Smilowitz NR, de Souza ACDA, Sykes R, Taqueti VR, Wei J. Coronary Arterial Function and Disease in Women With No Obstructive Coronary Arteries. Circ Res 2022; 130:529-551. [PMID: 35175840 PMCID: PMC8911308 DOI: 10.1161/circresaha.121.319892] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ischemic heart disease (IHD) is the leading cause of mortality in women. While traditional cardiovascular risk factors play an important role in the development of IHD in women, women may experience sex-specific IHD risk factors and pathophysiology, and thus female-specific risk stratification is needed for IHD prevention, diagnosis, and treatment. Emerging data from the past 2 decades have significantly improved the understanding of IHD in women, including mechanisms of ischemia with no obstructive coronary arteries and myocardial infarction with no obstructive coronary arteries. Despite this progress, sex differences in IHD outcomes persist, particularly in young women. This review highlights the contemporary understanding of coronary arterial function and disease in women with no obstructive coronary arteries, including coronary anatomy and physiology, mechanisms of ischemia with no obstructive coronary arteries and myocardial infarction with no obstructive coronary arteries, noninvasive and invasive diagnostic strategies, and management of IHD.
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Affiliation(s)
- Harmony R Reynolds
- Sarah Ross Soter Center for Women’s Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, G12 8TA, UK, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK, Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Rohit Samuel
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacqueline Saw
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathaniel R Smilowitz
- Sarah Ross Soter Center for Women’s Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Ana Carolina do A.H. de Souza
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiology), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Sykes
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, G12 8TA, UK, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Viviany R. Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiology), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Janet Wei
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2268] [Impact Index Per Article: 1134.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Abstract
Racism and racial bias influence the lives and cardiovascular health of minority individuals. The fact that minority groups tend to have a higher burden of cardiovascular disease risk factors is often a result of racist policies that restrict opportunities to live in healthy neighbourhoods and have access to high-quality education and healthcare. The fact that minorities tend to have the worst outcomes when cardiovascular disease develops is often a result of institutional or individual racial bias encountered when they interact with the healthcare system. In this review, we discuss bias, discrimination, and structural racism from the viewpoints of cardiologists in Canada, the United Kingdom, and the US, and how racial bias impacts cardiovascular care. Finally, we discuss proposals to mitigate the impact of racism in our specialty.
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Mathew A, Hong Y, Yogasundaram H, Nagendran J, Punnoose E, Ashraf S, Fischer L, Abdullakutty J, Pisharody S, Bainey K, Graham M. Sex and Medium-term Outcomes of ST-Segment Elevation Myocardial Infarction in Kerala, India: A Propensity Score–Matched Analysis. CJC Open 2021; 3:S71-S80. [PMID: 34993436 PMCID: PMC8712709 DOI: 10.1016/j.cjco.2021.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background Sex-based differences have been found in outcomes following ST-segment myocardial infarction (STEMI). Studies assessing sex-based differences in STEMI among Indian patients have reported conflicting results. Methods A prospective multicenter registry of consecutive patients with STEMI who presented to percutaneous coronary intervention (PCI)–capable hospitals in the Indian state of Kerala between June 2013 and March 2017 was used to assess 1-year outcomes. The primary endpoint was a composite of major adverse cardiac events (MACE), including death, stroke, nonfatal myocardial infarction, and rehospitalization for heart failure. Outcomes of 2 sex-based propensity score–matched groups were compared. Results We included 3194 patients (19.4% women). Women presenting with STEMI were older, had more traditional cardiovascular risk factors, and were more likely to be classified as living in poverty. After propensity-score matching, women experienced greater incidence of MACE (20.9% vs 14.3%, P < 0.01), primarily driven by increased 1-year mortality (14.3% vs 8.6%, P < 0.01). Women were more likely to experience prehospital delays, compared with men. Although reperfusion rates were similar between the groups, men were more likely than women to undergo reperfusion within the first 12 hours of chest pain onset. Among patients undergoing primary PCI, women were more likely to have delayed PCI than were men (80.2% vs 72.9%, P = 0.03). Procedural characteristics were similar between groups. Conclusions Women in this cohort experienced higher incidence of MACE at 1 year, compared to men, primarily owing to increased mortality. Timeliness of reperfusion appears to be the primary factor impacting differences in outcomes between the 2 groups and may represent an attractive target for quality-improvement initiatives.
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Affiliation(s)
- Anoop Mathew
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
- Division of Cardiology, Malankara Orthodox Syrian Christian Medical College Hospital, Kolenchery, Kerala, India
- Corresponding author: Dr Anoop Mathew, Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, 2C2 WMC, 8440 – 112 St, NW, Edmonton, Alberta T6G 2B7, Canada
| | - Yongzhe Hong
- Division of Cardiac Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Haran Yogasundaram
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Eapen Punnoose
- Division of Cardiology, Malankara Orthodox Syrian Christian Medical College Hospital, Kolenchery, Kerala, India
| | - S.M. Ashraf
- Division of Cardiology, Government Medical College Hospital, Pariyaram, Kerala, India
| | - Louie Fischer
- Division of Cardiology, Malankara Orthodox Syrian Christian Medical College Hospital, Kolenchery, Kerala, India
| | | | - Sunil Pisharody
- Division of Cardiology, Elamkulam Manakkal Sankaran Memorial Co-operative Hospital and Research Centre, Perinthalmanna, Kerala, India
| | - Kevin Bainey
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Michelle Graham
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
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Lindsey ML, Brunt KR, Kirk JA, Kleinbongard P, Calvert JW, de Castro Brás LE, DeLeon-Pennell KY, Del Re DP, Frangogiannis NG, Frantz S, Gumina RJ, Halade GV, Jones SP, Ritchie RH, Spinale FG, Thorp EB, Ripplinger CM, Kassiri Z. Guidelines for in vivo mouse models of myocardial infarction. Am J Physiol Heart Circ Physiol 2021; 321:H1056-H1073. [PMID: 34623181 PMCID: PMC8834230 DOI: 10.1152/ajpheart.00459.2021] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 12/11/2022]
Abstract
Despite significant improvements in reperfusion strategies, acute coronary syndromes all too often culminate in a myocardial infarction (MI). The consequent MI can, in turn, lead to remodeling of the left ventricle (LV), the development of LV dysfunction, and ultimately progression to heart failure (HF). Accordingly, an improved understanding of the underlying mechanisms of MI remodeling and progression to HF is necessary. One common approach to examine MI pathology is with murine models that recapitulate components of the clinical context of acute coronary syndrome and subsequent MI. We evaluated the different approaches used to produce MI in mouse models and identified opportunities to consolidate methods, recognizing that reperfused and nonreperfused MI yield different responses. The overall goal in compiling this consensus statement is to unify best practices regarding mouse MI models to improve interpretation and allow comparative examination across studies and laboratories. These guidelines will help to establish rigor and reproducibility and provide increased potential for clinical translation.
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Affiliation(s)
- Merry L Lindsey
- Department of Cellular and Integrative Physiology, Center for Heart and Vascular Research, University of Nebraska Medical Center, Omaha, Nebraska
- Research Service, Nebraska-Western Iowa Health Care System, Omaha, Nebraska
| | - Keith R Brunt
- Department of Pharmacology, Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
| | - Jonathan A Kirk
- Department of Cell and Molecular Physiology, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois
| | - Petra Kleinbongard
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany
| | - John W Calvert
- Carlyle Fraser Heart Center of Emory University Hospital Midtown, Atlanta, Georgia
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Lisandra E de Castro Brás
- Department of Physiology, The Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Kristine Y DeLeon-Pennell
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
- Research Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
| | - Dominic P Del Re
- Department of Cell Biology and Molecular Medicine, Cardiovascular Research Institute, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Nikolaos G Frangogiannis
- Division of Cardiology, Department of Medicine, The Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, New York
| | - Stefan Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Richard J Gumina
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ganesh V Halade
- Division of Cardiovascular Sciences, Department of Medicine, University of South Florida, Tampa, Florida
| | - Steven P Jones
- Department of Medicine, Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky
| | - Rebecca H Ritchie
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University (Parkville Campus), Victoria, Australia
| | - Francis G Spinale
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the Columbia Veteran Affairs Medical Center, Columbia, South Carolina
| | - Edward B Thorp
- Department of Pathology and Feinberg Cardiovascular and Renal Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Crystal M Ripplinger
- Department of Pharmacology, University of California Davis School of Medicine, Davis, California
| | - Zamaneh Kassiri
- Department of Physiology, Cardiovascular Research Center, University of Alberta, Edmonton, Alberta, Canada
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Huded CP, Dalton JE, Kumar A, Krieger NI, Kassis N, Phelan M, Kravitz K, Reed GW, Krishnaswamy A, Kapadia SR, Khot U. Relationship of Neighborhood Deprivation and Outcomes of a Comprehensive ST Elevation Myocardial Infarction Protocol. J Am Heart Assoc 2021; 10:e024540. [PMID: 34779652 PMCID: PMC9075260 DOI: 10.1161/jaha.121.024540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background We evaluated whether a comprehensive ST‐segment–elevation myocardial infarction protocol (CSP) focusing on guideline‐directed medical therapy, transradial percutaneous coronary intervention, and rapid door‐to‐balloon time improves process and outcome metrics in patients with moderate or high socioeconomic deprivation. Methods and Results A total of 1761 patients with ST‐segment–elevation myocardial infarction treated with percutaneous coronary intervention at a single hospital before (January 1, 2011–July 14, 2014) and after (July 15, 2014– July 15, 2019) CSP implementation were included in an observational cohort study. Neighborhood deprivation was assessed by the Area Deprivation Index and was categorized as low (≤50th percentile; 29.0%), moderate (51st –90th percentile; 40.8%), and high (>90th percentile; 30.2%). The primary process outcome was door‐to‐balloon time. Achievement of guideline‐recommend door‐to‐balloon time goals improved in all deprivation groups after CSP implementation (low, 67.8% before CSP versus 88.5% after CSP; moderate, 50.7% before CSP versus 77.6% after CSP; high, 65.5% before CSP versus 85.6% after CSP; all P<0.001). Median door‐to‐balloon time among emergency department/in‐hospital patients was significantly noninferior in higher versus lower deprivation groups after CSP (noninferiority limit=5 minutes; Pnoninferiority high versus moderate = 0.002, high versus low <0.001, moderate versus low = 0.02). In‐hospital mortality, the primary clinical outcome, was significantly lower after CSP in patients with moderate/high deprivation in unadjusted (before CSP 7.0% versus after CSP 3.1%; odds ratio [OR], 0.42 [95% CI, 0.25–0.72]; P=0.002) and risk‐adjusted (OR, 0.42 [95% CI, 0.23–0.77]; P=0.005) models. Conclusions A CSP was associated with improved ST‐segment–elevation myocardial infarction care across all deprivation groups and reduced mortality in those from moderate or high deprivation neighborhoods. Standardized initiatives to reduce care variability may mitigate social determinants of health in time‐sensitive conditions such as ST‐segment–elevation myocardial infarction.
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Affiliation(s)
- Chetan P Huded
- Department of Cardiology Saint Luke's Mid-America Heart Institute Kansas City MO
| | - Jarrod E Dalton
- Department of Quantitative Health Sciences Lerner Research Institute Cleveland Clinic Cleveland OH
| | - Anirudh Kumar
- Department of Cardiovascular Medicine Thoracic Institute Cleveland Clinic Heart, Vascular Cleveland OH.,Center for Healthcare Delivery Innovation Thoracic Institute Cleveland Clinic Heart, Vascular Cleveland OH
| | - Nikolas I Krieger
- Department of Quantitative Health Sciences Lerner Research Institute Cleveland Clinic Cleveland OH
| | - Nicholas Kassis
- Department of Cardiovascular Medicine Thoracic Institute Cleveland Clinic Heart, Vascular Cleveland OH.,Center for Healthcare Delivery Innovation Thoracic Institute Cleveland Clinic Heart, Vascular Cleveland OH
| | - Michael Phelan
- Department of Emergency Medicine Emergency Services Institute Cleveland Clinic Cleveland OH
| | - Kathleen Kravitz
- Department of Cardiovascular Medicine Thoracic Institute Cleveland Clinic Heart, Vascular Cleveland OH
| | - Grant W Reed
- Department of Cardiovascular Medicine Thoracic Institute Cleveland Clinic Heart, Vascular Cleveland OH
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine Thoracic Institute Cleveland Clinic Heart, Vascular Cleveland OH
| | - Samir R Kapadia
- Department of Cardiovascular Medicine Thoracic Institute Cleveland Clinic Heart, Vascular Cleveland OH
| | - Umesh Khot
- Department of Cardiovascular Medicine Thoracic Institute Cleveland Clinic Heart, Vascular Cleveland OH.,Center for Healthcare Delivery Innovation Thoracic Institute Cleveland Clinic Heart, Vascular Cleveland OH
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44
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Pacheco C, Mullen KA, Coutinho T, Jaffer S, Parry M, Van Spall HG, Clavel MA, Edwards JD, Sedlak T, Norris CM, Dhukai A, Grewal J, Mulvagh SL. THE CANADIAN WOMEN’S HEART HEALTH ALLIANCE ATLAS ON THE EPIDEMIOLOGY, DIAGNOSIS, AND MANAGEMENT OF CARDIOVASCULAR DISEASE IN WOMEN -- CHAPTER 5: SEX- AND GENDER-UNIQUE MANIFESTATIONS OF CARDIOVASCULAR DISEASE. CJC Open 2021; 4:243-262. [PMID: 35386135 PMCID: PMC8978072 DOI: 10.1016/j.cjco.2021.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/17/2021] [Indexed: 12/15/2022] Open
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45
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Hyland PM, Xu J, Shen C, Markson LJ, Manning WJ, Strom JB. Race, sex and age disparities in echocardiography among Medicare beneficiaries in an integrated healthcare system. Heart 2021; 108:956-963. [PMID: 34615667 DOI: 10.1136/heartjnl-2021-319951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/08/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To identify potential race, sex and age disparities in performance of transthoracic echocardiography (TTE) over several decades. METHODS TTE reports from five academic and community sites within a single integrated healthcare system were linked to 100% Medicare fee-for-service claims from 1 January 2005 to 31 December 2017. Multivariable Poisson regression was used to estimate adjusted rates of TTE utilisation after the index TTE according to baseline age, sex, race and comorbidities among individuals with ≥2 TTEs. Non-white race was defined as black, Asian, North American Native, Hispanic or other categories using Medicare-assigned race categories. RESULTS A total of 15 870 individuals (50.1% female, mean 72.2±12.7 years) underwent a total of 63 535 TTEs (range 2-55/person) over a median (IQR) follow-up time of 4.9 (2.4-8.5) years. After the index TTE, the median TTE use was 0.72 TTEs/person/year (IQR 0.43-1.33; range 0.12-26.76). TTE use was lower in older individuals (relative risk (RR) for 10-year increase in age, 0.91, 95% CI 0.89 to 0.92, p<0.001), women (RR 0.97, 95% CI 0.95 to 0.99, p<0.001) and non-white individuals (RR 0.95, 95% CI 0.93 to 0.97, p<0.001). Black women in particular had the lowest relative use of TTE (RR 0.92, 95% CI 0.88 to 0.95, p<0.001). The only clinical conditions associated with increased TTE use after multivariable adjustment were heart failure (RR 1.04, 95% CI 1.00 to 1.08, p=0.04) and chronic obstructive pulmonary disease (RR 1.05, 95% CI 1.00 to 1.10, p=0.04). CONCLUSIONS Among Medicare beneficiaries with multiple TTEs in a single large healthcare system, the median TTE use after the index TTE was 0.72 TTEs/person/year, although this varied widely. Adjusted for comorbidities, female sex, non-white race and advancing age were associated with decreased TTE utilisation.
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Affiliation(s)
- Patrick M Hyland
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jiaman Xu
- Harvard Medical School, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts, USA
| | - Changyu Shen
- Harvard Medical School, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts, USA
| | - Lawrence J Markson
- Harvard Medical School, Boston, Massachusetts, USA.,Information Systems, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Warren J Manning
- Harvard Medical School, Boston, Massachusetts, USA.,Departments of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jordan B Strom
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA .,Harvard Medical School, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts, USA
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46
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Ya'qoub L, Lemor A, Dabbagh M, O'Neill W, Khandelwal A, Martinez SC, Ibrahim NE, Grines C, Voeltz M, Basir MB. Racial, Ethnic, and Sex Disparities in Patients With STEMI and Cardiogenic Shock. JACC Cardiovasc Interv 2021; 14:653-660. [PMID: 33736772 DOI: 10.1016/j.jcin.2021.01.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/18/2020] [Accepted: 01/05/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the combined impact of race, ethnicity, and sex on in-hospital outcomes using data from the National Inpatient Sample. BACKGROUND Cardiogenic shock (CS) is a major cause of mortality following ST-segment elevation myocardial infarction (STEMI). Early revascularization reduces mortality in such patients. Mechanical circulatory support (MCS) devices are increasingly used to hemodynamically support patients during revascularization. Little is known about racial, ethnic, and sex disparities in patients with STEMI and CS. METHODS The National Inpatient Sample was queried from January 2006 to September 2015 for hospitalizations with STEMI and CS. The associations between sex, race, ethnicity, and outcomes were examined using complex-samples multivariate logistic or generalized linear model regressions. RESULTS Of 159,339 patients with STEMI and CS, 57,839 (36.3%) were women. In-hospital mortality was higher for all women (range 40% to 45.4%) compared with men (range 30.4% to 34.7%). Women (adjusted odds ratio [aOR]: 1.11; 95% confidence interval [CI]: 1.06 to 1.16; p < 0.001) as well as Black (aOR: 1.18; 95% CI: 1.04 to 1.34; p = 0.011) and Hispanic (aOR: 1.19; 95% CI: 1.06 to 1.33; p = 0.003) men had higher odds of in-hospital mortality compared with White men, with Hispanic women having the highest odds of in-hospital mortality (aOR: 1.46; 95% CI: 1.26 to 1.70; p < 0.001). Women were older (age: 69.8 years vs. 63.2 years), had more comorbidities, and underwent fewer invasive cardiac procedures, including revascularization, right heart catheterization, and MCS. CONCLUSIONS There are significant racial, ethnic, and sex differences in procedural utilization and clinical outcomes in patients with STEMI and CS. Women are less likely to undergo invasive cardiac procedures, including revascularization and MCS. Women as well as Black and Hispanic patients have a higher likelihood of death compared with White men.
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Affiliation(s)
- Lina Ya'qoub
- Department of Cardiology, Ochsner-Louisiana State University, Shreveport, Louisiana, USA.
| | - Alejandro Lemor
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohammed Dabbagh
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - William O'Neill
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Akshay Khandelwal
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sara C Martinez
- Providence Medical Group Cardiology Associates, St. Peter Hospital, Olympia, Washington, USA
| | - Nasrien E Ibrahim
- Divisionof Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Cindy Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
| | - Michelle Voeltz
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
| | - Mir B Basir
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
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47
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Dennis JA, Zhang Y, Zhang F, Kopel J, Abohelwa M, Nugent K. Comparison of 30-day mortality and readmission frequency in women versus men with acute myocardial infarction. Proc AMIA Symp 2021; 34:668-672. [PMID: 34732982 PMCID: PMC8545157 DOI: 10.1080/08998280.2021.1945364] [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: 04/30/2021] [Revised: 06/07/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
This study aimed to assess gender differences in hospitalization incidence, 30-day mortality, and 30-day readmission rates for acute myocardial infarction (AMI) in a Southwestern US medical center. Hospital billing records for AMI admissions were compiled from January 2013 to June 2019, resulting in a sample size of 2394. Billing data included gender, age, principal procedure, insurance status, principal diagnosis, and race/ethnicity. Multivariate logistic regression was used to estimate gender differences in mortality after adjustment for the aforementioned factors. Men were hospitalized for AMI over twice as frequently, yet women had higher AMI mortality than men (9.3% vs. 6.1%, P < 0.01). Female AMI patients were older on average and slightly less likely to undergo percutaneous transluminal coronary angioplasty than men. Thirty-day readmission rates did not differ by gender. In absolute terms, AMI hospitalizations and deaths are larger in number in men, but AMI hospitalizations more frequently end in death in women.
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Affiliation(s)
- Jeff A. Dennis
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Yan Zhang
- Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth, Texas
| | - Fangyuan Zhang
- Department of Mathematics and Statistics, Texas Tech University, Lubbock, Texas
| | - Jonathan Kopel
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Mostafa Abohelwa
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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48
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Babiolakis CS, Sharma S, Sayed N, Abunassar JG, Haseeb S, Abuzeid W. The effect of sex on door-to-balloon time in patients presenting with ST-elevation myocardial infarction and referred for primary percutaneous coronary intervention: A systematic review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:120-127. [PMID: 34334335 DOI: 10.1016/j.carrev.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/19/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Abstract
Timely reperfusion using primary percutaneous coronary intervention (pPCI) is the cornerstone of acute ST-elevation myocardial infarction (STEMI) management. We conducted a systematic review to examine the effect of sex on door-to-balloon (D2B) time and symptom-to-balloon (S2B) time. We observed longer D2B times and S2B times in female patients presenting with STEMI and referred for pPCI when compared to male patients. Future work is required to try and elucidate and mitigate sex-based front-line treatment delays for female STEMI patients.
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Affiliation(s)
- Corinne S Babiolakis
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Shubham Sharma
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Nawid Sayed
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Joseph G Abunassar
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Sohaib Haseeb
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia.
| | - Wael Abuzeid
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
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49
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Stehli J, Dinh D, Dagan M, Duffy SJ, Brennan A, Smith K, Andrew E, Nehme Z, Reid CM, Lefkovits J, Stub D, Zaman S. Sex Differences in Prehospital Delays in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention. J Am Heart Assoc 2021; 10:e019938. [PMID: 34155902 PMCID: PMC8403281 DOI: 10.1161/jaha.120.019938] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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 Women with ST‐segment–elevation myocardial infarction experience delays in reperfusion compared with men with little data on each time component from symptom onset to reperfusion. This study analyzed sex discrepancies in patient delays, prehospital system delays, and hospital delays. Methods and Results Consecutive patients with ST‐segment–elevation myocardial infarction treated with percutaneous coronary intervention across 30 hospitals in the Victorian Cardiac Outcomes Registry (2013–2018) were analyzed. Data from the Ambulance Victoria Data warehouse were used to perform linkage to the Victorian Cardiac Outcomes Registry for all patients transported via emergency medical services (EMS). The primary end point was EMS call‐to‐door time (prehospital system delay). Secondary end points included symptom‐to‐EMS call time (patient delay), door‐to‐device time (hospital delay), 30‐day mortality, major adverse cardiovascular events, and major bleeding. End points were analyzed according to sex and adjusted for age, comorbidities, cardiogenic shock, cardiac arrest, and symptom onset time. A total of 6330 (21% women) patients with ST‐segment–elevation myocardial infarction were transported by EMS. Compared with men, women had longer adjusted geometric mean symptom‐to‐EMS call times (47.0 versus 44.0 minutes; P<0.001), EMS call‐to‐door times (58.1 versus 55.7 minutes; P<0.001), and door‐to‐device times (58.5 versus 54.9 minutes; P=0.006). Compared with men, women had higher 30‐day mortality (odds ratio [OR], 1.38; 95% CI, 1.06–1.79; P=0.02) and major bleeding (OR, 1.54; 95% CI, 1.08–2.20; P=0.02). Conclusions Female patients with ST‐segment–elevation myocardial infarction experienced excess delays in patient delays, prehospital system delays, and hospital delays, even after adjustment for confounders. Prehospital system and hospital delays resulted in an adjusted excess delay of 10 minutes compared with men.
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Affiliation(s)
- Julia Stehli
- School of Clinical Sciences at Monash Health Monash Cardiovascular Research Centre Monash University Melbourne Australia
| | - Diem Dinh
- Centre of Cardiovascular Research and Education in Therapeutics School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Misha Dagan
- Department of General Medicine The Alfred Hospital Melbourne Australia
| | - Stephen J Duffy
- Centre of Cardiovascular Research and Education in Therapeutics School of Public Health and Preventive Medicine Monash University Melbourne Australia.,Department of Cardiology The Alfred Hospital Melbourne Australia.,Baker Heart and Diabetes Institute Melbourne Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Karen Smith
- Centre for Research and Evaluation Ambulance Victoria Melbourne Australia.,Department of Epidemiology and Preventive Medicine Monash University Melbourne Australia
| | - Emily Andrew
- Centre for Research and Evaluation Ambulance Victoria Melbourne Australia.,Department of Epidemiology and Preventive Medicine Monash University Melbourne Australia
| | - Ziad Nehme
- Centre for Research and Evaluation Ambulance Victoria Melbourne Australia.,Department of Epidemiology and Preventive Medicine Monash University Melbourne Australia
| | - Christopher M Reid
- Centre for Research and Evaluation Ambulance Victoria Melbourne Australia.,School of Public Health Curtin University Perth Australia
| | - Jeffrey Lefkovits
- Centre of Cardiovascular Research and Education in Therapeutics School of Public Health and Preventive Medicine Monash University Melbourne Australia.,Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Dion Stub
- Centre of Cardiovascular Research and Education in Therapeutics School of Public Health and Preventive Medicine Monash University Melbourne Australia.,Department of Cardiology The Alfred Hospital Melbourne Australia.,Centre for Research and Evaluation Ambulance Victoria Melbourne Australia.,Baker Heart and Diabetes Institute Melbourne Australia
| | - Sarah Zaman
- School of Clinical Sciences at Monash Health Monash Cardiovascular Research Centre Monash University Melbourne Australia.,Department of Cardiology Westmead Hospital Sydney Australia.,Westmead Applied Research Centre University of Sydney Australia
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50
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Vogel B, Acevedo M, Appelman Y, Bairey Merz CN, Chieffo A, Figtree GA, Guerrero M, Kunadian V, Lam CSP, Maas AHEM, Mihailidou AS, Olszanecka A, Poole JE, Saldarriaga C, Saw J, Zühlke L, Mehran R. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet 2021; 397:2385-2438. [PMID: 34010613 DOI: 10.1016/s0140-6736(21)00684-x] [Citation(s) in RCA: 454] [Impact Index Per Article: 151.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease is the leading cause of death in women. Decades of grassroots campaigns have helped to raise awareness about the impact of cardiovascular disease in women, and positive changes affecting women and their health have gained momentum. Despite these efforts, there has been stagnation in the overall reduction of cardiovascular disease burden for women in the past decade. Cardiovascular disease in women remains understudied, under-recognised, underdiagnosed, and undertreated. This Commission summarises existing evidence and identifies knowledge gaps in research, prevention, treatment, and access to care for women. Recommendations from an international team of experts and leaders in the field have been generated with a clear focus to reduce the global burden of cardiovascular disease in women by 2030. This Commission represents the first effort of its kind to connect stakeholders, to ignite global awareness of sex-related and gender-related disparities in cardiovascular disease, and to provide a springboard for future research.
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Affiliation(s)
- Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monica Acevedo
- Divisón de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yolande Appelman
- Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gemma A Figtree
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundations Trust, Newcastle Upon Tyne, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore; Cardiovascular Sciences Academic Clinical Programme, Duke-National University of Singapore, Singapore
| | - Angela H E M Maas
- Department of Women's Cardiac Health, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anastasia S Mihailidou
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia; Cardiovascular and Hormonal Research Laboratory, Kolling Institute, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Agnieszka Olszanecka
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jeanne E Poole
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Clara Saldarriaga
- Department of Cardiology and Heart Failure Clinic, Clinica CardioVID, University of Antioquia, Medellín, Colombia
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Liesl Zühlke
- Departments of Paediatrics and Medicine, Divisions of Paediatric and Adult Cardiology, Red Cross Children's and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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