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Itoh T. Just Because the Acute Myocardial Infarction Patient Is Simply Elderly, or Is There Something Else? - We Need to Acknowledge Sex Differences. Circ J 2024; 88:1208-1210. [PMID: 37952971 DOI: 10.1253/circj.cj-23-0755] [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: 11/14/2023]
Affiliation(s)
- Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
- Division of Community Medicine, Department of Medical Education, Iwate Medical University
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2
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Elbarbary M, Shalaby HK, Elshokafy SM, Khalil MA. Gender differences in presentation, management, and outcomes among Egyptian patients with acute coronary syndrome: a single-centre registry. BMC Cardiovasc Disord 2024; 24:364. [PMID: 39014340 PMCID: PMC11251322 DOI: 10.1186/s12872-024-03996-8] [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: 03/07/2024] [Accepted: 06/20/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Despite a significant rise in cardiovascular disease (CVD)-related mortality in low- and middle-income countries (LMICs), data are scarce regarding the quality of care provided, particularly for women. METHODS This is a prospective observational, cross-sectional study. Acute coronary syndrome (ACS) patients presented to the Cardiology Department at Tanta University, Egypt, between September 1, 2023, and December 31, 2023, were enrolled. The study assessed gender disparities by comparing men and women regarding presentation, management, and major adverse cardiovascular events (MACE) occurrence during hospitalization and 30 days after discharge. RESULTS A total of 400 ACS patients were included, with 29.5% being women. Women were comparatively older (59 ± 9 years vs. 55 ± 13 years), with a significantly higher prevalence of hypertension (70.3% vs. 47.5%) and diabetes (55% vs. 36.8%). Non-ST-segment elevation myocardial infarction (Non-STEMI) was more common in women (35.29% vs. 21%). Dyspnea was expressed by 34.4% of women (vs. 21.35% of men). Women were hospitalized later (9.29 h vs. 6.74 h). In-hospital outcomes were poorer for women with worse NYHA classes III and IV. Additionally, the odds ratio (OR) for in-hospital cardiac mortality was 0.303 (95% CI 0.103-0.893) for women compared to men. However, a one-month follow-up for MACE post-hospital discharge did not indicate significant gender differences. CONCLUSIONS The current study suggests that women with ACS in Egypt exhibit a higher risk profile for CVD compared to men and tend to present later with atypical symptoms. Women additionally experience poorer in-hospital MACE and higher cardiac mortality. Therefore, increasing awareness about ACS syndrome and eliminating obstacles that delay hospital admission are imperative.
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Affiliation(s)
- Mohammed Elbarbary
- Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Hazem K Shalaby
- Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Salma M Elshokafy
- Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed A Khalil
- Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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3
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Sun TY, Hardin J, Nieva HR, Natarajan K, Cheng RF, Ryan P, Elhadad N. Large-scale characterization of gender differences in diagnosis prevalence and time to diagnosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.12.23296976. [PMID: 37873224 PMCID: PMC10592987 DOI: 10.1101/2023.10.12.23296976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
We carry out an analysis of gender differences in patterns of disease diagnosis across four large observational health datasets and find that women are routinely older when first assigned most diagnoses. Among 112 acute and chronic diseases, women experience longer lengths of time between symptom onset and disease diagnosis than men for most diseases regardless of metric used, even when only symptoms common to both genders are considered. These findings are consistent for patients with private as well as government insurance. Our analysis highlights systematic gender differences in patterns of disease diagnosis and suggests that symptoms of disease are measured or weighed differently for women and men. Data and code leverage the open-source common data model and analytic code and results are publicly available.
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Affiliation(s)
- Tony Yue Sun
- Department of Biomedical Informatics, Columbia University; New York City, USA
| | - Jill Hardin
- Janssen Research and Development; Titusville, USA
| | - Harry Reyes Nieva
- Department of Biomedical Informatics, Columbia University; New York City, USA
- Department of Medicine, Harvard Medical School; Boston, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University; New York City, USA
| | - Ru-fong Cheng
- Gender Equality Division, Bill and Melinda Gates Foundation; Seattle, USA
| | - Patrick Ryan
- Janssen Research and Development; Titusville, USA
| | - Noémie Elhadad
- Department of Biomedical Informatics, Columbia University; New York City, USA
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4
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Mohseni-Alsalhi Z, Vesseur MAM, Wilmes N, Laven SAJS, Meijs DAM, van Luik EM, Vaes EWP, Dikovec CJR, Wiesenberg J, Almutairi MF, Janssen EBNJ, de Haas S, Spaanderman MEA, Ghossein-Doha C. The Representation of Females in Studies on Antihypertensive Medication over the Years: A Scoping Review. Biomedicines 2023; 11:1435. [PMID: 37239106 PMCID: PMC10216827 DOI: 10.3390/biomedicines11051435] [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: 04/05/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The leading global risk factor for cardiovascular-disease-related morbidity and mortality is hypertension. In the past decade, attention has been paid to increase females' representation. The aim of this study is to investigate whether the representation of females and presentation of sex-stratified data in studies investigating the effect of antihypertensive drugs has increased over the past decades. METHODS After systematically searching PubMed and Embase for studies evaluating the effect of the five major antihypertensive medication groups until May 2020, a scoping review was performed. The primary outcome was the proportion of included females. The secondary outcome was whether sex stratification was performed. RESULTS The search resulted in 73,867 articles. After the selection progress, 2046 studies were included for further analysis. These studies included 1,348,172 adults with a mean percentage of females participating of 38.1%. Female participation in antihypertensive studies showed an increase each year by 0.2% (95% CI 0.36-0.52), p < 0.01). Only 75 (3.7%) studies performed sex stratification, and this was the highest between 2011 and 2020 (7.2%). CONCLUSION Female participation showed a slight increase in the past decade but is still underrepresented compared to males. As data are infrequently sex-stratified, more attention is needed to possible sex-related differences in treatment effects to different antihypertensive compounds.
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Affiliation(s)
- Zenab Mohseni-Alsalhi
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Maud A. M. Vesseur
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Nick Wilmes
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Sophie A. J. S. Laven
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Daniek A. M. Meijs
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center (MUMC+), Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Eveline M. van Luik
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Esmée W. P. Vaes
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Cédric J. R. Dikovec
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Jan Wiesenberg
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Mohamad F. Almutairi
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Emma B. N. J. Janssen
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
| | - Sander de Haas
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
| | - Marc E. A. Spaanderman
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Chahinda Ghossein-Doha
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
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Weininger D, Cordova JP, Wilson E, Eslava DJ, Alviar CL, Korniyenko A, Bavishi CP, Hong MK, Chorzempa A, Fox J, Tamis-Holland JE. Delays to Hospital Presentation in Women and Men with ST-Segment Elevation Myocardial Infarction: A Multi-Center Analysis of Patients Hospitalized in New York City. Ther Clin Risk Manag 2022; 18:1-9. [PMID: 35018099 PMCID: PMC8742618 DOI: 10.2147/tcrm.s335219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/23/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Previous studies have shown longer delays from symptom onset to hospital presentation (S2P time) in women than men with acute myocardial infarction. The aim of this study is to understand the reasons for delays in seeking care among women and men presenting with an ST-Segment Elevation Myocardial Infarction (STEMI) through a detailed assessment of the thoughts, perceptions and patterns of behavior. Patients/Methods and Results A total of 218 patients with STEMI treated with primary angioplasty at four New York City Hospitals were interviewed (24% female; Women: 68.7 ± 13.1 years and men: 60.7 ± 13.8 years) between January 2009 and August 2012. A significantly larger percentage of women than men had no chest pain (62% vs 36%, p<0.01). Compared to men, a smaller proportion of women thought they were having a myocardial infarction (15% vs 34%, p=0.01). A larger proportion of women than men had S2P time >90 minutes (72% of women vs 54% of men, p= 0.03). Women were more likely than men to hesitate before seeking help, and more women than men hesitated because they did not think they were having an AMI (91% vs 83%, p=0.04). Multivariate regression analysis showed that female sex (Odds Ratio: 2.46, 95% CI 1.10–5.60 P=0.03), subjective opinion it was not an AMI (Odds Ratio 2.44, 95% CI 1.20–5.0, P=0.01) and level of education less than high school (Odds ratio 7.21 95% CI 1.59–32.75 P=0.01) were independent predictors for S2P >90 minutes. Conclusion Women with STEMI have longer pre-hospital delays than men, which are associated with a higher prevalence of atypical symptoms and a lack of belief in women that they are having an AMI. Greater focus should be made on educating women (and men) regarding the symptoms of STEMI, and the importance of a timely response to these symptoms.
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Affiliation(s)
| | | | | | | | - Carlos L Alviar
- NYU Medical Center and Bellevue Hospital Center, New York, NY, USA
| | | | | | - Mun K Hong
- Bassett Healthcare Network, Cooperstown, NY, USA
| | | | - John Fox
- Mount Sinai Beth Israel Hospital, New York, NY, USA
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Kimura T, Akahori H, Asakura M, Nakao K, Ozaki Y, Kimura K, Ako J, Noguchi T, Suwa S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Saito Y, Hirohata A, Morita Y, Inoue T, Okamura A, Mano T, Wake M, Tanabe K, Shibata Y, Owa M, Tsujita K, Funayama H, Kokubu N, Kozuma K, Uemura S, Toubara T, Saku K, Oshima S, Nishimura K, Miyamoto Y, Ogawa H, Ishihara M. Impact of Age on Gender Difference in Long-term Outcome of Patients With Acute Myocardial Infarction (from J-MINUET). Am J Cardiol 2021; 142:5-13. [PMID: 33279486 DOI: 10.1016/j.amjcard.2020.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Although gender difference in long-term outcomes after acute myocardial infarction have been shown previously, impact of age on gender difference is still controversial. This study focused on the association between age and gender difference in long-term outcome. We analyzed data from 3,283 consecutive patients who were included in a prospective, nationwide, multicenter registry (Japan Registry of Acute Myocardial Infarction Diagnosed by Universal Definition) from 2012 to 2014. The primary end point was the major adverse cardiovascular event (MACE), which was defined as a composite of death, myocardial infarction, stroke, heart failure, and revascularization for unstable angina during 3 years. Patients were divided into 4 strata according to age: those with age <65 years (group 1: n = 1161), 65 to 74 years (group 2: n = 954), 75 to 84 years (group 3: n = 866) and 84< years (group 4: n = 302). Although the crude incidence of 3-year MACE was significantly higher in women than men (36.4% vs. 28.5%, p <0.001), there was not significant gender difference in each group (group 1, 19.6% vs 19.0%, p = 0.74; group 2, 33.1% vs 28.3%, p = 0.25; group 3, 38.9% vs 39.6%, p = 0.54; and group 4, 54.0% vs 56.8%, p = 0.24). In conclusion, although women had higher crude incidence of 3-year MACE than men, there was no gender difference in each group.
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7
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Arigo D, Brown MM, Pasko K, Ainsworth MC, Travers L, Gupta A, Downs DS, Smyth JM. Rationale and Design of the Women's Health And Daily Experiences Project: Protocol for an Ecological Momentary Assessment Study to Identify Real-Time Predictors of Midlife Women's Physical Activity. JMIR Res Protoc 2020; 9:e19044. [PMID: 33055065 PMCID: PMC7596655 DOI: 10.2196/19044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/14/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Midlife women are at an elevated risk for cardiovascular disease (CVD) and associated mortality. Those who have additional risk conditions such as obesity or hypertension report specific barriers to engaging in cardioprotective behaviors such as physical activity (PA). Considerable effort has been devoted to understanding PA determinants and designing interventions for midlife women, although with suboptimal success, as increasing PA could meaningfully attenuate CVD risk. An updated approach to understanding PA among midlife women could improve upon existing resources by focusing on novel psychosocial influences on PA in this population (ie, body satisfaction, social interactions, social comparisons, mood state) and within-person relations between these influences and PA in the natural environment. OBJECTIVE The overarching goal of Project WHADE (Women's Health And Daily Experiences) is to use an ecological momentary assessment (EMA) approach to capture ecologically valid relations between midlife women's psychosocial experiences and PA as they engage in their normal daily activities. The primary aim of the study is to identify within-person psychosocial predictors of variability in PA (ie, experiences associated with higher vs lower PA for a given individual). METHODS Midlife women (aged 40-60 years) with one or more additional risk markers for CVD (eg, hypertension) will be recruited from primary care clinics and the general community (target n=100). Eligible women will complete an initial survey and a face-to-face baseline session before engaging in a 10-day EMA protocol. Psychosocial experiences will be assessed using a brief self-report via a smartphone 5 times per day, and PA will be assessed throughout waking hours using a research-grade monitor. Participants will return for a brief exit interview at the end of 10 days. Multilevel models that address the nested structure of EMA data will be used to evaluate the study aims. RESULTS Recruitment and enrollment are ongoing, and a total of 75 women have completed the protocol to date. Data collection is expected to be completed in Fall 2020. CONCLUSIONS Project WHADE is designed to identify naturally occurring psychosocial experiences that predict short-term variability in midlife women's PA. As such, the results of this study should advance the current understanding of PA among midlife women by providing further insight into within-person psychosocial influences on PA in this group. In the future, this information could help inform the design of interventions for this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/19044.
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Affiliation(s)
- Danielle Arigo
- Department of Psychology, Rowan University, Glassboro, NJ, United States
- Department of Family Medicine, Rowan School of Osteopathic Medicine, Stratford, NJ, United States
| | - Megan M Brown
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | - Kristen Pasko
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | | | - Laura Travers
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | - Adarsh Gupta
- Department of Family Medicine, Rowan School of Osteopathic Medicine, Stratford, NJ, United States
| | - Danielle Symons Downs
- Departments of Kinesiology and Obstetrics & Gynecology, Pennsylvania State University, University Park, PA, United States
| | - Joshua M Smyth
- Departments of Biobehavioral Health and Medicine, Pennsylvania State University, University Park, PA, United States
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Birnbach B, Höpner J, Mikolajczyk R. Cardiac symptom attribution and knowledge of the symptoms of acute myocardial infarction: a systematic review. BMC Cardiovasc Disord 2020; 20:445. [PMID: 33054718 PMCID: PMC7557019 DOI: 10.1186/s12872-020-01714-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/24/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Since the knowledge of the symptoms of acute myocardial infarction (AMI) may reduce the decision time for patients to seek help in case of an AMI, we aimed to summarize evidence on the knowledge of the AMI symptoms and the symptom attribution in case of an acute coronary syndrome (ACS). METHODS Therefore, we systematically searched the databases PubMed, CINAHL, Embase, and Cochrane Library for relevant studies published between January 1, 2008 and 2019 (last search August 1, 2019). RESULTS A total of 86 studies were included, with a composite sample size of 354,497 participants. The weighted mean of the knowledge scores for the symptoms of AMI of 14,420 participants from the general population, was 42.1% (when maximum score was considered 100%) and 69.5% for 7642 cardiac patients. There was a substantially better level of knowledge for six symptoms ('chest pain or discomfort', 'shortness of breath', 'pain or discomfort in arms or shoulders', 'feeling weak, lightheaded, or faint', 'pain or discomfort in the jaw, neck, or back', and 'sweating') (49.8-88.5%) compared to the four less obvious/atypical symptoms 'stomach or abdominal discomfort', 'nausea or vomiting', 'headache', and 'feeling of anxiety' (8.7-36.7%). Only 45.1% of 14,843 patients, who experienced ACS, have correctly attributed their symptoms to a cardiac cause. CONCLUSION In conclusion, we found a moderate to good knowledge of "classic" and insufficient knowledge of less obvious symptoms of AMI. This might suggest that increasing knowledge about less obvious symptoms of AMI could be beneficial. It appears also important to address cardiac attribution of symptoms.
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Affiliation(s)
- Benedikt Birnbach
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jens Höpner
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany.
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Tisminetzky M, Gurwitz JH, Miozzo R, Nunes A, Gore JM, Lessard D, Yarzebski J, Granillo E, Goldberg RJ. Age Differences in the Chief Complaint Associated With a First Acute Myocardial Infarction and Patient's Care-Seeking Behavior. Am J Med 2020; 133:e501-e507. [PMID: 32199808 PMCID: PMC7483814 DOI: 10.1016/j.amjmed.2020.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study set out to describe age differences in patient's chief complaint related to a first myocardial infarction and how the "typicality" of patient's acute symptoms relates to extent of prehospital delay. METHODS The medical records of 2586 residents of central Massachusetts hospitalized at 11 greater Worcester medical centers with a first myocardial infarction on a biennial basis between 2001 and 2011 were reviewed. RESULTS The average age of the study population was 66.4 years, 39.6% were women, 40.2% were diagnosed with a ST-elevation myocardial infarction (STEMI), and 72.0 % presented with typical symptoms of myocardial infarction, namely acute chest pain or pressure. Patients were categorized into 5 age strata: >55 years (23%), 55-64 years (20%), 65-74 years (19%), 75-84 years (22%), and ≥85 years (16%). The lowest proportion (11%) of atypical symptoms of myocardial infarction was observed in patients <55 years, increasing to 17%, 28%, 40%, and 51% across the respective age groups. The most prevalent chief complaint reported at the time of hospitalization was chest pain, but the proportion of patients reporting this symptom decreased from the youngest (83%) to the oldest patient groups (45%). There was a slightly increased risk of prehospital delay across the different age groups (higher in the oldest old) in those who presented with atypical, rather than typical, symptoms of myocardial infarction. CONCLUSIONS The present results provide insights to the presenting chief complaint of patients hospitalized with a first myocardial infarction according to age and the relation of symptom presentation to patient's care-seeking behavior.
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Affiliation(s)
- Mayra Tisminetzky
- Meyers Primary Care Institute, Worcester, Mass; Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Mass; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass.
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, Worcester, Mass; Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Mass; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Ruben Miozzo
- Johns Hopkins Bloomberg School of Public Health Baltimore, Md
| | - Anthony Nunes
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Joel M Gore
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Jorge Yarzebski
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Edgard Granillo
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Robert J Goldberg
- Meyers Primary Care Institute, Worcester, Mass; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
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10
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van Oosterhout REM, de Boer AR, Maas AHEM, Rutten FH, Bots ML, Peters SAE. Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta-analysis. J Am Heart Assoc 2020; 9:e014733. [PMID: 32363989 PMCID: PMC7428564 DOI: 10.1161/jaha.119.014733] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/13/2020] [Indexed: 12/24/2022]
Abstract
Background Timely recognition of patients with acute coronary syndromes (ACS) is important for successful treatment. Previous research has suggested that women with ACS present with different symptoms compared with men. This review assessed the extent of sex differences in symptom presentation in patients with confirmed ACS. Methods and Results A systematic literature search was conducted in PubMed, Embase, and Cochrane up to June 2019. Two reviewers independently screened title-abstracts and full-texts according to predefined inclusion and exclusion criteria. Methodological quality was assessed using the Newcastle-Ottawa Scale. Pooled odds ratios (OR) with 95% CI of a symptom being present were calculated using aggregated and cumulative meta-analyses as well as sex-specific pooled prevalences for each symptom. Twenty-seven studies were included. Compared with men, women with ACS had higher odds of presenting with pain between the shoulder blades (OR 2.15; 95% CI, 1.95-2.37), nausea or vomiting (OR 1.64; 95% CI, 1.48-1.82) and shortness of breath (OR 1.34; 95% CI, 1.21-1.48). Women had lower odds of presenting with chest pain (OR 0.70; 95% CI, 0.63-0.78) and diaphoresis (OR 0.84; 95% CI, 0.76-0.94). Both sexes presented most often with chest pain (pooled prevalences, men 79%; 95% CI, 72-85, pooled prevalences, women 74%; 95% CI, 72-85). Other symptoms also showed substantial overlap in prevalence. The presence of sex differences has been established since the early 2000s. Newer studies did not materially change cumulative findings. Conclusions Women with ACS do have different symptoms at presentation than men with ACS, but there is also considerable overlap. Since these differences have been shown for years, symptoms should no longer be labeled as "atypical" or "typical."
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Affiliation(s)
- Roos E. M. van Oosterhout
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Annemarijn R. de Boer
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
- Dutch Heart FoundationThe Haguethe Netherlands
| | - Angela H. E. M. Maas
- Department of CardiologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Frans H. Rutten
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Sanne A. E. Peters
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
- The George Institute for Global HealthUniversity of OxfordUnited Kingdom
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11
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Ohama A, Mizuguchi Y, Hashimoto S, Yamada T, Taniguchi N, Nakajima S, Hata T, Takahashi A. Impact of living alone on the care and outcomes of patients with ST-elevation myocardial infarction. J Cardiol 2019; 75:628-634. [PMID: 31866189 DOI: 10.1016/j.jjcc.2019.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/11/2019] [Accepted: 11/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to investigate the association between living alone at home and the care and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (pPCI). METHODS In total, 557 patients with STEMI underwent pPCI between January 2008 and September 2017. Among them, we included 208 patients who were transferred directly by emergency medical services from their home to the hospital. RESULTS Patients were classified into two groups, namely living alone (n = 45) and living with others (n = 163). There were no significant differences in age, sex, and cardiovascular risk factors between the two groups. The onset-to-door (OTD) and onset-to-balloon times were significantly shorter in patients living with others than in those living alone (106.4 vs. 190.8 min, p < 0.01 and 152.3 vs. 236.9 min; p < 0.01, respectively). The left ventricular ejection fraction after pPCI was significantly lower in patients living alone than in those living with others (48.7 % vs. 54.9 %, p < 0.01). Multivariate logistic regression analysis indicated that living alone and the incidence of congestive heart failure were independent predictors of a longer OTD time. CONCLUSIONS Patients living alone were less likely to arrive early at the hospital than those living with others. A greater understanding of the inter-relationships among living alone, access to acute cardiac care, and outcomes is essential.
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Affiliation(s)
- Ayumi Ohama
- Cardiovascular Department, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan
| | - Yukio Mizuguchi
- Cardiovascular Department, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan.
| | - Sho Hashimoto
- Cardiovascular Department, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan
| | - Takeshi Yamada
- Cardiovascular Department, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan
| | - Norimasa Taniguchi
- Cardiovascular Department, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan
| | - Shunsuke Nakajima
- Cardiovascular Department, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan
| | - Tetsuya Hata
- Cardiovascular Department, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan
| | - Akihiko Takahashi
- Cardiovascular Department, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan
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12
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Cachera D, Balen F, Charpentier S. Patients présentant un syndrome coronarien aigu avec sus-décalage du segment ST admis en structure d’urgence après régulation par un Centre 15. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : La cardiopathie ischémique est une des principales causes de mortalité en Europe. Cette mortalité importante est l’apanage particulier des syndromes coronariens avec élévation du segment ST (SCA ST+). Si la prise en charge préhospitalière de ces patients (de l’appel à la table de coronarographie) est sous la responsabilité des Samu, certains patients échappent à la filière malgré un appel au Centre 15. Notre objectif était de décrire ces patients porteurs d’un SCA ST+, admis en structure d’urgence (SU) après régulation par un Centre 15.
Méthode : Il s’agit d’une étude observationnelle de cohorte rétrospective incluant tous les patients admis en SU du CHU de Toulouse du 1er avril 2015 au 31 janvier 2017 avec un diagnostic final de SCA ST+.
Résultats : Sur les 139 patients qui ont été admis en SU pour SCA ST+, 96 (69 %) avaient contacté le Centre 15. Les dossiers de 89 patients ont été analysés. On retrouve une importante proportion de patientes de plus de 75 ans, qui représentent un quart de la population. Seulement 30 patients (34 %) présentaient une douleur typique.
Discussion : Notre étude retrouve un taux de douleurs atypiques et une proportion de femmes âgées plus importante que la littérature portant sur la description des patients porteurs de SCA ST+. Ces atypies de présentation peuvent expliquer la difficulté à réguler et orienter ces patients.
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13
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Madonna R, Balistreri CR, De Rosa S, Muscoli S, Selvaggio S, Selvaggio G, Ferdinandy P, De Caterina R. Impact of Sex Differences and Diabetes on Coronary Atherosclerosis and Ischemic Heart Disease. J Clin Med 2019; 8:jcm8010098. [PMID: 30654523 PMCID: PMC6351940 DOI: 10.3390/jcm8010098] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/30/2018] [Accepted: 01/11/2019] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular diseases (CVD) including coronary artery disease (CAD) and ischemic heart disease (IHD) are the main cause of mortality in industrialized countries. Although it is well known that there is a difference in the risk of these diseases in women and men, current therapy does not consider the sexual dimorphism; i.e., differences in anatomical structures and metabolism of tissues. Here, we discuss how genetic, epigenetic, hormonal, cellular or molecular factors may explain the different CVD risk, especially in high-risk groups such as women with diabetes. We analyze whether sex may modify the effects of diabetes at risk of CAD. Finally, we discuss current diagnostic techniques in the evaluation of CAD and IHD in diabetic women.
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Affiliation(s)
- Rosalinda Madonna
- Center of Aging Sciences and Translational Medicine-CESI-MeT, Institute of Cardiology, "G. d'Annunzio" University, Via dei Vestini 31, 66100 Chieti, Italy.
- Department of Internal Medicine, University of Texas Medical School in Houston, Houston, 77065 TX, USA.
| | - Carmela Rita Balistreri
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90134 Palermo, Italy.
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, University "Magna Græcia'' of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University of Rome, 00133 Rome, Italy.
| | - Stefano Selvaggio
- Geriatric Division, A.R.N.A.S. Ospedale "Garibaldi" Nesima, 95122 Catania, Italy.
| | | | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, 1085 Budapest, Hungary.
- Pharmahungary Group, 6722 Szeged, Hungary.
| | - Raffaele De Caterina
- Institute of Cardiology, University of Pisa, C/o Ospedale di Cisanello, Via Paradisa 2, 56124 Pisa, Italy.
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14
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Liakos M, Parikh PB. Gender Disparities in Presentation, Management, and Outcomes of Acute Myocardial Infarction. Curr Cardiol Rep 2018; 20:64. [DOI: 10.1007/s11886-018-1006-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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15
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Ladwig KH, Fang X, Wolf K, Hoschar S, Albarqouni L, Ronel J, Meinertz T, Spieler D, Laugwitz KL, Schunkert H. Comparison of Delay Times Between Symptom Onset of an Acute ST-elevation Myocardial Infarction and Hospital Arrival in Men and Women <65 Years Versus ≥65 Years of Age.: Findings From the Multicenter Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) Study. Am J Cardiol 2017; 120:2128-2134. [PMID: 29122276 DOI: 10.1016/j.amjcard.2017.09.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 12/23/2022]
Abstract
Early administration of reperfusion therapy in acute ST-elevation myocardial infarctions (STEMI) is crucial to reduce mortality. Although female sex and old age are key factors contributing to an inadequate long prehospital delay time, little is known whether women ≥65 years are a particular risk population. Hence, we studied the interaction of sex and age (<65 years or ≥65 years) and the contribution of chest pain to delay time during STEMI. Bedside interview data were collected in 619 STEMI patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Sex and age group stratification disclosed an excess delay risk for women ≥65 years, accounting for a 2.39 (95% confidence interval (CI) 1.39 to 4.10)-fold higher odds to delay longer than 2 hours compared with all other patient groups including younger women (p ≤0.002). Median delay time was 266 minutes in women ≥65 years and 148 minutes in younger women (p <0.001). Chest pain during STEMI had the lowest frequency both in women (81%) and men ≥65 years (83%) and the highest frequency (95%) in younger women. Experiencing non-chest pain was 2.32-fold (95% CI, 1.20 to 4.46, p <0.05) higher in women ≥65 years than in all other patients. Mediation analysis disclosed that the effect accounted for only 9% of the variance. Age specific educational strategies targeting women ≥65 years at risk are urgently needed. To tailor adequate strategies, more research is required to understand age- and sex driven barriers to timely identification of ischemic symptoms.
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Affiliation(s)
- Karl-Heinz Ladwig
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich, Germany.
| | - Xiaoyan Fang
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Kathrin Wolf
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Sophia Hoschar
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Loai Albarqouni
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Joram Ronel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Thomas Meinertz
- Department of Cardiology, University Heart Center Hamburg Eppendorf, Klinikum Stephansplatz Hamburg, Germany
| | - Derek Spieler
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich, Germany; Klinik und Poliklinik für Innere Medizin I: Kardiologie, Angiologie, Pneumologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Heribert Schunkert
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich, Germany; Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
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16
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Kim HS, Lee KS, Eun SJ, Choi SW, Kim DH, Park TH, Yun KH, Yang DH, Hwang SJ, Park KS, Kim RB. Gender Differences in Factors Related to Prehospital Delay in Patients with ST-Segment Elevation Myocardial Infarction. Yonsei Med J 2017; 58:710-719. [PMID: 28540982 PMCID: PMC5447100 DOI: 10.3349/ymj.2017.58.4.710] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/22/2017] [Accepted: 03/19/2017] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The aim of our study was to investigate gender differences in factors related to prehospital delay and identify whether the knowledge of acute myocardial infarction symptoms affects this delay in Korean patients with ST-elevation myocardial infarction (STEMI). MATERIALS AND METHODS A total of 350 patients (286 men, 64 women) with confirmed STEMI were interviewed to investigate socio-demographics, history of disease, symptom onset time, and factors that contributed to delayed decision time in seeking treatment and hospital arrival time from symptom onset. Factors associated with prehospital delay were examined separately by gender using univariate and multivariate analyses. RESULTS Female patients had higher proportions of ≥60-minute decision time and ≥120-minute arrival time compared to male patients (33.9% vs. 23.1%, 60.9% vs. 52.1%, respectively). However, the difference was not statistically significant (p=0.093 and 0.214, respectively). Previous cardiovascular disease (CVD) was associated with increased decision time in men, whereas, in women, lower educational status caused a greater delay in decision time. Factors associated with hospital arrival time excluding delayed decision time were referral from another hospital, previous CVD, and percutaneous coronary intervention in men, and referral from another hospital in women. CONCLUSION Gender differences exist in factors related to prehospital delay. Therefore, public education to reduce prehospital delay should be conducted according to gender with a focus on the pertinent factors.
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Affiliation(s)
- Hee Sook Kim
- Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Cheongju, Korea
- Department of Public Health Science, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Kun Sei Lee
- Department of Preventive Medicine, Konkuk University College of Medicine, Seoul, Korea
| | - Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Si Wan Choi
- Department of Internal Medicine, Chungnam National University Hospital and School of Medicine, Daejeon, Korea
| | - Dae Hyeok Kim
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Tae Ho Park
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Kyeong Ho Yun
- Department of Cardiovascular Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Dong Heon Yang
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seok Jae Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Hospital, Jinju, Korea
| | - Ki Soo Park
- Department of Preventive Medicine, Gyeongsang National University School of Medicine and Institute of Health Sciences, Jinju, Korea.
| | - Rock Bum Kim
- Center for Regional Cardiocerebrovascular Disease, Gyeongsang National University Hospital, Jinju, Korea.
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18
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Mayer DD, Rosenfeld A. Symptom Interpretation in Women With Diabetes and Myocardial Infarction. DIABETES EDUCATOR 2016; 32:918-24. [PMID: 17102159 DOI: 10.1177/0145721706294262] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to describe the role of diabetes in acute myocardial infarction (MI) symptom interpretation. Methods This is a secondary data analysis of a study of treatment-seeking delay in women with acute MI (N = 52). This study included a subsample of those with diabetes (n = 16). Women were interviewed while hospitalized with MI about their actions, thoughts, and feelings from symptom onset to entry into the health care system. Qualitative description was the method of analysis. Results Three major themes were identified in the qualitative data: diabetes and decision making, presenting symptoms, and symptom attribution. Not all women included information about diabetes in their story, but those who checked blood sugars generally found it to be elevated. Diabetes was a factor in decision making for more than half of the sample. Presenting symptoms were variable but raised hypotheses about shortness of breath as a common presenting symptom for women with diabetes and MI. The third theme, symptom attribution, revealed confusion as to the cause of symptoms. Conclusions These results provide insight into symptom interpretation in women with diabetes and MI. Women with diabetes should consider atypical symptoms such as shortness of breath, gastrointestinal symptoms, and fluctuating blood sugars as reasons to seek care. Education for women with diabetes should include action plans for how to recognize and respond to symptoms. More research on the influence of diabetes on MI symptom attribution and decision making is needed.
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Affiliation(s)
- Dorothy Dale Mayer
- The School of Nursing, Oregon Health & Science University, Portland (Ms Mayer, Dr Rosenfeld)
- College of Nursing, Montana State University, Missoula (Ms Mayer)
| | - Anne Rosenfeld
- The School of Nursing, Oregon Health & Science University, Portland (Ms Mayer, Dr Rosenfeld)
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19
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Nielsen CGA, Laut KG, Jensen LO, Ravkilde J, Terkelsen CJ, Kristensen SD. Patient delay in patients with ST-elevation myocardial infarction: Time patterns and predictors for a prolonged delay. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:583-591. [DOI: 10.1177/2048872616676570] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Kristina G Laut
- Department of Cardiology, Aarhus University Hospital, Denmark
| | | | - Jan Ravkilde
- Department of Cardiology, Aalborg University Hospital, Denmark
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20
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Ng VG, Lansky AJ. Controversies in the Treatment of Women with ST-Segment Elevation Myocardial Infarction. Interv Cardiol Clin 2016; 5:523-532. [PMID: 28582000 DOI: 10.1016/j.iccl.2016.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Coronary artery disease is the leading cause of death in women. Women with ST-segment elevation myocardial infarctions continue to have worse outcomes compared with men despite advancements in therapies. Furthermore, these differences are particularly pronounced among young men and women with myocardial infarctions. Differences in the pathophysiology of coronary artery plaque development, disease presentation, and recognition likely contribute to these outcome disparities. Despite having worse outcomes compared with men, women clearly benefit from aggressive treatment and the latest therapies. This article reviews the treatment options for ST-segment elevation myocardial infarctions and the outcomes of women after treatment with reperfusion therapies.
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Affiliation(s)
- Vivian G Ng
- Yale University School of Medicine, New Haven, CT, USA
| | - Alexandra J Lansky
- Heart and Vascular Clinical Research Program, Yale University School of Medicine, PO Box 208017, New Haven, CT 06520-8017, USA.
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DeVon HA, Ryan CJ, Zerwic JJ. Is the Medical Record an Accurate Reflection of Patients’ Symptoms During Acute Myocardial Infarction? West J Nurs Res 2016; 26:547-60. [PMID: 15359057 DOI: 10.1177/0193945904265452] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Documentation of symptoms in the medical record provides clinicians and researchers with valuable information about the patient’s experience during acute myocardial infarction (AMI). To examine the consistency between the patient’s reported symptoms and the medical record, 215 patients were interviewed and their medical records examined for information about their admission symptoms. Chest pain was the most frequently reported and recorded symptom, and there was good agreement between the patient’s report and the medical record. Although fatigue was the second most frequently reported symptom by patients, it was rarely documented in the medical record. Time of symptom onset was identified by 87.9% of patients but only documented in 60.5% of medical records. Clinicians may be recording those symptoms that support the AMI diagnosis and not those perceived to be less relevant. Findings suggest that the medical record is an inaccurate and inadequate source of information about patients’ actual experience of AMI symptoms.
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22
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Brink E, Karlson BW, Hallberg LRM. To Be Stricken with Acute Myocardial Infarction: A Grounded Theory Study of Symptom Perception and Care-seeking Behaviour. J Health Psychol 2016; 7:533-43. [DOI: 10.1177/1359105302007005673] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The process of perceiving symptoms of illness is complex, and many patients delay seeking care when symptoms of acute myocardial infarction occur. However delayed treatment can have great consequences for the prognosis. This article reports on a grounded theory study, the aim of which was to increase our understanding of the individual’s thoughts, feelings and actions at the onset of an acute heart attack. Qualitative analysis of semi-structured interviews revealed four different ways of perceiving the onset of symptoms: understanding, misinterpretation, amazement and disregard. The symptom perception categories were related to two core categories labelled health beliefs and acute reactions. Some persons were aware of risks for coronary heart disease and were ready to seek care immediately. Several others had illusions of invulnerability. Such illusions caused people to delay seeking care at the onset of symptoms of myocardial infarction.
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Affiliation(s)
- Eva Brink
- University of Göteborg & University of Trollhättan/Uddevalla, Sweden,
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Nilsson G, Mooe T, Söderström L, Samuelsson E. Pre-hospital delay in patients with first time myocardial infarction: an observational study in a northern Swedish population. BMC Cardiovasc Disord 2016; 16:93. [PMID: 27176816 PMCID: PMC4866271 DOI: 10.1186/s12872-016-0271-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 05/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background In myocardial infarction (MI), pre-hospital delay is associated with increased mortality and decreased possibility of revascularisation. We assessed pre-hospital delay in patients with first time MI in a northern Swedish population and identified determinants of a pre-hospital delay ≥ 2 h. Methods A total of 89 women (mean age 72.6 years) and 176 men (mean age 65.8 years) from a secondary prevention study were enrolled in an observational study after first time MI between November 2009 and March 2012. Total pre-hospital delay was defined as the time from the onset of symptoms suggestive of MI to admission to the hospital. Decision time was defined as the time from the onset of symptoms until the call to Emergency Medical Services (EMS). The time of symptom onset was assessed during the episode of care, and the time of call to EMS and admission to the hospital was based on recorded data. The first medical contact was determined from a mailed questionnaire. Determinants associated with pre-hospital delay ≥ 2 h were identified by multivariable logistic regression. Results The median total pre-hospital delay was 5.1 h (IQR 18.1), decision time 3.1 h (IQR 10.4), and transport time 1.2 h (IQR 1.0). The first medical contact was to primary care in 52.3 % of cases (22.3 % as a visit to a general practitioner and 30 % by telephone counselling), 37.3 % called the EMS, and 10.4 % self-referred to the hospital. Determinants of a pre-hospital delay ≥ 2 h were a visit to a general practitioner (OR 10.77, 95 % CI 2.39–48.59), call to primary care telephone counselling (OR 3.82, 95 % CI 1.68–8.68), chest pain as the predominant presenting symptom (OR 0.24, 95 % CI 0.08–0.77), and distance from the hospital (OR 1.03, 95 % CI 1.02–1.04). Among patients with primary care as the first medical contact, 67.0 % had a decision time ≥ 2 h, compared to 44.7 % of patients who called EMS or self-referred (p = 0.002). Conclusions Pre-hospital delay in patients with first time MI is prolonged considerably, particularly when primary care is the first medical contact. Actions to shorten decision time and increase the use of EMS are still necessary. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0271-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gunnar Nilsson
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development - Östersund, Umeå University, Umeå, Sweden.
| | - Thomas Mooe
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Söderström
- Unit of Research, Education and Development, Östersund Hospital, Region Jämtland Härjedalen, Östersund, Sweden
| | - Eva Samuelsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Predictors of Delay in Seeking Health Care among Myocardial Infarction Patients, Minia District, Egypt. Adv Prev Med 2015; 2015:342361. [PMID: 26779348 PMCID: PMC4686676 DOI: 10.1155/2015/342361] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/24/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives. To determine the barriers that hinder early seeking of medical care among Minia's myocardial infarction patients. Methods. The study was based on individual interviews with 207 men and women with a first confirmed myocardial infarction (MI), admitted to the coronary care units of hospitals in Minia city in the period from April 1 to August 30, 2014. Data was collected via structured questionnaire and patient medical charts. The delay was evaluated by assisting patients to triangulate time of symptom onset and time of professional health care by placing both times in context of daily activities that participants could easily remember. Results. The median (25th, 75th percentiles) delay time was 4 (2, 10) h. Only 32.8% of patients arrived within 2 hours of symptoms onset. Variables that significantly predicted prehospital delay time were patient's misinterpretation of nature of pain with OR 8.98 (95% CI) (3.97-20.32), illiteracy 7.98 (2.77-22.95), age (>65) 5.07 (1.57-16.29), and pain resistance behavior 4.61 (2.04-10.41). Conclusions. Interventions to decrease prehospital delay must focus on improving public awareness of acute myocardial infarction symptoms and increasing their knowledge on early treatment benefits.
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Attributing Responsibility: Hospitals Account for 20% of Variance in Acute Myocardial Infarction Patient Mortality. J Healthc Qual 2015; 38:52-61. [PMID: 26181099 DOI: 10.1097/jhq.0000000000000008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Applying a log-logistic accelerated failure time mixed effects model to a sample of 95,504 in-hospital patients with acute myocardial infarction (AMI) between 2005 and 2010 in the United States, we measured the relative contribution of hospitals (vs. patients) in explaining in-hospital AMI mortality. Before adjusting for age, race, income, 29 comorbidities of AMI patients, and primary payer, hospital characteristics explained 19.93% of the variance in AMI in-hospital mortality. After controlling for these, variance explained declined by 5.65%, to 14.28%. These findings have implications for policymakers in assessing hospitals' "responsibility" for AMI patient mortality, for hospitals in allocating resources toward improving AMI patient care, and for medical intermediaries in making liability judgments and payment allocations to hospitals.
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Lichtman JH, Leifheit-Limson EC, Watanabe E, Allen NB, Garavalia B, Garavalia LS, Spertus JA, Krumholz HM, Curry LA. Symptom recognition and healthcare experiences of young women with acute myocardial infarction. Circ Cardiovasc Qual Outcomes 2015; 8:S31-8. [PMID: 25714826 DOI: 10.1161/circoutcomes.114.001612] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prompt recognition of acute myocardial infarction symptoms and timely care-seeking behavior are critical to optimize acute medical therapies. Relatively little is known about the symptom presentation and care-seeking experiences of women aged ≤55 years with acute myocardial infarction, a group shown to have increased mortality risk as compared with similarly aged men. Understanding symptom recognition and experiences engaging the healthcare system may provide opportunities to reduce delays and improve acute care for this population. METHODS AND RESULTS We conducted a qualitative study using in-depth interviews with 30 women (aged 30-55 years) hospitalized with acute myocardial infarction to explore their experiences with prodromal symptoms and their decision-making process to seek medical care. Five themes characterized their experiences: (1) prodromal symptoms varied substantially in both nature and duration; (2) they inaccurately assessed personal risk of heart disease and commonly attributed symptoms to noncardiac causes; (3) competing and conflicting priorities influenced decisions about seeking acute care; (4) the healthcare system was not consistently responsive to them, resulting in delays in workup and diagnosis; and (5) they did not routinely access primary care, including preventive care for heart disease. CONCLUSIONS Participants did not accurately assess their cardiovascular risk, reported poor preventive health behaviors, and delayed seeking care for symptoms, suggesting that differences in both prevention and acute care may be contributing to young women's elevated acute myocardial infarction mortality relative to men. Identifying factors that promote better cardiovascular knowledge, improved preventive health care, and prompt care-seeking behaviors represent important target for this population.
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Affiliation(s)
- Judith H Lichtman
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.).
| | - Erica C Leifheit-Limson
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.)
| | - Emi Watanabe
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.)
| | - Norrina B Allen
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.)
| | - Brian Garavalia
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.)
| | - Linda S Garavalia
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.)
| | - John A Spertus
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.)
| | - Harlan M Krumholz
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.)
| | - Leslie A Curry
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.)
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McCabe PJ, Chamberlain AM, Rhudy L, DeVon HA. Symptom Representation and Treatment-Seeking Prior to Diagnosis of Atrial Fibrillation. West J Nurs Res 2015; 38:200-15. [PMID: 25694177 DOI: 10.1177/0193945915570368] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Early treatment-seeking for symptoms of atrial fibrillation (AF) is critical to avert AF-related stroke and heart failure, but early treatment is hindered if symptoms are not accurately interpreted. The purpose of this research was to describe symptom representation and treatment-seeking responses prior to diagnosis of AF. For this descriptive study, 150 participants were surveyed to describe the type and temporality of symptoms, perceptions regarding the cause, seriousness, controllability of symptoms, and responses to symptoms prior to diagnosis. Participants' mean age was 66.5 years, and 51% were female. Participants perceived symptoms as having nondisease-based causes, as not very serious, and as amenable to self-management. The majority took a wait and see response with 69% waiting more than 1 week after symptom onset to seek treatment. Lack of recognition of the seriousness of symptoms of AF and delayed treatment put patients at risk of poorer outcomes.
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Affiliation(s)
| | | | - Lori Rhudy
- Mayo Clinic, Rochester, MN, USA University of Minnesota, Minneapolis, MN
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Arora G, Bittner V. Chest Pain Characteristics and Gender in the Early Diagnosis of Acute Myocardial Infarction. Curr Cardiol Rep 2015; 17:5. [DOI: 10.1007/s11886-014-0557-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Park JS, Cha KS, Shin D, Lee DS, Lee HW, Oh JH, Choi JH, Lee HC, Hong TJ, Jeong MH, Ahn Y, Chae SC, Kim YJ. Impact of non-chest pain complaint as a presenting symptom on door-to-balloon time and clinical outcomes in patients with acute ST-elevation myocardial infarction. Am J Cardiol 2014; 114:1801-9. [PMID: 25438905 DOI: 10.1016/j.amjcard.2014.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/14/2014] [Accepted: 09/14/2014] [Indexed: 11/18/2022]
Abstract
Many patients with ST-elevation myocardial infarctions (STEMIs) have non-chest pain complaints and are given low priority during triage. This prospective, multicenter, observational, registry-based study investigated the impact of non-chest pain complaints on door-to-balloon (DTB) time and clinical outcomes. Patients with STEMI who had undergone primary percutaneous coronary intervention were compared with respect to the presence of chest pain or non-chest pain complaints as presenting symptoms. To eliminate biased estimates, a propensity score model was built, and 2 cohorts of 1:1 matched patients were obtained. Propensity matching identified 2 cohorts of 976 patients each. After comparing patients with chest pain and those with non-chest pain complaints, significant delays in the median DTB time were noted (74 vs 84 minutes, respectively; p <0.001). Non-chest pain complaints were independent predictors of DTB time in the multivariate linear regression models. In-hospital mortality (adjusted hazard ratio [HR] 1.402, 95% confidence interval [CI] 0.727 to 2.705, p = 0.313), all-cause mortality (adjusted HR 1.175, 95% CI 0.453 to 3.853, p = 0.642), and major adverse cardiac events at follow-up (adjusted HR 0.139, 95% CI 0.876 to 1.48, p = 0.331) did not differ between the 2 groups of patients. In conclusion, short- and long-term clinical outcomes in patients with STEMI with non-chest pain complaints do not differ from those of patients with chest pain as the presenting symptom, despite having delayed diagnosis and reperfusion.
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Affiliation(s)
- Jin Sup Park
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Kwang Soo Cha
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea; Medical Research Institute, Pusan National University Hospital, Busan, South Korea.
| | - Donghun Shin
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Dae Sung Lee
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Hye Won Lee
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Jun-Hyok Oh
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Jung Hyun Choi
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Han Cheol Lee
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Taek Jong Hong
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Shung Chull Chae
- Department of Cardiology, Kyungpook National University Hospital, Daegu, South Korea
| | - Young Jo Kim
- Department of Cardiology, Yeungnam University Hospital, Daegu, South Korea
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Forsling E, Lundqvist R, Eliasson M, Isaksson RM. Health care contact is higher in the week preceding a first myocardial infarction: A review of medical records in Northern Sweden in 2007. Eur J Cardiovasc Nurs 2014; 14:450-6. [PMID: 24982433 DOI: 10.1177/1474515114541027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 05/28/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prodromal symptoms before myocardial infarction (MI) are common, but there are limited data regarding health care contact prior to the acute onset of MI and the impact of gender on early presentation to health care. AIMS The purpose of this study was to describe and analyse prodromal symptoms reported in medical records and study health care contact in the week before the acute onset of MI in comparison to the general population. METHODS From the Northern Sweden MONICA Study we accessed the medical records of 359 patients aged 32-74 years with a first MI in the county of Norrbotten in 2007. We identified those patients' health care contact during the seven days before the MI and compared them with the weekly number of contacts in the general population aged 45-74 years in the county during 2007. RESULTS We found that 23.1% of the women and 17.6% of the men had at least one contact the week before the MI. With the exception of the 14 women aged 45-55 years, health care consumption in both women and men in all age groups between 45- 74 years of age was 75%-165% higher in the week prior to the MI than in the general population of the same ages. In the first health care contact, pain-related symptoms were most frequent (43%), and fatigue was present in 8% of patients. There were no differences between women and men in health care consumption or presenting symptoms. CONCLUSION Both women and men with a first MI are in contact more frequently than the general population in the week prior to the event.
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Affiliation(s)
- Elin Forsling
- Department of Research, Norrbotten County Council, Sweden Department of Medicine, Sunderby Hospital, Sweden
| | | | - Mats Eliasson
- Department of Medicine, Sunderby Hospital, Sweden Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Rose-Marie Isaksson
- Department of Research, Norrbotten County Council, Sweden Division of Nursing, Linköping University, Sweden
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Mackay MH, Ratner PA, Nguyen M, Percy M, Galdas P, Grunau G. Inconsistent measurement of acute coronary syndrome patients' pre-hospital delay in research: a review of the literature. Eur J Cardiovasc Nurs 2014; 13:483-93. [PMID: 24532675 DOI: 10.1177/1474515114524866] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients' treatment-seeking delay remains a significant barrier to timely initiation of reperfusion therapy. Measurement of treatment-seeking delay is central to the large body of research that has focused on pre-hospital delay (PHD), which is primarily patient-related. This research has aimed to quantify PHD and its effects on morbidity and mortality, identify contributing factors, and evaluate interventions to reduce such delay. A definite time of symptom onset in acute coronary syndrome (ACS) is essential for determining delay, but difficult to establish. This literature review aimed to explore the variety of operational definitions of both PHD and symptom onset in published research. METHODS AND RESULTS We reviewed the English-language literature from 1998-2013 for operational definitions of PHD and symptom onset. Of 626 papers of possible interest, 175 were deemed relevant. Ninety-seven percent reported a delay time and 84% provided an operational definition of PHD. Three definitions predominated: (a) symptom onset to decision to seek help (18%); (b) symptom onset to hospital arrival (67%), (c) total delay, incorporating two or more intervals (11%). Of those that measured delay, 8% provided a definition of which symptoms triggered the start of timing. CONCLUSION We found few and variable operational definitions of PHD, despite American College of Cardiology/American Heart Association recommendations to report specific intervals. Worryingly, definitions of symptom onset, the most elusive component of PHD to establish, are uncommon. We recommend that researchers (a) report two PHD delay intervals (onset to decision to seek care, and decision to seek care to hospital arrival), and (b) develop, validate and use a definition of symptom onset. This will increase clarity and confidence in the conclusions from, and comparisons within and between studies.
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Affiliation(s)
- Martha H Mackay
- School of Nursing, University of British Columbia, Canada St. Paul's Hospital (Providence Health Care), Vancouver, Canada
| | | | - Michelle Nguyen
- St. Paul's Hospital (Providence Health Care), Vancouver, Canada
| | | | | | - Gilat Grunau
- School of Nursing, University of British Columbia, Canada
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El-Menyar AA, Al Suwaidi J. Impact of gender in patients with acute coronary syndrome. Expert Rev Cardiovasc Ther 2014; 7:411-21. [DOI: 10.1586/erc.09.10] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Bösner S, Bönisch K, Haasenritter J, Schlegel P, Hüllermeier E, Donner-Banzhoff N. Chest pain in primary care: is the localization of pain diagnostically helpful in the critical evaluation of patients?--A cross sectional study. BMC FAMILY PRACTICE 2013; 14:154. [PMID: 24138299 PMCID: PMC3853238 DOI: 10.1186/1471-2296-14-154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 09/25/2013] [Indexed: 11/12/2022]
Abstract
Background Chest pain is a common complaint and reason for consultation in primary care. Traditional textbooks still assign pain localization a certain discriminative role in the differential diagnosis of chest pain. The aim of our study was to synthesize pain drawings from a large sample of chest pain patients and to examine whether pain localizations differ for different underlying etiologies. Methods We conducted a cross-sectional study including 1212 consecutive patients with chest pain recruited in 74 primary care offices in Germany. Primary care providers (PCPs) marked pain localization and radiation of each patient on a pictogram. After 6 months, an independent interdisciplinary reference panel reviewed clinical data of every patient, deciding on the etiology of chest pain at the time of patient recruitment. PCP drawings were entered in a specially designed computer program to produce merged pain charts for different etiologies. Dissimilarities between individual pain localizations and differences on the level of diagnostic groups were analyzed using the Hausdorff distance and the C-index. Results Pain location in patients with coronary heart disease (CHD) did not differ from the combined group of all other patients, including patients with chest wall syndrome (CWS), gastro-esophageal reflux disease (GERD) or psychogenic chest pain. There was also no difference in chest pain location between male and female CHD patients. Conclusions Pain localization is not helpful in discriminating CHD from other common chest pain etiologies.
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Affiliation(s)
- Stefan Bösner
- Department of General Practice/Family Medicine, Philipps University Marburg, Marburg, Germany.
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Ng VG, Meller S, Shetty S, Lansky AJ. Diagnosing and characterizing coronary artery disease in women: developments in noninvasive and invasive imaging techniques. J Cardiovasc Transl Res 2013; 6:740-51. [PMID: 23918630 DOI: 10.1007/s12265-013-9500-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/08/2013] [Indexed: 01/07/2023]
Abstract
Cardiovascular disease is the leading cause of death in men and women in the USA; yet, coronary artery disease (CAD) continues to be underrecognized and underdiagnosed in women. Noninvasive and invasive imaging techniques are constantly being developed in order to more accurately assess CAD. At the same time, the impact of gender on the interpretation and accuracy of these studies is still being elucidated. Furthermore, new imaging techniques have improved our understanding of CAD pathophysiology and progression and have begun to reveal gender differences in the development of CAD. This article will review current imaging techniques and their application to diagnosing and understanding CAD in women.
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Affiliation(s)
- Vivian G Ng
- Yale University School of Medicine, P.O. Box 208017, New Haven, CT, 06520-8017, USA
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Tamura A, Naono S, Torigoe K, Hino M, Maeda S, Shinozaki K, Zaizen H, Kadota J. Gender differences in symptoms during 60-second balloon occlusion of the coronary artery. Am J Cardiol 2013; 111:1751-4. [PMID: 23499277 DOI: 10.1016/j.amjcard.2013.02.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
Abstract
Previous investigations have demonstrated the presence of gender differences in the symptoms of angina pectoris and acute coronary syndrome. However, most of these investigations have had certain limitations, including being retrospective, an interview-related bias, a various duration of myocardial ischemia, and a lack of multivariate analysis, all of which would have affected the results. Accordingly, we prospectively examined the presence or absence of chest pain and non-chest pain symptoms during a 60-second balloon inflation in the setting of percutaneous coronary intervention, which provides a unique model of transient myocardial ischemia, in 110 men and 80 women with coronary artery disease. Chest pain and/or non-chest pain symptoms (occipital pain, jaw pain, neck/throat pain, shoulder pain, upper arm pain, back pain, and nausea) were observed during the balloon inflation in 72 men and 52 women. In the 124 patients with any symptoms during the balloon inflation, non-chest pain symptoms were more common in women than in men (31% vs 14%, p = 0.02); however, the incidence of chest pain did not differ between the men and women. After adjustment for covariables, including age, body mass index, hypertension, diabetes mellitus, current smoking, previous myocardial infarction, target vessels, β-blocker use, and calcium antagonist use, female gender remained significantly associated with non-chest pain symptoms (odds ratio 3.3, 95% confidence interval 1.2 to 9.9, p = 0.02). In conclusion, non-chest pain symptoms during the 60-second balloon occlusion of the coronary artery were more common in women than in men, supporting the presence of the gender difference in myocardial ischemic symptoms.
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Dreyer RP, Beltrame JF, Tavella R, Air T, Hoffmann B, Pati PK, Di Fiore D, Arstall M, Zeitz C. Evaluation of gender differences in Door-to-Balloon time in ST-elevation myocardial infarction. Heart Lung Circ 2013; 22:861-9. [PMID: 23628331 DOI: 10.1016/j.hlc.2013.03.078] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/17/2013] [Accepted: 03/18/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND A delayed Door-to-Balloon (DTB) time in women with ST-elevation myocardial infarction (STEMI) has been associated with an increased mortality. The objectives of this study were to (a) quantify the components of the delayed DTB time in women and (b) assess the independent effect of gender on DTB time in patients undergoing percutaneous coronary intervention (PCI) for STEMI. METHODS Clinical parameters were prospectively collected for 735 STEMI patients undergoing primary PCI from 2006 to 2010, with particular attention to the components of DTB time, including the onset of chest pain and the 'code' notification of the STEMI team by the Emergency Department. RESULTS Women were significantly older with more co-morbidity. Upon hospital arrival they also experienced delays in Door-to-Code (23 vs. 17 min, P=.012), Code-to-Balloon (63 vs. 57 min, P=.001) and thus DTB time (88 vs. 72 min, P=.001). After multivariate adjustment, independent determinants of DTB time included female gender (ratio of geometric means [RGM]=1.13; 95% CI 1.02-1.26; P=.022), hypertension (RGM=1.12, 95% CI 1.02-1.23, P=.014), maximum ST-elevation (RGM=0.97, 95% CI 0.94-0.98, P<.001), office hours (RGM=0.84, 95% CI 0.78-0.92, P<.001) and triage category (RGM=1.23, 95% CI 1.09-1.40, P=.001). CONCLUSIONS Women experience delays in identification of the STEMI diagnosis and also in the PCI process. Thus a multifaceted approach addressing both the diagnosis and management of STEMI in women is required.
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Affiliation(s)
- Rachel P Dreyer
- Cardiology Unit, The Queen Elizabeth Hospital (The Basil Hetzel Institute), Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Damasceno CA, de Queiroz TL, Santos CADST, Mussi FC. [Factors associated with the decision to seek health care in myocardial infarction: gender differences]. Rev Esc Enferm USP 2013; 46:1362-70. [PMID: 23380779 DOI: 10.1590/s0080-62342012000600012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 04/25/2012] [Indexed: 11/21/2022] Open
Abstract
Analyze cognitive and emotional variables between genders in terms of the decision time (DT) to seek care when experiencing symptoms of myocardial infarction. One hundred adults were interviewed at two hospitals in Salvador-BA. The analysis used percentage means, the chi-square test, and a robust linear regression model. Most participants were male, with a mean age of 58.78 years and a low socioeconomic status. The geometrical mean of the sample was 1.1h (0.9h for men, and 1.4h for women). A shorter decision time was found for those who considered their symptoms to be severe, and a longer decision time for those who expected symptoms to improve and took something to feel better, with statistically significant associations. An interaction was observed between gender and the following variables: waiting for symptoms to improve (p=0.014), concealing symptoms (p=0.016) and asking for help (p=0.050), thus an association was observed between the variables of interest and DT. The decision times were long and were affected by cognitive, emotional and gender variables. Nursing care may promote early assistance.
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Affiliation(s)
- Carla Almeida Damasceno
- Departamento de Ciências Exatas, Universidade Estadual de Feira de Santana, Salvador, BA, Brasil.
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Bergman HE, Reeve BB, Moser RP, Scholl S, Klein WMP. Development of a Comprehensive Heart Disease Knowledge Questionnaire. AMERICAN JOURNAL OF HEALTH EDUCATION 2013; 42:74-87. [PMID: 21720571 DOI: 10.1080/19325037.2011.10599175] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND: Heart disease is the number one killer of both men and women in the United States, yet a comprehensive and evidence-based heart disease knowledge assessment is currently not available. PURPOSE: This paper describes the 2 phase development of a novel heart disease knowledge questionnaire. METHODS: After review and critique of the existing literature, a questionnaire addressing 5 central domains of heart disease knowledge was constructed. In Phase I, 606 undergraduates completed a 82-item questionnaire. In Phase II, 248 undergraduates completed a revised 74-item questionnaire. In both phases, item clarity and difficulty were evaluated, along with the overall factor structure of the scale. RESULTS: Exploratory and confirmatory factor analyses were used to reduce the scale to 30 items with fit statistics, CFI = .82, TLI = .88, and RMSEA = .03. Scores were correlated moderately positively with an existing scale and weakly positively with a measure of health literacy, thereby establishing both convergent and divergent validity. DISCUSSION: The finalized 30-item questionnaire is a concise, yet discriminating instrument that reliably measures participants' heart disease knowledge levels. TRANSLATION TO HEALTH EDUCATION PRACTICE: Health professionals can use this scale to assess their patients' heart disease knowledge so that they can create a tailored program to help their patients reduce their heart disease risk.
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Affiliation(s)
- Hannah E Bergman
- Division of Cancer Control and Population Sciences, National Cancer Institute
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40
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Ng VG, Lansky AJ. Interventions for ST Elevation Myocardial Infarction in Women. Interv Cardiol Clin 2012; 1:453-465. [PMID: 28581963 DOI: 10.1016/j.iccl.2012.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The management of ST-segment elevation myocardial infarction (STEMI) has significantly advanced from supportive care to reperfusion therapies with thrombolytics and percutaneous coronary revascularization techniques. These advances have improved the outcomes of patients with STEMI. Although cardiovascular disease is the leading cause of death in both men and women, the minority of patients in trials studying the impact of these therapies on outcomes are women. Multiple studies have shown that men and women do not have equivalent outcomes after STEMI. This article reviews the treatment options for STEMI and the outcomes of women after treatment with reperfusion therapies.
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Affiliation(s)
- Vivian G Ng
- Valve Program, Yale University School of Medicine, Yale University Medical Center, PO Box 208017, New Haven, CT 06520-8017, USA
| | - Alexandra J Lansky
- Valve Program, Yale University School of Medicine, Yale University Medical Center, PO Box 208017, New Haven, CT 06520-8017, USA.
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Yang HY, Huang JH, Hsu CY, Chen YJ. Gender differences and the trend in the acute myocardial infarction: a 10-year nationwide population-based analysis. ScientificWorldJournal 2012; 2012:184075. [PMID: 22997490 PMCID: PMC3444858 DOI: 10.1100/2012/184075] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 08/01/2012] [Indexed: 11/19/2022] Open
Abstract
It is not clear whether gender is associated with different hospitalization cost and lengths for acute myocardial infarction (AMI). We identified patients hospitalized for primary diagnosis of AMI with (STEMI) or without (NSTEMI) ST elevation from 1999 to 2008 through a national database containing 1,000,000 subjects. As compared to that in 1999~2000, total (0.35‰ versus 0.06‰, P < 0.001) and male (0.59‰ versus 0.07‰, P < 0.001) STEMI hospitalization percentages were decreased in 2007~2008, but female STEMI hospitalization percentages were not different from 1999 to 2008. However, NSTEMI hospitalization percentages were similar over the 10-year period. The hospitalization age for AMI, STEMI, and NSTEMI was increased over the 10-year period by 14, 9, and 7 years in male, and by 18, 18, and 21 years in female. The female and male hospitalization cost and lengths were similar in the period. As compared to nonmedical center, the hospitalization cost for STEMI in medical center was higher in male patients, but not in female patients, and the hospitalization cost for NSTEMI was higher in both male and female gender. We found significant differences between male and female, medical center and non-medical center, or STEMI and NSTEMI on medical care over the 10-year period.
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Affiliation(s)
- Hung-Yu Yang
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Xinglong Road, Wenshan District, Taipei 116, Taiwan
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O'Donnell S, McKee G, O'Brien F, Mooney M, Moser DK. Gendered symptom presentation in acute coronary syndrome: a cross sectional analysis. Int J Nurs Stud 2012; 49:1325-32. [PMID: 22763336 DOI: 10.1016/j.ijnurstu.2012.06.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 05/10/2012] [Accepted: 06/04/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The international literature suggests that the symptom presentation of acute coronary syndrome may be different for men and women, yet no definitive conclusion about the existence of gendered presentation in ACS has been provided. OBJECTIVE This study examines whether gendered symptom presentation exists in a well-defined sample of men and women with ACS. DESIGN AND SETTING A cross-sectional analysis of baseline data pertaining to symptom experience and medical profiles were recorded for all ACS patients who participated in a multi-centered randomized control trial, in 5 hospitals, in Dublin, Ireland. PARTICIPANTS : Patients were deemed eligible if they were admitted through the Emergency Department (ED) with a diagnosis of ACS, if they were at least 21 years of age and able to read and converse in English. Patients were excluded if they had serious co-morbidities, cognitive, hearing or vision impairment. METHODS Patients were interviewed 2-4 days following their ACS event and data was gathered using the ACS response to symptom index. RESULTS The study included 1947 patients of whom 28% (n=545) were women. Chest pain was the most commonly experienced symptom in men and women, reported by 71% of patients. Using logistic regression and adjusting for clinical and demographic variables, women had greater odds of experiencing shortness of breath (50% vs 43%; odds ratio [OR]=1.32; 95% CI=1.08-1.62; p=.006) palpitations (5.5% vs 2.8%; OR=2.17; CI=1.31-3.62; p=.003) left arm pain (34% vs 30.5%; OR=1.27; CI=1.02-1.58; p=.03) back pain (7.5% vs 4.8%; OR=1.56; CI=1.03-2.37; p=.034) neck or jaw pain (21.5% vs 13.8%; OR=1.84; CI=1.41-2.40; p=.001) nausea (28% vs 24%; OR=1.30; CI=1.03-1.65; p=.024) a sense of dread (13.4% vs 10.5%; OR=1.47; CI=1.08-2.00; p=.014) and fatigue (29% vs 21.5%; OR=1.64; CI=1.29-2.07; p=.001) than their male counterparts. CONCLUSIONS Although chest pain is the most commonly experienced symptom by men and women, other ACS symptomology may differ significantly between genders.
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Affiliation(s)
- Sharon O'Donnell
- School of Nursing & Midwifery, University of Dublin Trinity College, Dublin, Ireland.
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Pilote L, Karp I. GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: From bench to beyond-Premature Acute Coronary SYndrome). Am Heart J 2012; 163:741-746.e2. [PMID: 22607849 DOI: 10.1016/j.ahj.2012.01.022] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 01/26/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND Previous research has not adequately addressed the topic of sex and gender differences in occurrence of premature acute coronary syndrome (ACS). This study will investigate the clinical presentation, prognosis, and health care use in young men and women with ACS. METHODS We have set up a prospective, multicenter study of 1,576 patients aged 18-55 years and admitted to hospital with ACS. At baseline, questionnaires will be administered, and anthropometric and biological measurements will be performed. The patients will be observed for at least 1 year, with additional questionnaires being administered at 1, 6, and 12 months post-discharge. A review of medical records will be performed both at baseline and during follow-up. CONCLUSIONS This study will provide important evidence on the roles that a wide range of behavioral, environmental, and biological factors play in premature ACS and will help determine to what extent these roles depend on the individual's sex and gender. Ultimately, the knowledge derived from this study may facilitate accurate diagnosis and effective prevention and management of ACS in young women and men.
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Affiliation(s)
- Louise Pilote
- Division of General Internal Medicine, McGill University Health Centre, 687 Pine Avenue West, Montreal, Quebec, Canada.
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Almond SC, Salisbury H, Ziebland S. Women's experience of coronary heart disease: why is it different? ACTA ACUST UNITED AC 2012. [DOI: 10.12968/bjca.2012.7.4.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Susanna C Almond
- Health Experiences Research Group, University of Oxford, 2nd Floor, 23–38 Hythe Bridge Street, Oxford, OX1 2ET
| | | | - Sue Ziebland
- Health Experiences Research Group, University of Oxford
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Women's Experiences and Behaviour at Onset of Symptoms of ST Segment Elevation Acute Myocardial Infarction. Eur J Cardiovasc Nurs 2011; 10:241-7. [DOI: 10.1016/j.ejcnurse.2010.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 10/07/2010] [Accepted: 10/08/2010] [Indexed: 11/20/2022]
Abstract
Background: Minimizing time from onset of symptoms to treatment (treatment delay) is crucial for patients with ST segment elevation acute myocardial infarction (STEMI), and one of the great challenges is to reduce the delay relating to the prehospital behaviour of the patient (patient delay). Studies indicate that women delay longer than men and insights into this area could lead to improved health education programmes aimed at reducing patient delay in women with STEMI. Method: Open interviews with 14 women with STEMI were held during their hospital stay from June to September 2009. The interviews were aimed at exploring determinants of treatment delay, and were carried out and analysed within a phenomenological framework. Findings: Three themes emerged important for the delay in seeking medical assistance: (1) Knowledge and ideas of AMI symptoms and risks. (2) Ambivalence whether to call for medical assistance or to cope with the situation. (3) Actions and strategies taken after onset of symptoms. Conclusions: Three factors determined whether women showed appropriate behaviour for reduced patient delay after onset of symptoms: (1) identifying the symptoms as being of cardiac origin, (2) having a prepared action plan in case of an emergency situation, and (3) living with someone or contacting other persons.
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46
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Butala NM, Desai MM, Linnander EL, Wong YR, Mikhail DG, Ott LS, Spertus JA, Bradley EH, Aaty AA, Abdelfattah A, Gamal A, Kholeif H, el-Baz M, Allam AH, Krumholz HM. Gender differences in presentation, management, and in-hospital outcomes for patients with AMI in a lower-middle income country: evidence from Egypt. PLoS One 2011; 6:e25904. [PMID: 22022463 PMCID: PMC3192760 DOI: 10.1371/journal.pone.0025904] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 09/13/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Many studies in high-income countries have investigated gender differences in the care and outcomes of patients hospitalized with acute myocardial infarction (AMI). However, little evidence exists on gender differences among patients with AMI in lower-middle-income countries, where the proportion deaths stemming from cardiovascular disease is projected to increase dramatically. This study examines gender differences in patients in the lower-middle-income country of Egypt to determine if female patients with AMI have a different presentation, management, or outcome compared with men. METHODS AND FINDINGS Using registry data collected over 18 months from 5 Egyptian hospitals, we considered 1204 patients (253 females, 951 males) with a confirmed diagnosis of AMI. We examined gender differences in initial presentation, clinical management, and in-hospital outcomes using t-tests and χ(2) tests. Additionally, we explored gender differences in in-hospital death using multivariate logistic regression to adjust for age and other differences in initial presentation. We found that women were older than men, had higher BMI, and were more likely to have hypertension, diabetes mellitus, dyslipidemia, heart failure, and atrial fibrillation. Women were less likely to receive aspirin upon admission (p<0.01) or aspirin or statins at discharge (p = 0.001 and p<0.05, respectively), although the magnitude of these differences was small. While unadjusted in-hospital mortality was significantly higher for women (OR: 2.10; 95% CI: 1.54 to 2.87), this difference did not persist in the fully adjusted model (OR: 1.18; 95% CI: 0.55 to 2.55). CONCLUSIONS We found that female patients had a different profile than men at the time of presentation. Clinical management of men and women with AMI was similar, though there are small but significant differences in some areas. These gender differences did not translate into differences in in-hospital outcome, but highlight differences in quality of care and represent important opportunities for improvement.
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Affiliation(s)
- Neel M Butala
- Yale School of Medicine, New Haven, Connecticut, United States of America.
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Benziger CP, Bernabe-Ortiz A, Miranda JJ, Bukhman G. Sex differences in health care-seeking behavior for acute coronary syndrome in a low income country, Peru. Crit Pathw Cardiol 2011; 10:99-103. [PMID: 21836822 PMCID: PMC3152304 DOI: 10.1097/hpc.0b013e318223e375] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE : Recognizing reasons for prehospital delay after symptoms of acute coronary syndrome (ACS) is established in developed countries yet evidence from Latin America is limited. We aimed to assess ACS symptom recognition, health care-seeking behavior, and confidence in local health care facilities to take care of ACS by gender in a sample of Peruvians. METHODS : A community-based interview survey in a peri-urban area in Lima, Peru. The 24-item study instrument included vignettes and questions assessing identification of urgent and emergent ACS symptoms, anticipated help-seeking behaviors, and confidence in local health care facilities. RESULTS : In the study population (90 people; 45.6% men; mean age, 43.5 years), women were 4 times less likely to correctly attribute symptoms of chest pain to the heart (OR = 0.23; 95% CI: 0.063-0.87; P = 0.03). Women were much more likely to respond that a man would "Seek help" (OR = 4.54; 95% CI: 1.21-16.90; P = 0.024) and that "Yes," a woman would be less likely to seek help for chest pain symptoms (OR = 3.26; 95% CI: 1.13-9.41 P = 0.029) after adjusting for age, education level, age at migration, and history of chest pain. Women were less likely than men to think that their local Health Care Post would help them if they had a heart attack (2.1% vs. 14.6%; P = 0.04), and only 18.7% of women believed that their local emergency room would help them. CONCLUSIONS : Our findings suggest women are less likely to seek help for chest pain and women and men in a peri-urban area in Peru are not confident in their local health care facility to treat urgent or emergent ACS symptoms.
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Affiliation(s)
- Catherine Pastorius Benziger
- University of Minnesota Medical School, Minneapolis, MN, USA
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gene Bukhman
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA
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Kirchberger I, Heier M, Kuch B, Wende R, Meisinger C. Sex differences in patient-reported symptoms associated with myocardial infarction (from the population-based MONICA/KORA Myocardial Infarction Registry). Am J Cardiol 2011; 107:1585-9. [PMID: 21420056 DOI: 10.1016/j.amjcard.2011.01.040] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 01/26/2011] [Accepted: 01/26/2011] [Indexed: 12/18/2022]
Abstract
Many studies have examined gender-related differences in symptoms of acute myocardial infarction (AMI). However, findings have been inconsistent, largely because of different study populations and different methods of symptom assessment and data analysis. This study was based on 568 women and 1,710 men 25 to 74 years old hospitalized with a first-ever AMI from January 2001 through December 2006 recruited from a population-based AMI registry. Occurrence of 13 AMI symptoms was recorded using standardized patient interview. After controlling for age, migration status, body mass index, smoking, some co-morbidities including diabetes, and type and location of AMI through logistic regression modeling, women were significantly more likely to complain of pain in the left shoulder/arm/hand (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.10 to 1.69), pain in the throat/jaw (OR 1.78, 95% CI 1.43 to 2.21), pain in the upper abdomen (OR 1.39, 95% CI 1.02 to 1.91), pain between the shoulder blades (OR 2.22, 95% CI 1.78 to 2.77), vomiting (OR 2.23, 95% CI 1.67 to 2.97), nausea (OR 1.94, 95% CI 1.56 to 2.39), dyspnea (OR 1.45, 95% CI 1.17 to 1.78), fear of death (OR 2.17, 95% CI 1.73 to 2.72), and dizziness (OR 1.49, 95% CI 1.16 to 1.91) than men. Furthermore, women were more likely to report >4 symptoms (OR 2.14, 95% CI 1.72 to 2.66). No significant gender differences were found in chest pain, feelings of pressure or tightness, diaphoresis, pain in the right shoulder/arm/hand, and syncope. In conclusion, women and men did not differ regarding the chief AMI symptoms of chest pain or feelings of tightness or pressure and diaphoresis. However, women were more likely to have additional symptoms.
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DeVon HA, Saban KL, Garrett DK. Recognizing and Responding to Symptoms of Acute Coronary Syndromes and Stroke in Women. J Obstet Gynecol Neonatal Nurs 2011; 40:372-82. [DOI: 10.1111/j.1552-6909.2011.01241.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Bossaert L, O'Connor RE, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, Nolan JP, Hoek TLV, Walters DL, Wong A, Welsford M, Woolfrey K. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2011; 81 Suppl 1:e175-212. [PMID: 20959169 DOI: 10.1016/j.resuscitation.2010.09.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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