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Kawa KL, Jacobs C, Wiens EJ. Outcome disparities in acute coronary syndrome patients from rural versus urban settings: A narrative review of causes, and strategies to minimize them. Curr Probl Cardiol 2024; 49:102682. [PMID: 38795806 DOI: 10.1016/j.cpcardiol.2024.102682] [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: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024]
Abstract
Acute coronary syndrome (ACS) remains an important cause of morbidity and mortality worldwide. Critical elements of improving outcomes in ACS patients include timely access to acute care including prompt revascularization if indicated, and subsequent ongoing secondary prevention and risk factor modification, ideally with cardiovascular specialists. It is being increasingly realized that ACS patients from rural settings suffer from inferior outcomes compared to their urban counterparts due to factors such as delayed diagnosis, delayed access to acute care, and less accessibility to specialized follow up. This narrative review will examine the importance of timely access to care in ACS patients, particularly in ST-elevation myocardial infarction; how barriers in access to care affects outcomes in various rural populations; and strategies that have been shown to improve such access, and therefore hopefully achieve more equitable health outcomes compared to patients who live in urban settings.
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Affiliation(s)
- Kristal L Kawa
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cheryl Jacobs
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Evan J Wiens
- Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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Williams TD, Kaur A, Warner T, Aslam M, Clark V, Walker R, Ngo DTM, Sverdlov AL. Cardiovascular outcomes of cancer patients in rural Australia. Front Cardiovasc Med 2023; 10:1144240. [PMID: 37180785 PMCID: PMC10167273 DOI: 10.3389/fcvm.2023.1144240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
Background Cancer and heart disease are the two most common health conditions in the world, associated with high morbidity and mortality, with even worse outcomes in regional areas. Cardiovascular disease is the leading cause of death in cancer survivors. We aimed to evaluate the cardiovascular outcomes of patients receiving cancer treatment (CT) in a regional hospital. Methods This was an observational retrospective cohort study in a single rural hospital over a ten-year period (17th February 2010 to 19th March 2019). Outcomes of all patients receiving CT during this period were compared to those who were admitted to the hospital without a cancer diagnosis. Results 268 patients received CT during the study period. High rates of cardiovascular risk factors: hypertension (52.2%), smoking (54.9%), and dyslipidaemia (38.4%) were observed in the CT group. Patients who had CT were more likely to be readmitted with ACS (5.9% vs. 2.8% p = 0.005) and AF (8.2% vs. 4.5% p = 0.006) when compared to the general admission cohort. There was a statistically significant difference observed for all cause cardiac readmission, with a higher rate observed in the CT group (17.1% vs. 13.2% p = 0.042). Patients undergoing CT had a higher rate of mortality (49.5% vs. 10.2%, p ≤ 0.001) and shorter time (days) from first admission to death (401.06 vs. 994.91, p ≤ 0.001) when compared to the general admission cohort, acknowledging this reduction in survival may be driven at least in part by the cancer itself. Conclusion There is an increased incidence of adverse cardiovascular outcomes, including higher readmission rate, higher mortality rate and shorter survival in people undergoing cancer treatment in rural environments. Rural cancer patients demonstrated a high burden of cardiovascular risk factors.
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Affiliation(s)
- Trent D. Williams
- Hunter New England Local Health District, New Lambton, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Nursing and Midwifery, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Nursing and Midwifery Centre: Hunter New England Local Health District, New Lambton, NSW, Australia
- Newcastle Centre of Excellence in Cardio-Oncology, New Lambton Heights, NSW, Australia
| | - Amandeep Kaur
- Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Thomas Warner
- Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Maria Aslam
- Hunter New England Local Health District, New Lambton, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Vanessa Clark
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Nursing and Midwifery, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute Asthma and Breathing Research Program, Newcastle, NSW, Australia
| | - Rhonda Walker
- Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Doan T. M. Ngo
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- Newcastle Centre of Excellence in Cardio-Oncology, New Lambton Heights, NSW, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Aaron L. Sverdlov
- Hunter New England Local Health District, New Lambton, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- Newcastle Centre of Excellence in Cardio-Oncology, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
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Loten C, Nutt H, Bull N. Death rates following emergency department chest pain assessment. Emerg Med Australas 2023; 35:525-527. [PMID: 36843305 DOI: 10.1111/1742-6723.14186] [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: 06/21/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 02/28/2023]
Abstract
OBJECTIVES We sought to define the rate of unexpected death from acute coronary syndrome or arrhythmia in chest pain patients directly discharged from the ED. METHODS Retrospective audit of all chest pain patients at a tertiary ED for 7 years. Medical and post-mortem records of the deceased were reviewed with independent cardiologist adjudication to determine outcomes. Primary outcome measure was 28-day unexpected death secondary to acute coronary syndrome or arrhythmia. RESULTS During the study period, 25 924 patients presented with chest pain, 292 (1.1%, 95% confidence interval [CI] 0.99-1.01%) died within 28 days. Of these, 16 680(64%, 95% CI 63.88-64.12%) were discharged by ED, two (0.01%, 95% CI 0-0.011%) of this group died from the primary outcome. CONCLUSION Unexpected death is very uncommon after ED discharge of chest pain patients.
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Affiliation(s)
- Conrad Loten
- Department of Emergency Medicine, John Hunter Hospital, Hunter New England Health, Newcastle, New South Wales, Australia
| | - Hannah Nutt
- Department of Emergency Medicine, John Hunter Hospital, Hunter New England Health, Newcastle, New South Wales, Australia
| | - Neva Bull
- School of Psychology, The University of Newcastle, Newcastle, New South Wales, Australia
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Saito Y, Oyama K, Tsujita K, Yasuda S, Kobayashi Y. Treatment strategies of acute myocardial infarction: updates on revascularization, pharmacological therapy, and beyond. J Cardiol 2023; 81:168-178. [PMID: 35882613 DOI: 10.1016/j.jjcc.2022.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/06/2022] [Indexed: 10/16/2022]
Abstract
Owing to recent advances in early reperfusion strategies, pharmacological therapy, standardized care, and the identification of vulnerable patient subsets, the prognosis of acute myocardial infarction has improved. However, there is still considerable room for improvement. This review article summarizes the latest evidence concerning clinical diagnosis and treatment of acute myocardial infarction.
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Affiliation(s)
- Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Kazuma Oyama
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Ofoma UR, Joynt Maddox KE. Improving the Detection of ST-Segment Elevation Myocardial Infarction in Rural Settings: When Texting Saves Lives. JAMA Cardiol 2022; 7:698-699. [PMID: 35612840 DOI: 10.1001/jamacardio.2022.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Uchenna R Ofoma
- Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri
| | - Karen E Joynt Maddox
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri
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