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Greene A, Sapp J, Hirsch G, Sandila N, Quraishi A, El-Khateeb O, Kirkland S, Stewart R, Anderson K, Chedrawy E, Campbell S, Herman C, Goldstein J, Carter A, Andreou P, Collins A, Travers A, Parkash R. Cardiovascular Outcomes in Nova Scotia during the Early Phase of the COVID-19 Pandemic. CJC Open 2021; 4:324-336. [PMID: 34977521 PMCID: PMC8704736 DOI: 10.1016/j.cjco.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background This study sought to determine the impact of the pandemic response to healthcare delivery on outcomes in patients with cardiovascular disease. Methods This is a population-based cohort study performed in the province of Nova Scotia (population 979,499), between Pre-COVID (March 1, 2017 - March 16, 2020) and in-COVID (March 17, 2020 - December 31, 2020) periods. Adult patients (≥18 years) with new onset or existing cardiovascular disease were included for comparison between periods. The main outcome measures included: cardiovascular emergency department visits or hospitalizations, mortality, and out-of-hospital cardiac arrest. Results In the first month of the in-COVID period, emergency department visits (n=51,750) for cardiac symptoms decreased by 20.8% (95% CI 14.0% - 27.0%, p<0.001). Cardiovascular hospitalizations (n=20 609) declined by 48.1% (95% CI 40.4% to 54.9%, p<0.001). In-hospital mortality rate increased in patients with cardiovascular admissions in secondary care institutions by 55.1% (95%CI 10.1%-118%, p=0.013). A decline of 20.4% - 44.0% occurred in cardiovascular surgical/interventional procedures. Out-of-hospital cardiac arrests (n=5528) increased from a monthly mean of 115±15 to 136±14, beginning in May, 2020. Mortality for ambulatory patients awaiting cardiac intervention (n=14,083) increased from 0.16% (n=12501) to 2.49% (n=361) in the in-COVID period (p<0.0001). Conclusion This study demonstrates increased cardiovascular morbidity and mortality during restrictions maintained during COVID-19, in an area with low burden of COVID-19 disease. As the healthcare system recovers or enters subsequent waves of COVID-19, these findings should inform communication to the public regarding cardiovascular symptoms and policy for delivery of cardiovascular care.
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Affiliation(s)
- Alison Greene
- Division of Cardiac Surgery, Department of Surgery, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - John Sapp
- Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Greg Hirsch
- Division of Cardiac Surgery, Department of Surgery, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Navjot Sandila
- Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Ata Quraishi
- Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Osama El-Khateeb
- Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Susan Kirkland
- Departments of Community Health & Epidemiology and Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert Stewart
- Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Kim Anderson
- Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Edgar Chedrawy
- Division of Cardiac Surgery, Department of Surgery, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Samuel Campbell
- Division of Emergency Medical Services, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Christine Herman
- Division of Cardiac Surgery, Department of Surgery, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Judah Goldstein
- Division of Emergency Medical Services, QEII Health Sciences Center, Halifax, Nova Scotia, Canada.,Emergency Health Services, Halifax, Nova Scotia, Canada
| | - Alexandra Carter
- Division of Emergency Medical Services, QEII Health Sciences Center, Halifax, Nova Scotia, Canada.,Emergency Health Services, Halifax, Nova Scotia, Canada
| | - Pantelis Andreou
- Departments of Community Health & Epidemiology and Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Adair Collins
- Emergency Health Services, Halifax, Nova Scotia, Canada
| | - Andrew Travers
- Division of Emergency Medical Services, QEII Health Sciences Center, Halifax, Nova Scotia, Canada.,Emergency Health Services, Halifax, Nova Scotia, Canada
| | - Ratika Parkash
- Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
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Wach A, Faßbender C, Ackermann H, Parzeller M. [A retrospective mortality analysis of natural deaths of the 65+ generation based on postmortem autopsies performed at the Institute of Legal Medicine in Frankfurt am Main during two periods]. Rechtsmedizin (Berl) 2021; 31:509-519. [PMID: 33716407 PMCID: PMC7938877 DOI: 10.1007/s00194-021-00469-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY In Germany, a constant demographic change is taking place, which leads to an increasing aging of the society. The present study aimed to analyze natural deaths occurring at an age of ≥ 65 years, since health vulnerability in this age group is gaining importance. MATERIAL AND METHODS Autopsy reports of the Institute of Forensic Medicine, University Hospital of the Goethe University Frankfurt/Main, Germany, were retrospectively evaluated regarding natural death cases of ≥ 65-year-olds in a time comparison (period I: 2000-2002; period II: 2013-2015). RESULTS During both periods, a total of 1206 autopsies concerning this age group were performed. Among these, 404 cases (33.5%) of unnatural death and 39 cases (3.2%) of a combination of natural and unnatural death were recorded; in 94 cases (7.8%), the manner of death could not be elucidated. The majority (n = 669; 55.5%) included cases of natural death. In the largest group of these (n = 350; 52.3%), cardiac causes of death were predominant, followed by 132 (19.7%) respiratory and 47 (7.0%) abdominal causes of death. In addition, 37 (5.5%) cases of malignant neoplasms, 33 (4.9%) of ruptures of large vessels, 33 (4.9%) of cerebral, and 37 (5.5%) other cases of natural death were noted. A significant decrease of cardiac causes of death was observed in the comparison of periods I and II. In particular, there was a significant decrease in high-grade occlusive coronary sclerosis. Moreover, there were significant differences between both sexes. Men had significantly more bypasses, stents and heart scars and suffered a myocardial infarction about 10 years earlier than women. CONCLUSION The results of the present study are largely consistent with the literature. The decrease in numbers of cardiac deaths may be attributed to increasingly better medical care and to a significantly higher rate of stent implantation. Especially in times of pandemics, the role of forensic gerontology will become more important.
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Affiliation(s)
- A. Wach
- Institut für Rechtsmedizin, Universitätsklinikum, Goethe-Universität Frankfurt a.M., Kennedyallee 104, 60596 Frankfurt am Main, Deutschland
| | - C. Faßbender
- Institut für Rechtsmedizin, Universitätsklinikum, Goethe-Universität Frankfurt a.M., Kennedyallee 104, 60596 Frankfurt am Main, Deutschland
| | - H. Ackermann
- Institut für Biostatistik und Mathematische Modellierung, Zentrum der Gesundheitswissenschaften, Klinikum und Fachbereich Medizin, Goethe-Universität Frankfurt a.M., Frankfurt am Main, Deutschland
| | - M. Parzeller
- Institut für Rechtsmedizin, Universitätsklinikum, Goethe-Universität Frankfurt a.M., Kennedyallee 104, 60596 Frankfurt am Main, Deutschland
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Peters SA, Colantonio LD, Chen L, Bittner V, Farkouh ME, Rosenson RS, Jackson EA, Dluzniewski P, Poudel B, Muntner P, Woodward M. Sex Differences in Incident and Recurrent Coronary Events and All-Cause Mortality. J Am Coll Cardiol 2020; 76:1751-1760. [DOI: 10.1016/j.jacc.2020.08.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/31/2020] [Accepted: 08/12/2020] [Indexed: 01/08/2023]
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Elamragy AA, Meshaal MS, El-Kholy AA, Rizk HH. Gender differences in clinical features and complications of infective endocarditis: 11-year experience of a single institute in Egypt. Egypt Heart J 2020; 72:5. [PMID: 31965410 PMCID: PMC6974112 DOI: 10.1186/s43044-020-0039-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/12/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND No data exists about the gender differences among patients with infective endocarditis (IE) in Egypt. The objective was to study possible gender differences in clinical profiles and outcomes of patients in the IE registry of a tertiary care center over 11 years. RESULTS The IE registry included 398 patients with a median age of 30 years (interquartile range, 15 years); 61.1% were males. Males were significantly older than females. Malignancy and recent culprit procedures were more common in females while chronic liver disease and intravenous drug abuse (IVDU) were more in males. IE on top of structurally normal hearts was significantly more in males (25.6% vs 13.6%, p = 0.005) while rheumatic valvular disease was more common in females (46.3% vs 29.9%, p = 0.001). There was no difference in the duration of illness before presentation to our institution. The overall complication rate was high but significantly higher in females. However, there were no significant differences in the major complications: mortality, fulminant sepsis, renal failure requiring dialysis, heart failure class III-IV, or major cerebrovascular emboli. CONCLUSION In this registry, IE occurred predominantly in males. Females were significantly younger at presentation. History of recent culprit procedures was more common in females while IVDU was more common in males who had a higher incidence of IE on structurally normal hearts. The overall complication rate was higher in women. IE management and its outcomes were similar in both genders.
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Affiliation(s)
- Ahmed Adel Elamragy
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt.
| | - Marwa Sayed Meshaal
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Amani Ali El-Kholy
- Department of Clinical Pathology and Microbiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Hussein Hassan Rizk
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
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Southern DA, James MT, Wilton SB, DeKoning L, Quan H, Knudtson ML, Ghali WA. Expanding the impact of a longstanding Canadian cardiac registry through data linkage: challenges and opportunities. Int J Popul Data Sci 2018; 3:441. [PMID: 32935018 PMCID: PMC7299492 DOI: 10.23889/ijpds.v3i3.441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) began as a province-wide inception cohort of all adult Alberta residents undergoing cardiac catheterization for ischemic heart disease. Strengths of the APPROACH initiative include the prospective collection of detailed clinical, procedural, and treatment information, measured at point-of-care. While this aspect of APPROACH provides data users with several advantages over use of typical administrative data, the ability to link APPROACH with data from multiple other sources has provided several unique opportunities to measure cardiovascular care and outcomes. As of June 2018, clinical information has been collected by APPROACH on over 240,000 adult Alberta residents. Linkage of this rich clinical data to administrative health data (eg. Vital statistics, hospitalizations, ambulatory events, prescription medications), secondary use clinical data (e.g. laboratory, ECG, rehabilitation, EMR, imaging) and other data sources (eg. Geospatial, crime data, meteorological) allows better study of the determinants of a patient's health trajectory. This paper describes applied examples of work that has leveraged the potential of linking several datasets with the APPROACH registry.
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Affiliation(s)
- Danielle A Southern
- Department of Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Matthew T James
- Department of Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
- Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Stephen B Wilton
- Libin Cardiovascular Institute of Alberta, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Lawrence DeKoning
- Department of Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
- Calgary Laboratory Services, 3535 Research Road NW, Calgary, AB, T2L 2K8
- Department of Paediatrics, Alberta Children's Hospital, 2888 Shaganappi Tr NW, Calgary, Alberta, T3B 6A8, Canada
| | - Hude Quan
- Department of Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Merril L Knudtson
- Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - William A Ghali
- Department of Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
- Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
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Jarrah MI, Hammoudeh AJ, Al-Natour DB, Khader YS, Tabbalat RA, Alhaddad IA, Kullab SM. Gender differences in risk profile and outcome of Middle Eastern patients undergoing percutaneous coronary intervention. Saudi Med J 2017; 38:149-155. [PMID: 28133687 PMCID: PMC5329626 DOI: 10.15537/smj.2017.2.16301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives: To determine the gender differences in cardiovascular risk profile and outcomes among patients undergoing percutaneous coronary intervention (PCI). Methods: In a prospective multicenter study of consecutive Middle Eastern patients managed with PCI from January 2013 to February 2014 in 12 tertiary care centers in Amman and Irbid, Jordan. Clinical and coronary angiographic features, and major cardiovascular events were assessed for both genders from hospital stay to 1 year. Results: Women comprised 20.6% of 2426 enrolled patients, were older (mean age 62.9 years versus 57.2 years), had higher prevalence of hypertension (81% versus 57%), diabetes (66% versus 44%), dyslipidemia (58% versus 46%), and obesity (44% versus 25%) compared with men, p<0.001. The PCI for ST-segment elevation myocardial infarction was indicated for fewer women than men (23% versus 33%; p=0.001). Prevalence of single or multi-vessel coronary artery disease was similar in women and men. More women than men had major bleeding during hospitalization (2.2% versus 0.6%; p=0.003) and at one year (2.5% versus 0.9%; p=0.007). There were no significant differences between women and men in mortality (3.1% versus 1.7%) or stent thrombosis (2.1% versus 1.8%) at 1 year. Conclusion: Middle Eastern women undergoing PCI had worse baseline risk profile compared with men. Except for major bleeding, no gender differences in the incidence of major adverse cardiovascular events were demonstrated.
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Affiliation(s)
- Mohamad I Jarrah
- Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordon. E-mail.
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Abstract
Lipid-lowering therapy, particularly with statins, reduces the risk of cardiovascular mortality; however, there is uncertainty about their efficacy in patients with heart failure, including those without coronary artery stenosis. A clinical database was studied to determine whether lipid-lowering therapy is associated with improved survival in persons with heart failure—with or without concomitant coronary artery stenosis. During an 8-year period, 6060 people with a history of heart failure underwent coronary angiography. At the time of angiography, 1216 received a lipid-lowering agent. During a median follow-up of 4.7 years, 7.1 deaths per 100 person-years occurred among users of lipid-lowering therapy, compared with 7.8 per 100 person-years among nonusers (adjusted hazard ratio 0.87, 95% confidence interval 0.77-0.97). Use of lipid-lowering therapy was associated with a reduced risk of death in patients with heart failure. Current evidence supports statin use in individuals with recognized heart failure and concomitant coronary heart disease, dyslipidemia, or diabetes mellitus. More data are needed before statins can be recommended in those with isolated heart failure.
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Affiliation(s)
- Joel G Ray
- Department of Medicine, Divisions of General Internal Medicine and Endocrinology and Metabolism, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada.
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Donataccio MP, Puymirat E, Parapid B, Steg PG, Eltchaninoff H, Weber S, Ferrari E, Vilarem D, Charpentier S, Manzo-Silberman S, Ferrières J, Danchin N, Simon T. In-hospital outcomes and long-term mortality according to sex and management strategy in acute myocardial infarction. Insights from the French ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2005 Registry. Int J Cardiol 2015; 201:265-70. [DOI: 10.1016/j.ijcard.2015.08.065] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
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Chapa DW, Akintade B, Schron E, Friedmann E, Thomas SA. Is health-related quality of life a predictor of hospitalization or mortality among women or men with atrial fibrillation? J Cardiovasc Nurs 2014; 29:555-64. [PMID: 24165699 DOI: 10.1097/JCN.0000000000000095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Little is known about predictors of mortality or hospitalization in women compared with men in patients with atrial fibrillation (AF). Although there are established gender differences in patients with coronary artery disease (CAD), differences have not been established in AF. OBJECTIVES The aim of this study was to examine clinical and health-related quality of life (HRQOL) predictors of mortality and 1-year hospitalization in women compared with men with AF. METHODS Limited-use data from the National Institutes of Health/National Heart, Lung, and Blood Institute Atrial Fibrillation Follow-up Investigation of Rhythm Management clinical trial provided the sample of 693 patients with AF, 262 women and 431 men. Clinical predictors examined were heart failure (HF), CAD, left ventricular ejection fraction, diabetes, stroke, and age. Predictors of HRQOL included overall HRQOL (Medical Outcomes Study Short Form-36 physical [PCS] and mental component scores) and cardiovascular HRQOL using Quality of Life Index-Cardiac Version. RESULTS Mortality did not differ (women, 11.4%; men, 14.5%; χ(2)1 = 0.437, P = .509) according to gender, with mean 3.5-year follow-up. Different variables independently predicted mortality for women and men. For women, diabetes (hazard ratio [HR], 3.415; P = .003), HF (HR, 2.346; P = .027), stroke (HR, 2.41; P = .032), and age (HR, 1.117; P = .002), and for men, CAD (HR, 1.914; P = 02), age (HR, 1.103, P = < .001), worse PCS (HR, 1.089, P = .001), and worse Quality of Life Index-Cardiac Version score (HR, 1.402, P = .025) independently predicted mortality.One-year hospitalization (women, 38.9%; men, 36.4%) did not differ by gender (χ(2)1 = 0.914, P = .339). Different variables independently predicted 1-year hospitalization-for women: diabetes (odds ratio [OR], 2.359; P = .022), worse PCS (OR, 1.070; P = .003), and rhythm control trial arm (OR, 2.111; P = .006); for men: HF (OR, 2.072; P = .007), worse PCS (OR, 1.045; P = .019), living alone (OR, 1.913; P = .036), and rhythm control trial arm (OR, 2.113; P < .001). CONCLUSION Only clinical status predicted mortality among women; HRQOL and clinical status predicted mortality among men. Both clinical and HRQOL variables predicted hospitalization for women and men. Increased monitoring of HRQOL and interventions designed to target the clinical and HRQOL predictors could impact mortality and hospitalization. Nursing interventions may prove effective for modifying most of the predictors of mortality and hospitalization for women and men with AF.
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Hansen KW, Soerensen R, Madsen M, Madsen JK, Jensen JS, von Kappelgaard LM, Mortensen PE, Galatius S. Developments in the invasive diagnostic-therapeutic cascade of women and men with acute coronary syndromes from 2005 to 2011: a nationwide cohort study. BMJ Open 2015; 5:e007785. [PMID: 26063568 PMCID: PMC4466619 DOI: 10.1136/bmjopen-2015-007785] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To investigate for trends in sex-related differences in the invasive diagnostic-therapeutic cascade in a population of patients with acute coronary syndromes (ACS). DESIGN A nationwide cohort study. SETTING Administrative and clinical registries covering all hospitalisations, invasive cardiac procedures and deaths in the Danish population of 5.6 million inhabitants. PARTICIPANTS We included 52,565 patients aged 30-90 years who were hospitalised with a first ACS from January 2005 to November 2011. Follow-up was 60 days from the day of index admission. MAIN OUTCOME MEASURES Diagnostic coronary angiography, percutaneous coronary intervention or coronary artery bypass within 60 days of index admission. RESULTS Women constituted 36%, were older, had more comorbidity and were less likely to be admitted to a hospital with cardiac catheterisation facilities than men. Mortality rates were similar for both sexes. Diagnostic coronary angiography was performed less frequently on women compared with men, both within 1 day (31% vs 42%; p<0.001) and within 60 days (67% vs 80%; p<0.001), yielding adjusted female-male HRs of 0.83 (0.79-0.87) and 0.86 (0.84-0.89), respectively.Among the 39,677 patients undergoing coronary angiography, non-obstructive coronary artery disease was more frequent among women than men (22% vs 9%; p<0.001). Women were less likely to undergo percutaneous coronary intervention (58% vs 72%; p<0.001) and coronary artery bypass (6% vs 11%, p<0.001) within 60 days than men, yielding adjusted HRs of 0.96 (0.92-0.99) and 0.81 (0.74-0.89), respectively. The sex-related differences were not attenuated over time for any of the invasive cardiac procedures (p values for trend >0.05). CONCLUSIONS In this nationwide study, men were more likely to undergo an invasive approach than women when hospitalised with a first ACS--a difference persisting from 2005 to 2011. Future studies should focus on the potential mechanisms behind this differential treatment.
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Affiliation(s)
- Kim Wadt Hansen
- Department of Cardiology, University Hospital Bispebjerg, Bispebjerg, Denmark
| | - R Soerensen
- Department of Cardiology, University Hospital Gentofte, Hellerup, Denmark
| | - M Madsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J K Madsen
- Emergency Department, Holbaek University Hospital, Holbaek, Denmark
| | - J S Jensen
- Department of Cardiology, University Hospital Gentofte, Hellerup, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - L M von Kappelgaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- The Danish Heart Registry, Denmark
| | - P E Mortensen
- The Danish Heart Registry, Denmark
- Department of Thoracic Surgery, Odense University Hospital, Denmark
| | - S Galatius
- Department of Cardiology, University Hospital Bispebjerg, Bispebjerg, Denmark
- The Danish Heart Registry, Denmark
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Modica M, Ferratini M, Spezzaferri R, De Maria R, Previtali E, Castiglioni P. Gender differences in illness behavior after cardiac surgery. J Cardiopulm Rehabil Prev 2014; 34:123-9. [PMID: 24500263 DOI: 10.1097/HCR.0000000000000043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Differences in the ways male and female patients confront their illness after cardiac surgery may contribute to previously observed gender differences in the outcomes of cardiac rehabilitation. The aim of this cross-sectional study was to verify whether there are gender-related differences in illness behavior (IB) soon after cardiac surgery and before entering cardiac rehabilitation. METHODS Patients (N = 1323) completed the IB Questionnaire and Hospital Anxiety and Depression Scale (HADS) 9 ± 5 (mean ± SD) days after cardiac surgery. The scores were tested for gender differences in score distributions (Mann-Whitney U test) and in prevalence of clinically relevant scores (the Pearson χ² test). Multivariate regression analyses were made with IB Questionnaire and HADS scores as independent variables, and gender, age, education, marital status, and type of surgery as predictors. RESULTS Denial was significantly (P < .01) prevalent among the men (3.6 ± 1.4) versus women (3.2 ± 1.6), whereas disease conviction (men = 2.1 ± 1.5, women = 2.5 ± 1.6), dysphoria (men = 1.5 ± 1.5, women = 2.0 ± 1.6), anxiety (men = 6.0 ± 3.6, women = 6.9 ± 3.9), and depression (men = 5.3 ± 3.8, women = 6.5 ± 4.0) were significantly more prevalent among women. The prevalences of clinically relevant scores for disease conviction, anxiety, and depression were also significantly higher in women. Multivariate analysis showed that gender predicted these scores even after the removal of confounders. CONCLUSIONS Gender differences exist in denial, disease conviction, and dysphoria, probably depending on the culturally assigned roles of men and women. As these aspects of IB may compromise treatment compliance and the quality of life, the efficacy of cardiac rehabilitation programs might be improved taking into account the different prevalences in men and women.
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12
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Suessenbacher A, Wanitschek M, Dörler J, Neururer S, Frick M, Pachinger O, Alber HF. Sex differences in independent factors associated with coronary artery disease. Wien Klin Wochenschr 2014; 126:718-26. [PMID: 25216757 DOI: 10.1007/s00508-014-0602-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 08/24/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND Women undergoing coronary angiography (CA) due to chest pain are more likely to present with less extensive coronary artery disease (CAD) than men, which might be attributed to different effects of cardiovascular risk factors on coronary atherogenesis between sexes. The aim of the present study was to evaluate sex differences in independent factors associated with obstructive and non-obstructive CAD in a large consecutive cohort of patients undergoing elective CA. METHODS Data from 7819 patients (2653 women and 5184 men), including cardiovascular risk factors, clinical presentation, CAD severity and treatment decisions were analysed. RESULTS Women were older than men (65 ± 11 vs. 63 ± 11 years, p < 0.001); low-density lipoprotein cholesterol (LDL; 125 ± 38 vs. 122 ± 37 mg/dL, p < 0.001) and high-density lipoprotein cholesterol (HDL) cholesterol levels (62 ± 18 vs. 51 ± 15 mg/dL, p < 0.001) were higher in women; and smokers were more frequently men (14.4 vs. 20.1%, p < 0.001). Men more frequently had an obstructive CAD (41.1 vs. 65.6%, p < 0.001). Multivariable analyses revealed age, HDL cholesterol, hypercholesterolaemia, diabetes mellitus, arterial hypertension and a positive family history being associated with obstructive CAD in both sexes, whereas smoking was independently associated with obstructive CAD only in women. The association of hypercholesterolaemia with obstructive CAD was stronger in men. For non-obstructive CAD, no sex-specific associated factors could be identified. CONCLUSION The impact of smoking and hypercholesterolaemia on coronary atherosclerosis is different between women and men. This might be taken into account when planning individual interventions to reduce cardiovascular risk.
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Anjo D, Santos M, Rodrigues P, Brochado B, Sousa MJ, Barreira A, Viamonte S, Fernandes P, Reis AH, Lopes Gomes J, Torres S. Os benefícios da reabilitação cardíaca na doença coronária: uma questão de género? Rev Port Cardiol 2014; 33:79-87. [DOI: 10.1016/j.repc.2013.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 06/25/2013] [Indexed: 11/20/2022] Open
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14
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Anjo D, Santos M, Rodrigues P, Brochado B, Sousa MJ, Barreira A, Viamonte S, Fernandes P, Reis AH, Lopes Gomes J, Torres S. The benefits of cardiac rehabilitation in coronary heart disease: A gender issue? Revista Portuguesa de Cardiologia (English Edition) 2014; 33:79-87. [DOI: 10.1016/j.repce.2013.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Tasić I, Lazarević G, Stojanović M, Kostić S, Rihter M, Djordjević D, Simonović D, Vulić D, Stefanović V. Health-related quality of life in patients with coronary artery disease after coronary revascularization. Open Med (Wars) 2013; 8:618-26. [DOI: 10.2478/s11536-012-0135-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractThe aim of this study was to investigate the quality of life (HRQoL) in coronary artery disease(CAD) patients, admitted for rehabilitation within 3 months after an acute coronary event, in relation to treatment strategy [conservative treatment without revascularization (WR), percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG)]. Methods: Overall 719 consecutive CAD patients were involved in the study: WR (n=170), PTCA (n=226), CABG (n=323). HRQoL was estimated using the SF-36 questionnaire for total QoL and its two dimensions for physical and mental health [physical and mental component scores (PCS, MCS)]. Sexual dysfunction was assessed using the ASEX scale. Results: Significantly higher PCS, MCS and total SF-36, but lower ASEX score, were found in men compared with women. The ASEX score was significantly affected by age. Significantly higher PCS was found in PTCA group compared with that of CABG group. In multivariate analysis a significant positive association was obtained between PCS/MCS and male sex, between regular exercise, hyperlipoproteinemia, and permanent stress. ASEX was significantly positively associated with the age, CHF and non smoking. Conclusion: The results of this study have demonstrated significantly better HRQoL in men, younger CAD patients, patients who underwent PTCA and in patients without self-reported exposition to stress.
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Beck CA, Southern DA, Saitz R, Knudtson ML, Ghali WA. Alcohol and drug use disorders among patients with myocardial infarction: associations with disparities in care and mortality. PLoS One 2013; 8:e66551. [PMID: 24039695 PMCID: PMC3770618 DOI: 10.1371/journal.pone.0066551] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 05/10/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Because alcohol and drug use disorders (SUDs) can influence quality of care, we compared patients with and without SUDs on frequency of catheterization, revascularization, and in-hospital mortality after acute myocardial infarction (AMI). METHODS This study employed hospital discharge data identifying all adult AMI admissions (ICD-9-CM code 410) between April 1996 and December 2001. Patients were classified as having an SUD if they had alcohol and/or drug (not nicotine) abuse or dependence using a validated ICD-9-CM coding definition. Catheterization and revascularization data were obtained by linkage with a clinically-detailed cardiac registry. Analyses (controlling for comorbidities and disease severity) compared patients with and without SUDs for post-MI catheterization, revascularization, and in-hospital mortality. RESULTS Of 7,876 AMI unique patient admissions, 2.6% had an SUD. In adjusted analyses mortality was significantly higher among those with an SUD (odds ratio (OR) 2.02; 95%CI: 1.10-3.69), while there was a trend toward lower catheterization rates among those with an SUD (OR 0.75; 95%CI: 0.55-1.01). Among the subset of AMI admissions who underwent catheterization, the adjusted hazard ratio for one-year revascularization was 0.85 (95%CI: 0.65-1.11) with an SUD compared to without. CONCLUSIONS Alcohol and drug use disorders are associated with significantly higher in-hospital mortality following AMI in adults of all ages, and may also be associated with decreased access to catheterization and revascularization. This higher mortality in the face of poorer access to procedures suggests that these individuals may be under-treated following AMI. Targeted efforts are required to explore the interplay of patient and provider factors that underlie this finding.
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Affiliation(s)
- Cynthia A. Beck
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Danielle A. Southern
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Richard Saitz
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | | | - William A. Ghali
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
- Institute for Public Health (IPH), University of Calgary, Calgary, Alberta, Canada
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Buja P, D'Amico G, Facchin M, Barioli A, Napodano M, Capodanno D, Musumeci G, Frigo AC, Saia F, Menozzi A, De Benedictis M, Lee MS, Lettieri C, Tamburino C, Sardella G, Isabella G, Tarantini G. Gender-related differences of diabetic patients undergoing percutaneous coronary intervention with drug-eluting stents: A real-life multicenter experience. Int J Cardiol 2013; 168:139-43. [DOI: 10.1016/j.ijcard.2012.09.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 07/17/2012] [Accepted: 09/14/2012] [Indexed: 11/15/2022]
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Simon T, Puymirat E, Lucke V, Bouabdallaoui N, Lognoné T, Aissaoui N, Cohen S, Ashrafpoor G, Roul G, Jouve B, Levy G, Charpentier S, Grollier G, Ferrières J, Danchin N; au nom des investigateurs FAST-MI 2010. [Acute myocardial infarction in women. Initial characteristics, management and early outcome. The FAST-MI registry]. Ann Cardiol Angeiol (Paris) 2013; 62:221-6. [PMID: 23920136 DOI: 10.1016/j.ancard.2013.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 06/13/2013] [Indexed: 11/23/2022]
Abstract
AIM To assess gender differences in characteristics, management, and hospital outcomes in patients participating in the French FAST-MI 2010 registry. POPULATION Three thousand and seventy-nine patients hospitalised for ST-elevation (STEMI) or non-ST-elevation (NSTEMI) myocardial infarction in 213 French centres during a 1-month period at the end of 2010. RESULTS Women account for 27% of the population and more frequently present with NSTEMI. They are 9 years older than men on average, although 25% of women with STEMI are less than 60 years of age. Management of STEMI is similar, after adjustment for baseline characteristics. However, fewer women are treated with primary percutaneous coronary angioplasty. In NSTEMI, although use of coronary angiography is similar, fewer women get treated with angioplasty. Most medications are used in a similar way in men and women, except thienopyridines, with fewer women receive prasugrel. After adjustment, in-hospital mortality is similar for men and women. CONCLUSION Myocardial infarction is not specific to men: one out of four patients admitted for myocardial infarction is a woman. Initial management is rather similar for men and women, after taking into account differences in baseline characteristics. Percutaneous coronary angioplasty, however, remains less frequently used in women. In-hospital complications have become rarer and do not differ according to sex.
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Stephens P, Ross-Degnan D, Wagner AK. Does access to medicines differ by gender? Evidence from 15 low and middle income countries. Health Policy 2013; 110:60-6. [PMID: 23422029 DOI: 10.1016/j.healthpol.2013.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 01/21/2013] [Accepted: 01/26/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine gender differences in access to prescribed medicines in 15 lower and middle income countries. METHODS The proportion of consultations with at least one prescription for women in three age groups (<15, 15-59, 60+ years) with acute respiratory infections (ARI), depression and diabetes in routine audits was compared to the expected proportion calculated from WHO Global Burden of Disease estimates. Newer oral hypoglycaemic medication prescribing was also analysed. Differences reported by country, age group, and condition. FINDINGS 487,841 consultations examined between January 2007 and September 2010 in low (n = 1), lower middle (6), and upper middle income (8) countries. No country favoured one gender exclusively, but gender differences were common. Taking the 15 countries together, only diabetes treatment revealed a significant difference, with women being treated less often than expected (p = 0.02). No consistent differences found across countries grouped by World Bank income category, WHO region or Global Gender Gap Index. Overall, women had equal access to newer oral hypoglycaemics. CONCLUSION Gender differences in access to prescribed medicines for three common conditions are common, but favour neither gender consistently. This challenges prevailing hypotheses of systematic disparities in access to care for women. Evidence about gender disparities should influence policy design.
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Affiliation(s)
- Peter Stephens
- IMS HEALTH, 210 Pentonville Road, London, N1 9JY, United Kingdom.
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21
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Shehab A, Al-Dabbagh B, AlHabib KF, Alsheikh-Ali AA, Almahmeed W, Sulaiman K, Al-Motarreb A, Nagelkerke N, Al Suwaidi J, Hersi A, Al Faleh H, Asaad N, Al Saif S, Amin H. Gender disparities in the presentation, management and outcomes of acute coronary syndrome patients: data from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2). PLoS One 2013; 8:e55508. [PMID: 23405162 PMCID: PMC3566183 DOI: 10.1371/journal.pone.0055508] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 12/27/2012] [Indexed: 11/19/2022] Open
Abstract
Background Gender-related differences in mortality of acute coronary syndrome (ACS) have been reported. The extent and causes of these differences in the Middle-East are poorly understood. We studied to what extent difference in outcome, specifically 1-year mortality are attributable to demographic, baseline clinical differences at presentation, and management differences between female and male patients. Methodology/Principal Findings Baseline characteristics, treatment patterns, and 1-year mortality of 7390 ACS patients in 65 hospitals in 6 Arabian Gulf countries were evaluated during 2008–2009, as part of the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2). Women were older (61.3±11.8 vs. 55.6±12.4; P<0.001), more overweight (BMI: 28.1±6.6 vs. 26.7±5.1; P<0.001), and more likely to have a history of hypertension, hyperlipidemia or diabetes. Fewer women than men received angiotensin-converting enzyme inhibitors (ACE), aspirin, clopidogrel, beta blockers or statins at discharge. They also underwent fewer invasive procedures including angiography (27.0% vs. 34.0%; P<0.001), percutaneous coronary intervention (PCI) (10.5% vs. 15.6%; P<0.001) and reperfusion therapy (6.9% vs. 20.2%; P<0.001) than men. Women were at higher unadjusted risk for in-hospital death (6.8% vs. 4.0%, P<0.001) and heart failure (HF) (18% vs. 11.8%, P<0.001). Both 1-month and 1-year mortality rates were higher in women than men (11% vs. 7.4% and 17.3% vs. 11.4%, respectively, P<0.001). Both baseline and management differences contributed to a worse outcome in women. Together these variables explained almost all mortality disparities. Conclusions/Significance Differences between genders in mortality appeared to be largely explained by differences in prognostic variables and management patterns. However, the origin of the latter differences need further study.
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Affiliation(s)
- Abdulla Shehab
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
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O'Brien EC, Rose KM, Suchindran CM, Sturmer T, Chang PP, Alonso A, Baggett CD, Rosamond WD. Temporal trends in medical therapies for ST- and non-ST elevation myocardial infarction: (from the Atherosclerosis Risk in Communities [ARIC] Surveillance Study). Am J Cardiol 2013; 111:305-11. [PMID: 23168284 PMCID: PMC4075033 DOI: 10.1016/j.amjcard.2012.09.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 09/27/2012] [Accepted: 09/27/2012] [Indexed: 11/20/2022]
Abstract
Reports from large studies using administrative data sets and event registries have characterized recent temporal trends and treatment patterns for acute myocardial infarction. However, few were population based, and fewer examined differences in patterns of treatment for patients presenting with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). The aim of this study was to examine 22-year trends in the use of 10 medical therapies and procedures by STEMI and NSTEMI classification in 30,986 definite or probable myocardial infarctions in the Atherosclerosis Risk in Communities (ARIC) Community Surveillance Study from 1987 to 2008. Weighted multivariate Poisson regression, controlling for gender, race and center classification, age, and Predicting Risk of Death in Cardiac Disease Tool score, was used to estimate average annual percentage changes in medical therapy use. From 1987 to 2008, 6,106 hospitalized events (19.7%) were classified as STEMIs and 20,302 (65.5%) as NSTEMIs. Among patients with STEMIs, increases were noted in the use of angiotensin-converting enzyme inhibitors (6.4%, 95% confidence interval [CI] 5.7 to 7.2), antiplatelet agents other than aspirin (5.0%, 95% CI 4.0% to 6.0%), lipid-lowering medications (4.5%, 95% CI 3.1% to 5.8%), β blockers (2.7%, 95% CI 2.4% to 3.0%), aspirin (1.2%, 95% CI 1.0% to 1.3%), and heparin (0.8%, 95% CI 0.4% to 1.3%). Among patients with NSTEMIs, the use of angiotensin-converting enzyme inhibitors (5.5%, 95% CI 5.0% to 6.1%), antiplatelet agents other than aspirin (3.7%, 95% CI 2.7% to 4.7%), lipid-lowering medications (3.0%, 95% CI% 1.9 to 4.1%), β blockers (4.2%, 95% CI 3.9% to 4.4%), aspirin (1.9%, 95% CI 1.6% to 2.1%), and heparin (1.7%, 95% CI 1.3% to 2.1%) increased. Among patients with STEMIs, decreases in the use of thrombolytic agents (-7.2%, 95% CI -7.9% to -6.6%) and coronary artery bypass grafting (-2.4%, 95% CI -3.6% to -1.2%) were observed. Similar increases in percutaneous coronary intervention and decreases in the use of thrombolytic agents and coronary artery bypass grafting were noted among all patients. In conclusion, trends of increasing use of evidence-based therapies were found for patients with STEMIs and those with NSTEMIs over the past 22 years.
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Affiliation(s)
- Emily C O'Brien
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel USA.
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De Feo S, Tramarin R, Ambrosetti M, Riccio C, Temporelli PL, Favretto G, Furgi G, Griffo R. Gender differences in cardiac rehabilitation programs from the Italian survey on cardiac rehabilitation (ISYDE-2008). Int J Cardiol 2012; 160:133-9. [DOI: 10.1016/j.ijcard.2011.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Revised: 03/06/2011] [Accepted: 04/14/2011] [Indexed: 12/19/2022]
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Aguilar SA, Patel M, Castillo E, Patel E, Fisher R, Ochs G, Pringle J, Mahmud E, Dunford JV. Gender Differences in Scene Time, Transport Time, and Total Scene to Hospital Arrival Time Determined by the Use of a Prehospital Electrocardiogram in Patients with Complaint of Chest Pain. J Emerg Med 2012; 43:291-7. [DOI: 10.1016/j.jemermed.2011.06.130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 04/13/2011] [Accepted: 06/05/2011] [Indexed: 01/10/2023]
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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: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Clement FM, Manns BJ, Brownell B, Faris PD, Graham MM, Humphries K, Love M, Knudtson ML, Ghali WA. A multi-region assessment of population rates of cardiac catheterization and yield of high-risk coronary artery disease. BMC Health Serv Res 2011; 11:323. [PMID: 22115358 PMCID: PMC3252261 DOI: 10.1186/1472-6963-11-323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 11/24/2011] [Indexed: 11/30/2022] Open
Abstract
Background There is variation in cardiac catheterization utilization across jurisdictions. Previous work from Alberta, Canada, showed no evidence of a plateau in the yield of high-risk disease at cardiac catheterization rates as high as 600 per 100,000 population suggesting that the optimal rate is higher. This work aims 1) To determine if a previously demonstrated linear relationship between the yield of high-risk coronary disease and cardiac catheterization rates persists with contemporary data and 2) to explore whether the linear relationship exists in other jurisdictions. Methods Detailed clinical information on all patients undergoing cardiac catheterization in 3 Canadian provinces was available through the Alberta Provincial Project for Outcomes Assessment in Coronary Heart (APPROACH) disease and partner initiatives in British Columbia and Nova Scotia. Population rates of catheterization and high-risk coronary disease detection for each health region in these three provinces, and age-adjusted rates produced using direct standardization. A mixed effects regression analysis was performed to assess the relationship between catheterization rate and high-risk coronary disease detection. Results In the contemporary Alberta data, we found a linear relationship between the population catheterization rate and the high-risk yield. Although the yield was slightly less in time period 2 (2002-2006) than in time period 1(1995-2001), there was no statistical evidence of a plateau. The linear relationship between catheterization rate and high-risk yield was similarly demonstrated in British Columbia and Nova Scotia and appears to extend, without a plateau in yield, to rates over 800 procedures per 100,000 population. Conclusions Our study demonstrates a consistent finding, over time and across jurisdictions, of linearly increasing detection of high-risk CAD as population rates of cardiac catheterization increase. This internationally-relevant finding can inform country-level planning of invasive cardiac care services.
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Affiliation(s)
- Fiona M Clement
- Department of Medicine, Faculty of Medicine, University of Calgary, Foothills Medical Centre-North Tower, 9th Floor, 1403 29th Street NW, Calgary, AB T2N 2T9, Canada
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Dueñas M, Ramirez C, Arana R, Failde I. Gender differences and determinants of health related quality of life in coronary patients: a follow-up study. BMC Cardiovasc Disord 2011; 11:24. [PMID: 21619566 PMCID: PMC3125287 DOI: 10.1186/1471-2261-11-24] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 05/27/2011] [Indexed: 01/23/2023] Open
Abstract
Background The role of gender differences in Health Related Quality Life (HRQL) in coronary patients is controversial, so understanding the specific determinants of HRQL in men and women might be of clinical importance. The aim of this study was to know the gender differences in the evolution of HRQL at 3 and 6 months after a coronary event, and to identify the key clinical, demographic and psychological characteristics of each gender associated with these changes. Methods A follow-up study was carried out, and 175 patients (112 men and 63 women) with acute myocardial infarction (AMI) or unstable angina were studied. The SF-36v1 health questionnaire was used to assess HRQL, and the GHQ-28 (General Health Questionnaire) to measure mental health during follow-up. To study the variables related to changes in HRQL, generalized estimating equation (GEE) models were performed. Results Follow-up data were available for 55 men and 25 women at 3 months, and for 35 men and 12 women at 6 months. Observations included: a) Revascularization was performed later in women. b) The frequency of rehospitalization between months 3 and 6 of follow-up was higher in women c) Women had lower baseline scores in the SF-36. d) Men had progressed favourably in most of the physical dimensions of the SF-36 at 6 months, while at the same time women's scores had only improved for Physical Component Summary, Role Physical and Social Functioning; e) the variables determining the decrease in HRQL in men were: worse mental health and angina frequency; and in women: worse mental health, history of the disease, revascularization, and angina frequency. Conclusions There are differences in the evolution of HRQL, between men and women after a coronary attack. Mental health is the determinant most frequently associated with HRQL in both genders. However, other clinical determinants of HRQL differed with gender, emphasizing the importance of individualizing the intervention and the content of rehabilitation programs. Likewise, the recognition and treatment of mental disorders in these patients could be crucial.
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Affiliation(s)
- María Dueñas
- Área de Medicina Preventiva y Salud Pública, Universidad de Cádiz, Spain
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Tawfik M, Samir R, Farag N. Outcome of coronary angiography and percutaneous coronary intervention in Egyptian women with chronic stable angina. Egypt Heart J 2011. [DOI: 10.1016/j.ehj.2011.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Jackson EA, Moscucci M, Smith DE, Share D, Dixon S, Greenbaum A, Grossman PM, Gurm HS. The association of sex with outcomes among patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction in the contemporary era: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). Am Heart J 2011; 161:106-112.e1. [PMID: 21167341 DOI: 10.1016/j.ahj.2010.09.030] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 09/23/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND historically, women with ST elevation myocardial infarction (STEMI) have had a higher mortality compared with men. It is unclear if these differences persist among patients undergoing contemporary primary percutaneous coronary intervention (PCI) with focus on early reperfusion. METHODS we assessed the impact of sex on the outcome of 8,771 patients with acute STEMI who underwent primary PCI from 2003 to 2008 at 32 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry. A propensity-matched analysis was performed to adjust for differences in baseline characteristics and comorbidities between men and women. RESULTS twenty-nine percent of the cohort was female. Compared with men, women were older and had more comorbidity. Female sex was associated with a higher unadjusted in-hospital mortality (6.02% vs 3.45%, odds ratio [OR] 1.79, 95% CI 1.45-2.22, P < .0001) and higher risk of contrast-induced nephropathy (OR 1.75, P < .0001), vascular complications (OR 2.13, P < .0001), and postprocedure transfusion (OR 2.84, P < .0001). The gap in sex-specific mortality narrowed over time. In a propensity-matched analysis, female sex was associated with a higher rate of transfusion (OR 1.88, 95% CI 1.57-2.24, P < .0001) and vascular complications (OR 1.65, 95% CI 1.26-2.14, P < .0002); but there was no difference in mortality (OR 1.30, 95% CI 0.98-1.72, P = .07). CONCLUSIONS women make up approximately one third of patients undergoing primary PCI for STEMI. Female sex is associated with an apparent hazard of increased mortality among patients undergoing primary PCI for STEMI, but this difference is likely explained by older age and worse baseline comorbidities among women.
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Affiliation(s)
- Elizabeth A Jackson
- Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI, USA
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Grace SL, Racco C, Chessex C, Rivera T, Oh P. A narrative review on women and cardiac rehabilitation: Program adherence and preferences for alternative models of care. Maturitas 2010; 67:203-8. [DOI: 10.1016/j.maturitas.2010.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 07/01/2010] [Accepted: 07/03/2010] [Indexed: 12/18/2022]
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Kreatsoulas C, Sloane D, Pogue J, Velianou JL, Anand SS. Referrals in acute coronary events for CARdiac catheterization: The RACE CAR trial. Can J Cardiol 2010; 26:290-6. [PMID: 20931097 DOI: 10.1016/s0828-282x(10)70436-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Women with acute coronary syndromes have lower rates of cardiac catheterization (CC) than men. OBJECTIVE To determine whether sex⁄gender, age, risk level and patient preference influence physician decision making to refer patients for CC. METHODS Twelve clinical scenarios controlling for sex⁄gender, age (55 or 75 years of age), Thrombolysis in Myocardial Infarction risk score (low, moderate or high) and patient preference for CC (agreeable or refused⁄no preference expressed) were designed. Scenarios were administered to specialists across Canada using a web-based computerized survey instrument. Questions were standardized using a five-point Likert scale ranging from 1 (very unlikely to benefit from CC) to 5 (very likely to benefit from CC). Outcomes were assessed using a two-tailed mixed linear regression model. RESULTS Of 237 scenarios, physicians rated men as more likely to benefit from CC than women (mean [± SE] 4.44±0.07 versus 4.25±0.07, P=0.03), adjusted for age, risk and patient preference. Low-risk men were perceived to benefit more than low-risk women (4.20±0.13 versus 3.54±0.14, P<0.01), and low-risk younger patients were perceived to benefit more than low-risk older patients (4.52±0.17 versus 3.22±0.16, P<0.01). Regardless of risk, patients who agreed to CC were perceived as more likely to benefit from CC than patients who were disagreeable or made no comment at all (5.0±0.23, 3.67±0.21, 2.95±0.14, respectively, P<0.01). CONCLUSION Canadian specialists' decisions to refer patients for CC appear to be influenced by sex⁄gender, age and patient preference in clinical scenarios in which cardiac risk is held constant. Future investigation of possible age and sex⁄gender biases as proxies for risk is warranted.
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Sedlak TL, Pu A, Aymong E, Gao M, Khan N, Quan H, Humphries KH. Sex differences in coronary catheterization and revascularization following acute myocardial infarction: time trends from 1994 to 2003 in British Columbia. Can J Cardiol 2010; 26:360-4. [PMID: 20847962 DOI: 10.1016/s0828-282x(10)70410-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Studies before the turn of the century reported sex differences in procedure rates. It is unknown whether these differences persist. OBJECTIVES To examine time trends and sex differences in coronary catheterization and revascularization following acute myocardial infarction (AMI). METHODS A retrospective analysis was performed of all patients 20 years of age or older who were admitted to hospital in British Columbia with an AMI between April 1, 1994, and March 31, 2003. Segmented regression analysis was used to examine the inflection point of the time trend in 90-day catheterization rates post-AMI. Multivariable Cox regression modelling was used to evaluate sex differences in receiving catheterization and revascularization following AMI. RESULTS Ninety-day coronary catheterization rates increased significantly over the study period for both men and women (P<0.0001 for trend), with a steeper increase beginning in September 2000. Women were less likely to undergo catheterization than men, even after adjustment for baseline differences; this sex effect was modified by age and care in the intensive care unit or cardiac care unit (ICU⁄CCU). Specifically, ICU⁄CCU admission eliminated the sex difference among patients who were younger than 65 years of age. Conditional on receiving cardiac catheterization post-AMI, female sex was not associated with a lower likelihood of receiving revascularization within one year (HR 0.96; 95% CI 0.91 to 1.02). CONCLUSIONS Despite recent increases in catheterization rates post-AMI, women were less likely to undergo catheterization than men. Interestingly, access to ICU⁄CCU care removed the sex difference in catheterization access in patients younger than 65 years of age.
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Sambola A, Fernández-Hidalgo N, Almirante B, Roca I, González-Alujas T, Serra B, Pahissa A, García-Dorado D, Tornos P. Sex differences in native-valve infective endocarditis in a single tertiary-care hospital. Am J Cardiol 2010; 106:92-8. [PMID: 20609654 DOI: 10.1016/j.amjcard.2010.02.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 02/21/2010] [Accepted: 02/21/2010] [Indexed: 11/22/2022]
Abstract
The aim of this study was to assess whether the clinical characteristics, management, and outcomes of infective endocarditis differ in women and men through a prospective observational cohort study at a single tertiary care teaching hospital. From January 2000 to December 2008, 271 new cases of infective endocarditis were diagnosed (183 in men, 88 in women) according to modified Duke criteria, and patients were followed for 1 year. Women were older than men (mean age 63 +/- 16 vs 58 +/- 18 years, p = 0.006); more women were taking immunosuppressants (14% vs 3%, p = 0.006) and had mitral valve involvement (52% vs 36%, p = 0.02). However, more men had human immunodeficiency virus infection than women. There were no gender differences in Charlson index, regurgitation severity, culprit pathogens, or major complications. When surgery was indicated, women were less likely to undergo the procedure (26% vs 47%, relative risk [RR] 0.4, 95% confidence interval [CI] 0.2 to 0.7), p = 0.001). Mortality tended to be higher in women in the hospital (32% vs 23%, RR 1.58, 95% CI 1 to 2.5, p = 0.05) and at 1 year (38% vs 26%, RR 1.7, 95% CI 1.0 to 2.9, p = 0.04). Surgical treatment was a protective factor against death in the hospital (RR 0.18, 95% CI 0.04 to 0.77, p = 0.02) and at 1 year (RR 0.12, 95% CI 0.03 to 0.48, p = 0.03) after adjustment for age, gender, Charlson index, infection by Staphylococcus aureus, severity at presentation, heart failure, acute renal failure, stroke, and the ejection fraction. In conclusion, women with infective endocarditis were slightly older than men but showed similar co-morbidities. Women underwent surgery less frequently and consequently had worse prognosis than men.
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Abstract
BACKGROUND Most small renal tumors are amenable to partial nephrectomy (PN). Studies have documented the association of radical nephrectomy (RN) with an increased risk of comorbid conditions, such as chronic kidney disease. Despite evidence of equivalent oncologic outcomes, PN remains under used within the United States. In this study, the authors identified the most recent trends in kidney surgery for small renal tumors and determined which factors were associated with the use of PN versus RN within the United States. METHODS A population-based patient cohort was analyzed using the Surveillance, Epidemiology and End Results cancer registry (SEER 1999-2006). The authors identified 18,330 patients ages 40 to 90 years who underwent surgery for kidney tumors <or=4 cm in the United States between 1999 and 2006. RESULTS In total, 11,870 patients (65%) underwent RN, and 6460 patients (35%) underwent PN. The ratio of PN to RN increased yearly (P < .001), representing 45% of kidney surgeries in 2006 for small tumors. There were significant differences in the cohort of patients who underwent PN versus RN, including age, sex, tumor location, marital status, year of treatment, and tumor size. When adjusting for these variables, being a man, age <or=70 years, urban residence, smaller tumor size, and more recent treatment year were predictors of PN. CONCLUSIONS Although the total numbers of PN procedures increased in the United States between 1999 and 2006, there remains a significant under use of PN, particularly among women, the elderly, and those living in rural locations. Further investigation will be required to determine the reasons for these disparities, and strategies to optimize access to PN need to be developed.
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Affiliation(s)
- Lori M Dulabon
- Department of Urology, New York University School of Medicine, New York, New York 10016, USA
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Chieffo A, Hoye A, Mauri F, Mikhail G, Ammerer M, Grines C, Grinfeld L, Madan M, Presbitero P, Skelding KA, Weiner BH, Mehran R. Gender-based issues in interventional cardiology: a consensus statement from the Women in Innovations (WIN) initiative. Rev Esp Cardiol 2010; 63:200-8. [PMID: 20109417 DOI: 10.1016/s1885-5857(10)70038-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cardiovascular disease is the leading cause of mortality in women yet studies have suggested it is often under-recognized. Of particular concern is the apparent suboptimal treatment of women in comparison to men, with less revascularization and use of evidence-based medications. The Women in Innovations group of cardiologists, aims to highlight these issues and change perceptions to optimize the treatment of female patients with cardiovascular disease, support future research, and encourage and guide the training of female interventional cardiologists.
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Affiliation(s)
- Alaide Chieffo
- Invasive Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
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Lee LC, Poh KK, Tang TPL, Tan YL, Tee HW, Tan HC. The Impact of Gender on the Outcomes of Invasive versus Conservative Management of Patients with Non-ST-Segment Elevation Myocardial Infarction. Ann Acad Med Singap 2010. [DOI: 10.47102/annals-acadmedsg.v39n3p168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: Studies have suggested that women who present with non-ST-segment elevation myocardial infarction (NSTEMI) may differ in their clinical response to early invasive strategy compared to male patients. We examined the impact of gender difference in NSTEMI patients on outcomes following invasive versus conservative treatment. Materials and Methods: Patients enrolled in our national myocardial infarction (MI) registry between January 2000 and September 2005 with diagnosis of NSTEMI were retrospectively analysed. The study endpoint was the occurrence of major adverse cardiac events (MACE) in the patients at 1 year. Results: A total of 1353 patients (62.2% male) with NSTEMI were studied. The mean age of men was 62 ± 14 versus 72 ± 12 years in women in the cohort (P <0.001). The prevalence of hypertension and diabetes mellitus were significantly higher in women. Men were more likely to undergo revascularisation than women (OR, 2.97; 95% CI, 2.18-3.89, P <0.001). Among those who were revascularised, there was no gender difference in survival or recurrent MI rates during hospitalisation and at 1 year. Compared to medical therapy, percutaneous coronary intervention (PCI) was associated with a significant reduction in MACE in both women (OR, 0.44; 95% CI, 0.20-0.95) and men (OR, 0.40; 95% CI, 4.79-12.75). The most important predictor of MACE for females was diabetes mellitus (HR, 1.98; 95% CI, 1.17-3.33). Conclusions: There is a gender-based difference in the rate of revascularisation among patients with NSTEMI. Women benefit from an invasive approach as much as men, despite their advanced age, with similar rates of mortality and recurrent MI at 1-year follow-up.
Key words: Acute coronary syndrome, Major adverse cardiac events, Management strategies, Women
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Affiliation(s)
- Li-Ching Lee
- National University Heart Centre and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kian-Keong Poh
- National University Heart Centre and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tiffany PL Tang
- National University Heart Centre and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yee-Leng Tan
- National University Heart Centre and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Han-Wen Tee
- National University Heart Centre and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Huay-Cheem Tan
- National University Heart Centre and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Ahmad M, Arifi AA, Onselen RV, Alkodami AA, Zaibag M, Khaldi AAA, Najm HK. Gender differences in the surgical management and early clinical outcome of coronary artery disease: Single centre experience. J Saudi Heart Assoc 2010; 22:47-53. [PMID: 23960594 DOI: 10.1016/j.jsha.2010.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 02/02/2010] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To investigate the gender disparity in the distribution of patient-related risk factors and their effect on the surgical management and clinical outcome of coronary artery disease in Saudi population. MATERIALS AND METHODS We carried out a retrospective analysis of prospectively collected data of 971 patients undergoing isolated coronary artery bypass grafting (CABG) at our institution between January 2005 and December 2008. Seven hundred and eighty seven patients (81%) were males and 184 patients (19%) were females. We analyzed gender-based difference in clinical presentation and patient-related pre-operative risk factors and studied their impact on surgical management and clinical outcome. RESULTS The mean age was 59.5 years in males and 63.4 years in females (p = <0.0001). Associated co-morbidities were higher in females. Prevalence of diabetes mellitus was 61.2% in males and 78.8% in females (p-value = <0.0001); hypertension 61.9% in males and 79.9% in females (p-value <0.0001); hyperlipidemia 66.7% in males and 77.7% in females (p-value 0.0035); morbid obesity 24.7% in males and 45.1% in females (p-value <0.0001); and Hypothyroidism 2.5% in males and 13.6% in females (p-value <0.0001). Smoking was the only risk factor with higher prevalence in males compared to females (44.2% v/s 2.2%; p-value <0.0001). The mean logistic euroSCORE was 3.94 in males and 5.51 in females (p < 0.0003). On-pump and off-pump CABG was carried out in equal numbers in two groups. Females required urgent surgery and less than 3 grafts more frequently while males underwent elective surgery and more than 3 grafts in greater numbers. No significant difference was present between the two gender groups in aortic occlusion times and bypass times. Univariant analysis revealed females gender as an independent risk factor for higher in-hospital mortality (1.1% versus 4.9% p = 0.0026) and higher incidence of post-operative complications like surgical wound infection, need for prolonged ventilation, low cardiac output state and multi-organ failure (p-values 0.01 or less). CONCLUSION Female gender is an independent predictor of adverse outcome after isolated CABG due to significantly higher co-morbidities and acute presentation and independent of their peri-operative management. Therefore, major socioeconomic education and preventive measures are needed to reduce the burden of major co-morbidities in females and to seek early cardiac advice and care.
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Affiliation(s)
- Munir Ahmad
- King Abdulaziz Cardiac Centre, King Abdul Aziz Medical City, Riyadh, Saudi Arabia
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Chieffo A, Hoye A, Mauri F, Mikhail G, Ammerer M, Grines C, Grinfeld L, Madan M, Presbitero P, Skelding KA, Weiner BH, Mehran R. Cuestiones relativas al sexo en cardiología intervencionista: declaración de consenso de la iniciativa Women in Innovations (WIN). Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70038-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chieffo A, Hoye A, Mauri F, Mikhail G, Ammerer M, Grines C, Grinfeld L, Madan M, Presbitero P, Skelding K, Weiner B, Mehran R. Gender-based issues in interventional cardiology: a consensus statement from the Women in Innovations (WIN) initiative. EUROINTERVENTION 2010; 5:773-9. [DOI: 10.4244/eijv5i7a130] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Chieffo A, Hoye A, Mauri F, Mikhail GW, Ammerer M, Grines C, Grinfeld L, Madan M, Presbitero P, Skelding KA, Weiner BH, Mehran R. Gender-based issues in interventional cardiology: A consensus statement from the Women in Innovations (WIN) Initiative. Catheter Cardiovasc Interv 2010; 75:145-52. [DOI: 10.1002/ccd.22327] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hvelplund A, Galatius S, Madsen M, Rasmussen JN, Rasmussen S, Madsen JK, Sand NP, Tilsted HH, Thayssen P, Sindby E, Hojbjerg S, Abildstrom SZ. Women with acute coronary syndrome are less invasively examined and subsequently less treated than men. Eur Heart J 2009; 31:684-90. [DOI: 10.1093/eurheartj/ehp493] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Meyers BM, Vira T, Chow CM, Abramson BL. Coronary artery bypass graft surgery and primary percutaneous coronary intervention choices in patients with similar coronary anatomy: A computer-based simulation examines the sex gap. Can J Cardiol 2009; 25:649-53. [PMID: 19898697 DOI: 10.1016/s0828-282x(09)70162-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Sex differences (or a 'sex gap') exist in the rates of cardiac revascularization. It was evaluated whether physician preference contributes to this difference. OBJECTIVES To obtain information on how cardiac specialists manage male and female patients being evaluated for coronary artery disease. METHODS A computer-based patient simulation program was developed. Six sex-matched clinical vignettes (three pairs) with uninterpreted coronary angiograms were shown to specialists, who were blinded to the purpose of the study. The sex-matched scenarios were balanced with respect to symptoms, comorbidities and coronary anatomy. Physicians were surveyed on management and rationale. RESULTS Fifty physicians were surveyed, consisting mainly of cardiologists from tertiary cardiac centres in Ontario. Among the three sexmatched pairs, the frequencies at which percutaneous coronary intervention (including drug-eluting stents), bypass surgery and medical therapy were chosen did not differ across sexes. The means for men and women, respectively, were 47% and 50% for percutaneous coronary intervention, 32% and 26% for bypass surgery, and 21% and 24% for medical treatment. CONCLUSIONS In the present pilot study, cardiac specialists chose similar rates of medical, interventional and surgical procedures independent of a patient's sex. Although large registry trials show that sex differences in management exist, the present data suggest that cardiac specialist preference is less likely to be a factor if coronary angiography was performed. Further research is required to explore the causes of sex discrepancies in cardiac care.
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Affiliation(s)
- B M Meyers
- St Michael's Hospital, University of Toronto, Toronto, Canada
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Dodek P, Kozak JF, Norena M, Wong H. More men than women are admitted to 9 intensive care units in British Columbia. J Crit Care 2009; 24:630.e1-8. [PMID: 19427166 DOI: 10.1016/j.jcrc.2009.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 01/15/2009] [Accepted: 02/16/2009] [Indexed: 12/16/2022]
Abstract
PURPOSE The aim of this study is to determine if more males than females are admitted to adult intensive care units (ICUs). MATERIALS AND METHODS In 9 tertiary and community hospitals in British Columbia, Canada, we expressed the number of patients admitted to hospital and to ICU from 1998 to 2008 as a proportion of the population of the main regions served by these hospitals, and for ICU patients in 1 tertiary hospital, as a proportion of the hospital population. Patients not residing in the region of this tertiary hospital or whose addresses were unknown and admissions for sex-specific diagnoses were excluded from the main analyses. Male proportion was divided by female proportion for age groups by decade. Multivariate regression was used to determine the association between sex and admission to ICU after adjustment for confounders. RESULTS Normalized male-to-female ratio of ICU admissions to the 9 hospitals was greater than 1. In the tertiary hospital analyzed in more detail, the male-to-female ratio for admissions to hospital or to ICU, normalized to the population in the community or hospital, respectively, was greater than 1 for all age groups, and this ratio increased with age. After adjustment for covariates, males and females less than 80 years of age were roughly equally likely to be admitted to ICU from hospital, but in patients aged 80 or older, men were much more likely than women to be admitted (odds ratio, 2.14; 95% confidence interval, 1.56-2.94). CONCLUSION More men than women are admitted to ICUs; this difference is especially prominent in elderly patients.
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Affiliation(s)
- Peter Dodek
- Center for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC, Canada.
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King KM, Southern DA, Cornuz J, Maitland A, Knudtson ML, Ghali WA. Elevated body mass index and use of coronary revascularization after cardiac catheterization. Am J Med 2009; 122:273-80. [PMID: 19167691 DOI: 10.1016/j.amjmed.2008.09.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 09/02/2008] [Accepted: 09/04/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obese persons suffer discrimination in society that may extend to health care use. We investigated whether overweight and obese patients are as likely to undergo coronary reperfusion or revascularization as patients of normal body weight. METHODS Detailed clinical data were collected for an inception cohort of patients from Alberta, Canada, who underwent cardiac catheterization between April 2001 and March 2004. The patients' likelihood of receiving any revascularization, percutaneous coronary intervention, or coronary artery bypass graft surgery in the year after cardiac catheterization was examined on the basis of body mass index (BMI) grouping. Use of revascularization was examined separately for patients with high- and low-risk coronary disease. RESULTS Of 27,460 patients who had BMI data recorded, 24% were of normal weight, 42% were overweight, and 35% were obese. Although overweight and obese patients were more likely to have percutaneous coronary intervention (adjusted hazard ratio [HR]=1.07, 95% confidence interval [CI], 1.01-1.12 and HR 1.08, 95% CI, 1.01-1.13, respectively), obese patients (BMI>30) were less likely to receive coronary artery bypass graft surgery (adjusted HR=0.93, 95% CI, 0.87-1.00). This was primarily because of less use of coronary artery bypass graft surgery for the most obese patients (obesity class III) with low-risk coronary anatomy (adjusted HR=0.61, 95% CI, 0.36-1.02). CONCLUSION The pattern of use of revascularization procedures after cardiac catheterization differs somewhat across BMI subgroups. These differences might be clinically appropriate, but they warrant further exploration.
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Affiliation(s)
- Kathryn M King
- Centre for Health and Policy Studies, Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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Broddadottir H, Jensen L, Norris C, Graham M. Health-Related Quality of Life in Women with Coronary Artery Disease. Eur J Cardiovasc Nurs 2009; 8:18-25. [DOI: 10.1016/j.ejcnurse.2008.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 05/27/2008] [Accepted: 05/29/2008] [Indexed: 11/23/2022]
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Schmaltz HN, Southern DA, Maxwell CJ, Knudtson ML, Ghali WA. Patient sex does not modify ejection fraction as a predictor of death in heart failure: insights from the APPROACH cohort. J Gen Intern Med 2008; 23:1940-6. [PMID: 18830763 PMCID: PMC2596502 DOI: 10.1007/s11606-008-0804-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 04/08/2008] [Accepted: 08/20/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Normal and low ejection fraction (EF) heart failure patients appear to have similar outcomes. OBJECTIVE The object of this study was to determine whether sex modifies the effects of left ventricular EF on prevalent heart failure mortality. DESIGN Prospective cohort study. PATIENTS Patients (n = 6, 095) with a diagnosis of heart failure and a measure of EF undergoing cardiac catheterization in Alberta, Canada between April 1999 and December 2004; follow-up continued through October 2005. MEASUREMENTS All-cause mortality was assessed in analyses stratified by patient sex and EF (<or=50% vs. >50%). MAIN RESULTS Overall, female heart failure patients were older, had more hypertension, valvular disease, less systolic impairment and coronary artery disease. Baseline medication use was similar in the four sex-EF groups. Low EF heart failure mortality over 6.5 years was slightly higher but was not significantly modified by patient sex. This relationship remained unchanged after adjustment for differences in baseline characteristics and process of care (women normal EF, reference group; men normal EF adjusted HR 1.1, 95% CI 0.9-1.3; women low EF adjusted HR 1.5, 95% CI 1.1-2.0; men low EF adjusted HR 1.6, 95% CI 1.2-2.1). CONCLUSIONS Patient sex did not appear to modify the negative effects of low EF on long-term survival in this prospective study of prevalent heart failure. The small absolute difference in survival between low and normal EF heart failure highlights the need for further research into optimal therapy for the latter, a less well-understood condition.
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Norris CM, Spertus JA, Jensen L, Johnson J, Hegadoren KM, Ghali WA. Sex and gender discrepancies in health-related quality of life outcomes among patients with established coronary artery disease. Circ Cardiovasc Qual Outcomes 2008; 1:123-30. [PMID: 20031799 DOI: 10.1161/circoutcomes.108.793448] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although eradicating discrepancies in health is of unquestioned importance, there are few studies examining health-related quality of life (HRQOL) among men and women with coronary artery disease (CAD), a highly prevalent and morbid condition among industrialized nations. This study compares the HRQOL outcomes of men and women in Alberta, Canada, 1 year after the documentation of coronary artery disease by cardiac catheterization. METHOD AND RESULTS Patients' disease-specific HRQOL was assessed 1 year after angiography using the Seattle Angina Questionnaire, whereas their generic health status, burden of depressive symptoms, and social support were respectively quantified with the EuroQol EQ-5D, the Center for Epidemiological Studies Depression Scale (short form), and the Medical Outcomes Study social support scale. The latter 2 instruments were used to adjust Seattle Angina Questionnaire outcomes for potential confounding characteristics hypothesized to be associated with sex and gender. General linear modeling and a change in Seattle Angina Questionnaire scores from baseline to 1 year were used to compare the HRQOL outcomes of men and women, after adjusting for demographics, clinical factors, depressive symptoms, and social support differences between groups. A total of 2394 (60% of those eligible) patients responded to the baseline and the 1-year follow-up survey. The adjusted mean 1-year Seattle Angina Questionnaire scores were significantly higher in men when compared with women, even after adjustment for all clinical factors, social support, depressive symptoms, and baseline HRQOL scales. Not only were women noted to have worse health status at the time of angiography, but despite adjusting for these differences, residual discrepancies in 1-year health status persisted. CONCLUSIONS Women with coronary artery disease report worse HRQOL 1 year after coronary angiography when compared with men, and the discrepancies observed are only partially accounted for by sex differences in depression and social support. As a result, the measurement of gender roles and perceptions may be the best place to persist on the quest to identifying and understanding the noted discrepancies in cardiac recovery and HRQOL outcomes.
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Cho L, Hoogwerf B, Huang J, Brennan DM, Hazen SL. Gender differences in utilization of effective cardiovascular secondary prevention: a Cleveland clinic prevention database study. J Womens Health (Larchmt) 2008; 17:515-21. [PMID: 18345999 DOI: 10.1089/jwh.2007.0443] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous studies have suggested that women with cardiovascular disease may receive less aggressive care than men. Using a large cardiology database from a tertiary referral center, we sought to determine if treatment differences still persist in the current era. METHODS We analyzed data on 2462 patients who were referred for secondary prevention to the Preventive Cardiology Clinic at The Cleveland Clinic Foundation between 1997 and 2004. The primary objective was to evaluate use of effective secondary preventive therapies, by gender, as outlined in the ACC/AHA guidelines, such as antiplatelet therapy, beta-blockers, statins, and angiotensin-converting enzyme (ACE) inhibitors. Multivariate logistic regression analysis was performed to assess the independent effect of gender on all cause mortality. RESULTS Women were older (62.2 +/- 11.1 vs. 59.4 +/- 11.0, p < 0.001) and more likely to be hypertensive (68.1% vs. 56.1%, p < 0.001) than men. Overall, women were more likely than men to have higher baseline C-reactive protein (CRP) (6.14 +/- 13.4 vs. 4.9 +/- 10.7, p < 0.001), low-density lipoprotein cholesterol (LDL-C) (135 +/- 66 vs. 116 +/- 46, p < 0.001), high-density lipoprotein cholesterol (HDL-C) (52 +/- 17 vs. 41 +/- 11, p < 0.001), and total cholesterol (238 +/- 98 vs. 202 +/- 65, p < 0.001). Women were less likely to be on antiplatelet therapy (76.6 % vs. 85.0%, p < 0.001) and statins or any lipid-lowering therapy (62.6% vs. 67.1%, p = 0.04) compared with men on presentation. CONCLUSIONS Even in the current era, women with established cardiovascular disease continue to receive less aggressive care than men. They are less likely to be on aspirin and statin therapy. More aggressive efforts should be made to treat both men and women with standard secondary preventive efforts.
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Affiliation(s)
- Leslie Cho
- Women's Cardiovascular Center, Preventive Cardiology and Rehabilitation, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Nguyen JT, Berger AK, Duval S, Luepker RV. Gender disparity in cardiac procedures and medication use for acute myocardial infarction. Am Heart J 2008; 155:862-8. [PMID: 18440333 DOI: 10.1016/j.ahj.2007.11.036] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Accepted: 11/30/2007] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Determine if gender bias is present in contemporary management of acute myocardial infarction (AMI). BACKGROUND Despite major advances in medicine, disparities in healthcare still persist. Previous studies on gender bias in the diagnosis and treatment of AMI are inconsistent and may not represent more contemporary practice. METHODS AND RESULTS Data were collected from the Minnesota Heart Survey, a population-based study of patients presenting with AMI in 2001-02. In-hospital diagnostic and therapeutic approaches were compared between women and men using logistic regression models. We identified 1242 women and 1378 men with an AMI defined by either positive cardiac biomarkers or ST-elevation on electrocardiogram. There were no differences in the prescription of aspirin, beta-blockers, ACE inhibitors or angiotensin receptor blockers. Women were 46% less likely than men to undergo investigative coronary angiography [OR = 0.54 (0.45-0.64)]. After accounting for confounders, women remained less likely to be referred for angiography [OR = 0.73 (0.57-0.94)]. Revascularization rates, were similar between women and men [OR = 0.96 (0.72-1.28)]. However, women were more likely to undergo PCI [OR = 1.41 (1.07-1.86)] whereas men were more likely to have coronary artery bypass grafting (CABG) [OR = 0.57 (0.39-0.84)]. When severity of coronary artery disease (CAD) was incorporated into the model, gender no longer influenced the modality of coronary revascularization. CONCLUSIONS There is no evidence of gender bias in the pharmacologic treatment of AMI. Evidence of gender bias persists in the referral of patients for coronary angiography but not in the subsequent use of coronary revascularization.
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Reynolds HR. Percutaneous and surgical revascularization procedures in women. Curr Cardio Risk Rep 2008; 2:227-232. [DOI: 10.1007/s12170-008-0042-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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