1
|
Aleshchenko E, Apfelbacher C, Baust K, Calaminus G, Droege P, Glogner J, Horenkamp-Sonntag D, Ihle P, Kaatsch P, Klein M, Kloppe T, Kuepper-Nybelen J, Langer T, Luepkes C, Marschall U, Meier I, Merzenich H, Spix C, Swart E, Trocchi P. VersKiK: Study protocol of an observational registry-based study on the current state of follow-up care and adherence to follow-up guidelines after cancer in childhood or adolescence. Cancer Epidemiol 2023; 87:102469. [PMID: 37806118 DOI: 10.1016/j.canep.2023.102469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/14/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND This article describes the study design of the quantitative part of the VersKiK study, The primary objectives of this study are to examine the occurrence of late effects in survivors of childhood or adolescent cancer (module 1), investigate health-related vulnerabilities and medical service utilization within this survivor group (modules 1 and 3), and assess the alignment between documented follow-up care for cardiological and audiological late effects with guideline recommendations, along with evaluating the extent of adherence among paediatric cancer survivors (module 3). METHODS This is a non-interventional retrospective observational cohort study. It is based on stochastically linked insurance claims data from approximately 150,000 statutory insured persons with information concerning around 25,000-30,000 cancer survivors recorded in the German Childhood Cancer Register (GCCR). To explore adherence to selected follow-up guidelines, intention to treat treatment data from clinical study groups for particular diagnostic entities will be additionally included. DISCUSSION The growing group of survivors after cancer in childhood and adolescence is representing a special population with an increasing demand for life-long healthcare services through relative high probability of late effects. Currently, there is a limited evidence in Germany on utilization of corresponding medical services and adherence to follow-up guidelines. With this study design, we are aiming to address these gaps and, consequently, suggest improvements to existing follow-up guidelines and follow-up care provision in Germany.
Collapse
Affiliation(s)
- E Aleshchenko
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke Univiersity, Magdeburg, Germany.
| | - C Apfelbacher
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke Univiersity, Magdeburg, Germany
| | - K Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - G Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - P Droege
- Health Services and Quality Research, Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany
| | - J Glogner
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | | | - P Ihle
- PMV research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Köln, Germany
| | - P Kaatsch
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - M Klein
- DAK-Gesundheit, Hamburg, Germany
| | - T Kloppe
- OFFIS-Institute for Information Technology, Oldenburg, Germany
| | - J Kuepper-Nybelen
- PMV research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Köln, Germany
| | - T Langer
- University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - C Luepkes
- OFFIS-Institute for Information Technology, Oldenburg, Germany
| | | | - I Meier
- Techniker Krankenkasse (TK), Hamburg, Germany
| | - H Merzenich
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - C Spix
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - E Swart
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke Univiersity, Magdeburg, Germany
| | - P Trocchi
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke Univiersity, Magdeburg, Germany
| |
Collapse
|
2
|
Makowski L, Feld J, Koeppe J, Engelbertz C, Illner J, Kuehnemund L, Fischer A, Lange SA, Droege P, Guenster C, Gerss J, Reinecke H, Freisinger E. Sex related differences in vascular interventions and outcome of patients with critical limb threatening ischemia in a real-world cohort. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2038] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The prevalence of critical limb threatening ischemia (CLTI) is increasing worldwide and the focus is the reduction of outcome events like death or amputation of the lower limb (LL). Sex related differences in medical supply and outcome are a current matter of debate.
Purpose
In the present study, we included patients with CLTI in an unselected “real-world” cohort and studied sex related differences in their risk profile and vascular interventions, as well as their impact on long-term outcome.
Methods
We analyzed 119,953 unselected patients of the public health insurance in Germany (AOK), which were hospitalized between 2010 and 2017 for a main diagnosis of CLTI (Rutherford stage (RF) 4–6). In our data files, a baseline period of 2 years previous index hospitalization and a follow-up period until 2018 was included.
Results
In our cohort, more than half were male CLTI patients (57% male vs. 43% female), while female CLTI patients were at higher age (median: 73.8 years male vs. 81.4 years female). Male patients had higher ratios of diabetes, dyslipidemia, smoking, cerebrovascular disease and chronic coronary syndrome, whereas female CLTI patients show a higher prevalence of hypertension, atrial fibrillation, chronic heart failure and chronic kidney disease (all p<0.001). During index hospitalisation more than one quarter of all CLTI patients suffered from rest pain (RF 4), and approximately one third for minor (RF 5) and one third for major (RF 6) tissue lost. Female patients were more often diagnosed with RF 5 (32% male vs. 36% female), while the proportion of male patients was slightly higher at RF 4 (29% male vs. 27% female) and RF 6 (39% male vs. 37% female, all p<0.001).
During index hospitalization, almost 70% underwent any diagnostic angiography and in 63% of all patients a revascularization procedure was performed. Both were carried out more often in male patients (both p<0.001).The Kaplan Meier curve showed an increased mortality rate in female patients during follow up (figure 1), while no differences were observed for the combined endpoint amputation of the LL or death. Interestingly after adjustment for age and patients risk'constellation, female gender was associated with increased overall-survival (female HR 0.95; 95%-CI 0.94–0.96, p<0.001) and amputation-free survival which is a combined endpoint of amputation of the LL or death (female HR 0.84; 95%-CI 0.83–0.85, p<0.001).
Conclusion
Female patients with CLTI were older and showed lower rates of diagnostic angiography and revascularization procedures of the LL during index hopsitalization. Nevertheless, male sex was an independent risk factor for all-cause mortality and the combined endpoint amputation of the LL or death during long-term follow-up. These results indicate that further analyses are needed to determine the various individual needs of male and female CLTI patients.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The project upon which this publication is based was funded by The Federal Joint Committee, Innovation Committee (G-BA, Innovationsfonds, number 01VSF18051).
Collapse
Affiliation(s)
- L Makowski
- University Hospital of Munster, Cardiol, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - J Feld
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - J Koeppe
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - C Engelbertz
- University Hospital of Munster, Cardiol, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - J Illner
- University Hospital of Munster, Cardiol, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - L Kuehnemund
- University Hospital of Munster, Cardiol, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - A Fischer
- University Hospital of Munster, Cardiol, Dept. of Cardiology III - Adult Congenital and Valvular Heart Disease, Muenster, Germany, Muenster, Germany
| | - S A Lange
- University Hospital of Munster, Cardiol, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - P Droege
- AOK Research Institute (WidO), Berlin, Germany
| | - C Guenster
- AOK Research Institute (WidO), Berlin, Germany
| | - J Gerss
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - H Reinecke
- University Hospital of Munster, Cardiol, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - E Freisinger
- University Hospital of Munster, Cardiol, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | | |
Collapse
|
3
|
Lange SA, Feld J, Kuehnemund L, Koeppe J, Makowski L, Engelbertz CH, Gerss J, Droege P, Ruhnke TH, Guenster CH, Freisinger E, Reinecke H. Acute and long-term outcomes of ST-elevation myocardial infarction in cancer patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1119] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Myocardial infarctions (MI) and cancer are each very serious morbidities. To evaluate their interaction in the “real world”, a retrospective analysis was performed in patients with ST-elevation MI (STEMI) and pre-existing cancer.
Methods
Anonymized data from patients admitted to hospital between 2010 and 2017 due to STEMI were analyzed from 24 months before and up to nine years after the index hospitalization by one of Germany's largest statutory Health Insurance Funds (Allgemeine Ortskrankenkasse - AOK). Qualitative data were tested via two-sided Chi-squared test and quantitative data were tested using a two- sided Wilcoxon test. The eight year overall survival (OS) rate was determined with a Kaplan Meier estimator. The endpoint OS was analysed using multivariable Cox-regression model.
Results
From 175,262 STEMI patients, 27,213 had cancer (15.5%). Most frequent were skin (24.9%), prostate (17.0%), colon (11.0%), breast (10.9%), urinary tract (10.6%), and lung cancer (5.2%). STEMI patients with malignancies were older, presented more often with coronary three-vessel-disease, classical risk factors, atrial arrhythmias, kidney disease, heart failure, cerebrovascular and peripheral artery disease (PAD) (each p<0.001). They showed more often previous MI, percutaneous coronary interventions (PCI), cardiac surgery, and stroke (all p<0.001). Acute PCIs were applied approximately 2–6 percent points less frequently compared to those without (w/o) cancer, with less drug-eluting and more often bare metal stents (all p<0.001). In-hospital adverse events occurred more frequently in cancer. Eight-year survival was 57.3% (95% CI 57.0% – 57.7%) w/o cancer, and ranged between 41.2% and 19.2% in distinct cancer types. Multivariable Cox regression for death during follow-up found e.g. lung cancer (HR 2.04, 95% CI 1.92–2.17), PAD stage 4–6 (HR 1.78, 95% CI 1.72–1.84) and previous stroke (HR 1.44, 95% CI 1.31–1.54) to have the strongest effect, while obesity (HR 0.95, 95% CI 0.93–0.97) was associated with lower mortality (all p<0.001).
Conclusion
In this large “real world” health insurance data from Germany, prognosis after STEMI was markedly reduced but differed widely between cancer types. No withholding of revascularization therapies in cancer patients could be observed.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Federal Joint Committee, Innovation Committee (G-BA, Innovationsfonds, number 01VSF18051).
Collapse
Affiliation(s)
- S A Lange
- University Hospital of Muenster, Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure,, Muenster, Germany
| | - J Feld
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - L Kuehnemund
- University Hospital of Muenster, Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure,, Muenster, Germany
| | - J Koeppe
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - L Makowski
- University Hospital of Muenster, Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure,, Muenster, Germany
| | - C H Engelbertz
- University Hospital of Muenster, Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure,, Muenster, Germany
| | - J Gerss
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - P Droege
- AOK Research Institute (WIdO), Berlin, Germany
| | - T H Ruhnke
- AOK Research Institute (WIdO), Berlin, Germany
| | | | - E Freisinger
- University Hospital of Muenster, Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure,, Muenster, Germany
| | - H Reinecke
- University Hospital of Muenster, Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure,, Muenster, Germany
| |
Collapse
|
4
|
Engelbertz C, Koeppe J, Feld J, Makowski L, Kuehnemund L, Fischer AJ, Lange SA, Guenster C, Droege P, Ruhnke T, Gerss J, Freisinger E, Reinecke H. Contemporary in-hospital and long-term prognosis of patients with acute ST-elevation myocardial infarction and chronic kidney disease in Germany. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2918] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although acute myocardial infarction (AMI) incidence and mortality have decreased over the last decades, survival rates of AMI patients remain rather stable. About 25% of patients with ST-elevation myocardial infarction (STEMI) suffer from chronic kidney disease (CKD).
Purpose
We sought to determine short- and long-term mortality in STEMI patients with different stages of CKD.
Methods
We identified all patients who were hospitalised with a main diagnosis of STEMI between 2010 and 2017 from the dataset of the Federal Association of the Local Health Insurance Funds (Allgemeine Ortskasse), Germany. The patients were grouped according to their CKD stage at index hospitalisation. We analysed concomitant diseases, in-hospital treatment and complications. Overall survival was analysed using Kaplan Meier methods and predictors for overall survival were identified by Cox regression analysis.
Results
A total of 175,187 patients were identified with an index hospitalisation for STEMI, thereof 137,682 (78.6%) patients without CKD, 8,347 (4.8%) patients with CKD stage 2, 20,459 (11.7%) patients with CKD stage 3, and 4,960 (2.8%) patients with CKD stage 4. The CKD stages 1, 5 and 5d (dialysis dependent CKD) each comprised less than 1,500 patients (<1.0%). STEMI patients with CKD were older and had more often cardiovascular risk factors, e.g. diabetes (no CKD: 33.2% vs CKD stage 5: 66.1%, p<0.001). Overall, patients with CKD received percutaneous coronary interventions (no CKD: 84.4% vs CKD stage 4: 62.0%, p<0.001) less frequently, and suffered more often from complications like shock (no CKD: 12.5% vs. CKD stage 5: 27.7%, p<0.001) or requirement of invasive/non-invasive ventilation (no CKD: 17.3% vs. CKD stage 5: 42.7%, p<0.001) than patients without CKD. With increasing CKD stages, patients were more likely to die within 30 days after STEMI (30-day mortality no CKD: 13.7% vs. CKD stage 5d: 37.2%, p<0.001). Kaplan-Meier estimates showed dramatically decreasing survival with decreasing renal function (Figure 1). Multivariable time-dependent Cox regression analysis for overall survival showed that the CKD stages 4, 5 and 5d, as well as chronic limb threatening ischemia (CLTI) were associated with a higher risk for death (CKD stage 5d: hazard ratio (HR) 5.64; 95% CI 5.42–5.86; CKD stage 5: HR 2.55; 95% CI 2.37–2.73; CKD stage 4: 1.72; 95% CI 1.66–1.78; CLTI: 2.06; 95% CI 1.98–2.13; all p<0.001).
Conclusion
CKD is a frequent co-morbidity in patients with STEMI which is associated with a devastating prognosis especially for patients with advanced CKD stages. More research is needed to gain evidence on optimized treatment strategies for patients with STEMI and concomitant CKD in this highly vulnerable cohort.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The project upon which this publication is based was funded by The Federal Joint Committee, Innovation Committee (G-BA, Innovationsfonds, number 01VSF18051). Figure 1. Unadjusted Kaplan-Meier survival curves
Collapse
Affiliation(s)
- C Engelbertz
- University Hospital Muenster, Cardiol., Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - J Koeppe
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - J Feld
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - L Makowski
- University Hospital Muenster, Cardiol., Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - L Kuehnemund
- University Hospital Muenster, Cardiol., Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - A J Fischer
- University Hospital Muenster, Cardiol., Department of Cardiology III - Adult Congenital and Valvular Heart Disease, Muenster, Germany
| | - S A Lange
- University Hospital Muenster, Cardiol., Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - C Guenster
- AOK Research Institute (WIdO), Berlin, Germany
| | - P Droege
- AOK Research Institute (WIdO), Berlin, Germany
| | - T Ruhnke
- AOK Research Institute (WIdO), Berlin, Germany
| | - J Gerss
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - E Freisinger
- University Hospital Muenster, Cardiol., Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - H Reinecke
- University Hospital Muenster, Cardiol., Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| |
Collapse
|
5
|
Fischer AJ, Feld J, Kuehnemund L, Makowski L, Engelbertz CM, Guenster C, Gerss J, Droege P, Ruhnke T, Lange SA, Reinecke H, Freisinger E, Koeppe J. Sex-specific differences in first event of st- elevation myocardial infarction; new insights on age-related mortality. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1110] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
For patients with ST-elevation myocardial infarction (STEMI) as the primary manifestation of coronary artery disease (CAD), data on predictors and outcome are limited. We hypothesized that specifically age and sex influence short- and long-term outcome in patients after first event of STEMI.
Methods and results
Based on claims data of the Federal Association of the Local Health Insurance Funds (Allgemeine Ortskrankenkasse) (≈26 million insurance holders in Germany with ≈83 million inhabitants), adults with STEMI between 01/2014 to 12/2015 and no history of CAD were selected for further analysis. Patient demographics, details on in-hospital treatment as well as age- and sex-related differences in 30-day mortality, re-infarction/ death, major adverse cardiovascular events (MACE), overall and long-term survival were assessed.
Overall, 17,444 patients presented with STEMI as the primary manifestation of CAD throughout the study period, thereof 33% were women. At index, women were older compared to men (median age 74 years vs. 60 years) and suffered from more cardiovascular comorbidities such as diabetes (35.8% vs. 25.2% in men), chronic kidney disease (26.0% vs. 14.9% in men), and arterial hypertension (84.6% vs. 72.6%; all p<0.001). Women with STEMI underwent endovascular reperfusion (78.5% vs. 88.1%) or coronary artery bypass grafting (4.2% vs. 5.5%; both p<0.001) less frequently. In-hospital complications such as shock (19.2% vs. 16.0%) and resuscitation (15.1% vs. 12.9%; both p<0.001) were observed more often in women.
Female sex was independently associated with adjusted 30-day mortality (Odds Ratio 1.17; p=0.01). Long-term outcomes revealed women to be at increased risk of the combined end-point of re-infarction and/or death (Hazard ratio (HR) 1.09; p=0.01), MACE (HR 1.09; p=0.01) and all-cause mortality (HR 1.10; p=0.01). Particularly in patients younger than 60 years, female sex was a strong predictor of adverse outcomes. Surprisingly, among patients that survived at least 90 days after STEMI, no differences between the sexes were noted regarding long-term survival (HR 0.99; p=0.91) (see Figure for adjusted odds/hazard ratios presenting the association of sex with different endpoints depending on age after first event of STEMI).
Conclusion
On non-selective data, two-thirds of patients with STEMI as the primary manifestation of CAD were male. Women were observed to receive endovascular reperfusion less frequently than men and suffered from more in-hospital complications. Being female and younger than 60 years was associated with an increased risk of adverse outcomes specifically early after STEMI.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The study is part of the GenderVasc project funded by the joint federal committee, Germany.
Collapse
Affiliation(s)
- A J Fischer
- University of Muenster, Department of Cardiology III – Adult Congenital and Valvular Heart Disease, Muenster, Germany
| | - J Feld
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - L Kuehnemund
- University hospital Münster, Department of Cardiology I – Coronary and Peripheral Vascular disease, Heart failure, Muenster, Germany
| | - L Makowski
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - C M Engelbertz
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - C Guenster
- AOK Nordost, AOK Research Institute (WIdO), Berlin, Germany, Berlin, Germany
| | - J Gerss
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - P Droege
- AOK Nordost, AOK Research Institute (WIdO), Berlin, Germany, Berlin, Germany
| | - T Ruhnke
- AOK Nordost, AOK Research Institute (WIdO), Berlin, Germany, Berlin, Germany
| | - S A Lange
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - H Reinecke
- University hospital Münster, Department of Cardiology I – Coronary and Peripheral Vascular disease, Heart failure, Muenster, Germany
| | - E Freisinger
- University hospital Münster, Department of Cardiology I – Coronary and Peripheral Vascular disease, Heart failure, Muenster, Germany
| | - J Koeppe
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| |
Collapse
|
6
|
Kuehnemund L, Koeppe J, Fischer AJ, Feld J, Illner J, Makowski L, Engelbertz C, Gerss J, Droege P, Guenster C, Reinecke H, Freisinger E. Sex-specific differences in management and treatment in ST-elevation myocardial infarction – a German nationwide real-life analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2779] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Acute myocardial infarction (AMI) continues to be the leading cause of death in men and women worldwide. The outcome of patients with AMI improved during the last years but the impact of sex is under current debate since female sex has repeatedly to be associated with an unfavourable outcome in AMI.
Purpose
This retrospective routine-data-based analysis sought to examine sex differences of recent trends in in-patient healthcare and outcome of ST-elevation myocardial infarction (STEMI).
Methods
The dataset of the Federal Association of the Local Health Insurance Funds was used to identify patients who were hospitalized for STEMI in Germany between January 2010 and December 2017. Further, data on concomitant diseases, risk constellations, selected cardiovascular procedures, as well as in-hospital and 30-days mortality were assessed and further analyzed with regard to sex differences.
Results
In total, we identified 175,187 STEMI patients over the 8-year period, thereof about 35% female patients. Women with STEMI were older (median (interquartile range (IQR)): 76 (19) vs. 64 (20) years in men) and had more comorbidities including diabetes (44.9% vs. 35.5%), hypertension (90.9% vs. 82.8%), congestive heart failure (54.7% vs. 43.8%) and chronic kidney disease (33.5% vs. 22.3%); all p<0.001). Further, female STEMI patients underwent less often percutaneous coronary intervention during hospitalization (PCI; 75.5% vs. 85.2%; p<0.001). Complications such as shock (14.8% vs. 13.0%) and bleeding (9.3% vs. 6.6%; both p<0.001) could be observed more frequently in women.
Female sex was independently associated with a higher adjusted 30-day mortality (Odds Ratio 1.08; CI 1.05–1.12; p<0.001).
Conclusion
In a contemporary unselected cohort, one-third of STEMI patients are female. Women with STEMI are older with higher cardiovascular risk, and continue to receive less likely interventional revascularization therapy compared to male STEMI patients. Moreover, female STEMI patients were observed higher complications and death during index hospitalization and 30 days thereafter. Further analyses are urgently needed to identify causes of under-treatment and impaired outcome in women with STEMI.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): joint federal committee, Germany.
Collapse
Affiliation(s)
- L Kuehnemund
- University Hospital, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - J Koeppe
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - A J Fischer
- University Hospital of Munster, Cardiol., Dept. of Cardiology III - Adult Congenital and Valvular Heart Disease Muenster, Germany, Muenster, Germany
| | - J Feld
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - J Illner
- University Hospital, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - L Makowski
- University Hospital, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - C Engelbertz
- University Hospital, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - J Gerss
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - P Droege
- AOK Research Institute (WIdO), Berlin, Germany
| | - C Guenster
- AOK Research Institute (WIdO), Berlin, Germany
| | - H Reinecke
- University Hospital, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - E Freisinger
- University Hospital, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | | |
Collapse
|
7
|
|