Avi Sabbag1, Shlomi Matetzky1, Shmuel Gottlieb2, Paul Fefer1, Orly Kohanov1, Shaul Atar3, Doron Zahger4, Avital Porter5, Bella Koifman6, Ilan Goldenberg1, Amit Segev7. 1. Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel. 2. Department of Cardiology, Shaare-Zedek Medical Center, Bikur Cholim Campus, the Hebrew University School of Medicine, Jerusalem, Israel. 3. Department of Cardiology, The Western Galilee Medical Center, Nahariya, Bar-Ilan University, Ramat-Gan, Israel. 4. Department of Cardiology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. 5. The Heart Institute, Rabin Medical Center, Petach-Tikva, Sackler School of Medicine, Tel Aviv University, Israel. 6. The Heart Center, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Israel. 7. Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel. Electronic address: amit.segev@sheba.health.gov.il.
Abstract
BACKGROUND: Few data exist on the recent trends in the outcome of women hospitalized with acute coronary syndrome. We examined temporal trends in the hospital management and outcomes of women hospitalized with acute coronary syndrome in a real-world setting. METHODS: We evaluated time-dependent changes in the clinical characteristics, management strategies, and outcomes of women enrolled in the Acute Coronary Syndrome Israeli Surveys (ACSIS) between 2000 and 2010. Periods were categorized as early (2000-2004) and late (2006-2010). RESULTS: Among 11,536 patients enrolled in ACSIS, 2710 (24%) were women. Frequency of women presenting with acute coronary syndrome had declined from 25% in 2000 to 22% in 2010 (P for trend = .002). Women presented less frequently with ST-elevation myocardial infarction and more frequently with associated comorbidities (P < .001 for both). There was no significant reduction in the time delay from symptom onset to emergency department between early and late periods (median: 128 vs 125 minutes; P = .86). This was further reflected in no increase in the frequency of women meeting the goal of door-to-balloon time of ≤90 minutes. The utilization of evidence-based cardiovascular therapies had increased significantly over the past decade (P < .001 for all). After multivariate adjustment, admission in the late surveys was associated with a significant reduction in 30-day major adverse cardiac events and 1-year mortality (hazard ratio 0.76; 95% confidence interval, 0.65-0.9, and 0.73; 0.59-0.89, respectively). CONCLUSIONS: Despite increased frequency of comorbidities and lack of change in time to admission among women hospitalized with acute coronary syndrome, temporal change in management strategies over the last decade may have contributed to improved outcomes in this population.
BACKGROUND: Few data exist on the recent trends in the outcome of women hospitalized with acute coronary syndrome. We examined temporal trends in the hospital management and outcomes of women hospitalized with acute coronary syndrome in a real-world setting. METHODS: We evaluated time-dependent changes in the clinical characteristics, management strategies, and outcomes of women enrolled in the Acute Coronary Syndrome Israeli Surveys (ACSIS) between 2000 and 2010. Periods were categorized as early (2000-2004) and late (2006-2010). RESULTS: Among 11,536 patients enrolled in ACSIS, 2710 (24%) were women. Frequency of women presenting with acute coronary syndrome had declined from 25% in 2000 to 22% in 2010 (P for trend = .002). Women presented less frequently with ST-elevation myocardial infarction and more frequently with associated comorbidities (P < .001 for both). There was no significant reduction in the time delay from symptom onset to emergency department between early and late periods (median: 128 vs 125 minutes; P = .86). This was further reflected in no increase in the frequency of women meeting the goal of door-to-balloon time of ≤90 minutes. The utilization of evidence-based cardiovascular therapies had increased significantly over the past decade (P < .001 for all). After multivariate adjustment, admission in the late surveys was associated with a significant reduction in 30-day major adverse cardiac events and 1-year mortality (hazard ratio 0.76; 95% confidence interval, 0.65-0.9, and 0.73; 0.59-0.89, respectively). CONCLUSIONS: Despite increased frequency of comorbidities and lack of change in time to admission among women hospitalized with acute coronary syndrome, temporal change in management strategies over the last decade may have contributed to improved outcomes in this population.
Authors: Monica Parry; Abida Dhukai; Hance Clarke; Ann Kristin Bjørnnes; Joseph A Cafazzo; Lynn Cooper; Paula Harvey; Joel Katz; Chitra Lalloo; Marit Leegaard; France Légaré; Mike Lovas; Judith McFetridge-Durdle; Michael McGillion; Colleen Norris; Laura Parente; Rose Patterson; Louise Pilote; Leah Pink; Jennifer Price; Jennifer Stinson; Akib Uddin; J Charles Victor; Judy Watt-Watson; Carol Auld; Christine Faubert; Deborah Park; Marianne Park; Beatrice Rickard; Vincenza Spiteri DeBonis Journal: BMJ Open Date: 2020-03-09 Impact factor: 2.692
Authors: Joshua B Wenner; Graham C Wong; John A Cairns; Michele Perry-Arnesen; Wendy Tocher; Martha Mackay; Joel Singer; Terry Lee; Christopher B Fordyce Journal: CJC Open Date: 2020-01-30