Erica C Leifheit-Limson1, Gail D'Onofrio2, Mitra Daneshvar3, Mary Geda4, Héctor Bueno5, John A Spertus6, Harlan M Krumholz7, Judith H Lichtman8. 1. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut. Electronic address: erica.leifheit-limson@yale.edu. 2. Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut. 3. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut. 4. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut. 5. Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 6. Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri. 7. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine and the Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut. 8. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
Abstract
BACKGROUND: Differences between sexes in cardiac risk factors, perceptions of cardiac risk, and health care provider discussions about risk among young patients with acute myocardial infarction (AMI) are not well studied. OBJECTIVES: This study compared cardiac risk factor prevalence, risk perceptions, and health care provider feedback on heart disease and risk modification between young women and men hospitalized with AMI. METHODS: We studied 3,501 AMI patients age 18 to 55 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study in U.S. and Spanish hospitals between August 2008 and January 2012, comparing the prevalence of 5 cardiac risk factors by sex. Modified Poisson regression was used to assess sex differences in self-perceived heart disease risk and self-reported provider discussions of risk and modification. RESULTS: Nearly all patients (98%) had ≥1 risk factor, and 64% had ≥3. Only 53% of patients considered themselves at risk for heart disease, and even fewer reported being told they were at risk (46%) or that their health care provider had discussed heart disease and risk modification (49%). Women were less likely than men to be told they were at risk (relative risk: 0.89; 95% confidence interval: 0.84 to 0.96) or to have a provider discuss risk modification (relative risk: 0.84; 95% confidence interval: 0.79 to 0.89). There was no difference between women and men for self-perceived risk. CONCLUSIONS: Despite having significant cardiac risk factors, only one-half of young AMI patients believed they were at risk for heart disease before their event. Even fewer discussed their risks or risk modification with their health care providers; this issue was more pronounced among women.
BACKGROUND: Differences between sexes in cardiac risk factors, perceptions of cardiac risk, and health care provider discussions about risk among young patients with acute myocardial infarction (AMI) are not well studied. OBJECTIVES: This study compared cardiac risk factor prevalence, risk perceptions, and health care provider feedback on heart disease and risk modification between young women and men hospitalized with AMI. METHODS: We studied 3,501 AMI patients age 18 to 55 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study in U.S. and Spanish hospitals between August 2008 and January 2012, comparing the prevalence of 5 cardiac risk factors by sex. Modified Poisson regression was used to assess sex differences in self-perceived heart disease risk and self-reported provider discussions of risk and modification. RESULTS: Nearly all patients (98%) had ≥1 risk factor, and 64% had ≥3. Only 53% of patients considered themselves at risk for heart disease, and even fewer reported being told they were at risk (46%) or that their health care provider had discussed heart disease and risk modification (49%). Women were less likely than men to be told they were at risk (relative risk: 0.89; 95% confidence interval: 0.84 to 0.96) or to have a provider discuss risk modification (relative risk: 0.84; 95% confidence interval: 0.79 to 0.89). There was no difference between women and men for self-perceived risk. CONCLUSIONS: Despite having significant cardiac risk factors, only one-half of young AMI patients believed they were at risk for heart disease before their event. Even fewer discussed their risks or risk modification with their health care providers; this issue was more pronounced among women.
Authors: Dariush Mozaffarian; Emelia J Benjamin; Alan S Go; Donna K Arnett; Michael J Blaha; Mary Cushman; Sarah de Ferranti; Jean-Pierre Després; Heather J Fullerton; Virginia J Howard; Mark D Huffman; Suzanne E Judd; Brett M Kissela; Daniel T Lackland; Judith H Lichtman; Lynda D Lisabeth; Simin Liu; Rachel H Mackey; David B Matchar; Darren K McGuire; Emile R Mohler; Claudia S Moy; Paul Muntner; Michael E Mussolino; Khurram Nasir; Robert W Neumar; Graham Nichol; Latha Palaniappan; Dilip K Pandey; Mathew J Reeves; Carlos J Rodriguez; Paul D Sorlie; Joel Stein; Amytis Towfighi; Tanya N Turan; Salim S Virani; Joshua Z Willey; Daniel Woo; Robert W Yeh; Melanie B Turner Journal: Circulation Date: 2014-12-17 Impact factor: 29.690
Authors: Judith H Lichtman; Erica C Leifheit-Limson; Emi Watanabe; Norrina B Allen; Brian Garavalia; Linda S Garavalia; John A Spertus; Harlan M Krumholz; Leslie A Curry Journal: Circ Cardiovasc Qual Outcomes Date: 2015-02-24
Authors: Philip Greenland; Maria Deloria Knoll; Jeremiah Stamler; James D Neaton; Alan R Dyer; Daniel B Garside; Peter W Wilson Journal: JAMA Date: 2003-08-20 Impact factor: 56.272
Authors: Erica C Leifheit-Limson; John A Spertus; Kimberly J Reid; Sara B Jones; Viola Vaccarino; Harlan M Krumholz; Judith H Lichtman Journal: J Womens Health (Larchmt) Date: 2013-07-10 Impact factor: 2.681
Authors: Kelly C Epps; Elizabeth M Holper; Faith Selzer; Helen A Vlachos; Sarah K Gualano; J Dawn Abbott; Alice K Jacobs; Oscar C Marroquin; Srihari S Naidu; Peter W Groeneveld; Robert L Wilensky Journal: Circ Cardiovasc Qual Outcomes Date: 2016-02
Authors: Emelia J Benjamin; Michael J Blaha; Stephanie E Chiuve; Mary Cushman; Sandeep R Das; Rajat Deo; Sarah D de Ferranti; James Floyd; Myriam Fornage; Cathleen Gillespie; Carmen R Isasi; Monik C Jiménez; Lori Chaffin Jordan; Suzanne E Judd; Daniel Lackland; Judith H Lichtman; Lynda Lisabeth; Simin Liu; Chris T Longenecker; Rachel H Mackey; Kunihiro Matsushita; Dariush Mozaffarian; Michael E Mussolino; Khurram Nasir; Robert W Neumar; Latha Palaniappan; Dilip K Pandey; Ravi R Thiagarajan; Mathew J Reeves; Matthew Ritchey; Carlos J Rodriguez; Gregory A Roth; Wayne D Rosamond; Comilla Sasson; Amytis Towfighi; Connie W Tsao; Melanie B Turner; Salim S Virani; Jenifer H Voeks; Joshua Z Willey; John T Wilkins; Jason Hy Wu; Heather M Alger; Sally S Wong; Paul Muntner Journal: Circulation Date: 2017-01-25 Impact factor: 29.690
Authors: Liam R Brunham; Kelsey Lynch; Amy English; Rory Sutherland; Jian Weng; Raymond Cho; Graham C Wong; Aslam H Anis; Gordon A Francis; Nadia A Khan; Bruce McManus; David Wood; Keith R Walley; Jonathon Leipsic; Karin H Humphries; Alison Hoens; Andrew D Krahn; G B John Mancini; Simon Pimstone Journal: Clin Cardiol Date: 2018-06-11 Impact factor: 2.882
Authors: Jacob A Udell; Gregg C Fonarow; Thomas M Maddox; Christopher P Cannon; W Frank Peacock; Warren K Laskey; Maria V Grau-Sepulveda; Eric E Smith; Adrian F Hernandez; Eric D Peterson; Deepak L Bhatt Journal: Clin Cardiol Date: 2018-05-11 Impact factor: 2.882
Authors: Rachel P Dreyer; Christopher Sciria; Erica S Spatz; Basmah Safdar; Gail D'Onofrio; Harlan M Krumholz Journal: Circ Cardiovasc Qual Outcomes Date: 2017-02-22