Assuntos
Pesquisa sobre Serviços de Saúde/métodos , Avaliação de Resultados da Assistência ao Paciente , Participação do Paciente , Medidas de Resultados Relatados pelo Paciente , Cuidado Transicional , Academias e Institutos , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Determinantes Sociais da SaúdeRESUMO
Critical to eliminating the sex and gender gap in cardiovascular health is addressing known differences in disease burden, disparities in treatment and clinical outcomes, and the scientific importance of sex as a biological variable that influences resilience, pathophysiology, and ultimately the health of women. Furthermore, key disparities exist at the intersection of sex/gender and race/ethnicity where women of color are disproportionately affected by higher burden of disease and poorer outcomes in several cardiovascular conditions. Through efforts to galvanize strategic partnerships, The NHLBI Strategic Vision sets forth research priorities across all of its objectives relevant to the cardiovascular health of women; it encourages strategic partnerships in both establishing and implementing research priorities. The Vision promotes a promise of precision medicine that embraces sex as its highest order, leverages an integrated approach to data science, explores sex influences on molecular underpinnings of disease, and advances sex-specific and race-sex interaction analyses toward the elimination of gaps in the cardiovascular care and health of all women.
Assuntos
Doenças Cardiovasculares , Disparidades nos Níveis de Saúde , Saúde da Mulher , Doenças Cardiovasculares/etnologia , Efeitos Psicossociais da Doença , Feminino , Humanos , Masculino , National Heart, Lung, and Blood Institute (U.S.) , Fatores Sexuais , Estados UnidosRESUMO
BACKGROUND: We investigated race-ethnic and sex-specific relationships of left ventricular (LV) structure and LV function in African American and white men and women at 43 to 55 years of age. METHODS AND RESULTS: The Coronary Artery Risk Development in Young Adults (CARDIA) Study enrolled African American and white adults, age 18 to 30 years, from 4 US field centers in 1985-1986 (Year-0) who have been followed prospectively. We included participants with echocardiographic assessment at the Year-25 examination (n=3320; 44% men, 46% African American). The end points of LV structure and function were assessed using conventional echocardiography and speckle-tracking echocardiography. In the multivariable models, we used, in addition to race-ethnic and gender terms, demographic (age, physical activity, and educational level) and cardiovascular risk variables (body mass index, systolic blood pressure, diastolic blood pressure, heart rate, presence of diabetes, use of antihypertensive medications, number of cigarettes/day) at Year-0 and -25 examinations as independent predictors of echocardiographic outcomes at the Year-25 examination (LV end-diastolic volume [LVEDV]/height, LV end-systolic volume [LVESV]/height, LV mass [LVM]/height, and LVM/LVEDV ratio for LV structural indices; LV ejection fraction [LVEF], Ell, and Ecc for systolic indices; and early diastolic and atrial ratio, mitral annulus early peak velocity, ratio of mitral early peak velocity/mitral annulus early peak velocity; ratio, left atrial volume/height, longitudinal peak early diastolic strain rate, and circumferential peak early diastolic strain rate for diastolic indices). Compared with women, African American and white men had greater LV volume and LV mass (P<0.05). For LV systolic function, African American men had the lowest LVEF as well as longitudinal (Ell) and circumferential (Ecc) strain indices among the 4 sex/race-ethnic groups (P<0.05). For LV diastolic function, African American men and women had larger left atrial volumes; African American men had the lowest values of Ell and Ecc for diastolic strain rate (P<0.05). These race/sex differences in LV structure and LV function persisted after adjustment. CONCLUSIONS: African American men have greater LV size and lower LV systolic and diastolic function compared to African American women and to white men and women. The reasons for these racial-ethnic differences are partially but not completely explained by established cardiovascular risk factors.
Assuntos
Negro ou Afro-Americano , Doença da Artéria Coronariana/etnologia , Doença da Artéria Coronariana/fisiopatologia , Disparidades nos Níveis de Saúde , Ventrículos do Coração/fisiopatologia , Disfunção Ventricular Esquerda/etnologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda , População Branca , Adulto , Distribuição de Qui-Quadrado , Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia Doppler , Feminino , Insuficiência Cardíaca/etnologia , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Volume Sistólico , Estados Unidos/epidemiologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Remodelação VentricularAssuntos
Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Terapia por Ultrassom , Ultrassonografia , Bioengenharia , Doenças Cardiovasculares/diagnóstico por imagem , Sistema Cardiovascular , Comunicação , Congressos como Assunto , Ecocardiografia/normas , Ecocardiografia/tendências , Ecocardiografia Doppler , Desenho de Equipamento , Humanos , Imageamento Tridimensional , Relações Interprofissionais , Sistema de Registros , Pesquisa , Software , Avaliação da Tecnologia Biomédica , Terapia Trombolítica/métodos , Ultrassonografia/tendências , Ultrassonografia de IntervençãoRESUMO
BACKGROUND: Consultation with cardiologists may improve the quality of ambulatory care and reduce disparities for patients with heart disease. We assessed the use of cardiology consultations and the associated quality by race/ethnicity, gender, insurance status, and site of care. METHODS AND RESULTS: In a retrospective cohort, we examined electronic records of 9761 adults with coronary artery disease or congestive heart failure (CHF) receiving primary care at practices affiliated with 2 academic medical centers during 2000 to 2005. During this period, 79.6% of patients with coronary artery disease and 90.3% of patients with CHF had a cardiology consultation. In multivariate analyses, women were less likely to receive a consultation than men for both conditions (coronary artery disease: hazard ratio, 0.89; 95% CI, 0.85 to 0.93; CHF: hazard ratio, 0.93; 95% CI, 0.87 to 0.99). Women also had 15% fewer follow-up consultations than men (P<0.001). Similarly, patients at community health centers were less likely to receive a consultation (coronary artery disease: hazard ratio, 0.79; 95% CI, 0.74 to 0.84; CHF: hazard ratio, 0.77; 95% CI: 0.71 to 0.84) and had 20% fewer follow-up consultations (P<0.001) relative to those at hospital-based practices. Black and Hispanic patients with CHF had 13% fewer follow-up consultations than white patients (P=0.01 and P=0.04, respectively). In adjusted analyses, consultation was associated with better processes of care compared with no consultation (P<0.001), particularly for women (P<0.001 for interaction between consultation and gender). CONCLUSIONS: Among ambulatory patients with coronary artery disease or CHF, women and those at community health centers have less access to cardiologists. Consultation is associated with better quality of care and narrows the gender gap in quality.
Assuntos
Cardiologia/estatística & dados numéricos , Doença da Artéria Coronariana/etnologia , Insuficiência Cardíaca/etnologia , Seguro/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , População Negra/estatística & dados numéricos , Centros Comunitários de Saúde/estatística & dados numéricos , Doença da Artéria Coronariana/terapia , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Insuficiência Cardíaca/terapia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Ambulatório Hospitalar/estatística & dados numéricos , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Distribuição por Sexo , População Branca/estatística & dados numéricos , Adulto JovemRESUMO
Although community health centers (CHCs) provide primary health services to the medically underserved and poor, limited access to off-site specialty services may lead to poorer outcomes among underinsured CHC patients. This study evaluates access to specialty health services for patients receiving care in CHCs, using a survey of medical directors of all federally qualified CHCs in the United States in 2004. Respondents reported that uninsured patients had greater difficulty obtaining access to off-site specialty services, including referrals and diagnostic testing, than did patients with Medicaid, Medicare, or private insurance.
Assuntos
Centros Comunitários de Saúde/organização & administração , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Medicina/estatística & dados numéricos , Pobreza , Encaminhamento e Consulta/estatística & dados numéricos , Especialização , Adulto , Centros Comunitários de Saúde/estatística & dados numéricos , Economia Médica , Acessibilidade aos Serviços de Saúde/economia , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Medicaid/estatística & dados numéricos , Área Carente de Assistência Médica , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Diretores Médicos , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/organização & administração , Encaminhamento e Consulta/economia , Estados UnidosRESUMO
Community health centers (CHCs) are responsible for providing care for more than fifteen million Americans, many of whom are members of groups who have been documented to receive low-quality care. This study examines the quality of care for patients with chronic disease in a nationally representative sample of federally funded CHCs. Fewer than half of eligible patients received appropriate care for the majority of indicators measured, and uninsured patients received poorer care than insured patients. Although the quality of chronic disease care in CHCs compares favorably with that of care received in other settings, gaps in quality were observed for the uninsured.