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1.
Rev. esp. cardiol. (Ed. impr.) ; 64(11): 1060-1064, nov. 2011. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-91162

RESUMO

Las características atípicas del síndrome coronario agudo en las mujeres favorecen las diferencias en su manejo y su tratamiento. Por ello nos propusimos indagar sobre estas diferencias en el manejo urgente del infarto agudo de miocardio sin elevación del ST (IAMSEST). Se recogieron 39 variables de 539 pacientes con IAMSEST de 97 servicios de urgencias españoles y, tras ajustar por las 10 diferencias basales, las únicas diferencias significativas fueron que las mujeres tardaban más en acudir a urgencias (odds ratio [OR]=0,52; intervalo de confianza [IC] del 95%, 0,28-0,95) y recibían más clopidogrel (OR=1,65; IC del 95%, 1,06-2,56). La tendencia a menos ingresos en coronarias-intensivos (el 42,9 frente al 55,6%) y menos práctica de cateterismo (el 29,7 frente al 40,7%) desapareció tras el ajuste (AU)


The atypical characteristics of acute coronary syndrome in women lead to differences in management and treatment. We investigated these differences in the urgent management of non-ST-segment acute myocardial infarction (NSTEMI). Data on 39 variables were collected from 539 patients with NSTEMI treated at 97 Spanish emergency departments. After adjustment for 10 baseline differences, the only significant differences were that time-to-arrival at the emergency department was longer for women (odds ratio [OR]=0.52; 95% confidence interval [CI], 0.28-0.95) and that they received more clopidogrel (OR=1.65; 95% CI, 1.06-2.56). The trend to fewer admissions to coronary or intensive care units (42.9% vs 55.6%) and fewer catheterization procedures (29.7% vs 40.7%) disappeared after adjustment (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Emergências/epidemiologia , Medicina de Emergência/métodos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio , Eletrocardiografia , Análise de Variância
3.
Rev Esp Cardiol ; 64(11): 1060-4, 2011 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-21700375

RESUMO

The atypical characteristics of acute coronary syndrome in women lead to differences in management and treatment. We investigated these differences in the urgent management of non-ST-segment acute myocardial infarction (NSTEMI). Data on 39 variables were collected from 539 patients with NSTEMI treated at 97 Spanish emergency departments. After adjustment for 10 baseline differences, the only significant differences were that time-to-arrival at the emergency department was longer for women (odds ratio [OR]=0.52; 95% confidence interval [CI], 0.28-0.95) and that they received more clopidogrel (OR=1.65; 95% CI, 1.06-2.56). The trend to fewer admissions to coronary or intensive care units (42.9% vs 55.6%) and fewer catheterization procedures (29.7% vs 40.7%) disappeared after adjustment. We conclude that there are virtually no differences in treatment in women with N-STEMI in prehospital and emergency care.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Infarto do Miocárdio/terapia , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/terapia , Idoso , Doenças Cardiovasculares/epidemiologia , Cuidados Críticos/estatística & dados numéricos , Eletrocardiografia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/terapia , Exame Físico , Sistema de Registros , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologia
4.
Rev. esp. cardiol. (Ed. impr.) ; 64(3): 233-236, mar. 2011. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-86038

RESUMO

Se analizan las diferencias en el manejo de la fibrilación auricular en varones y mujeres tomando como referencia de base poblacional un área sanitaria. Se incluyeron 668 pacientes (359 mujeres) que consultaron por fibrilación auricular. Las mujeres presentaban más edad, insuficiencia cardiaca y dependencia funcional que los varones. Respecto al manejo de la fibrilación auricular, ellas recibían más frecuentemente digoxina y menos frecuentemente cardioversión eléctrica y valoración por un cardiólogo, y su conocimiento del tratamiento era menor. Tras estratificar los resultados por edad y ajustarlos por insuficiencia cardiaca y grado de dependencia, las mujeres de 85 o más años recibían más frecuentemente digoxina y las menores de 65 años, menos frecuentemente cardioversión. Se concluye que existen diferencias de género en el manejo de la fibrilación auricular, las cuales no pueden ser totalmente atribuidas a diferencias de las características clínicas poblacionales entre mujeres y varones(AU)


Differences in the treatment of atrial fibrillation between men and women were investigated by using patients in a local health district as a reference population. The study included 688 patients (359 female) who presented with atrial fibrillation. Women were older, more frequently had heart failure, and were more often functionally dependent than men. With regards to the management of atrial fibrillation, women were prescribed digoxin more frequently than men, but underwent electrical cardioversion less often, were less frequently seen by a cardiologist, and understood less about their treatment. After stratifying the findings by age and adjusting for heart failure and the degree of functional dependence, it was observed that women aged over 85 years were prescribed digoxin more often than men, while women aged under 65 years underwent cardioversion less often than men. In conclusion, gender differences observed in the treatment of atrial fibrillation cannot be fully explained by differences in clinical characteristics between men and women in the population(AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Gênero e Saúde , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Insuficiência Cardíaca/epidemiologia , Estudos Retrospectivos , Estudos Transversais , Atenção Primária à Saúde
5.
Rev Esp Cardiol ; 64(3): 233-6, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21324575

RESUMO

Differences in the treatment of atrial fibrillation between men and women were investigated by using patients in a local health district as a reference population. The study included 688 patients (359 female) who presented with atrial fibrillation. Women were older, more frequently had heart failure, and were more often functionally dependent than men. With regards to the management of atrial fibrillation, women were prescribed digoxin more frequently than men, but underwent electrical cardioversion less often, were less frequently seen by a cardiologist, and understood less about their treatment. After stratifying the findings by age and adjusting for heart failure and the degree of functional dependence, it was observed that women aged over 85 years were prescribed digoxin more often than men, while women aged under 65 years underwent cardioversion less often than men. In conclusion, gender differences observed in the treatment of atrial fibrillation cannot be fully explained by differences in clinical characteristics between men and women in the population.


Assuntos
Fibrilação Atrial/terapia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Espanha
6.
Med Clin (Barc) ; 134(15): 671-7, 2010 May 22.
Artigo em Espanhol | MEDLINE | ID: mdl-20181365

RESUMO

BACKGROUND AND OBJECTIVE: To evaluate the differences by sex in clinic presentation, diagnostic approach and initial treatment in patients with acute heart failure who are attended in emergency rooms. PATIENTS AND METHODS: Prospective, evaluated, descriptive, transverse and multicentric study, which includes all patients attended by acute heart failure in emergency rooms of 10 Spanish centers between April 15th and May 15th, 2007 (n=944). Data were recorded regarding socio-demographic, comorbidity, previous heart disease, complementary explorations, previous home treatment, and therapeutic measurements in emergency. RESULTS: Regarding men, women (n=501; 53%) were older (79+/-9 and 75+/-10, P<.001), and had more hypertension (83,4% vs 74,9%, P<.01), valvular heart disease (23,1% vs 17,8%, P<.05) and obesity (21,9% vs 15,6%, P<.05); however, they also had less prevalence of coronary heart disease (26,5% vs 43,3%, P=.001) and smoking (4,4 % vs 18,7%, P<.001). According to outpatient treatment, women were less likely to be treated with beta blockers (19,6% vs 30,2%, P<.001) and antithrombotics (34,1% vs 41,3%, P<.05). Treatment administered in the emergency was similar in both groups, yet women received more frequently digoxin (25,7% vs 17,4%, P<.01). Moreover, women were admitted to the cardiology department less often (8,0% vs 13,8%, P<.01). CONCLUSIONS: In emergency, the diagnostic and therapeutic approach is very similar in both sexes and the most cases, differences can be justified due to the different patients' profile and the ambulatory handling before their consultation to emergency.


Assuntos
Tratamento de Emergência , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Doença Aguda , Idoso , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores Sexuais , Espanha
8.
Emergencias (St. Vicenç dels Horts) ; 20(6): 399-404, nov.-dic. 2008. tab
Artigo em Espanhol | IBECS | ID: ibc-70069

RESUMO

Objetivo: Valorar si existen diferencias en la aproximación diagnóstica del dolor torácico en un servicio de urgencias hospitalario (SUH) en función del género. Método: Pacientes consecutivos visitados en la unidad de dolor torácico de un SUH durante16 meses. Tras la primera valoración y el electrocardiograma, los pacientes se clasificaron en cuatro protocolos diferentes: P1 (síndrome coronario agudo (SCA) con elevación del ST); P2 (SCA con descenso del ST); P3 (dolor torácico probablemente coronario con electrocardiograma (ECG) normal o no diagnóstico) y P4 (dolor torácico no coronario).La variable dependiente fue el género, y las independientes el tiempo puerta–ECG(t1) para cada protocolos; en P1 y P2 el lugar de ingreso del paciente; y en P3 los porcentajes de pacientes a los que se les hizo doble determinación de troponina y prueba de esfuerzo y los tiempos puerta-alta (t2) y puerta-prueba de esfuerzo (t3). En las variables en que se hallaron diferencias significativas, se estratificó por edad y TIMI. Resultados: Se visitaron 4.568 pacientes (5% P1, 8% P2, 46% P3, 41% P4). El 45%fueron mujeres, con una edad media de 74 ± 18 años (varones 58 ± 18 años ;p < 0,001) y un TIMI menor de 2 en el 63% de ellas (varones 47%; p < 0,001). El t1(mediana, en minutos) fue superior en las mujeres en todos los protocolos (P1: 7 vs 5,p = 0,06; P2: 12 vs 9, p = 0,15; P3: 15 vs 13, p < 0,01; P4: 21 vs 19, p = 0,25). Las mujeres ingresaron con menor frecuencia en las unidades de cuidados intensivos o intermedios(36% vs 62%, p < 0,001) y se les solicitaron menos pruebas de esfuerzo(33% vs 39%; p < 0,01). Al estratificar por edad, sólo se mantuvo significativo un menor porcentaje de ingresos en intensivos/intermedios en las mujeres entre 71 y 80 años y una menor cantidad de pruebas de esfuerzo en las mujeres entre 81-90 años. Al estratificar por TIMI, también desaparecieron gran parte de las diferencias y sólo se mantuvieron unos porcentajes inferiores de ingresos en intensivos/intermedios para las mujeres con TIMI <= 2 (15% vs 43%; p < 0,01) y de pruebas de esfuerzo en mujeres con TIMI entre 3 y 4 (23% vs 33%; p = 0,04).Conclusiones: La aproximación diagnóstica del dolor torácico en el SUH puede parecer menos intensa en las mujeres, pero muchas de las diferencias inicialmente observadas desaparecen al estratificar por la edad y el TIMI (AU)


Objective: To assess whether the diagnosis of chest pain is approached differently in men and women attending hospital emergency services. Method: Patients who were treated consecutively in the chest pain unit of a hospital emergency department over a period of 16 months were studied. After the preliminary examination and electrocardiogram (ECG), patient assessment followed 1 of 4 protocols: P1, acute coronary syndrome (ACS) with ST elevation; P2, ACS with ST depression; P3, chest pain with probable ACS but a normal or inconclusive ECG; and P4, chest pain unrelated to ACS. Gender was the dependent variable. The independent variables were time from arrival at the door of the emergency room until the first ECG (t1) for each protocol; the admitting department for P1 and P2 patients; and the percentage of patients in whomtroponin was measured twice and a stress test was ordered, door arrival to discharge time (t2), and door arrival to stress test time (t3) for P3 patients. Variables that were significantly different between genders were studied further with the population stratified by age and risk score for thrombosis in myocardial infarction (TIMI).Results: A total of 4568 patients were attended (5% P1, 8% P2, 46% P3, 41% P4). Forty-five percent were women. The mean (SD) ages were 74 (18) years for women and 58 (18) years for men (P<.001). Sixty-three percent of women and47% of men had a TIMI risk score less than 2 (P<.001). The median t1 was longer for women than men in all protocols(P1, 7 minutes vs 5 minutes, respectively, P=.06; P2, 12 vs 9 minutes, P=.15; P3, 15 vs 13 minutes, P<.01; P4, 21 vs 19minutes, P=.25). Women were admitted to intensive or intermediate care units less often than men (36% vs 62%,P<.001) and stress tests were less often ordered for them (33% vs 39%, P<.01). The only difference that remained after stratifying by age was a lower percentage of intensive or intermediate care unit admission for women between 71 and80 years of age and fewer stress tests for women between 81 and 90 years old. Many differences also disappeared after stratifying by TIMI risk score. Women with TIMI risk scores less than 2 were less often admitted to intensive or intermediate care units than men (15% vs 43%, P<.01); those with scores between 3 and 4 were less often scheduled for stress tests (23% vs 33%, P=.04).Conclusions: The diagnosis of chest pain in this hospital emergency department seems to be less energetically pursued in women; however, many of the differences initially observed disappear when the population is stratified by age and TIMI risk score (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Dor no Peito/diagnóstico , Emergências/epidemiologia , Identidade de Gênero , Cuidados Críticos/métodos , Prognóstico , Isquemia Miocárdica/complicações , Revascularização Miocárdica/métodos , Cuidados Críticos/tendências , Revascularização Miocárdica/instrumentação , Revascularização Miocárdica/tendências , Revascularização Miocárdica
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