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Absence of sex differences in pharmacotherapy for acute myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature179138
Source
Can J Cardiol. 2004 Jul;20(9):899-905
Publication Type
Article
Date
Jul-2004
Author
Susan E Jelinski
William A Ghali
Gerry A Parsons
Colleen J Maxwell
Author Affiliation
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Source
Can J Cardiol. 2004 Jul;20(9):899-905
Date
Jul-2004
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Aged
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Anticoagulants - therapeutic use
Aspirin - therapeutic use
Calcium Channel Blockers - therapeutic use
Canada - epidemiology
Cohort Studies
Drug Evaluation
Drug Therapy
Female
Fibrinolytic Agents - therapeutic use
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction - drug therapy
Patient Admission
Platelet Aggregation Inhibitors - therapeutic use
Sex Factors
Urban health
Abstract
Previous studies have indicated that sex differences may exist in the pharmacological management of acute myocardial infarction (AMI), with female patients being treated less aggressively.
To determine if previously reported sex differences in AMI medication use were also evident among all AMI patients treated at hospitals in an urban Canadian city.
All patients who had a primary discharge diagnosis of AMI from all three adult care hospitals in Calgary, Alberta, in the 1998/1999 fiscal year were identified from hospital administrative records (n=914). A standardized, detailed chart review was conducted. Information collected from the medical charts included sociodemographic and clinical characteristics, comorbid conditions, and cardiovascular medication use during hospitalization and at discharge.
Similar proportions of female and male patients were treated with thrombolytics, beta-blockers, angiotensin-converting enzyme inhibitors, nitrate, heparin, diuretics and digoxin. Among patients aged 75 years and over, a smaller proportion of female patients received acetylsalicylic acid in hospital than did male patients (87% versus 95%; P=0.026). Multivariable logistic regression analysis revealed that, after correction for age, use of other anticoagulants/antiplatelets and death within 24 h of admission, sex was no longer an independent predictor for receipt of acetylsalicylic acid in hospital. Medications prescribed at discharge were similar between male and female patients.
The results from this Canadian chart review study, derived from detailed clinical data, indicate that the pattern of pharmacological treatment of female and male AMI patients during hospitalization and at discharge was very similar. No sex differences were evident in the treatment of AMI among patients treated in an urban Canadian centre.
PubMed ID
15266360 View in PubMed
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Absolute risk reductions, relative risks, relative risk reductions, and numbers needed to treat can be obtained from a logistic regression model.

https://arctichealth.org/en/permalink/ahliterature152508
Source
J Clin Epidemiol. 2010 Jan;63(1):2-6
Publication Type
Article
Date
Jan-2010
Author
Peter C Austin
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5, Canada. peter.austin@ices.on.ca
Source
J Clin Epidemiol. 2010 Jan;63(1):2-6
Date
Jan-2010
Language
English
Publication Type
Article
Keywords
Data Interpretation, Statistical
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Logistic Models
Myocardial Infarction - drug therapy - mortality
Ontario - epidemiology
Risk Reduction Behavior
Treatment Outcome
Abstract
Logistic regression models are frequently used in cohort studies to determine the association between treatment and dichotomous outcomes in the presence of confounding variables. In a logistic regression model, the association between exposure and outcome is measured using the odds ratio (OR). The OR can be difficult to interpret and only approximates the relative risk (RR) in certain restrictive settings. Several authors have suggested that for dichotomous outcomes, RRs, RR reductions, absolute risk reductions, and the number needed to treat (NNT) are more clinically meaningful measures of treatment effect.
We describe a method for deriving clinically meaningful measures of treatment effect from a logistic regression model. This method involves determining the probability of the outcome if each subject in the cohort was treated and if each subject was untreated. These probabilities are then averaged across the study cohort to determine the average probability of the outcome in the population if all subjects were treated and if they were untreated.
Risk differences, RRs, and NNTs were derived using a logistic regression model.
Clinically meaningful measures of effect can be derived from a logistic regression model in a cohort study. These methods can also be used in randomized controlled trials when logistic regression is used to adjust for possible imbalance in prognostically important baseline covariates.
Notes
Comment In: J Clin Epidemiol. 2010 Jan;63(1):7-819762212
PubMed ID
19230611 View in PubMed
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Achieving optimal care for ST-segment elevation myocardial infarction in Canada.

https://arctichealth.org/en/permalink/ahliterature162934
Source
CMAJ. 2007 Jun 19;176(13):1843-4
Publication Type
Article
Date
Jun-19-2007
Author
Andrew Travers
Author Affiliation
Emergency Health Services Nova Scotia, Dartmouth, NS. traverah@gov.ns.ca
Source
CMAJ. 2007 Jun 19;176(13):1843-4
Date
Jun-19-2007
Language
English
Publication Type
Article
Keywords
Angioplasty, Balloon, Coronary
Canada
Critical Pathways
Electrocardiography
Emergency Medical Services - standards - utilization
Fibrinolytic Agents - therapeutic use
Humans
Myocardial Infarction - drug therapy - therapy
Notes
Cites: Acad Emerg Med. 2006 Jan;13(1):84-916365334
Cites: Eur Heart J. 2003 Jan;24(1):28-6612559937
Cites: Circulation. 2003 Dec 9;108(23):2851-614623806
Cites: Can J Cardiol. 2004 Sep;20(11):1075-915457302
Cites: CMAJ. 2007 Jun 19;176(13):1833-817576980
Cites: Eur Heart J. 2006 May;27(10):1146-5216624832
Cites: Eur Heart J. 2006 Jul;27(13):1530-816757491
Cites: N Engl J Med. 2006 Nov 30;355(22):2308-2017101617
Comment On: CMAJ. 2007 Jun 19;176(13):1833-817576980
PubMed ID
17576982 View in PubMed
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[A comparative study in Stockholm. Significant differences between hospitals in mortality among patients with acute myocardial infarction]

https://arctichealth.org/en/permalink/ahliterature55080
Source
Lakartidningen. 1992 Oct 28;89(44):3684-6
Publication Type
Article
Date
Oct-28-1992
Author
N. Rehnqvist
C. Falkenberg
K. Schenk-Gustafsson
T. Schultz
Author Affiliation
Medicinska kliniken, Danderyds sjukhus, S:t Görans, Stockholm.
Source
Lakartidningen. 1992 Oct 28;89(44):3684-6
Date
Oct-28-1992
Language
Swedish
Publication Type
Article
Keywords
Adult
Aged
Comparative Study
Female
Hospitals, Municipal - standards
Humans
Male
Medical Audit
Middle Aged
Myocardial Infarction - drug therapy - mortality
Sweden - epidemiology
Notes
Comment In: Lakartidningen. 1992 Dec 16;89(51-52):4492-31469996
PubMed ID
1460986 View in PubMed
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[A controlled trial with prolonged follow up: percutaneous intervention in acute myocardial infarction is equivalent to thrombolytic therapy]

https://arctichealth.org/en/permalink/ahliterature53870
Source
Lakartidningen. 2001 Aug 8;98(32-33):3397-9
Publication Type
Article
Date
Aug-8-2001
Author
P. Tornvall
M. Johansson
I. Herzfeld
T. Nilsson
Author Affiliation
Kardiologiska kliniken, Karolinska sjukhuset, Stockholm. per.tornvall@ks.se
Source
Lakartidningen. 2001 Aug 8;98(32-33):3397-9
Date
Aug-8-2001
Language
Swedish
Publication Type
Article
Keywords
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Case-Control Studies
Comparative Study
English Abstract
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Infarction - drug therapy - mortality - therapy
Myocardial Reperfusion - methods
Shock - drug therapy - therapy
Thrombolytic Therapy - contraindications
Abstract
Previous studies comparing percutaneous coronary intervention (PCI) with thrombolysis for treatment of myocardial infarction with ST-elevation have in meta-analyses but not in randomized trials shown that PCI is more effective. Despite a large volume of primary PCI performed in Sweden no controlled trials have been carried out. The present study included 96 patients with myocardial infarction with ST-segment elevation treated with primary PCI 1995-1998. The main indications were shock (15 cases), contraindication to thrombolysis (24 cases), as an alternative to thrombolysis (57 cases), with a mortality in the respective groups of 67, 25 and 10 percent. Controls matched for age and infarct location and treated with thrombolysis could be identified for 55 of the patients treated with PCI. After four years 40 percent and 52 percent of the patients treated with PCI and thrombolysis respectively reached the combined endpoint of death/myocardial infarction/revascularization/angina pectoris (not significant). In conclusion, the study shows that primary PCI in patients with myocardial infarction with ST-segment elevation can be performed safely also in Sweden.
PubMed ID
11526657 View in PubMed
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[Acute myocardial infarction in Mid-Norway: transportation for thrombolytic treatment or primary percutaneous coronary intervention?].

https://arctichealth.org/en/permalink/ahliterature140877
Source
Tidsskr Nor Laegeforen. 2010 Sep 9;130(17):1714-6
Publication Type
Article
Date
Sep-9-2010
Author
Hanne Saettem Beltesbrekke
Mari Bergan Husa
Harald Vik-Mo
Author Affiliation
Institutt for sirkulasjon og bildediagnostikk, Norges teknisk-naturvitenskapelige universitet og Hjertemedisinsk avdeling, St. Olavs hospital, 7006 Trondheim, Norway.
Source
Tidsskr Nor Laegeforen. 2010 Sep 9;130(17):1714-6
Date
Sep-9-2010
Language
Norwegian
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Air Ambulances
Angioplasty, Balloon, Coronary
Cohort Studies
Female
Humans
Male
Middle Aged
Myocardial Infarction - drug therapy - therapy
Norway
Physician's Practice Patterns
Prognosis
Thrombolytic Therapy
Time Factors
Transportation of Patients
Treatment Outcome
Abstract
Occluded coronary arteries should be opened urgently in patients who have acute myocardial infarction and ST-elevation in ECG. When transport times are long, thrombolytic treatment is a good alternative to primary percutaneous coronary intervention (PCI). The purpose of this study was to assess choice of treatment strategy in cases where time after start of symptoms and transport time are decisive for the outcome.
A cohort study of 379 patients, who had myocardial infarction and ST-elevation, and were admitted to St. Olav's Hospital, Trondheim, Norway in the period 1.11.2007-31.1.2009.
268 patients (71 %) were treated with PCI, and 111 patients (29 %) with thrombolytic treatment. 173 patients (46 %) were transported by helicopter. The counties in Mid-Norway used markedly different treatment strategies for these patients.
Great regional differences were observed in the use of PCI and thrombolytic treatment in Mid-Norway.
PubMed ID
20835281 View in PubMed
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Acute myocardial infarction: profile and management at a tertiary care hospital in Karachi.

https://arctichealth.org/en/permalink/ahliterature47555
Source
J Pak Med Assoc. 2002 Jan;52(1):45-50
Publication Type
Article
Date
Jan-2002
Author
Z. Samad
A. Rashid
M A U Khan
S. Mithani
M H Khan
M S M Khan
S S Malik
U S Nehal
S. Sami
M. Karim
Author Affiliation
Department of Community Health Sciences, Aga Khan University Hospital, Karachi.
Source
J Pak Med Assoc. 2002 Jan;52(1):45-50
Date
Jan-2002
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Chi-Square Distribution
Female
Hospital Mortality
Humans
Length of Stay
Male
Middle Aged
Myocardial Infarction - drug therapy - mortality - physiopathology
Pakistan - epidemiology
Retrospective Studies
Risk factors
Abstract
OBJECTIVE: Acute Myocardial Infarction (AMI) is a rising epidemic in developing countries. While studies in the West have established the characteristics and management of AMI patients, comprehensive data reflecting these issues in the Pakistani subjects is scarce. This study examined the profile and management of AMI in patients hospitalized at a tertiary care hospital in Karachi, Pakistan. METHODS: Three hundred forty four patients admitted in 1998 with the diagnosis of AMI met our inclusion criteria. Data on presentation, investigations, monitoring and therapy was obtained. Chi-square and t tests were used to analyze the data. RESULTS: Out of 344 patients with AMI, 71% were males; 58% had a Q wave MI. Majority of the patients who presented within 2 hours of symptom onset (36%), had chest pain. Patients with dyspnea and no chest pain were more likely to present after 12 hours of the onset of symptoms. In-house mortality was found to be 10.8%. Low HDL and diabetes was associated with in-hospital complications. Twenty nine percent of patients were given thrombolytic therapy with a mean door-to-needle time of 1 hour 36 minutes; 33% of patients who were eligible of Streptokinase did not receive it. Cardiac catheterization was performed in 28% patients. Echocardiography and Exercise Tolerance Test, both under utilized, were performed in 67% and 16% of patients, respectively. Two hundred sixteen (70%) patients discharged from hospital were contacted via telephone and the 1-year mortality rate among them was 28%. CONCLUSION: The profile and management of AMI was in coherence with earlier, Western studies. Chest pain units need to be established in the Emergency Room. Patients should be risk stratified prior to discharge. Public awareness regarding primary and secondary prevention and symptoms of AMI needs to be increased.
PubMed ID
11963586 View in PubMed
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Adherence to beta-blocker therapy under drug cost-sharing in patients with and without acute myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature162000
Source
Am J Manag Care. 2007 Aug;13(8):445-52
Publication Type
Article
Date
Aug-2007
Author
Sebastian Schneeweiss
Amanda R Patrick
Malcolm Maclure
Colin R Dormuth
Robert J Glynn
Author Affiliation
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St (Ste 3030), Boston, MA 02120, USA. schneeweiss@post.harvard.edu
Source
Am J Manag Care. 2007 Aug;13(8):445-52
Date
Aug-2007
Language
English
Publication Type
Article
Keywords
Acute Disease
Adrenergic beta-Antagonists - economics - therapeutic use
Aged
Aged, 80 and over
British Columbia
Case-Control Studies
Cohort Studies
Comorbidity
Cost Sharing
Deductibles and Coinsurance
Diabetes Complications
Female
Health Policy - trends
Humans
Male
Medical Record Linkage
Myocardial Infarction - drug therapy - economics
Patient Compliance - statistics & numerical data
Prescription Fees
Vascular Diseases
Abstract
To evaluate the effects of patient copayment and coinsurance policies on adherence to therapy with beta-adrenergic blocking agents (beta-blockers) and on the rate of initiation of beta-blocker therapy after acute myocardial infarction (MI) in a population-based natural experiment.
Three sequential cohorts included British Columbia residents age 66 years and older who initiated beta-blocker therapy during time intervals with full drug coverage (2001), a $10 or $25 copayment (2002), and 25% coinsurance (2003-2004). We used linked data on all prescription drug dispensings, physician services, and hospitalizations. Follow-up of each cohort was 9 months after the policy changes.
We measured the proportion of subjects in each cohort who were adherent to beta-blocker therapy over time, with adherence defined as having >80% of days covered. We also measured the proportion of patients initiating beta-blocker therapy after acute MI. Policy effects were evaluated using multivariable regression.
Adherence to beta-blocker therapy was marginally reduced as a consequence of the copayment policy (-1.3 percentage points, 95% confidence interval [CI] = -2.5 , -0.04) or the coinsurance policy (-0.8 percentage points, 95% CI = -2.0, 0.3). The proportion of patients initiating beta-blockers after hospitalization for acute MI remained steady at about 61% during the study period, similar to that observed in a control population of elderly Pennsylvania residents with full drug coverage.
Fixed patient copayment and coinsurance policies had little negative effect on adherence to relatively inexpensive beta-blocker therapy, or initiation of beta-blockers after acute MI.
Notes
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PubMed ID
17685825 View in PubMed
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Adherence to statins, beta-blockers and angiotensin-converting enzyme inhibitors following a first cardiovascular event: a retrospective cohort study.

https://arctichealth.org/en/permalink/ahliterature174577
Source
Can J Cardiol. 2005 May 1;21(6):485-8
Publication Type
Article
Date
May-1-2005
Author
David F Blackburn
Roy T Dobson
James L Blackburn
Thomas W Wilson
Mary Rose Stang
William M Semchuk
Author Affiliation
College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada. d.blackburn@usask.ca
Source
Can J Cardiol. 2005 May 1;21(6):485-8
Date
May-1-2005
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Age Factors
Angina, Unstable - drug therapy
Angioplasty, Balloon, Coronary
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Cohort Studies
Coronary Artery Bypass
Databases as Topic
Drug Prescriptions - statistics & numerical data
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Linear Models
Male
Middle Aged
Myocardial Infarction - drug therapy
Patient Compliance - statistics & numerical data
Retrospective Studies
Saskatchewan
Severity of Illness Index
Time Factors
Abstract
Population studies of statin adherence are generally restricted to one to two years of follow-up and do not analyze adherence to other drugs.
To report long-term adherence rates for statins, angiotensin-converting enzyme (ACE) inhibitors and beta-blockers in patients who recently experienced a first cardiovascular event.
Linked administrative databases in the province of Saskatchewan were used in this retrospective cohort study. Eligible patients received a new statin prescription within one year of their first cardiovascular event between 1994 and 2001. Adherence to statins, beta-blockers and ACE inhibitors was assessed from the first statin prescription to a subsequent cardiovascular event.
Of 1221 eligible patients, the proportion of patients adherent to statin medications dropped to 60.3% at one year and 48.8% at five years. The decline in the proportion of adherent patients was most notable during the first two years (100% to 53.7%). Several factors were associated with statin adherence, including age (P = 0.012), number of physician service days (P = 0.037), chronic disease score (P = 0.032), beta-blocker adherence (P
PubMed ID
15917876 View in PubMed
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Adherence to statin therapy under drug cost sharing in patients with and without acute myocardial infarction: a population-based natural experiment.

https://arctichealth.org/en/permalink/ahliterature164224
Source
Circulation. 2007 Apr 24;115(16):2128-35
Publication Type
Article
Date
Apr-24-2007
Author
Sebastian Schneeweiss
Amanda R Patrick
Malcolm Maclure
Colin R Dormuth
Robert J Glynn
Author Affiliation
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120, USA. schneeweiss@post.harvard.edu
Source
Circulation. 2007 Apr 24;115(16):2128-35
Date
Apr-24-2007
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
British Columbia
Cohort Studies
Cost Sharing - economics - statistics & numerical data
Deductibles and Coinsurance - economics - statistics & numerical data
Drug Costs
Female
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - economics - therapeutic use
Insurance Coverage - economics - statistics & numerical data
Insurance, Pharmaceutical Services - classification - economics - statistics & numerical data
Male
Myocardial Infarction - drug therapy
National Health Programs - economics - statistics & numerical data
Patient Compliance - statistics & numerical data
Abstract
As medication spending grows, Medicare Part D will need to adapt its coverage policies according to emerging evidence from a variety of insurance policies. We sought to evaluate the consequences of copayment and coinsurance policies on the initiation of statin therapy after acute myocardial infarction and adherence to therapy in statin initiators using a natural experiment of all British Columbia residents aged 66 years and older.
Three consecutive cohorts that included all patients who began statin therapy during full drug coverage (2001), coverage with a $10 or $25 copay (2002), and coverage with a 25% coinsurance benefit (2003-2004) were followed up with linked healthcare utilization data (n=51,561). Follow-up of cohorts was 9 months after each policy change. Adherence to statin therapy was defined as > or = 80% of days covered. Relative to full-coverage policies, adherence to new statin therapy was significantly reduced, from 55.8% to 50.5%, under a fixed copayment policy (-5.4% points; 95% CI, -6.4% to -4.4%) and the subsequent coinsurance policy (-5.4% points; 95% CI, -6.3% to -4.4%). An uninterrupted increase in the proportion of patients initiating statin therapy after an acute myocardial infarction (1.7% points per quarter) was observed over the study period, similar to a Pennsylvania control population with full coverage. Sudden changes to full out-of-pocket spending, similar to Medicare's Part D "doughnut hole," almost doubled the risk of stopping statins (adjusted odds ratio, 1.94, 95% CI, 1.82 to 2.08).
Fixed patient copayment and coinsurance policies have negative effects on adherence to statin lipid-lowering drug therapy but not on their initiation after myocardial infarction.
PubMed ID
17420348 View in PubMed
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321 records – page 1 of 33.