BACKGROUND:Although increased attention has been paid to sex and racial differences in the management of myocardial infarction, it is unknown whether these differences have narrowed over time. METHODS:With the use of ...BACKGROUND:Although increased attention has been paid to sex and racial differences in the management of myocardial infarction, it is unknown whether these differences have narrowed over time. METHODS:With the use of data from the National Registry of Myocardial Infarction, we examined sex and racial differences in the treatment of patients who were deemed to be “ideal candidates”for particular treatments and in deaths among 598,911 patients hospitalized with myocardial infarction between 1994 and 2002. RESULTS:In the unadjusted analysis, sex and racial differences were observed for rates of reperfusion therapy(for white men, white women, black men, and black women:86.5, 83.3, 80.4, and 77.8 percent, respectively; P< 0.001), use of aspirin(84.4, 78.7, 83.7, and 78.4 percent, respectively; P< 0.001), use of beta-blockers(66.6, 62.9, 67.8, and 64.5 percent; P< 0.001), and coronary angiography(69.1,55.9, 64.0, and 55.0 percent; P< 0.001). After multivariable adjustment, racial and sex differences persisted for rates of reperfusion therapy(risk ratio for white women, black men, and black women:0.97, 0.91, and 0.89, respectively, as compared with white men) and coronary angiography(relative risk, 0.91, 0.82, and 0.76) but were attenuated for the use of aspirin(risk ratio, 0.97, 0.98, and 0.94) and beta-blockers(risk ratio, 0.98, 1.00, and 0.96);all risks were unchanged over time. Adjusted in-hospital mortality was similar among white women(risk ratio,1.05; 95 percent confidence interval, 1.03 to 1.07) and black men(risk ratio, 0.95; 95 percent confidence interval, 0.89 to 1.00), as compared with white men, but was higher among black women(risk ratio, 1.11; 95 percent confidence interval, 1.06 to 1.16) and was unchanged over time. CONCLUSIONS:Rates of reperfusion therapy, coronary angiography, and in-hospital death after myocardial infarction, but not the use of aspirin and beta-blockers, vary according to race and sex, with no evidence that the differences have narrowed in recent years.展开更多
Objectives We sought to determine whether changes in quality of life at 18 mon ths following aortic valve replacement differ depending on the use of tissue val ves or mechanical valves. Methods We prospectively studie...Objectives We sought to determine whether changes in quality of life at 18 mon ths following aortic valve replacement differ depending on the use of tissue val ves or mechanical valves. Methods We prospectively studied 73 patients with tiss ue valve replacements and 53 patients with mechanical valve replacements perform ed from April 1998 through March 1999 at Yale-New Haven Hospital. Quality of li fe was measured at baseline and at 18 months using the Medical Outcomes Trust Sh ort Form 36-Item Health Survey. Results Baseline unadjusted mean quality-of-l ife scores were lower in tissue valve recipients than in mechanical valve recipi ents and, for both groups, were generally lower than US population norms. At 18 months postoperatively, quality-of-life scores were greatly improved in both g roups and were comparable to population norms (ie, within one-half a standard d eviation). After adjusting for baseline quality of life, age, and other prognost ic factors in an analysis of covariance, improvements in quality-of-life score s for tissue valve recipients versus mechanical valve recipients were similar. O f 10(8 domains and 2 summary) scales examined, the only significant difference b etween the 2 groups was for the improvement in role limitations due to physical problems (Role Physical), which was more favorable in patients with mechanical v alve implants (P=.04). Conclusions The use of tissue valve implants versus mecha nical valve implants has little influence on improvement in quality of life at 1 8 months following aortic valve replacement. Thus, decisions about whether to ch oose a tissue valve or mechanical valve implant should depend upon other factors such as rates of complications and differences in the life span of the implants .展开更多
文摘BACKGROUND:Although increased attention has been paid to sex and racial differences in the management of myocardial infarction, it is unknown whether these differences have narrowed over time. METHODS:With the use of data from the National Registry of Myocardial Infarction, we examined sex and racial differences in the treatment of patients who were deemed to be “ideal candidates”for particular treatments and in deaths among 598,911 patients hospitalized with myocardial infarction between 1994 and 2002. RESULTS:In the unadjusted analysis, sex and racial differences were observed for rates of reperfusion therapy(for white men, white women, black men, and black women:86.5, 83.3, 80.4, and 77.8 percent, respectively; P< 0.001), use of aspirin(84.4, 78.7, 83.7, and 78.4 percent, respectively; P< 0.001), use of beta-blockers(66.6, 62.9, 67.8, and 64.5 percent; P< 0.001), and coronary angiography(69.1,55.9, 64.0, and 55.0 percent; P< 0.001). After multivariable adjustment, racial and sex differences persisted for rates of reperfusion therapy(risk ratio for white women, black men, and black women:0.97, 0.91, and 0.89, respectively, as compared with white men) and coronary angiography(relative risk, 0.91, 0.82, and 0.76) but were attenuated for the use of aspirin(risk ratio, 0.97, 0.98, and 0.94) and beta-blockers(risk ratio, 0.98, 1.00, and 0.96);all risks were unchanged over time. Adjusted in-hospital mortality was similar among white women(risk ratio,1.05; 95 percent confidence interval, 1.03 to 1.07) and black men(risk ratio, 0.95; 95 percent confidence interval, 0.89 to 1.00), as compared with white men, but was higher among black women(risk ratio, 1.11; 95 percent confidence interval, 1.06 to 1.16) and was unchanged over time. CONCLUSIONS:Rates of reperfusion therapy, coronary angiography, and in-hospital death after myocardial infarction, but not the use of aspirin and beta-blockers, vary according to race and sex, with no evidence that the differences have narrowed in recent years.
文摘Objectives We sought to determine whether changes in quality of life at 18 mon ths following aortic valve replacement differ depending on the use of tissue val ves or mechanical valves. Methods We prospectively studied 73 patients with tiss ue valve replacements and 53 patients with mechanical valve replacements perform ed from April 1998 through March 1999 at Yale-New Haven Hospital. Quality of li fe was measured at baseline and at 18 months using the Medical Outcomes Trust Sh ort Form 36-Item Health Survey. Results Baseline unadjusted mean quality-of-l ife scores were lower in tissue valve recipients than in mechanical valve recipi ents and, for both groups, were generally lower than US population norms. At 18 months postoperatively, quality-of-life scores were greatly improved in both g roups and were comparable to population norms (ie, within one-half a standard d eviation). After adjusting for baseline quality of life, age, and other prognost ic factors in an analysis of covariance, improvements in quality-of-life score s for tissue valve recipients versus mechanical valve recipients were similar. O f 10(8 domains and 2 summary) scales examined, the only significant difference b etween the 2 groups was for the improvement in role limitations due to physical problems (Role Physical), which was more favorable in patients with mechanical v alve implants (P=.04). Conclusions The use of tissue valve implants versus mecha nical valve implants has little influence on improvement in quality of life at 1 8 months following aortic valve replacement. Thus, decisions about whether to ch oose a tissue valve or mechanical valve implant should depend upon other factors such as rates of complications and differences in the life span of the implants .
