Gender,age, and heart failure with preserved left ventricular systolic function

OBJECTIVES: This study was designed to determine if women are more likely than men to have heart failure (HF) with preserved systolic function after adjustment for potential confounders, including age. BACKGROUND: Although prior evidence suggests an independent association between female gender and preserved left ventricular systolic function (LVSF) in patients with HF, existing studies are limited by referral biases, small sample sizes, or the inability to adjust for a wide range of potential confounding variables. METHODS: This is a cross-sectional study using data from retrospective medical chart abstraction of a national sample of Medicare beneficiaries hospitalized with the principal discharge diagnosis of HF in acute-care nongovernmental hospitals in the U.S. between April 1998 and March 1999. Patients were eligible for this analysis if they were age 65 years or older, had documentation of LVSF, and corroboration of the diagnosis of HF. We used multivariable logistic regression to identify the correlates of preserved LVSF, which was defined as qualitatively normal function or quantitatively reported ejection fraction > or =0.50. Stratified regressions by gender were performed to identify significant interactions. RESULTS: Of the 19,710 patients in the analysis, preserved LVSF was present in 6,700 (35%), 79% of whom were women. In contrast, among the 12,956 patients with impaired LVSF, only 49% were women. Patients with preserved LVSF were 1.5 years older than those with impaired LVSF. After adjustment for age and other patient factors, female gender remained strongly associated with preserved LVSF (calculated risk ratio = 1.71; 95% confidence interval 1.63 to 1.78). The association was consistent in all age groups, and was similar in patients with or without coronary artery disease, hypertension, pulmonary disease, renal insufficiency, or atrial fibrillation. CONCLUSIONS: In elderly patients hospitalized with HF, preserved systolic function is primarily a condition of women, independent of important demographic and clinical characteristics.     

Comparison of Prevalence and Risk Factors of Acute Coronary Syndrome in Patients with Different Ethnicity: A Cross-sectional Study

BackgroundAlthough the main risk factors of acute coronary syndrome (ACS) have been previously identified, there is not yet strong and consistent evidence about the ethnical differences of these risk factors. The aim of this study was to identify and compare the distribution of risk factors of ACS among two ethnic groups in northern Iran.MethodsThis cross-sectional study was done on a total of 250 patients (100 Fars and 150 Turkmen ethnics) with ACS admitted in coronary care units (CCU) of medical centers in Gonbad-e Kavus, a city in the Northeast of Iran. The demographic characteristics, clinical parameters and anthropometric indices of patients in two ethnic groups were recorded. In addition, Beacke''s questionnaire and Cohen''s scale were used to evaluate and compare the patients'' level of physical activity and perceived stress, respectively.ResultsThe mean age of the patients was 60.9±11.9 years and they were mostly males (54.8%) and married (84.8%). Findings showed that the prevalence of myocardial infarction in Fars patients was significantly higher than Turkmens (24% versus 15.3%; P=0.04). In addition, there was a significant difference in terms of the history of using opium (P=0.07) and opium sap (P=0.03), socioeconomic status (P=0.009), the place of residence (P=0.001) and type of health insurance services (P=0.001) between two groups. However, the clinical parameters and anthropometric indices and the level of physical activity and perceived stress were not significantly different between two groups (P>0.05).ConclusionThis study showed a significant difference in the prevalence and risk factor of ACS in patients with different ethnicity in northern Iran. This finding points to the importance of paying attention to the ethnicity-based difference in ACS prevalence and risk factors, especially in patients who are at high to intermediate risk for ACS, such as Turkmens.     

Healthcare utilization patterns and economic burden of animal bites: A cross-sectional study

Objective: To determine the healthcare utilization patterns and estimate the economic burden of animal bites in Golestan province, north part of Iran. Methods: This cross-sectional study was performed based on the data of 12181 animal-bite patients from Golestan province who were referred to the rabies prophylaxis centers between March 2019 and March 2020. The study was a societal perspective, and all patients were investigated by census method. The micro-costing method with a bottom-up approach as well as the human capital approach were used to estimate the economic burden. Results: In our study, the economic burden caused by animal bites was estimated at $1383639 (275354672060 Rials). The largest share of costs was related to direct healthcare costs, direct non-healthcare costs, and indirect costs accouting for 91％, 5％, and 4％, respectively. In addition, the average cost of a animal-bite patient was estimated at $113.5 (22605260 Rials) (The average cost of a case in type 2 and 3 exposures was $45 and $412.8, respectively). The largest share of direct healthcare costs was related to immunoglobulin, vaccine, and personnel expenses accounting for 61.3％, 19.8％, and 11.65％, respectively. Conclusions: Our study shows that animal bites in Golestan province, north of Iran impose a high economic burden on the communities, especially the healthcare system, which indicates the need to review management and control programs of animal bites and rabies based on animal-bite patterns of the area.     

Baseline quality indicator rates from the National Heart Failure Project: a HCFA initiative to improve the care of medicare beneficiaries with heart failure

This column is the third in a series reporting on Health Care Financing Administration (HCFA) initiatives to improve care for Medicare beneficiaries with heart failure. The first paper outlined the history of HCFA quality improvement projects and current initiatives to improve care in six priority areas: heart failure, acute myocardial infarction, stroke, pneumonia, diabetes, and breast cancer. The second reported in more detail the structure of the national inpatient fee-for-service heart failure initiative, known as the National Heart Failure project. It described the development of the quality indicators, the sampling strategy for selecting charts to be reviewed, and the types of local efforts spurred by the project through the activities of each state's HCFA contractor peer review organization. This article discusses baseline quality indicator rates from the National Heart Failure project. (c)2001 by CHF, Inc.