Sex-related inequalities in management of patients with acute coronary syndrome-results from the EURHOBOP study

Background: Real‐world data from different levels of hospital specialisation would help to understand if differences in management between women and men with acute coronary syndrome (ACS) are still a priority target. We aimed to identify sex inequalities in management of patients with different types of ACS. Methods: We analysed 1757 patients with a non‐ST‐elevation ACS (NSTEACS) and 1184 with ST elevation myocardial infarction (STEMI) or left bundle branch block (non‐classifiable (NC) ACS (STEMI/NC ACS group), consecutively discharged from ten Portuguese hospitals with different specialisation levels, between 2008 and 2010. We estimated odds ratios (OR) and 95% confidence intervals (95% CI) for the association between sex and the performance of coronary angiography, reperfusion and revascularisation. Results: Among STEMI/NC ACS, men had higher probability of performing coronary angiography than women (adjusted OR = 1.64, 95% CI: 1.11‐2.44), while among NSTEACS patients there was no significant difference by sex (adjusted OR = 1.26, 95% CI: 0.99‐1.62). In patients who underwent coronary angiography, there was no difference in proportion of women and men submitted to revascularisation, regardless of the ACS type. Although men with STEMI/NC ACS were more likely to undergo reperfusion (crude OR = 2.17, 95% CI: 1.68‐2.81), the effect became not significant after multivariable adjustment (adjusted OR = 1.33, 95% CI: 0.96‐1.84). Conclusion: Women diagnosed with STEMI/NC, but not NSTEACS, had lower probability when compared with men to be submitted to coronary angiography. There was no difference in performance of reperfusion and revascularisation by sex.Executive Agency for Health and Consumers, Grant/Award Number: 2008 13 12 - EURHOBOP; Universidade do Porto (EPIUnit), Grant/Award Number: POCI-01-0145-FEDER-006862

Prognostic Effect of the Dose of Loop Diuretic Over Five Years in Chronic Heart Failure

Background: High diuretic doses in chronic heart failure (HF) are potentially deleterious. We assessed the effect of dynamic furosemide dose on all-cause mortality among HF ambulatory patients. Methods and Results: A cohort of 560 ambulatory patients from an outpatient clinic specialized in HF, with median age 70 years, 67% male, and 89% with moderate-severely reduced ejection fraction, was retrospectively followed for up to 5 years. Dynamic furosamide exposure was categorized as low (0–59 mg/d), medium (60–119 mg/d), high (120–159 mg/d), and very high (≥160 mg/d). Extended Cox models were used to estimate the association between time-varying diuretic dose and mortality. A dose-dependent crude association between higher doses of furosemide and death (hazard ratio [HR] = 1.34, 95% confidence interval (CI): 1.06–2.16; HR = 2.09, 95% CI: 1.54–2.84, for high and very high dose, respectively) was totally explained by patients' characteristics and disease severity indicators (adjusted HR = 0.94, 95% CI: 0.63–1.38; HR = 1.10, 95% CI: 0.79–1.55, for high and very high dose, respectively). Conclusion: In this context, higher doses of diuretic did not impair survival, but rather indicated greater severity of the patient's condition.This study was funded by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology– FCT (Portuguese Ministry of Science, Technology and Higher Education) (FCOMP-01-0124-FEDER-011019), under the project “A pharmacoepidemiological approach to the study of prognosis in acute and chronic heart failure” (Ref. FCT PTDC/SAU-ESA/107940/2008) and the Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013)

Conversion methods for modified Jaffe reaction assays of serum creatinine

Background: Modifications in Jaffe serum creatinine (sCr) assays question the suitability of the results for direct comparison. Methods: sCr in adult in-patients was routinely measured either by SRM 909-standardized/noncompensated (method A) or isotope dilution mass spectrometry traceable/compensated method (reference). We converted values by method A into values by the reference using a formula provided by the manufacturer [Beckman Coulter (BC)] and traditional equating methods. Results: The BC-based conversion and linear equating resulted in underestimated sCr values, whereas equipercentile equating (EE) provided sCr with not significantly different distribution from the reference values. Proportions of patients with renal impairment did not differ between the reference and EE-converted sCr, as opposed to BC-recalculated values. Three percent of patients were classified into better renal function category when applying BC versus EE conversion. Conclusions: Equipercentile equation was a more accurate method for recalculation of sCr obtained from different Jaffe reaction assays than the linear equating or the BC linear formula. This study emphasizes the importance of the derivation sample specificity when applying research results to other real-world populations.This study was supported by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology (Portuguese Ministry of Science, Technology and Higher Education) under the Unidade de Investigação em Epidemiologia - Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01–0145-FEDER-006862; Ref. UID/DTP/04750/2013); the individual PhD Grant SFRH/BD/104037/2014 [“EMR (electronic medical record)-embedded predictive model for acute kidney injury in an acute care hospital”] was co-founded by the FCT and POCH/FSE Program

Patient and system delays in the treatment of acute coronary syndrome

Introduction Early reperfusion for patients with ST-segment elevation myocardial infarction (STEMI) is indicated by the European Society of Cardiology, while a timely invasive strategy is recommended for patients with high-risk and intermediate-risk non-ST-elevation acute coronary syndromes (NSTE-ACS). This study aims to assess patient and system delays according to diagnosis and risk profile, and to identify predictors of prolonged delay. Methods We assembled a cohort of patients (n=939) consecutively admitted to the cardiology department of two hospitals, one in the metropolitan area of Porto and one in the north-east region of Portugal, between August 2013 and December 2014. Results The proportion of patients with time from symptom onset to first medical contact (FMC) ≥120 min was highest among high-risk NSTE-ACS (57.7%), followed by intermediate-risk NSTE-ACS (52.1%) and STEMI (43.3%). Regardless of diagnosis and risk stratification, use of own transportation and inability to interpret cardiac symptoms correctly were associated with prolonged delays. Regarding system delays, we found that 78.0% of patients with STEMI and 65.8% of patients with high-risk NSTE-ACS were treated in a timeframe exceeding the recommended limits. Admission to a non-percutaneous coronary intervention-capable hospital, admission on weekends and complications at admission were associated with prolonged delays to treatment. Conclusions Due to both patient and system delays, a large proportion of STEMI and high-risk NSTE-ACS patients still fail to have access to timely reperfusion.This study was supported by the European Regional Development Fund (ERDF), through the Operational Programme “Competitiveness and Internationalization”, and national funding from the Foundation for Science and Technology (FCT), Portuguese Ministry of Education and Science (FCOMP-01-0124-FEDER-028709), under the project “Inequalities in coronary heart disease management and outcomes in Portugal” (FCT PTDC/DTP-EPI/0434/2012) and the Unidade de Investigação em Epidemiologia – Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013)

Comparison between selected hormone and protein levels in serum and prostate tissue homogenates in men with benign prostatic hyperplasia and metabolic disorders

Katarzyna Grzesiak,1 Aleksandra Rył,2 Irena Baranowska-Bosiacka,3 Iwona Rotter,2 Barbara Dołęgowska,4 Marcin Słojewski,5 Olimpia Sipak-Szmigiel,6 Weronika Ratajczak,1 Anna Lubkowska,7 Emilia Metryka,3 Małgorzata Piasecka,1 Maria Laszczyńska1 1Department of Histology and Developmental Biology, Pomeranian Medical University, Szczecin, Poland; 2Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, Szczecin, Poland; 3Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Szczecin, Poland; 4Department of Laboratory Medicine, Pomeranian Medical University, Szczecin, Poland; 5Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland; 6Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University, Szczecin, Poland; 7Department of Functional Diagnostics and Physical Medicine, Pomeranian Medical University, Szczecin, Poland Purpose: The purpose of the study was to assess the relationship between changes in the levels of selected hormones in serum and prostate tissue homogenate in regard to metabolic disorders in patients with diagnosed, surgically treated benign prostatic hyperplasia (BPH). Patients and methods: The study involved a group of 154 men with a diagnosis of BPH with metabolic syndrome (MetS) and without MetS. The serum levels of the hormones – total testosterone, free testosterone, insulin, dehydroepiandrosterone sulfate, estradiol, luteinizing hormone, sex hormone binding globulin (SHBG), and insulin-like growth factor-1 (IGF-1) – were determined using the ELISA method. Prostate tissue sections obtained from the patients during transurethral resection of the prostate were frozen in liquid nitrogen. We determined the levels of the same hormones. Results: There was a statistically significant difference between the groups in terms of serum SHBG levels, but not in the prostate tissue SHBG levels. A similar relationship was observed in regard to IGF-1, the serum levels of which were significantly higher in patients with MetS. MetS had an effect on the ratio of hormone levels in serum to their levels in the prostate tissue. Correlations between the levels of biochemical parameters and the levels of hormones in serum and the prostate tissue of BPH patients with and without MetS demonstrate that serum SHBG levels correlated weakly with waist size and triglyceride levels. Conclusion: The occurrence of MetS in BPH patients was associated with changes in the levels of hormones and proteins. These changes, however, were not always equivalent to changes in the levels of these parameters in prostate tissue. It should also be mentioned that MetS in BPH patients had an influence on a quantitative balance between the levels of SHBG in serum and prostate tissue. Keywords: benign prostatic hyperplasia, hormone levels, metabolic disorder