Breaking News
March 21, 2018 - Insurance Company Hurdles Burden Doctors, May Harm Patients
March 21, 2018 - Renal Transplant from HCV-Positive Donors Feasible
March 21, 2018 - Myelodysplastic syndrome: MedlinePlus Medical Encyclopedia
March 21, 2018 - Research reveals brain mechanism involved in language learning
March 21, 2018 - Many parents still hesitate to try early peanut introduction, survey finds
March 21, 2018 - Audiologist urges tinnitus sufferers facing ‘revolving door healthcare’ to seek support
March 21, 2018 - Study reveals impact of prostate cancer on wives and partners of sufferers
March 21, 2018 - ‘Almost a Miracle Drug’: What We Heard This Week
March 21, 2018 - Study shows NIH spent >$100 billion on basic science for new medicines
March 21, 2018 - Columbia researchers identify nerve cells that drive fruit fly’s escape behavior
March 21, 2018 - Sartorius Stedim Biotech selected by ABL Europe to supply single-use process technologies
March 21, 2018 - Increase in coffee consumption may help battle against colon cancer
March 21, 2018 - Hydrogel may accelerate healing of diabetic ulcers
March 21, 2018 - Dermira’s Two Phase 3 Trials Evaluating Olumacostat Glasaretil in Patients with Acne Vulgaris Did Not Meet Co-Primary Endpoints
March 21, 2018 - DePuy Synthes introduces ACTIS Total Hip System for improving initial implant stability
March 21, 2018 - ‘Oh, It Was Nothing’
March 21, 2018 - Herbal drug kratom linked to salmonella illnesses, CDC says
March 21, 2018 - New optical point-of-care device could enhance screening for thyroid nodules
March 21, 2018 - FDA Expands Approval of Adcetris (brentuximab vedotin) for First-Line Treatment of Stage III or IV Classical Hodgkin Lymphoma in Combination with Chemotherapy
March 21, 2018 - Eosinophilic Esophagitis: Late Manifestation of Allergic March
March 21, 2018 - Signaling pathway involving the Golgi apparatus identified in cells with Huntington’s disease
March 21, 2018 - Quintupling inhaled steroid doses may not benefit children with asthma
March 21, 2018 - Study shows clear connection between cardiovascular fitness in middle age and dementia risk
March 21, 2018 - Premature babies have higher risks of health complications in Bangladesh
March 21, 2018 - Child’s temperament and parenting influence weight gain in babies
March 21, 2018 - Researchers find the heart to be capable of arrhythmia termination after local gene therapy
March 21, 2018 - Inhealthcare to provide digital infrastructure for NHS to help protect people from falls
March 21, 2018 - Flu Season Finally Slowing Down
March 21, 2018 - Mixed Results for Shorter DAPT in ACS Patients
March 21, 2018 - Scientists discover fish scale-derived collagen effective for healing wounds
March 21, 2018 - Genomics England announces new partnership to improve efficiency of next-generation sequencing analysis
March 21, 2018 - Adjuvant AC chemotherapy found to be effective in treating HRD-positive breast cancer patients
March 21, 2018 - Researchers identify new treatment targets for lung diseases using big data
March 21, 2018 - Kids see more women in science than five decades ago
March 21, 2018 - Research shows link between chronic fatigue syndrome and lower thyroid hormone levels
March 21, 2018 - Alzheimer’s disease on the rise
March 21, 2018 - Two Agents Equal as Pretreatment for Adrenal Tumor Surgery
March 21, 2018 - ‘Icebreaker’ protein opens genome for T cell development, researchers find
March 21, 2018 - Women in medicine shout #Metoo about sexual harassment at work
March 21, 2018 - Mother’s pre-pregnancy waist size may be linked to child’s autism risk
March 21, 2018 - Second hand marijuana smoke can cause serious damage
March 21, 2018 - International study shows benefits of using MRI at the start of prostate cancer diagnosis
March 20, 2018 - Santhera Reports Outcome of Exploratory Trial with Idebenone in PPMS Conducted at the NIH
March 20, 2018 - ECG Patch Ups At-Home Afib Diagnosis in mSToPS Trial
March 20, 2018 - ROS-scavenging nanozymes for anti-inflammation therapeutics
March 20, 2018 - Genomics England announces appointment of global genomics pioneer as first CEO
March 20, 2018 - Test flight at German Aerospace Center in Cologne demonstrates functionality of deficopter
March 20, 2018 - Music therapy helps treat combat-related psychological injuries in military personnel
March 20, 2018 - Innovative psychotherapeutic treatment protocol for obsessive-compulsive disorders
March 20, 2018 - Weight loss after lap-band surgery alleviates arthritic knee pain
March 20, 2018 - New diabetes drug may help obese people shed body weight
March 20, 2018 - Novel Peanut OIT a Winner in Phase III Trial
March 20, 2018 - Can gene therapy be harnessed to fight the AIDS virus?
March 20, 2018 - Education and academic achievement can lessen effects of child abuse, neglect
March 20, 2018 - Researchers develop new algorithm to make CPR more effective
March 20, 2018 - Diabetes medication reduces chance of late miscarriage, premature birth among women with PCOS
March 20, 2018 - SSRIs may be more effective option for treating anxious youth, UC research shows
March 20, 2018 - Antibiotics could benefit women suffering from chronic bladder pain
March 20, 2018 - Health Highlights: March 16, 2018
March 20, 2018 - Interventional Radiology Has a Problem of ‘Unseen’ Value
March 20, 2018 - Antibodies show effectiveness for HIV prevention and promise for treatment and cure
March 20, 2018 - New 3-D-printed technology will improve radiology training
March 20, 2018 - New study identifies key role for particular gene in 16p11.2 deletion syndrome
March 20, 2018 - Red and processed meat increase the risk of liver disease
March 20, 2018 - 50% of Australians do not brush teeth twice a day
March 20, 2018 - American Gene Technologies receives second immuno-oncology patent
March 20, 2018 - Study finds no link between long-term violent video game play and adult aggression
March 20, 2018 - Weight loss surgery widely underutilized among young patients with severe obesity
March 20, 2018 - Scientists uncover new answers to cell aging in children with rare, fatal disease
March 20, 2018 - The Pistoia Alliance Calls for Greater Life Sciences Collaboration to Build the ‘Lab of the Future’
March 20, 2018 - Morning Break: Psychopathic Thought; Americans Flout Zzz’s; Farm to Pharma
March 20, 2018 - Perceptions of old age change as we age
March 20, 2018 - New standards for public involvement in research launched across the UK
March 20, 2018 - Whole Genome Sequencing used as diagnostic solution for TB
March 20, 2018 - Researchers show how two cancer genes work together to trigger leukemia
March 20, 2018 - Scientists discover basic molecular mechanism that helps understand how ALS works
March 20, 2018 - Multi-center study to evaluate promising new intervention for upper limb dysfunction after SCI
March 20, 2018 - Researchers develop technology to program DNA for delivering cancer drugs
March 20, 2018 - Northwestern scientists bring precision medicine to rheumatoid arthritis
March 20, 2018 - Research suggests possible link between heading a soccer ball and brain imbalance
Four-step heart attack protocol can improve outcomes and reduce gender disparities in care

Four-step heart attack protocol can improve outcomes and reduce gender disparities in care

image_pdfDownload PDFimage_print

Cleveland Clinic researchers found that implementing a four-step protocol for the most severe type of heart attack not only improved outcomes and reduced mortality in both men and women, but eliminated or reduced the gender disparities in care and outcomes typically seen in this type of event.

The research was presented at the American College of Cardiology’s 67th Annual Scientific Session and published in the Journal of the American College of Cardiology.

Cardiovascular disease is the leading cause of death in women, and STEMI (ST elevation myocardial infarction, caused by an abrupt and prolonged blockage of the blood supply to the heart, impacts about one million women each year. Previous studies have shown that women with STEMI have worse clinical outcomes, including higher mortality and higher rates of in-hospital adverse events. Studies have shown women also typically have higher door-to-balloon times (time from when they arrive at the hospital to when they receive a coronary intervention like angioplasty and stenting). They receive lower rates of guideline-directed medical therapy: for example, they are treated with lower rates of aspirin within 24 hours. Previous studies have attributed the differences in care and outcomes in women with STEMI to their being older and higher risk patients than men, suggesting that these disparities may be inevitable.

In this study, Cleveland Clinic researchers put in place a comprehensive four-step protocol for STEMI patients, designed to minimize variability in care. It included: (1) standardized emergency department (ED) cardiac catheterization lab activation criteria, (2) a STEMI Safe Handoff Checklist, (3) immediate transfer to an available catheterization lab, and (4) using the radial artery in the wrist as the first option for percutaneous (under the skin) coronary intervention, like stenting. This approach has been shown to have fewer bleeding complications and improved survival when compared to using the femoral artery.

The results of the study showed improvements in both genders after implementation of the protocol, and substantial reductions in care differences between men and women.

Prior to the protocol, women had significantly higher 30-day mortality than men (10.7 percent vs 4.6 percent) prior to the protocol. Providers were able to lower the overall mortality rates for both men and women, and the difference between the genders was no longer statistically significant (6.5 percent vs. 3.3 percent). In-hospital deaths of women with STEMI were reduced by about 50 percent.

In addition, there was also no difference in rates of major adverse events such as in-hospital stroke, bleeding, vascular complication and transfusions after implementation. Prior to the protocol, mean door-to-balloon time for women was an average of 20 minutes longer compared to men, but afterwards, the times were equal between men and women. The system also resulted in equal rates of guideline-directed medical therapy in women.

“It’s long been known that the gender gap for these types of critical heart attacks is a real issue. However, there is very little data demonstrating successful strategies and no formal recommendation on how a system should be designed to provide the best possible care for women,” said Umesh Khot, M.D., vice chairman of Cardiovascular Medicine at Cleveland Clinic and senior author of the study. “Our research shows that putting into place a system that minimizes care variability raises the level of care for everyone and could be the first step to resolving the long-standing gender disparities.”

The prospective observational study looked at 1,272 consecutive STEMI patients at Cleveland Clinic, of which 868 were men and 404 were women. The four-step STEMI protocol was put into place July 15, 2014. Consecutive patients were studied from July 15, 2014, through December 31, 2016. Patients treated from January 1, 2011, through July 14, 2014, were studied as a control group. Patients were assessed for guideline-directed medical therapy prior to percutaneous coronary intervention, mean door-to-balloon time, in-hospital adverse events, and 30-day mortality.​


Tagged with:

About author

Related Articles