Objective The COVID‐19 pandemic has been associated with decreased incidence of acute coronary syndrome with worsened outcomes. Few studies have addressed the effects beyond the initial phases of the pandemic. This study elucidated the incidence, clinical characteristics, management, and outcomes of NSTEMI at a tertiary referral center from sample time periods of 2019–2022. Methods This study included consecutive NSTEMI patients from March 14–May 9, 2019–2022. Variables included baseline characteristics, clinical features on arrival, management strategy, time parameters, and adverse outcomes. The primary outcome was defined as death, heart failure requiring diuretics, and/or sustained ventricular arrhythmia. Results This study comprised 250 patients of whom 181 who were admitted during the COVID‐19 outbreak. Baseline characteristics were similar among groups. There was a reduction in door‐to‐angiography time from 29 h in 2019 to 19 h in 2020 [ p = 0.01] and 20 h in 2021 [ p = 0.02]. PCI intervention increased from 31.8% in 2019% to 50.0% in 2020 [ p = 0.05] and 54.7% in 2021 [ p < 0.01]. Median length‐of‐stay (LOS) was reduced from 3 days in 2019 to 2 days in 2020 [ p = 0.03]. There was no significant change in outcomes in COVID‐19 cohorts compared to control year. Conclusions NSTEMI patients during the first 2 years of the COVID‐19 pandemic were associated with reduced door‐to‐angiography times and increased percutaneous coronary intervention (PCI), and patients in year one were associated with reduced LOS. This study suggests that NSTEMI may be managed more efficiently thus reducing hospital bed utilization and potential costs.

IntroductionIn recent years, there has been a growing desire to address issues related to menstruation, particularly for adolescent girls. In low-income and middle-income countries, prior literature review of the adolescent menstrual experience suggests the need for further research into the impact and efficacy of interventions with this population. There is evidence to suggest the need for initiatives and research in higher-income countries like the USA. To date, the body of research on adolescent menstrual experience in the USA remains uncharacterised. Therefore, we propose a scoping review of the literature on this subject to better inform on areas for future primary study.Methods and analysesUsing the framework proposed by Arksey and O’Malley and expounded on by Levac et al and the Joanna Briggs Institute, we will search electronic databases (MEDLINE, CINAHL, PsycINFO, Web of Science, ProQuest Public Health Database, Social Science Citation Index, Social Services Abstracts and SocINDEX) and grey literature for relevant studies in consultation with experienced librarians. The abstracts and full-text from each reference will be screened by two independent reviewers for inclusion. Bibliographic data, study characteristics and themes will be extracted from studies selected for inclusion using a rubric created by the research team. Findings will be summarised and a list of subject areas for future primary research will be generated in consultation with stakeholders. The review will be conducted using the Preferred Reporting Items from Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.Ethics and disseminationFormal ethics training for this study is not required, as the research team will review publicly available studies. Stakeholders working in adolescent and menstrual health were consulted in designing this review. We will share key findings with stakeholders and in scholarly journals at the conclusion of the review.

Objective: Hypertension (HTN) affects 47% of adults in the United States (US). Medication adherence is difficult to achieve due to its benign course. This study aims to characterize the difference in HTN medication adherence between major regions of the US and the incongruity between urban and rural areas. Methods: This is a cross-sectional study consisting of 11,494 persons, representing over 71 million adults in the US, with a diagnosis of HTN. Data was obtained from the National Health Interview Survey in 2020. Variables include HTN medication adherence, access to regular care, household region, and urban-rural classification as defined by the National Center for Health Statistics. Chi-square test and logistic regression was used to compare the study groups. Results: HTN medication adherence was 75.6% in large urban (LU), 81.5% in large fringe urban (FU), 81.1% in medium urban (MU), and 83.3% in nonmetro (NM) areas [p < 0.001]. Using urban as the baseline comparison for a logistic regression model, a statistically significant difference was observed between LU and each individual group [p < 0.001] . This association remained significant when adjusting for covariates of BMI, marital status, insurance status, race, and age [p < 0.001]. Also, patients in LU were least likely to have a regular healthcare provider at 94.7% followed by 95.9% in FU, and 97.0% in MU and NM [p < 0.01]. Adherence across U.S. regions, defined as Northeast, South, Midwest, and West was statistically significant [p <0.01]. On logistic regression, West had a significantly lower adherence rate at 76.6% when compared to other regions [OR 0.69; 95% CI 0.56, 0.85; p < 0.05]. The odds increased further when adjusting for covariates of BMI, marital status, insurance status, race, and age [AOR 0.74; 95% CI 0.58, 0.95; p < 0.05]. Conclusion: Urban areas are associated with lower rates of HTN medication adherence with increasing adherence in smaller communities. Additionally, Western US is correlated with a lower adherence rate compared to other regions. Further investigation into sources for this discrepancy is warranted, including potential differences in public health campaigns, prescribing practices, and follow up care. This knowledge could assist in the development of targeted solutions.

Objective: The LGBTQ community faces unique psychosocial stressors and barriers in access to care. This study seeks to characterize the difference in hypertension (HTN) medication adherence between LGBTQ and straight men and the difference between LGBTQ and straight women. Methods: This cross-sectional study examines 1,905 self-identifying men and 2,349 women, who selected “gay” or “bisexual”, and 66,938 men and 76,464 women, who selected “straight”, for sexual orientation in response to the National Health Interview Survey (NHIS) conducted by the Center for Disease Control and Prevention (CDC) from 2016-2021. Other sexual orientations included under the umbrella term, LGBTQ, were not listed as options on the NHIS survey. Unpaired t-test was used to compare the study groups and linear regression was used to calculate slope (m) of the trendline. Statistical analysis was weighted for population size. Results: Gay/bisexual men [x = 70.1%, IQR 3.75%] had significantly lower rates [p < 0.001] of HTN medication adherence compared to straight men [x = 78.1%, IQR 5.5%]. The difference in HTN medication adherence between gay/bisexual women [x = 72.2%, IQR 13.1%] and straight women [x =82.4%, IQR 2.80], was also statistically significant [p = 0.014]. Adherence in both gay/bisexual and straight groups trended upward since 2016; however, the upward trend was steeper for straight men [m= 1.87] and women [m= 0.81] compared to gay/bisexual men [m= 1] and women [m= 0.12]. Conclusion: The findings of this study display significantly lower rates of HTN medication adherence between males and females who identify as gay/bisexual compared to those that identify as straight. Since 2016, the gap in medication adherence between gay/bisexual and straight has continued to widen. As medical systems strive to reduce health disparities across various marginalized groups, further research is needed to delineate potential sources for this difference and devise solutions.