Cardiovascular Outcomes and Rehospitalization Rates in Homeless Patients Admitted With Acute Myocardial Infarction

Balla, Sudarshan; Alqahtani, Fahad; Alhajji, Mohamed; Alkhouli, Mohamad

doi:10.1016/j.mayocp.2020.01.013

Cited by 21 publications

(29 citation statements)

References 18 publications

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“…Scholars have found that young patients with AMI have a high incidence of single-vessel coronary vascular disease, and most of them involve the anterior descending branch, and the necrotic myocardial area is smaller than that of the elderly [ 15 ]. Meanwhile, the atherosclerotic plaque in young patients is dominated by cellular fibrous tissue, which is often accompanied by intraplaque adipocytes and extracellular lipid accumulation, and a lower incidence of calcification.…”

Section: Discussionmentioning

confidence: 99%

Clinical Study on Characteristics and Risk Factors of Coronary Artery Lesions in Young Patients with Acute Myocardial Infarction

Liu

Zhang

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Epidemiological evidence suggests that the incidence of acute myocardial infarction (AMI) among people under 40 years of age has an increasing trend in recent years. Smoking, hypertension, diabetes mellitus, family history, and gender (male) are considered as classic risk factors for CHD, but the pathogenesis of CHD in young people is not exactly the same. Moreover, the relationship between the pattern of coronary artery disease and risk factors in young patients with acute myocardial infarction is inconclusive. In this study, we retrospectively studied the clinical data of 150 AMI patients treated in our hospital from January 2020 to May 2021. The patients were divided into the young group and elderly group according to the difference in age. The number of coronary artery lesions, the degree of coronary artery stenosis, the distribution dominance typing, the position of the lesions, and the presence of collateral circulation were observed and compared between the two groups. Multivariate logistic regression analysis was used to investigate the risk factors affecting coronary artery lesions in young patients with AMI. The results showed that the number of coronary lesions in young patients with AMI was mainly single-vessel, and the dominant type of distribution was mainly right dominant type. The stenosis degree is lighter than that of elderly patients, and the incidence of collateral circulation is lower than that of elderly patients, but the position of the lesions has no obvious regular. Smoking, staying up late, HDL-C, and LDL-C/ApoB were independent factors affecting the number of coronary artery lesions, and the changes of HDL-C and LDL-C/ApoB had an important influence on the degree of coronary stenosis in young patients. This provides a new idea for clinical treatment.

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Section: Discussionmentioning

confidence: 99%

Clinical Study on Characteristics and Risk Factors of Coronary Artery Lesions in Young Patients with Acute Myocardial Infarction

Liu

Zhang

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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“…Disparate definitions include “living in a shelter, motor vehicle, hotel, friend’s home, or tent,” “living on the street, shelter, transitional housing, staying with friends, or documentation of homelessness in the medical record,” and “lack of adequate nighttime residence,” to name a few . While some use billing codes, such as International Classification of Diseases, Ninth Revision, Clinical Modification code V60.0 (“lack of housing”), it is uncertain what clinical documentation was captured and how consistently housing status was assessed in practice . Additionally, although the VA data sets incorporated standard definitions about housing status, other large registries have not.…”

Section: Key Challengesmentioning

confidence: 99%

How Can We Improve Surgical Care of Patients Who Are Homeless?

2022

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The Current State of Surgical Care for Patients Who Are Homeless Homelessness is a national crisis. In the US, 580 466 people experienced homelessness on 1 night in 2020, up by 2.2% from 2019. 1 Compared with housed individuals, unhoused people have higher rates of chronic health conditions and mental illness, are hospitalized younger, and face barriers to obtaining adequate primary and preventive health care. To date, much of the scientific literature has focused on the medical and psychiatric care of the homeless population, with little research performed to guide surgical teams in tailoring surgical care and ensuring equitable delivery to the unhoused. Housing status undoubtedly affects surgical management, from preoperative assessment and preparation to intraoperative decision-making to postoperative care and rehabilitation (Figure). As homelessness rates rise, equipping surgeons with the tools to provide equitable, patient-centered care for this vulnerable population will be vital.The intersection of homelessness and surgical conditions has been evaluated in few studies. The largest cohorts come from national registries, like the Veterans Administration (VA), including a study by Titan et al 2 that found disproportionately higher rates of readmissions in patients who are homeless discharged to the community following surgery. The limited literature highlights risk factors for surgical complications or issues with postoperative care in the homeless individuals, like increased risk of infection or higher rates of readmission, usually in small series. Very few studies have identified strategies to address these inequities.

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“…Four of these studies evaluated the use of surgical interventions in homeless populations and found that homeless patients were less likely to receive surgery for burns, orthopedic trauma, and myocardial infarction. 27,36,37,46 Similarly, homeless patients were less likely to pursue surgical clinic visits and more likely to miss appointments for endoscopic procedures requiring anesthesia in safety-net and Veterans Affairs settings. 42,43 Hwang et.…”

Section: Domain 4: Overall Care Utilizationmentioning

confidence: 99%

Surgical Care of Patients Experiencing Homelessness: A Scoping Review Using a Phases of Care Conceptual Framework

Abel

Schwartz

Lin

et al. 2022

Journal of the American College of Surgeons

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What is the current state of literature regarding the surgical care of homeless patients? Findings: In this systematic scoping review of 23 studies, a Phases of Care framework was developed to organize evidence unique to the surgical care of homeless patients, a vulnerable and growing population. Selected studies were heterogeneous and limited, particularly regarding the impact of housing status on surgical or anesthetic approach. Definitions of homelessness varied or were absent across studies.Meaning: Research on optimal surgical care for the homeless is sparse. A key next step is recording housing status in surgical databases using a standardized definition.

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Cardiovascular Outcomes and Rehospitalization Rates in Homeless Patients Admitted With Acute Myocardial Infarction

Cited by 21 publications

References 18 publications

Clinical Study on Characteristics and Risk Factors of Coronary Artery Lesions in Young Patients with Acute Myocardial Infarction

Clinical Study on Characteristics and Risk Factors of Coronary Artery Lesions in Young Patients with Acute Myocardial Infarction

How Can We Improve Surgical Care of Patients Who Are Homeless?

Surgical Care of Patients Experiencing Homelessness: A Scoping Review Using a Phases of Care Conceptual Framework

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