Regional variation in coronary heart disease mortality trends in Portugal, 1981–2012

Araújo, Carla; Pereira, Marta; Viana, Marta; Rocha, Olga Laszczyńska; Bennett, Kathleen; Lunet, Nuno; Azevedo, Ana

doi:10.1016/j.ijcard.2016.09.059

Cited by 7 publications

(6 citation statements)

References 24 publications

(32 reference statements)

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“…Between and within country differences in management and outcomes of patients with ACS have been described, but remain poorly understood . In Portugal, between 1981 and 2012, relative declines of CHD mortality indicators were different by geographic region; consistent decreases in mortality rates were only observed in the most populated and urbanised regions . Our finding of significant differences by hospital in in‐hospital mortality of patients with ACS deserves further analysis.…”

Section: Discussionmentioning

confidence: 66%

“…The decrease in CHD mortality in Portugal was found to be greater among women compared to men, the result of effective primary and/or secondary prevention measures implemented in this group. Changes in the major cardiovascular risk factors in Portugal contributed significantly more to the CHD decrease among women than among men, mainly due to lifestyle changes, as the effect of risk factor lowering treatment was small and similar between sexes .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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Summary 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.

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Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…Prima facie , CVD mortality trends herald optimistic news as death rates have been reduced quite substantially in the last 4 decades, although differentiations have been observed according to the county-region, the statistical method applied and the source of mortality information [ 18 , 19 ]. In many European countries, in 2009 death rates from heart disease were <50% as compared with the 1980s [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Trends of Cardiovascular Disease Mortality in Relation to Population Aging in Greece (1956 - 2015)

Kollia¹,

Tragaki²,

Syngelakis³

et al. 2018

TOCMJ

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Background:Demographic dynamics and decreasing trends in mortality from chronic diseases are major contributors to the phenomenon of population aging. The purpose of the present study was to examine the association between cardiovascular disease (CVD) mortality and demographic indicators, in Greece the past 60 years.Methods:Life Expectancy at birth (LE), population age structure, fertility rates (TFR) and all-cause, CVD mortality rates were retrieved (data provided by the Hellenic Statistical Authority, 1956-2015). In order to test the research hypothesis time-series analysis was conducted.Results:Increasing trends in LE and in the older age (>65 or >80 years) groups’ share and declining trends in TFR were recorded. CVD mortality, after an upward course, showed decreasing trends during 1988–2009, accounting for the 96% and 97% increment in LE in men and women respectively. However, newer records (2010-2015) show a new upward trend. The declining trends in TFR were highly associated with the shifts towards the upper part of the population age pyramid.Conclusion:Population aging is a historically unprecedented event that cannot be avoided, deterred or alleviated. Its negative effects act cumulatively with the recent increases in cardiovascular mortality, especially in the light of the ongoing economic crisis which is expected to further exacerbate the existing contrasts. A possible way to successfully cope with the new demographic realities is to unlock an, up till now largely overlooked, opportunity named “healthy aging”.

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“…In Portugal, relative declines of CHD mortality indicators between 1981 and 2012 varied by geographic region, with consistent decreases in mortality rates observed only in the most populated and urbanized regions [35]. Despite the universal coverage of the NHS, resources and health professionals are concentrated in the major urban centers and along the coast, leaving the inland, specifically the northeastern region, underserved [18].…”

Section: Discussionmentioning

confidence: 99%

Missed Opportunities in Symptomatic Patients before a First Acute Coronary Syndrome: The EPIHeart Cohort Study

Araújo

Laszczyńska²,

Viana³

et al. 2017

Cardiology

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Objectives: The aim of this study was to assess the proportion of patients with a first episode of acute coronary syndrome (ACS) reporting preceding chest pain, having previously sought medical care and undergone the performance of exams, and to identify the determinants of seeking medical advice and undergoing electrocardiogram (ECG). Methods: Within a cohort study, 690 patients with a first episode of ACS were evaluated. A questionnaire was applied to assess chest pain within the preceding 6 months of the event and health system resources utilization. Determinants were identified by logistic regression. Results: Preceding chest pain was reported by 61% of patients, 43% of these sought medical help, of whom less than half underwent ECG, and in 39% pain was attributed to a problem of the heart. Patients with hypertension were more likely to seek medical care (adjusted odds ratio, OR, 2.13, 95% CI 1.29-3.51), and former smokers (OR 0.52, 95% CI 0.28-0.99) and patients of a higher social class (OR 0.16, 95% CI 0.05-0.48) were less likely to seek medical care. The performance of ECG was associated with male sex (OR 2.56, 95% CI 1.11-5.87), health subsystem coverage (OR 3.88, 95% CI 1.11-13.53), and living in the northeastern region (OR 9.07, 95% CI 4.07-20.24), whereas cognitive impairment (OR 0.37, 95% CI 0.15-0.92) and being employed (OR 0.36, 95% CI 0.14-0.97) were inversely associated. Conclusions: These results suggest there are opportunities to improve the diagnosis of myocardial ischemia before acute coronary events.

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Regional variation in coronary heart disease mortality trends in Portugal, 1981–2012

Abstract: In Portugal, between 1981 and 2012, relative declines of CHD mortality indicators were different by geographic region. Consistent decreases in mortality rates were only observed in the Centre, Lisbon and North, the most populated and urbanized regions.

Cited by 7 publications

References 24 publications

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

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

Trends of Cardiovascular Disease Mortality in Relation to Population Aging in Greece (1956 - 2015)

Missed Opportunities in Symptomatic Patients before a First Acute Coronary Syndrome: The EPIHeart Cohort Study

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