Female Cardiac Patients Research Articles

Treatment Motivation and Hopelessness among Cardiac Patients

Background: Cardiac patients' adherence to treatment regimens is crucial for their recovery and well-being. The role of psychological factors, including treatment motivation and hopelessness, in influencing treatment outcomes has gained increasing attention. Gender differences in these psychological aspects may have implications for tailoring patient care strategies.
 Objective: This study aimed to explore the differences in treatment motivation and hopelessness between male and female cardiac patients and to examine how these factors are related to demographic variables such as age, gender, education, and income.
 Methods: A total of 150 cardiac patients from the C-P-E Institute of Cardiology Multan were selected through purposive sampling for this cross-sectional study. The Treatment Motivation Questionnaire (TMQ) and the Beck Hopelessness Scale (BHS) were administered to assess treatment motivation and hopelessness, respectively. Data on demographic variables were also collected. Statistical analysis included mean, standard deviation, and t-tests.
 Results: The study found no significant difference in external motivation between females (mean=2.09, SD=0.35) and males (mean=2.02, SD=0.32, p=0.158). Internal motivation was significantly higher in males (mean=2.33, SD=0.27) compared to females (mean=2.23, SD=0.25, p=0.023). Help-seeking behavior was more prevalent in males (mean=2.45, SD=0.45) than in females (mean=2.28, SD=0.45, p=0.04). No significant difference was observed in confidence and overall treatment motivation between genders. Hopelessness was significantly higher in males (mean=12.05, SD=1.91) than in females (mean=11.43, SD=1.94, p=0.047).
 Conclusion: The study underscored significant gender differences in internal motivation and help-seeking behavior among cardiac patients, with males displaying higher levels of both. Additionally, males exhibited greater hopelessness than females. These findings suggest the need for gender-specific interventions to enhance treatment motivation and address hopelessness in cardiac patients.

Determining sex-specific preoperative haemoglobin levels associated with intraoperative red blood cell transfusion in cardiac surgery: a retrospective cohort study

BackgroundAnaemic cardiac surgery patients are at greater risk of intraoperative red blood cell transfusion. This study questions the application of the World Health Organization population-based anaemia thresholds (haemoglobin <120 g L−1 in non-pregnant females and <130 g L−1 in males) as appropriate preoperative optimisation targets for cardiac surgery. MethodsA retrospective cohort study was conducted on adults ≥18 yr old undergoing cardiopulmonary bypass surgery. Logistic regression was applied to define sex-specific preoperative haemoglobin concentrations with reduced probability of intraoperative red blood cell transfusion for cardiac surgery patients. ResultsData on 4384 male and 1676 female patients were analysed. Binarily stratified multivariable logistic regression odds of receiving intraoperative red blood cell transfusion increased in cardiac surgery patients >45 yr old (odds ratio [OR] 1.84; 95% confidence interval [CI] 1.33–2.55), surgery urgency <30 days (OR 2.03; 95% CI 1.66–2.48), combined coronary artery bypass grafting and valve surgery, or other surgery types (OR 2.24; 95% CI 1.87–2.67), and female sex (OR 1.92; 95% CI 1.62–2.28). The odds decreased by 8.4% with each 1 g L−1 increase in preoperative haemoglobin (OR 0.92; 95% CI 0.91–0.92). Logistic regression predicted females required a preoperative haemoglobin concentration of 133 g L−1 and males 127 g L−1 to have a 15% probability of intraoperative transfusion. ConclusionsThe World Health Organization female anaemia threshold of haemoglobin <120 g L−1 disproportionately disadvantages female cardiac surgery patients. A preoperative haemoglobin concentration ≥130 g L−1 in adult cardiac surgery patients would minimise their overall probability of intraoperative red blood cell transfusion to <15%.

Abstract 11219: Female Patients Attending Female Cardiologist-Led Heart Clinic in Iraq: Clinical Landscape and Echocardiographic Data

Introduction: In Iraq, traditional and tribal rules prevent many women from having access to healthcare unless being managed exclusively by female doctors. So, lack of female cardiologists (FC) in Iraq deprived many women from proper cardiovascular care.Considering the absent Women′s Heart Clinics in Iraq and lack of data on female cardiac patients,we sought to provide data regarding demographic and echocardiographic characteristics of women attending a female cardiologist-led heart clinic (FC-LHC) in a first report from Iraq Methods: Women who attended a FC-LHC were included, clinical and echocardiographic characteristics were recorded. Results: n=213, mean age (46.5±16.6)year.Hypertension (HT) and dyslipidemia were most reported risk factors.History of gestational HT was most common sex-specific risk factor (figA).Women′s comorbidities differs with their social status as HT, DM, IHD and dyslipidemia were highest in widowed women (91.3%, 43.5%, 21.7% and 39.1% respectively). Consuming fast food≥4/week was highest in divorced (33.3%) and single women (23.1%). OCP was used by 5.2% of women; in general and 10.3% of married women at reproductive age; in particular. Prevalence of DM,IHD and LV dysfunction differs according to women′s education (figB). Palpitation (46.5%) and dyspnoea (30%) were most common presentations. Cardio-Obstetric and Cardio-Oncology services were offered in 5.2% and 5.6% respectively (figC). LV diastolic dysfunction and mitral regurgitation were most common echocardiographic abnormalities (figD). Conclusion: Younger women&lt;65 years were more frequently attending FC-LHC.Prior history of gestational HT was the commonest sex-specific cardiovascular risk factor. Increasing diversity in cardiology workforce and establishing Women′s Heart Clinics that include FC are crucial in Iraq to promote focused cardiovascular care and education and to provide data for sex-specific research in cardiovascular management and outcomes

Impact of right anterolateral thoracotomy with a new approach on breast development: survey analysis of female cardiac surgery patients.

Our aim was to present the effects of submammarian thoracotomy by our new approach to breast development in young female patients between 8 and 14 years old. Atrial septal defect closure was performed in 55 female patients between 8 and 14 years old at the time of operation between January 2010 and January 2018 by median sternotomy or right anterolateral thoracotomy. These patients were called for a follow-up visits, breast examination were performed, and a questionnaire of 10 questions was applied. According to the answer given by the patients to the question of "how would you describe your scar" showed that the surgical method satisfies all patients cosmetically in study group. The overall satisfaction rate for the cosmetic results of operation was 100% versus 41.1%, respectively. The percentage of patients said no to the question "Do you experience lack of self-confidence related your scar" was significantly higher than the control group (p < 0.001). The percentage of those who said yes to the question "Would you like to be operated with the same approach if you will have surgery again?" in the study group was significantly higher than the control group (p = 0.002). We consider that our procedure is safe and effective with improved cosmetic results compared to median sternotomy which also confers many advantages such as less trauma, less pain, faster recovery, and shorter hospital stay. This study presents one of the largest series of paediatric patients operated by submammarian thoracotomy.

Stress-related psychopathology after cardiac surgery and intensive care treatment

• Cardiac surgery patients are at risk for post-traumatic stress disorder (PTSD) and depression, which might hamper recovery. • Factors associated with the development of PTSD and depression are variable. • Linear backwards regression identified higher trait anxiety to affect the occurrence of PTSD and depression significantly. • In this setting, female patients potentially benefit from intraoperative dexamethasone administration. Cardiac surgery patients are at risk for psychopathology. Symptoms of post-traumatic stress disorder (PTSD) and depression occur in 10–20% of these patients and affect their quality of life. The aim of this study was to assess factors associated with psychopathology after cardiac surgery. We followed participants of the multi-center randomized clinical trial Dexamethasone for Cardiac Surgery (DECS), on a single, intravenous dose of dexamethasone (1 mg/kg) or placebo during cardiac surgery, using validated questionnaires to assess PTSD and depressive symptoms after 1.5 to 4 years, as well as childhood trauma, trait anxiety, pre-existing psychopathology, and substance use. Saliva was used for genotyping of the hypothalamic-pituitary-adrenal-axis (HPA axis) glucocorticoid receptor gene. Linear backward regression analysis was performed with these factors, including pre-specified interaction terms of dexamethasone with sex and genotype. Complete data was available for 90% of cases ( n = 1111). The model including trait anxiety and the [dexamethasone x female sex] interaction explained 57% of variance in PTSD symptoms (Model fit F (2;4.817)=643.043, p <.001; R 2 =0 0.57). Similar explained variance was seen for depressive symptoms, where age, trait anxiety and the [dexamethasone x female sex] interaction provided the optimal model (Model fit F (3;4.261)=435,960, p <.001; R 2 =0.58). In this study psychopathology was assessed through validated questionnaires. Variability in data collection detail was present. This study suggests that the occurrence of psychopathology after cardiac surgery is influenced by higher trait anxiety. Female cardiac surgery patients may benefit from intra-operative dexamethasone administration.

Comparison of survival models and assessment of risk factors for survival of cardiovascular patients at Addis Ababa Cardiac Center, Ethiopia: a retrospective study.

Cardiovascular diseases (CVDs) is disorders of heart and blood vessels. It is a major health problem across the world, and 82% of CVD deaths is contributed by countries with low and middle income. The aim of this study was to choose appropriate model for the survival of cardiovascular patients data and identify the factors that affect the survival of cardiovascular patients at Addis Ababa Cardiac Center. A Retrospective study was conducted on patients under follow-up at Addis Ababa Cardiac Center between September 2010 to December 2018. The patients included have made either post operation or pre-operation. Out of 1042 cardiac patients, a sample of 332 were selected for the current study using simple random sampling technique. Non-parametric, semi-parametric and parametric survival models were used and comparisons were made to select the appropriate predicting model. Among the sample of 332 cardiac patients, only 67(20.2%) experienced CVD and the remaining 265(79.8%) were censored. The median and the maximum survival time of cardiac patients was 1925 and 1403 days respectively. The estimated hazard ratio of male patients to female patients is 1.926214 (95%CI: 1.111917-3.336847; p = 0.019) implying that the risk of death of male patients is 1.926214 times higher than female cardiac patients keeping the other covariates constant in the model. Even if, all semi parametric and parametric survival models fitted to the current data well, various model comparison criteria showed that parametric/weibull AFT survival model is better than the other. The governmental and non-governmental stakeholders should pay attention to give training on the risk factors identified on the current study to optimize individual's knowledge and awareness so that death due to CVDs can be minimized.

Gender-related dynamics of exercise tolerance in patients with acute coronary syndrome undergoing the outpatient phase of rehabilitation

Background. The relevance of the comparative study of exercise tolerance in male and female cardiac patients is due to the need to individualize physical rehabilitation programs.&#x0D; Aims: to study the impact of gender on exercise tolerance in patients with acute coronary syndrome undergoing a course of rehabilitation in a day hospital.&#x0D; Methods. 110 patients with acute coronary syndrome were examined: 81 men (73.6%) aged 34 to 75 years and 29 women (26.4%) aged 44 to 74 years. In accordance with the purpose of the study, all patients were exposed to stress testing before and after the end of the three-week rehabilitation course.&#x0D; Results. According to the analysis of the six-minute walk test and the Bicycle ergometric test, men had better physical endurance than women. Features of hemodynamic indicators during physical activity also correlate with gender: in comparison with men, the maximum physical load in women was accompanied by higher heart rate values. At the end of the rehabilitation course, women had a more pronounced improvement of Bicycle ergometry indicators: a greater increase in maximum power and the percentage of load performed during the test.&#x0D; Conclusions. The gender differences in exercise tolerance in cardiac patients identified in the study should be taken into account when designing rehabilitation programs.

Relationship of Vitamin D Levels with Simultaneous Occurrence of Periodontal and Cardiac Diseases

Objective: To observe relationship of vitamin D levels with the severity of periodontal disease and also with the occurrence of cardiac diseases. Study design: A cross-sectional study. Place and duration of study: Nishtar institute of dentistry, Multan from March 5th, 2019 to December 1st, 2019. Methodology: Total 150 subjects were enrolled in the study, of which half were suffering from cardiac and periodontal diseases and one third were only affected by periodontitis. Twenty five subjects were normal. Vitamin D and calcium levels were recorded from the blood samples. Mean and standard deviation were calculated between the groups with 2 sample t- test using SPSS v.23.0. The significance of difference was taken at p?0.05. Results: Vitamin D levels were 24.98±4.53ng/ml and 41.95±1.42ng/ml in patients with high and low intensity of periodontal disease, rspectively (p=0.22). Calcium levels were 8.43±0.14nmol/L and 8.69±0.28nmol/L in patients with high and low intensity of periodontal disease, rspectively (p=0.437). Among the male cardiac patients, vitamin D levels were 20.96±2.39ng/ml and 41.67±4.78ng/ml in high and low severity of periodontal disease cases (p=0.002), whereas calcium levels were 8.03±0.30nmol/L and 8.95±0.77nmol/L in high and low severity of periodontal disease cases (p=0.075). Among the female cardiac patients, vitamin D levels were 17.5±4.93ng/ml and 21.55±18.12ng/ml (p=0.83), while calcium levels were 8.4±0.33nmol/L and 8.57±0.24nmol/L in high and low severity of periodontal disease cases, respectively (p=0.677).

Effect of Ramadan on Cardiac Patients Attending Cardiology Department Of Chattogram Medical College Hospital

Background: During the Ramadan fast, among Muslims due to change in life-style, in terms of obtaining the daily calorie intake via two meals with alteration of medication schedule or reduction in sleep duration, might affect patients with cardiovascular diseases. The aim of this study was to determine the proportion of cardiac patients who fasted and factors associated with breaking fast. Methods and materials: This cross-sectional study was conducted during the month of Ramadan 2018 (17 May to 15 June) in the outdoor and indoor of Cardiology Department of Chattogram Medical College Hospital, Chattogram, Bangladesh. Muslim patient, age above 18 years was included. Pregnant lady lactating mother and Non-Muslims patients were excluded. Data regarding age, sex, comorbid conditions, fasting status and reason for breaking fast if applicable were collected through a case record form and cardio vascular condition was evaluated. Results: Out of 221 patients, 121 (54.8%) were admitted in indoor and 100 (45.2%) patients attended in outdoor. Male to female ratio was equal (Male 103 and female 118) and mean (±SD) age was 53.48±12.22 years. Of those, 76 (73.8%) male and 86 (72.9%) female were fasting. Significantly higher number of female broke fast than male [Male 41 (53.9%) versus female 65 (75.6%). One hundred and twenty fasted patients (78.4%) experienced symptom aggravation and most of them (91.7%) had to break their fast. Aggravating symptoms were chest pain, breathlessness and hypoglycemic attack present respectively in 68.1%, 16.3% and 12.5% patients. Besides symptoms aggravation, other causes of breaking fast were medication in 36 (22.1%) patients and diagnostic procedure in 4 (2.47%) patients. Conclusion: Ramadan fasting had significant effect on female cardiac patients than male. Findings should be investigated with a prospective study.&#x0D; JCMCTA 2019 ; 30 (1) : 27-30

Psychological Distress Among Female Cardiac Patients Presenting to a Women's Heart Health Clinic

Female cardiac patients are at greater risk for mental health disorders than their male counterparts, and these mental health disorders have been associated with increased cardiac morbidity and mortality. However, few studies have closely examined the mental health disorders found among the female cardiac population. The primary aim of this study was to examine the prevalence of psychological distress in a sample of female cardiac outpatients at an academic medical center. A secondary aim was to determine whether different demographic variables, cardiac risk factors, or cardiac diagnoses were associated with different levels of emotional distress. A survey, including demographic information, medical status, and standardized symptom measures was completed by 117 female patients scheduled for medical visits at an outpatient women's heart health clinic over a 4-month period. Using standardized self-report questionnaires, 38% scored in the moderate-to-severe range for at least 1 mental disorder and 50% endorsed current insomnia. Symptoms of clinical depression (20%) and anxiety (42)% were endorsed at higher rates than predominantly male or mixed comparison samples. Although there was no apparent relation between the severity of cardiac problems and the degree of psychological distress, women with diagnoses of hyperlipidemia, prediabetes, and diabetes reported greater psychological distress than those without these problems. Women with lower income also reported more psychological distress. In conclusion, our findings suggest an unmet need for integrated mental health services for female cardiac patients.

Association of Bystander and First‐Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement Initiative

BackgroundThe Institute of Medicine has called for actions to understand and target sex‐related differences in care and outcomes for out‐of‐hospital cardiac arrest patients. We assessed changes in bystander and first‐responder interventions and outcomes for males versus females after statewide efforts to improve cardiac arrest care.Methods and ResultsWe identified out‐of‐hospital cardiac arrests from North Carolina (2010–2014) through the CARES (Cardiac Arrest Registry to Enhance Survival) registry. Outcomes for men versus women were examined through multivariable logistic regression analyses adjusted for (1) nonmodifiable factors (age, witnessed status, and initial heart rhythm) and (2) nonmodifiable plus modifiable factors (bystander cardiopulmonary resuscitation and defibrillation before emergency medical services), including interactions between sex and time (ie, year and year2). Of 8100 patients, 38.1% were women. From 2010 to 2014, there was an increase in bystander cardiopulmonary resuscitation (men, 40.5%–50.6%; women, 35.3%–51.8%; P for each <0.0001) and in the combination of bystander cardiopulmonary resuscitation and first‐responder defibrillation (men, 15.8%–23.0%, P=0.007; women, 8.5%–23.7%, P=0.004). From 2010 to 2014, the unadjusted predicted probability of favorable neurologic outcome was higher and increased more for men (men, from 6.5% [95% confidence interval (CI), 5.1–8.0] to 9.7% [95% CI, 8.1–11.3]; women, from 6.3% [95% CI, 4.4–8.3] to 7.4% [95% CI, 5.5–9.3%]); while adjusted for nonmodifiable factors, it was slightly higher but with a nonsignificant increase for women (from 9.2% [95% CI, 6.8–11.8] to 10.2% [95% CI, 8.0–12.5]; men, from 5.8% [95% CI, 4.6–7.0] to 8.4% [95% CI, 7.1–9.7]). Adding bystander cardiopulmonary resuscitation and defibrillation before EMS (modifiable factors) did not substantially change the results.ConclusionsBystander and first‐responder interventions increased for men and women, but outcomes improved significantly only for men. Additional strategies may be necessary to improve survival among female cardiac arrest patients.

6. Multifunctional evaluation in elderly patients hospitalized for heart disease

Abstract Type Clinical research. Presentation Type Oral presentation. Introduction Frail patients with cardiovascular diseases have higher adverse events and complications, suggesting the need for more accurate functional stratification and careful evaluation of the risk/benefit ratio of invasive procedures. Apart from ongoing project aiming to evaluate the prognostic impact of the Short Physical Performance Battery (SPPB) and handgrip test on the incidence of death and hospitalization for all-causes in elderly patients hospitalized for heart disease, we will present baseline characteristics for the first enrolled group and frailty differences between genders. Methodology This is a prospective observational study targeting 324 patients with age ⩾65 years. It is looking for patients who fall into at least one of the following groups: 1st group; patients hospitalized for acute coronary syndrome, arrhythmias or heart failure. 2nd; patients admitted for Trans-catheter aortic valve implantation, and 3rd; patients admitted for cardiac surgery. Up to date, 92 patients were evaluated for frailty by using handgrip test (using dynamometer to measure force of muscular contraction), SPPB (to evaluate the functionality of the lower limbs) and short portable mental questionnaire SPMQ (10-item cognitive screening instrument reflects severe intellectual impairment). Descriptive analysis was used representing continuous and categorical data as mean ± SD and percentages, as appropriate. Results Between December 2015 and May 2016, we enrolled 92 patients. The mean age was 72.2 ± 6.1 years; 65.2% males, mean BMI was 32.8 ± 33.8 and two third were not educated. Length of stay 7.8 ± 6.7 days. Overall the traditional cardiovascular risk factors diabetes 70.7%, hypertension 72.8% and dyslipidemia 57.6%. (Mean SPMQ value for males 1.7 ± 1.8 and for females 3.0 ± 1.4), (mean hand grip strength value for males 26.4 ± 6.9 and female 16 ± 4.2), (and mean SPPB value for males 9.07.9 ± 2.9 and for females 6.0 ± 2.7). Conclusion Female cardiac patients are significantly frailer than males by the three functional tools.

Studies on serum biochemical parameters of trop T+ or trop T− cardiac patients and evaluation of risk factors for disease outcome with a correlation to dyslipidemic rat experiment

Cardiovascular diseases (CD) are the most leading cause of death in both developed and developing nations. Diseases severity depends on multiple factors like sedentary lifestyle, smoking, diabetes, and hypertension. Blood samples from diagnosed cardiac patients from several hospitals and registered pathological centers, Midnapore District, India (Feb. 2013—Jan. 2014; >45 years, male 37, and female 23) and age-matched control (male 12 and female 9) were employed for biochemical studies on lipid profiles, SGOT, LDH, CPK/CPK-MB, and troponin T levels. Oxidative stress marker malondialdehyde (MDA), antioxidant component non-protein-soluble thiol (NPSH), and superoxide dismutase (SOD) activity were tested. High lipid or fructose-fed (90 days, isocaloric to the control) rats was investigated to evaluate some risk factors and oxidant/antioxidant status in their serum, liver, and heart tissues. Serum SGOT and LDH in female cardiac patients were found to be significantly high in both trop T− or trop T+ patients. The present multiple comparison ANOVA test suggests that most of the factors and serum markers of female cardiac patients were at higher risks (significance value, p < 0.001) than those of male patients. It is noticed that the parameters are more severely impaired in trop T+ (p < 0.001) than in trop T− (p < 0.05–0.01) patients. The malondialdehyde (MDA) and NPSH levels were found to be higher in the case of serum samples of cardiac patients. In rat experiment, mean body weight of animals did not significantly change in different nutritional groups. However, the reno-somatic index (kidney weight/100 g bw) decreased significantly both in lipid or fructose-fed group. Cholesterol and triglyceride notably increased in lipid-fed and urate decreased in either diet group. The oxidant component MDA and antioxidant enzyme catalase and SOD1 activities significantly increased/impaired in rat liver and heart of lipid-fed group. It may be hypothesized that present markers and risk factors are significant for the disease initiation and pathogenesis both in male and female. The post-menopausal age group itself may be an independent risk factor in females. The animal experiment suggests that long-term high lipid consumption may initiate dyslipidemic condition with an increase in systemic oxidative stress.

Analysis of the vital exhaustion construct in a female population during cardiac rehabilitation

Vital Exhaustion (VE) is a psychological construct that has been shown to be predictive for cardiac morbidity and mortality. There are not sufficient data which clarify whether the female population express this construct differentely comparing to males. This study aims to analyze the construct of Vital Exhaustion in a population of women admitted to a cardiac rehabilitation program. The selected sample consisted of 854 women with an average age of 58 years (SD +/- 10.2). All patients were at their first hospitalization for a cardiac rehabilitation program. The tool used to analyze the construct of Vital Exhaustion was the B scale of the Cognitive Behavioural Assessment Hospital form (CBA-H). The study also analyzed the answers to the D scale of the CBA-H concerning aspects of lifestyle and behavioral habits. The percentage of women with considerable value of Vital Exhaustion was very high (67.7%). Moreover, the group of women with higher Vital Exhaustion showed more dysfunctional habits (smoking, poor physical activity, incorrect diet) and more referred psychological problems as well as job and/or family distress and insomnia. 207 women (24.2%) of the sample belonged to economically active population; 136 (69%) of these women presented a high value of VE and 61 (31%) a low one. Among the employed women, 24% of the group with high VE value reported to be unsatisfied, while the same condition lowered at 9.6% in the group with low VE value (p = .004); moreover, 41.7% versus 18.5% (p = .000) described their working life as a source of tension. Considering a sample of female cardiac patients, this study shows that the construct of Vital Exhaustion is particularly present. It also appears that the construct of Vital Exhaustion can be interpreted as an indicator of lifestyle problems in women, helping health-professionals in selecting efficient educational and/or psychological interventions.

Blinde vlekken in zorg voor het vrouwenhart

Abstract Cardiology has long been considered as a man’s disease and the discipline has been developed with the male patient as the common standard. In the past 25 years, technical developments have revealed that distinct female patterns of ischemic heart disease and heart failure exist that require a different diagnostic and therapeutic approach compared to the male patient. Although our knowledge has enormously increased and cardiovascular disease in women is now number the number one cause of death worldwide, clinical implementation into a more gender sensitive approach of patients is hampered by resistance within the male-dominated cardiology community. This currently results in less optimal treatment of female cardiac patients. This paper will describe the historical perspective and look forward to the steps that that are needed to improve every day cardiology care for female patients.

Differences in physical performance based on the Geriatric Nutritional Risk Index in elderly female cardiac patients.

Little is known about differences in the risk of poor nutritional status as assessed by the Geriatric Nutritional Risk Index (GNRI) in relation to physical performance in elderly female cardiac inpatients. The present study aimed to determine both differences in physical performance based on the GNRI and physical performance cut-off values according to the GNRI in elderly female cardiac inpatients. We enrolled 105 consecutive female Japanese inpatients aged ≥65 years (mean age, 74.6 years) with cardiac disease in this cross-sectional study. We divided the patients into two groups according to GNRI: high-GNRI group (≥92 points) (n = 71) and low-GNRI group (<92 points) (n = 34). Handgrip strength (HG), knee extensor muscle strength (KEMS), gait speed (GS), and one-leg standing time (OLST) were assessed as indices of hospital physical performance and compared between the two groups to determine cut-off values of physical performance. After adjustment for age and left ventricular ejection fraction, HG, KEMS, GS, and OLST were significantly lower in the low-GNRI versus high-GNRI group. Cut-off values by ROC curve analysis were 16.2 kgf (AUC = 0.66; p < 0.001) for HG, 34.3 % of body weight (AUC = 0.62; p = 0.04) for KEMS, 1.24 m/s (AUC = 0.72; p < 0.01) for GS, and 8.28 s (AUC = 0.62; p = 0.04) for OLST. The risk of poor nutrition, as indicated by a low GNRI, might be a predictor of lower physical performance. Cut-off values determined in this study might be minimum target goals for physical performance that can be attained by elderly female cardiac inpatients.

Gender Differences in Cardiovascular Therapy: Focus on Antithrombotic Therapy and Percutaneous Coronary Intervention

The epidemiology of coronary artery disease (CAD) differs between women and men: female cardiac patients are older and have poorer risk profiles than their male counterparts. This results in a preferential exclusion of women from participation in clinical trials, reducing their power to detect differences in performance of cardiovascular therapies in women. In general, all the antiplatelet and anticoagulant medications used in cardiac patients are equally effective in men and women, although women tend to experience a higher relative benefit due to their poorer risk profile. In particular, women with CAD benefit the most from interventional treatment combined with modern antithrombotic drugs. No gender-related differences in the reduction of thromboembolic risk with more potent antithrombotic drugs have been reported. On the other hand, a clear trend to a higher incidence of bleeding complications has been consistently reported in women, which might be related to a more frequent over-dosage of antithrombotic treatment in women than in men. Women are therefore one of the subgroups that might benefit the most from careful dose adjustment of available antithrombotic drugs. However, the development of a gender-based dosage guideline remains an unmet need in cardiology.

Predicting Mortality 12 Years After an Acute Cardiac Event

Research demonstrates that depression at the time of a cardiac event predicts early mortality. However, the best time for depression screening is unknown. We investigated the prognostic importance of inhospital and 2-month depressive symptoms in predicting 12-year mortality in female cardiac patients. A consecutive series of 170 women admitted to hospital after acute myocardial infarction or for coronary artery bypass graft surgery completed the Hospital Anxiety and Depression Scale inhospital and 2 months later. Hospital Anxiety and Depression Scale's depression subscale scores of 4 to 7 were classified as "mild" depressive symptoms and 8+ as "moderate/severe" depressive symptoms. Mortality was tracked through the Australian National Death Index and other sources. : One hundred sixty-three (96%) of the 170 women were successfully tracked after 12 years. Of these women, 136 (83%) completed the depression subscale of the Hospital Anxiety and Depression Scale at both assessments and were included in the analyses. Over 12 years, 45 (33%) women died. Using logistic regression and controlling for age, disease severity, and diabetes, mild inhospital depression predicted mortality (P = .02), whereas moderate/severe inhospital depression did not (P = .14). At 2 months, moderate/severe depression predicted mortality (P = .05), whereas mild depression did not (P = .09). Half the patients (49%) changed depression class by the 2-month assessment. The death rate was highest (64%) in those whose mild inhospital depressive symptoms increased to moderate/severe and lowest (14%) in those whose moderate/severe inhospital symptoms remitted. Mild inhospital depression and moderate/severe 2-month depression were predictive of 12-year deaths. The findings suggest a prognostic benefit in undertaking repeat depression screening 2 months after an acute cardiac event.

Measurement of depressive symptoms among cardiac patients: Should sex differences be considered?

Confounding of depressive and cardiac symptoms may hold implications for assessment. This study investigated psychometric properties and sex differences in two depression scales among cardiac patients. Cardiac inpatients from 11 hospitals were recruited and completed a mailed survey including the Beck Depression Inventory-II and Gotland Scale of Male Depression 1 year later. The scales were significantly correlated and both were associated with social desirability. Females scored higher than males on the fatigue factor only (p < .001). Psychometric properties of the Beck Depression Inventory-II were more favorable in this population. Practitioners must not overlook reports of fatigue in female cardiac patients.

Abstract P326: Impact of Cardiac Rehabilitation on Depressive Symptomatology in Female Cardiac Patients

BACKGROUND: Coronary artery disease (CAD) is the leading cause of mortality in women and is responsible for more than 500,000 lives each year in the United States. Depression and depressive symptomatology in healthy subjects increases cardiovascular mortality in both men and women and its prevalence is exponentially rising in women. Research suggests that participation in a cardiac rehabilitation (CR) program reduces depression. Unfortunately studies have shown that CR is widely underutilized, particularly with significantly lower CR enrollment rates among women. HYPOTHESIS: The aim of this study was to demonstrate the effect of CR in the improvement of depressive symptoms in female cardiac patients after a cardiovascular event enrolled at the Cardiac Health Center (CHC) New York Hospital Queens (NYHQ). METHODS: The study sample comprised of 295 patients who completed 36 visits of CR at CHC NYHQ from 2007-2009. Out of 295 patients (age 66.85 ±10.64), 214 are males (71%) and 81 are females (29%). Mood scores were assessed using the PHQ-9 at the initial visit and again upon completion of the CR program. Of the 81 female patients enrolled, 31 female patients had documented pre and post CR-PHQ scores and of the 214 male patients enrolled, 81male patients had documented pre and post CR-PHQ scores. Using paired t test average mean difference in mood scores was tested. RESULTS: There was a significant decrease in mood scores in female patients (7.57 ± 5.18 to 3.11 ± 4.00, Δ 4.45 p= 0.00) compared to male patients (5.72 ± 5.19 to 2.37 ± 3.95 Δ 3.34 p = 0.00) after the completion of CR. CONCLUSION: The result of this study confirms that both male and female cardiac patients demonstrated significant reduction in depressive symptoms upon completion of CR. Female cardiac patients reported higher levels of depressive symptoms than male cardiac patients at the beginning of CR and exhibited a significant decrease in mood scores at the end of CR. This evidence supports that CR is an effective treatment in the reduction of depressive symptoms among female cardiac patients. Future studies are needed to establish the relationship among gender, CR, and depression. Clearly this is a complex issue and further efforts are needed to institute strategies to increase participation rates among female cardiac patients.