ABSTRACT
INTRODUCTION: Since 2021, the world has been facing a cost-of-living crisis which has negatively affected population health. Meanwhile, little is known about its impact on patients' preferences to access care. We aimed to analyse public preference for the modality of consultation (virtual vs face-to-face) before and after the onset of crisis and factors associated with these preferences. METHODS: An online cross-sectional survey was administered to the public in the United Kingdom, Germany, Italy and Sweden. McNemar tests were conducted to analyse pre- and post-crisis differences in preferences; logistic regression was used to examine the demographic factors associated with public preferences. RESULTS: Since the onset of crisis, the number of people choosing virtual consultations has increased in the United Kingdom (7.0% vs 9.5% P < 0.001), Germany (6.6% vs 8.6%, P < 0.008) and Italy (6.0% vs 9.8%, P < 0.001). Before the crisis, a stronger preference for virtual consultations was observed in people from urban areas (OR 1.28, 95% CI 1.05-1.56), while increasing age was associated with a lower preference for virtual care (OR 0.966, 95% CI 0.961-0.972). Younger people were more likely to switch to virtual care, while change to face-to-face was associated with younger age and lower income (OR 1.34, 95% CI 1.12-1.62). Older adults were less likely to change preference. CONCLUSIONS: Since the onset of the cost-of-living crisis, public preference for virtual consultations has increased, particularly in younger population. This contrasts with older adults and people with lower-than-average incomes. The rationale behind patients' preferences should be investigated to ensure patients can access their preferred modality of care.
ABSTRACT
BACKGROUND: We aimed to provide a comprehensive overview of existing gender differences in acute coronary syndrome (ACS), with respect to treatment delays, invasive management of ACS, and short and long-term mortality in patients with ACS. METHODS: We defined 37 observational studies (OSs) and 21 randomized trials (RCTs) that best corresponded to our interests. OSs and RCTs were analyzed separately. RESULTS: Women with ACS more often experienced delays in treatment compared to men (OR 1.43; 95% CI, 1.12-1.82) in RCTs. Female patients were less often treated invasively: RCTs (OR 0.87; 95% CI, 0.83-0.9), OSs: (OR 0.66; 95% CI, 0.63-0.68). Women had higher crude in-hospital mortality (OR 1.56; 95% CI, 1.53-1.59) and 30-day mortality (OR 1.71; 95% CI, 1.22-2.4) in OSs and (OR 2.74; 95% CI, 2.48-3.02) in RCTs. After adjustment for multiple covariates, gender difference was attenuated: in-hospital mortality (OR 1.19; 95% CI, 1.17-1.2), 30-day mortality (OR 1.18; 95% CI, 1.12-1.24) in OSs. Unadjusted long-term mortality in women was higher than in men (OR 1.41; 95% CI, 1.31-1.52) in RCTs and (OR 1.4; 95% CI, 1.3-1.5) in OSs. CONCLUSION: Women with ACS experience a delay in time to treatment more often than men. They are also less likely to be treated invasively. Females have shown worse crude short-and long-term all-cause mortality compared to males. However, after adjustment for multiple covariates, a less significant gender difference has been observed. Considering the difference between crude and adjusted mortality, we deem it reasonable to conduct further investigations on gender-related influence of particular risk factors on the outcomes of ACS.
Subject(s)
Acute Coronary Syndrome , Male , Female , Humans , Acute Coronary Syndrome/therapy , Sex Factors , Time-to-Treatment , Hospital Mortality , Treatment OutcomeABSTRACT
Dyslipidemia has been widely acknowledged as one of the major predisposing factors for the development and progression of atherosclerosis. While advanced atherosclerosis confirmed to influence the prognosis of patients with acute coronary syndrome (ACS), it has not yet been established, whether this impact is gender-dependent. AIM: The aim of study was to investigate possible gender-related effect of dyslipidemia and generalized atherosclerosis on the long-term outcomes in patients with ACS. MATERIALS AND METHODS: A total of 247 patients (88 women and 159 men) with ACS were included. Sample was divided into two groups, according to gender. Patients' lipid and comorbidity profiles were assessed. Cumulative major adverse coronary events (MACE) were estimated throughout 3-year follow-up period. RESULTS: Women were older and had more comorbidities. Cumulative 3-year MACE rates were higher in women than in men (33% vs. 23%, p=0.06). In the multivariable Cox regression analysis abnormal lipid profiles were more significantly associated with higher MACE in females (HR=1.5, 95% CI [1-2,28], p<0.00001), compared with males (HR=1.0, 95% CI [0.5-2.08], p=0.4), as well as prior MI: (HR=3.8, 95% CI [1.4- 10.5], p<0.00001) vs. (HR=1.9, 95% [0.8-4.2], p=0.009) and concomitant peripheral artery disease (PAD): (HR=5.2, 95% CI [1.5-18.2], p<0.00001) vs. (HR=2.2, 95% CI [0.73-6.6], p=0.02) respectively. CONCLUSIONS: In our study dyslipidemia, concomitant PAD and history of MI were independent predictors of higher MACE more significantly in females with ACS than in males. Thus, it can be assumed that female patients require an increased medical attention with strict serum lipid control.
