The Influence of Gender on Symptom Characteristics During Acute Coronary Syndrome

性别对急性冠脉综合征症状特征的影响

• 批准号: 7864761
• 负责人: HOLLI A DEVON
• 金额: $ 47.47万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-28 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7864761
• 关键词: Accident and Emergency department; Address; Admission activity; Age; American; Back Pain; Biological; Biological Markers; Cardiovascular system; Caring; Characteristics; Clinical; Cluster Analysis; Comorbidity; Data; Data Collection; Diagnosis; Diagnostic tests; Distress; Dyspepsia; Evaluation; Event; Gender; Gender Identity; Genotype; Health; Health Care Seeking Behavior; Heart Diseases; Heart failure; Hospitals; Illinois; Incidence; Inflammation; Interleukin-18; Interleukin-6; Life; Link; Longitudinal Studies; Measures; Medical Records; Medical center; Methods; Myocardial Infarction; Myocardial Ischemia; Nausea; Oregon; Outcome; Participant; Patients; Pattern; Persons; Phenotype; Physiological; Predictive Value; Procedures; Prospective Studies; Recording of previous events; Recruitment Activity; Reporting; Research; Risk; Risk Factors; Sampling; Self Concept; Sensitivity and Specificity; Severities; Sex Characteristics; Shortness of Breath; Specificity; Stratification; Stroke; Structure; Symptoms; Testing; Triage; Tumor Necrosis Factor-alpha; Tumor Necrosis Factors; Unstable angina; Variant; Visit; Woman; acute coronary syndrome; base; care seeking; clinically significant; design; experience; functional status; men; mortality; novel strategies; pressure; prospective; psychologic; psychosocial; public health relevance; reproductive; sex; social

DESCRIPTION (provided by applicant): More than 1.4 million Americans are expected to experience an episode of acute coronary syndromes (ACS) in 2009. Evaluation of the symptoms of ACS is important since symptoms determine when, or if, patients seek care. Recent studies have identified gender differences in symptoms of ACS, however retrospective designs, abstraction of symptoms from medical records, and variations in assessment forms make it difficult to determine the clinical significance of gender differences or if gender specific health messages are warranted. Therefore, the aims of this prospective study are to: 1) evaluate for gender differences in the occurrence, severity, and distress of 14 ACS symptoms after adjusting for age, diagnosis, comorbidities, and functional status, 2) establish the sensitivity, specificity, and predictive value of symptoms as an indicator of ACS for women and men, 3) explore symptom clusters including characteristics of gender, age, diagnosis, comorbidities, and functional status, and 4) determine if there are gender differences in the longitudinal (30 days and 6 months) outcomes of functional status, major cardiovascular events, hospital admissions, emergency department visits, and mortality. An exploratory aim is to determine if a relationship exists between selected biomarkers and symptoms of ACS for women and men. A novel approach, in which symptoms are recorded in the emergency department as they are occurring, will be used. The sample will be comprised of 630 patients admitted to the emergency department with symptoms suggestive of ACS: 522 patients with confirmed ACS and 108 patients ruled out for ACS. Participants will be recruited from four medical centers in Illinois and Oregon. The 14-item ACS Symptom Checklist will be completed on presentation to the emergency department. Comorbidities, activity status, and patient variables will be measured when the patient is stable. Pilot data indicate that the procedures are feasible and safe. Analysis of covariance will be used to test the hypothesis that there are gender differences in symptoms. Symptom clusters will be examined using agglomerative cluster analysis, and outcomes will be evaluated using linear mixed methods. Findings will aid in establishing the clinical significance of ACS symptoms. PUBLIC HEALTH RELEVANCE: This study will address limitations of prior research including lack of prospective designs, systematic methods, standardized assessment forms, and evaluation of sensitivity and specificity of symptoms, particularly important since symptoms trigger health seeking behaviors. Given persistently long patient decision-delay, comprehensive evaluation of symptoms for a potential life-threatening illness take on added urgency.

描述（由申请人提供）：2009年，预计有140万美国人会经历急性冠状动脉综合征（AC）的发作。对ACS症状的评估很重要，因为症状决定了何时或是否寻求护理。最近的研究已经确定了ACS症状的性别差异，但是回顾性设计，症状的抽象以及评估形式的差异使得难以确定性别差异的临床意义，或者是否有必要确定性别特定的健康信息。因此，这项前瞻性研究的目的是：1）评估在调整年龄，诊断，合并症和功能状态后发生的性别差异，严重程度和困扰的14个AC症状，2）建立敏感性，特异性和预测性价值，以症状的症状指标，包括妇女的体系，3）探索症状的特征，包括症状的特征，是诊断症状的特征。功能状态和4）确定功能状况，重大心血管事件，医院入院，急诊就诊和死亡率的纵向（30天和6个月）的性别差异。探索性的目的是确定某些生物标志物和男性ACS症状之间是否存在关系。将使用一种新的方法，其中将使用急诊室记录症状。该样本将由630名进入急诊室的患者组成，症状提示ACS：522例已确认ACS患者和108名患者排除了ACS。参与者将从伊利诺伊州和俄勒冈州的四个医疗中心招募。 14项ACS症状清单将在急诊室介绍时完成。当患者稳定时，将测量合并症，活动状态和患者变量。试点数据表明该过程是可行且安全的。协方差分析将用于检验症状存在性别差异的假设。症状簇将使用聚集聚类分析检查，并将使用线性混合方法评估结果。发现将有助于确定ACS症状的临床意义。 公共卫生相关性：本研究将解决先前研究的局限性，包括缺乏前瞻性设计，系统的方法，标准化的评估表格以及对症状的敏感性和特异性的评估，尤其重要，因为症状触发了健康的行为。鉴于患者的持续长期决策，对潜在威胁生命的疾病的症状进行了全面评估，这会增加紧迫性。