Presentation of stable angina pectoris among women and South Asian people

Zaman, M Justin S; Junghans, Cornelia; Chen, Ruoling; Feder, Gene; Hemingway, Harry

doi:10.1503/cmaj.071763

Cited by 29 publications

(22 citation statements)

References 32 publications

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“…The potential underlying reasons for the observed imbalances in the use of invasive cardiac procedures are important to consider. Zaman et al (23) recruited 2189 South Asian and 5605 white patients with chest pain in the United Kingdom, and found that South Asians were less likely to undergo coronary angiography and revascularization within three years. Ethnic disparities are theoretically explained by multiple factors related to the patient, the health care system and the physician.…”

Section: Discussionmentioning

confidence: 99%

Invasive cardiac procedure use and mortality among South Asian and Chinese Canadians with coronary artery disease

Quan

Khan

et al. 2010

Canadian Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Invasive cardiac procedure use and mortality among South Asian and Chinese Canadians with coronary artery disease

Quan

Khan

et al. 2010

Canadian Journal of Cardiology

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“…. .resulted in a greater proportion of initial discharge to primary care with less frequent outpatient review and similar rates of referral for coronary angiography' 507 These two recommendations (arising from Zaman et al 147 ) for the first time make an unequivocal statement to clinicians that typical anginal pain does not differ by sex and ethnicity. This is important because it has previously been used as a post hoc justification of why rates of procedure use might differ between these groups Management of stable angina NICE CG126 508 Citations to our research: Griffin et al…”

Section: Department Of Health Cardiovascular Disease Outcomes Strategymentioning

confidence: 99%

Using nationwide ‘big data’ from linked electronic health records to help improve outcomes in cardiovascular diseases: 33 studies using methods from epidemiology, informatics, economics and social science in the ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER) programme

Hemingway

Feder

Denaxas

et al. 2017

Programme Grants Appl Res

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BackgroundElectronic health records (EHRs), when linked across primary and secondary care and curated for research use, have the potential to improve our understanding of care quality and outcomes.ObjectiveTo evaluate new opportunities arising from linked EHRs for improving quality of care and outcomes for patients at risk of or with coronary disease across the patient journey.DesignEpidemiological cohort, health informatics, health economics and ethnographic approaches were used.Setting230 NHS hospitals and 226 general practices in England and Wales.ParticipantsUp to 2 million initially healthy adults, 100,000 people with stable coronary artery disease (SCAD) and up to 300,000 patients with acute coronary syndrome.Main outcome measuresQuality of care, fatal and non-fatal cardiovascular disease (CVD) events.Data platform and methodsWe created a novel research platform [ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER)] based on linkage of four major sources of EHR data in primary care and national registries. We carried out 33 complementary studies within the CALIBER framework. We developed a web-based clinical decision support system (CDSS) in hospital chest pain clinics. We established a novel consented prognostic clinical cohort of SCAD patients.ResultsCALIBER was successfully established as a valid research platform based on linked EHR data in nearly 2 million adults with > 600 EHR phenotypes implemented on the web portal (seehttps://caliberresearch.org/portal). Despite national guidance, key opportunities for investigation and treatment were missed across the patient journey, resulting in a worse prognosis for patients in the UK compared with patients in health systems in other countries. Our novel, contemporary, high-resolution studies showed heterogeneous associations for CVD risk factors across CVDs. The CDSS did not alter the decision-making behaviour of clinicians in chest pain clinics. Prognostic models using real-world data validly discriminated risk of death and events, and were used in cost-effectiveness decision models.ConclusionsEmerging ‘big data’ opportunities arising from the linkage of records at different stages of a patient’s journey are vital to the generation of actionable insights into the diagnosis, risk stratification and cost-effective treatment of people at risk of, or with, CVD.Future workThe vast majority of NHS data remain inaccessible to research and this hampers efforts to improve efficiency and quality of care and to drive innovation. We propose three priority directions for further research. First, there is an urgent need to ‘unlock’ more detailed data within hospitals for the scale of the UK’s 65 million population. Second, there is a need for scaled approaches to using EHRs to design and carry out trials, and interpret the implementation of trial results. Third, large-scale, disease agnostic genetic and biological collections linked to such EHRs are required in order to deliver precision medicine and to innovate discovery.Study registrationCALIBER studies are registered as follows: study 2 – NCT01569139, study 4 – NCT02176174 and NCT01164371, study 5 – NCT01163513, studies 6 and 7 – NCT01804439, study 8 – NCT02285322, and studies 26–29 – NCT01162187. Optimising the Management of Angina is registered as Current Controlled Trials ISRCTN54381840.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme (RP-PG-0407-10314) (all 33 studies) and additional funding from the Wellcome Trust (study 1), Medical Research Council Partnership grant (study 3), Servier (study 16), NIHR Research Methods Fellowship funding (study 19) and NIHR Research for Patient Benefit (study 33).

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“…It has, however, become apparent that women with obstructive CAD often describe their symptoms different from what has been defined as typical. In a Caucasian population (2,676 women and 2,929 men) with chest pain, Zaman et al [4] found that women significantly more often complained about 'atypical chest pain' when compared with men. Furthermore, women with chronic stable angina are more likely than men to have chest pain at rest, during sleep or evoked by mental stress [5] in addition to their exercise-related symptoms.…”

Section: Clinical Presentationmentioning

confidence: 99%

Gender aspects in patients with angina and unobstructed coronary arteries

Ong

Athanasiadis

Sechtem

2013

Clin Res Cardiol Suppl

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A substantial proportion of patients investigated for anginal symptoms do not have obstructive coronary artery disease upon diagnostic coronary angiography. These patients are significantly more often female than male and many of them have a dysfunction of the coronary microcirculation as the underlying cause for their symptoms. In this article, we describe gender aspects in clinical conditions with angina despite unobstructed coronary arteries. Moreover, we try to give answers as to why microvascular dysfunction is more prevalent among women than men.

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Presentation of stable angina pectoris among women and South Asian people

Cited by 29 publications

References 32 publications

Invasive cardiac procedure use and mortality among South Asian and Chinese Canadians with coronary artery disease

Invasive cardiac procedure use and mortality among South Asian and Chinese Canadians with coronary artery disease

Gender aspects in patients with angina and unobstructed coronary arteries

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