Electrocardiographic ST-segment deviations and risk of death: significant age and gender differences in a large primary care population

Objective: The primary aim of the study was to determine accuracy, sensitivity and specificity of the Clock Drawing Test (CDT) in detecting probable dementia as compared to the multi-domain dementia screening test DemTect. Methods: The sample was derived from the general practitioner (GP)-based, cluster-randomized controlled intervention trial DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania). Selected from 6.440 patients systematically screened for dementia in primary care, we examined three groups (a,b,c) where the CDT (as index test) as well as the DemTect (as reference standard) were available. After excluding cases with missing values, we included a sample of n=462 with “probable dementia”, n=586 with “mild cognitive impairment” and n=553 with “no cognitive impairment” matched for age and gender. We analyzed the accuracy of the CDT in identifying people with probable dementia by the DemTect and report sensitivity, and specificity for the CDT. We further analyzed age and gender differences associated with the groups. Results: In comparison to the DemTect the CDT identified more than twice as many of the screened patients as cognitively impaired (63.1% in the CDT vs. 28.9% in the DemTect). The sensitivity and specificity for the CDT were 84.4% and 45.6% respectively. We found considerable age and gender differences for the performance of the CDT. Higher age (p < 0.001) and female sex (p < 0.001) were associated with incorrect clock drawings. Conclusion: The CDT shows a considerably high rate of false positive screening outcomes compared to the DemTect and disadvantages older people and women. Thus, in contrary to previous findings our results indicate that the CDT should not be used as exclusive instrument to screen for probable dementia in primary care.

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Age and gender differences in medical adherence after myocardial infarction: Women do not receive optimal treatment – The Netherlands claims database

European Journal of Preventive Cardiology ◽

10.1177/2047487317744363 ◽

2017 ◽

Vol 25 (2) ◽

pp. 181-189 ◽

Cited By ~ 28

Author(s):

Daniëlle C Eindhoven ◽

Alexander D Hilt ◽

Thomas C Zwaan ◽

Martin J Schalij ◽

C Jan Willem Borleffs

Keyword(s):

Myocardial Infarction ◽

Gender Differences ◽

Medical Adherence ◽

Age And Gender ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Age And Gender Differences ◽

And Gender ◽

One Year

Background Following myocardial infarction, medication is, besides lifestyle interventions, the cornerstone treatment to improve survival and minimize the occurrence of new cardiovascular events. Still, data on nationwide medication adherence are scarce. This study assesses medical adherence during one year following myocardial infarction, stratifying per type of infarct, age and gender. Design Retrospective cohort study. Methods In The Netherlands, all inhabitants are by law obliged to have health insurance and all claims data are centrally registered. In 2012 and 2013, all national diagnosis-codings of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) were acquired. Furthermore, information on retrieved medication was extracted from the Dutch Pharmacy Information System. Twelve months after discharge, the retrieved medication at the pharmacy of each pharmacological therapy (aspirin-species, P2Y12-inhibitor, statin, beta-blocker, angiotensin-converting enzyme-/angiotensin 2-inhibitor, vitamin-K antagonists or novel oral anticoagulant) were analysed. Results In total, 59,534 patients (67 ± 13 years, 39,545 (66%) male, 57% NSTEMI) were included, of whom 52,672 (88%) patients were analysed for one-year medical adherence. STEMI patients more often achieved optimal medical adherence than NSTEMI patients (60% vs. 40%, p ≤ 0.001). In both STEMI and NSTEMI, use of all five indicated drugs was higher in male patients compared with female (STEMI male 61% vs. female 57%, p ≤ 0.001; NSTEMI male 43% vs. female 37%, p ≤ 0.001. With increasing age, a gradual decrease was observed in the use of aspirin, P2Y12-inhibitors and statins. Conclusion Age and gender differences existed in medical adherence after myocardial infarction. Medical adherence was lower in women, young patients and elderly patients, specifically in NSTEMI patients.

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