Path Less Traveled: Providing Optimal Patient Care on the Road of Diagnostic Uncertainty.
Path Less Traveled: Providing Optimal Patient Care on the Road of Diagnostic Uncertainty.
复制标题
少走的路：在诊断不确定性的道路上提供最佳的患者护理。
DOI：
10.1161/circoutcomes.123.010318
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Khazanie,Prateeti
中科院分区：
文献类型：
--
作者：
Hogan,SheaE;Khazanie,Prateeti
心血管疾病是发病率和死亡率的主要原因，但在妇女中仍未得到充分诊断、治疗和研究。女性尚未从男性心血管疾病发病率的下降中受益，这表明在医学知识和护理服务方面存在巨大差距。2 .与男性相比，女性延迟向卫生保健系统就诊，不太可能接受密集的资源利用，并且需要更长时间才能得到诊断。3与男性相比，出现心肌缺血（急性和慢性）体征和症状的女性在冠状动脉造影上更有可能没有梗阻性冠状动脉疾病（定义为任何主要心外膜动脉狭窄< 50%）。与患有阻塞性冠状动脉疾病的妇女相比，这些没有阻塞性冠状动脉疾病的妇女有很高的医疗保健利用率，包括更高的重复心导管插入术和心绞痛住院率，以及更高的药物治疗费用。尽管与年龄和性别匹配的受试者相比，这些人群心血管不良结局的风险增加，但这些患者很少得到对其症状的解释或管理建议。5
Cardiovascular disease is a leading cause of mor-bidity and mortality but remains underdiagnosed, undertreated, and under-researched in women. 1 Women have yet to benefit from the declining cardiovascular disease rates experienced by men, demonstrating a significant gap in medical knowledge and care delivery. 2 Women delay presentation to health care systems, are less likely to undergo intensive resource utilization, and experience longer times to diagnosis compared with men. 3 Compared with their male counterparts, women presenting with signs and symptoms of myocardial ischemia (both acute and chronic) are more likely to have no obstructive coronary artery disease on coronary angiogram (defined as< 50% stenosis in any major epicardial artery). These women with no obstructive coronary artery disease have high health care utilization, including higher rates of repeat cardiac catheterizations and angina hospitalizations, and increased drug treatment costs compared with women who have obstructive coronary artery disease. 4 Although this population is at increased risk for adverse cardiovascular outcomes compared with age-and sex-matched subjects, these patients are rarely offered either an explanation for their symptoms or management recommendations. 5