PMID- 34004281
OWN - NLM
STAT- MEDLINE
DCOM- 20211227
LR  - 20221207
IS  - 1916-7075 (Electronic)
IS  - 0828-282X (Linking)
VI  - 37
IP  - 10
DP  - 2021 Oct
TI  - Clinical Presentation and Outcome of Patients Experiencing Homelessness 
      Presenting With ST-Segment Elevation Myocardial Infarction.
PG  - 1555-1561
LID - S0828-282X(21)00247-6 [pii]
LID - 10.1016/j.cjca.2021.05.003 [doi]
AB  - BACKGROUND: Cardiovascular disease remains a major cause of morbidity and 
      mortality among homeless adults. Despite major advances in the management of ST 
      elevation myocardial infarction (STEMI), limited information is available for the 
      clinical presentation and management and outcome of STEMI among patients 
      experiencing homelessness (PEH). METHODS: All patients presenting with STEMI 
      between January 1, 2008 and December 31, 2017 at a PCI capable STEMI network 
      inner city hospital comprised the study population. Baseline characteristics, 
      homeless status and clinical outcomes were determined from hospital records. The 
      primary outcome of in-hospital mortality was compared between PEH and nonhomeless 
      patients using a log-binomial regression model with propensity score adjusted 
      standardised mortality ratio weighting (SMRW). RESULTS: Among 2854 STEMI 
      admissions during the study period, 75 patients (2.6%) were identified as PEH. 
      The PEH group was younger (58 vs 63 years; P = 0.0002), predominantly male (96% 
      vs 76%), and more likely to present with cardiogenic shock or cardiac arrest (17% 
      vs 6%) compared with the nonhomeless group. The in-hospital mortality remained 
      significantly higher among PEH (risk ratio 3.83, 95% confidence interval 
      1.27-11.60) after propensity score adjustment. CONCLUSIONS: Despite universal 
      health care and contemporary STEMI management, PEH presenting with STEMI 
      experienced a 4-fold higher in-hospital mortality compared with the nonhomeless 
      cohort. Targeted interventions are needed to improve STEMI outcomes in this 
      high-risk group.
CI  - Copyright (c) 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All 
      rights reserved.
FAU - Liauw, Samantha S L
AU  - Liauw SSL
AD  - Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
FAU - Luong, Linh
AU  - Luong L
AD  - MAP Center for Urban Health Solutions, St Michael's Hospital, Unity Health 
      Toronto, Toronto, Ontario, Canada.
FAU - Liu, Shuangbo
AU  - Liu S
AD  - Department of Cardiology, St Boniface Hospital, University of Manitoba, Winnipeg, 
      Manitoba, Canada.
FAU - Atcha, Mohamed
AU  - Atcha M
AD  - Trillium Health Partners, Mississauga, Ontario, Canada.
FAU - Kwok, Yvonne
AU  - Kwok Y
AD  - MAP Center for Urban Health Solutions, St Michael's Hospital, Unity Health 
      Toronto, Toronto, Ontario, Canada.
FAU - Nisenbaum, Rosane
AU  - Nisenbaum R
AD  - MAP Center for Urban Health Solutions, St Michael's Hospital, Unity Health 
      Toronto, Toronto, Ontario, Canada.
FAU - Fam, Neil
AU  - Fam N
AD  - Unity Health Toronto, Toronto, Ontario, Canada.
FAU - Hwang, Stephen W
AU  - Hwang SW
AD  - MAP Center for Urban Health Solutions, St Michael's Hospital, Unity Health 
      Toronto, Toronto, Ontario, Canada.
FAU - Cheema, Asim N
AU  - Cheema AN
AD  - Unity Health Toronto, Toronto, Ontario, Canada. Electronic address: 
      asim.cheema@unityhealth.to.
LA  - eng
PT  - Journal Article
DEP - 20210515
PL  - England
TA  - Can J Cardiol
JT  - The Canadian journal of cardiology
JID - 8510280
SB  - IM
MH  - *Disease Management
MH  - Female
MH  - Follow-Up Studies
MH  - *Ill-Housed Persons
MH  - Hospital Mortality/trends
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Morbidity/trends
MH  - Ontario/epidemiology
MH  - Percutaneous Coronary Intervention
MH  - *Propensity Score
MH  - Retrospective Studies
MH  - ST Elevation Myocardial Infarction/diagnosis/*epidemiology/surgery
MH  - Treatment Outcome
EDAT- 2021/05/19 06:00
MHDA- 2021/12/28 06:00
CRDT- 2021/05/18 20:27
PHST- 2021/02/21 00:00 [received]
PHST- 2021/04/22 00:00 [revised]
PHST- 2021/05/07 00:00 [accepted]
PHST- 2021/05/19 06:00 [pubmed]
PHST- 2021/12/28 06:00 [medline]
PHST- 2021/05/18 20:27 [entrez]
AID - S0828-282X(21)00247-6 [pii]
AID - 10.1016/j.cjca.2021.05.003 [doi]
PST - ppublish
SO  - Can J Cardiol. 2021 Oct;37(10):1555-1561. doi: 10.1016/j.cjca.2021.05.003. Epub 
      2021 May 15.