6 results on '"Goh, Rachel Sze Jen"'
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2. Socioeconomic deprivation and prognostic outcomes in acute coronary syndrome: A meta-analysis using multidimensional socioeconomic status indices.
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Anand, Vickram Vijay, Zhe, Ethan Lee Cheng, Chin, Yip Han, Goh, Rachel Sze Jen, Lin, Chaoxing, Kueh, Martin Tze Wah, Chong, Bryan, Kong, Gwyneth, Tay, Phoebe Wen Lin, Dalakoti, Mayank, Muthiah, Mark, Dimitriadis, Georgios K., Wang, Jiong-Wei, Mehta, Anurag, Foo, Roger, Tse, Gary, Figtree, Gemma A., Loh, Poay Huan, Chan, Mark Y., and Mamas, Mamas A.
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ACUTE coronary syndrome , *SOCIOECONOMIC status , *ST elevation myocardial infarction , *MORTALITY , *DEATH rate - Abstract
Low socioeconomic status (SES) is an important prognosticator amongst patients with acute coronary syndrome (ACS). This paper analysed the effects of SES on ACS outcomes. Medline and Embase were searched for articles reporting outcomes of ACS patients stratified by SES using a multidimensional index, comprising at least 2 of the following components: Income, Education and Employment. A comparative meta-analysis was conducted using random-effects models to estimate the risk ratio of all-cause mortality in low SES vs high SES populations, stratified according to geographical region, study year, follow-up duration and SES index. A total of 29 studies comprising of 301,340 individuals were included, of whom 43.7% were classified as low SES. While patients of both SES groups had similar cardiovascular risk profiles, ACS patients of low SES had significantly higher risk of all-cause mortality (adjusted HR:1.19, 95%CI: 1.10–1.1.29, p < 0.001) compared to patients of high SES, with higher 1-year mortality (RR:1.08, 95%CI:1.03–1.13, p = 0.0057) but not 30-day mortality (RR:1.07, 95%CI:0.98–1.16, p = 0.1003). Despite having similar rates of ST-elevation myocardial infarction and non-ST-elevation ACS, individuals with low SES had lower rates of coronary revascularisation (RR:0.95, 95%CI:0.91–0.99, p = 0.0115) and had higher cerebrovascular accident risk (RR:1.25, 95%CI:1.01–1.55, p = 0.0469). Excess mortality risk was independent of region (p = 0.2636), study year (p = 0.7271) and duration of follow-up (p = 0.0604) but was dependent on the SES index used (p < 0.0001). Low SES is associated with increased mortality post-ACS, with suboptimal coronary revascularisation rates compared to those of high SES. Concerted efforts are needed to address the global ACS-related socioeconomic inequity. The current study was registered with PROSPERO, ID: CRD42022347987. [Display omitted] • Socioeconomic deprivation affects Acute Coronary Syndrome (ACS) outcomes and quality of care received. • The low SES group had significantly higher risk of all-cause mortality and lower rates of coronary revascularisation. • There was a disproportionately higher number of females and individuals with diabetes in the low SES group. • There are statistically significant differences in the results drawn based on the socioeconomic index used. [ABSTRACT FROM AUTHOR]
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- 2023
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3. Bayesian Meta-analysis of Direct Oral Anticoagulation Versus Vitamin K Antagonists With or Without Concomitant Antiplatelet After Transcatheter Aortic Valve Implantation in Patients With Anticoagulation Indication.
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Lee, Gabriel Sheng Jie, Tay, Hannah Si En, Teo, Vanessa Xin Yi, Goh, Rachel Sze Jen, Chong, Bryan, Chan, Siew Pang, Tay, Edgar, Lim, Yinghao, Yip, James, Chew, Nicholas W. S, and Kuntjoro, Ivandito
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HEART valve prosthesis implantation , *META-analysis , *MEDICAL information storage & retrieval systems , *COMBINATION drug therapy , *SYSTEMATIC reviews , *ANTICOAGULANTS , *TREATMENT effectiveness , *COMPARATIVE studies , *PLATELET aggregation inhibitors , *DESCRIPTIVE statistics , *MEDLINE , *ODDS ratio , *COMORBIDITY , *VITAMIN K - Abstract
Patients undergoing transcatheter aortic valve implantation (TAVI) commonly have co-morbidities requiring anticoagulation. However, the optimal post-procedural anticoagulation regimen is not well-established. This meta-analysis investigates safety and efficacy outcomes of direct oral anticoagulants (DOACs) and Vitamin K Antagonist (VKA), with or without concomitant antiplatelet therapy. We searched EMBASE and MEDLINE for appropriate studies. Subgroup analyses were performed for anticoagulant monotherapy and combined therapy with antiplatelet agents. Eleven studies (6359 patients) were included. Overall, there were no differences between DOACs and VKA for all-cause mortality (Odds Ratio [OR]:.69; Credible Interval [CrI]:.40–1.06), cardiovascular-related mortality (OR:.76; Crl:.13–3.47), bleeding (OR:.95; CrI:.75–1.17), stroke (OR: 1.04; CrI:.65–1.63), myocardial infarction (OR: 1.51; CrI:.55–3.84), and valve thrombosis (OR:.29; CrI:.01–3.54). For DOACs vs VKA monotherapy subgroup, there were no differences in outcomes. For the combined therapy subgroup, there was decreased odds of all-cause mortality in the DOACs group compared with the VKA group (OR:.13; CrI:.02–.65), but no differences for bleeding and stroke. DOACs and VKA have similar safety and efficacy profiles for post-TAVI patients with anticoagulation indication. However, if concomitant antiplatelet therapy is required, DOACs were more favorable than VKA for all-cause mortality. [ABSTRACT FROM AUTHOR]
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- 2023
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4. Higher mortality in acute coronary syndrome patients without standard modifiable risk factors: Results from a global meta-analysis of 1,285,722 patients.
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Kong, Gwyneth, Chin, Yip Han, Chong, Bryan, Goh, Rachel Sze Jen, Lim, Oliver Zi Hern, Ng, Cheng Han, Muthiah, Mark, Foo, Roger, Vernon, Stephen T., Loh, Poay Huan, Chan, Mark Y., Chew, Nicholas W.S., and Figtree, Gemma A.
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ACUTE coronary syndrome , *MYOCARDIAL infarction , *HEART failure , *PERIPHERAL vascular diseases , *CARDIOGENIC shock , *ST elevation myocardial infarction , *CARDIOVASCULAR diseases risk factors - Abstract
Standard modifiable cardiovascular risk factors (SMuRF), comprising diabetes, hyperlipidemia, hypertension, and smoking, are used for risk stratification in acute coronary syndrome (ACS). Recent studies showed an increasing proportion of SMuRF-less ACS patients. Embase, Medline and Pubmed were searched for studies comparing SMuRF-less and SMuRF patients with first presentation of ACS. We conducted single-arm analyses to determine the proportion of SMuRF-less patients in the ACS cohort, and compared the clinical presentation and outcomes of these patients. Of 1,285,722 patients from 15 studies, 11.56% were SMuRF-less. A total of 7.44% of non-ST-segment-elevation ACS patients and 12.87% of ST-segment-elevation myocardial infarction (STEMI) patients were SMuRF-less. The proportion of SMuRF-less patients presenting with STEMI (60.71%) tended to be higher than those with SMuRFs (49.21%). Despite lower body mass index and fewer comorbidities such as chronic kidney disease, peripheral arterial disease, stroke and heart failure, SMuRF-less patients had increased in-hospital mortality (RR:1.57, 95%CI:1.38 to 1.80) and cardiogenic shock (RR:1.39, 95%CI:1.18 to 1.65), but lower risk of heart failure (RR:0.91, 95%CI:0.83 to 0.99). On discharge, SMuRF-less patients were prescribed less statins (RR:0.93, 95%CI:0.91 to 0.95), beta-blockers (RR:0.94, 95%CI:0.92 to 0.96), P2Y12 inhibitors (RR: 0.98, 95%CI: 0.96 to 0.99), and angiotensin-converting-enzyme inhibitor or angiotensin-receptor blocker (RR:0.92, 95%CI:0.75 to 0.91). In this study level meta-analysis, SMuRF-less ACS patients demonstrate higher mortality compared with patients with at least one traditional atherosclerotic risk factor. Underuse of guideline-directed medical therapy amongst SMuRF-less patients is concerning. Unraveling novel risk factors amongst SMuRF-less individuals is the next important step. Standard modifiable cardiovascular risk factors (SMuRF), comprising diabetes mellitus, hyperlipidemia, hypertension, and smoking, are often used for risk stratification in acute coronary syndrome (ACS). Recent studies showed an increasing proportion of SMuRF-less ACS patients. Of 1,285,722 ACS patients, 11.56% were SMuRF-less. Despite lower body mass index and fewer comorbidities, SMuRF-less patients had increased in-hospital mortality and cardiogenic shock. However, despite worse outcomes, SMuRF-less patients were prescribed less guideline-directed medical therapies on discharge. Central Illustration. The Overall Proportion, Clinical Presentation, and Outcomes of SMuRF-less Patients with ACS. [Display omitted] • Standard modifiable risk factors (SMuRF - diabetes, hyperlipidemia, hypertension, smoking) are used for stratification in ACS. • Recent studies have showed an increasing proportion of SMuRF-less ACS patients. • Of 1,285,722 ACS patients, 11.56% were SMuRF-less. • Despite fewer comorbidities, SMuRF-less patients had increased in-hospital mortality and cardiogenic shock. • SMuRF-less patients were prescribed less guideline-directed medical therapies on discharge. [ABSTRACT FROM AUTHOR]
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- 2023
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5. THE GLOBAL BURDEN OF CARDIOVASCULAR DISEASES OVER THE NEXT 30 YEARS: PREDICTIONS FROM THE PAST 30 YEARS.
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Chong, Bryan, Jayabaskaran, Jayanth, Kueh, Martin Tze Wah, Goh, Rachel Sze Jen, Li, Henry, Chin, Yip Han, Kong, Gwyneth, Koh, Jaycie, Chew, Jocelyn, Muthiah, Mark, Wang, Jiong-Wei, Jain, Vardhmaan, Mehta, Anurag, Lim, Shir Lynn, Foo, Roger Sik-Yin, Park, Duk-Woo, Wang, Jian-An, Figtree, Gemma, Mamas, Mamas A., and Nicholls, Stephen J.
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GLOBAL burden of disease , *FORECASTING - Published
- 2024
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6. PROJECTIONS OF THE METABOLIC SYNDEMIC AND DISEASE SEVERITY IN 2040: A POPULATIONBASED STUDY IN THE UNITED STATES.
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Chong, Bryan, Koh, Jaycie, Lim, Jieyu, Kong, Gwyneth, Jayabaskaran, Jayanth, Chan, Yiong Huak, Chin, Yip Han, Goh, Rachel Sze Jen, Li, Henry, Kueh, Martin Tze Wah, Jain, Vardhmaan, Mamas, Mamas A., Chan, Mark, Muthiah, Mark, Mehta, Anurag, and Chew, Nicholas
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METABOLIC disorders - Published
- 2024
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