A prospective partner’s sexual history provides important information that can be used to minimise mating-related risks. Such information includes the number of past sexual partners, which has an inverse relationship with positive suitor evaluation. However, sexual encounters with new partners vary in frequency over time, providing an additional dimension of context not previously considered. Across three studies (N = 5,331) with 15 samples, we demonstrate that the impact of past partner number on a suitor’s desirability varies as a function of distribution over time. Using graphical representations of a suitor’s sexual history, we found that past partner number effects were smaller when the frequency of new sexual encounters decreased over time. This moderation effect was stronger, and often curvilinear, when past partner numbers were higher. We replicated these findings in 11 countries from five world regions. Sex differences were minimal and inconsistent pointing to a lack of a sexual double standards. Sociosexuality (openness to casual sex) was a consistent moderator and tended to mute the sexual history effects. These findings suggest that people not only attend to a potential mate’s quantity of sexual partners, but also the context surrounding these encounters such as pattern and timing. Together, the findings raise the possibility of an evolved mechanism for managing mating risks present in both sexes and across populations and adds nuance to a contentious topic of public interest.
Abstract Background/Introduction CT coronary angiography (CTCA) Fractional Flow Reserve (FFRCT) is a key investigation in chronic coronary syndrome (CCS) guidelines. FFR calculated from CTCA may help improve CTCA specificity for flow limiting disease, preventing unnecessary invasive coronary angiography (ICA). Purpose To (1) assess the treatment planning potential of FFRCT by determining the concordance of FFRCT with an ICA +/− invasive physiological assessment for the detection of flow limiting CAD in a real world NHS setting and (2) concordance sub-analysis of concordance of invasive iFR and FFRCT. Methods A single-centre retrospective analysis of a prospectively maintained clinical CTCA database. We identified patients with CCS who had CTCA FFRCT and subsequent ICA from August 2018 to January 2021. Concordance was assessed on a per patient and per vessel basis (major epicardial vessels: left main stem [LMS], left anterior descending artery [LAD], circumflex [LCx], right coronary artery [RCA]). Two non-invasive ischaemia thresholds were examined an FFRCT ≤0.8 and <0.75 (2 cm distal to stenosis). This was compared to a clinical ICA assessment where a flow limiting lesion was defined as a stenosis >70% (or >50% in the LMS) and/or an end vessel iFR ≤0.89 / FFR ≤0.8. All vessels that underwent an iFR, at the interventionists discretion, were then assessed relative to their end-vessel FFRCT. Results 565 patients had a CTCA with FFRCT and 164 patients had a subsequent ICA and were suitable for analysis. On a per patient basis 69% of those referred to ICA with an FFRCT ≤0.8 of at least one major epicardial vessel had any flow limiting CAD at ICA. With an FFRCT <0.75 this was 73%. Table 1 illustrates the per vessel concordance. A total of 120 vessels were included in the iFR subsection analysis. The mean FFRCT was 0.71 (±0.13) and mean iFR was 0.89 (±0.1). Accuracy was 54% (95% CI 45–63%) with a sensitivity of 89% (95% CI 76–96%), specificity 32% (95% CI 22–44%), positive predictive value 45% (95% CI 40–50%) and negative predictive value of 83% (95% CI 66–92%). A Pearson's correlation coefficient of 0.23 was found. Conclusion This study demonstrated that the negative predictive value of FFRCT was excellent, including importantly for LMS analysis. The specificity on a per vessel basis was good with the exception of the LAD assessment. This may have implications for interventional planning with this imaging modality. FFRCT correlated poorly with invasive iFR in this subsection analysis although selection bias may be contributing. There remains a significant proportion of patients referred for an ICA where no flow limiting CAD is found. Funding Acknowledgement Type of funding sources: None. Table 1. Per vessel concordance analysis of potential flow limiting FFRCT relative to clinical ICA findings. Analysed with an ischaemia threshold of FFRCT ≤0.80 and <0.75. PPV = Positive Predictive Value. NPV = Negative Predictive Value.
Since rapid access chest pain clinics (RACPC) were established to streamline stable chest pain assessment, CT coronary angiography (CTCA) has become the recommended investigation for patients without known coronary artery disease (CAD), with well-defined indications. This single-centre retrospective study assessed the feasibility of upfront GP-led CTCA prior to RACPC.
Methods
Electronic records for RACPC pathway patients without pre-existing CAD were reviewed from September - October 2019. Feasibility assessments included appropriateness for RACPC, clinical data recorded via referral versus RACPC assessment for defining CTCA indication and safety, and a comparison of the actual versus hypothetical pathways, impact on timelines and hospital encounters.
Results
106/172 patients screened met inclusion criteria, mean age 61 (±14) and 51% female. 102 (96%) referrals were 'appropriate'. No safety concerns were identified to preclude a CTCA-first strategy. The hypothetical pathway increased CTCA requests versus RACPC (84 vs 71), whilst improving adherence to guidelines and off-loading other services. 23 patients (22%) had no CAD, representing cases where one hospital encounter may be sufficient, which extrapolates to 138 less RACPC appointments annually (£21,666 in current NHS tariffs). The hypothetical pathway would have reduced referral-to-diagnosis by at least a median of 27 days (IQR 14–33).
Conclusion
A hypothetical CTCA-first pathway would have been feasible and safe in a real-world RACPC patient cohort without pre-existing CAD. This novel strategy would have increased referrals for CTCA, whilst streamlining patient pathways by accelerating time to diagnosis and reducing hospital encounters whilst improving NICE guidance adherence.
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