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Danchin N, Puymirat E, Isaaz K, Druelles P, Dibon O, Lefevre T, Bernasconi F, Drouet E, Ferrieres J, Schiele F, Simon T. 5197Correlates and prognostic significance of nuisance bleeding after acute myocardial infarction. The FAST-MI programme. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Following acute myocardial infarction (AMI), most patients receive potent antithrombotic medications, which may promote nuisance bleedings (ecchymoses, minor nose or dental bleeds etc.). Little information is available on the factors related to nuisance bleedings, nor on their prognostic significance in post-AMI patients.
Aims and methods
A health status questionnaire was sent to all patients participating in the nationwide French FAST-MI cohorts (2010 and 2015) one year after the acute episode, with a specific question on the presence of nuisance bleedings. Overall, 3968 patients answered the question on the presence nuisance bleedings. In the 2010 cohorts, we also analysed whether the presence of nuisance bleedings at one year was an independent correlate of 5-year mortality.
Results
54% of the patients reported the presence of nuisance bleedings (59% in 2010 and 51% in 2015). In univariate analyses, nuisance bleedings were more frequently found in younger patients, women, patients with STEMI, current smokers, patients treated with PCI, those receiving newer P2Y12 inhibitors or ACE-inhibitors but less frequent in patients with diabetes, hypertension, or those receiving ARBs or direct oral anticoagulants. Using logistic regression analysis, however, the only independent correlates of nuisance bleedings were: female gender (OR 1.45, 1.25–1.68), age ≤60 years (OR 1.22, 1.06–1.41), VKAs (OR 1.72, 1.28–2.31), clopidogrel (OR 1.62, 1.29–2.03), prasugrel (OR 3.16, 2.43–4.09), ticagrelor (OR 2.61, 2.04–3.35) at discharge, diabetes (OR 0.74, 0.63–0.88) and year 2015 vs 2010 (OR 0.62, 0.53–0.73).
In the 2010 cohort, the presence of nuisance bleeding at one year was not a predictor of mortality at 5 years (90% survival in both patients with or without nuisance bleedings; adjusted HR 0.96, 95% CI 0.69–1.33) (Figure).
Figure 1. 5-yr survival by nuisance bleed
Conclusion
Nuisance bleedings one year after AMI are extremely frequent. They are more common in women, younger patients, in patients receiving P2Y12 inhibitors, especially newer P2Y12-i, and in those receiving VKAs; in contrast, diabetic patients report less nuisance bleedings. The presence of nuisance bleeding at one year does not appear to impact 5-year mortality.
Acknowledgement/Funding
Amgen, AstraZeneca, Bayer, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novartis, Pfizer, Sanofi, Servier
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Ferrieres J, Banks V, Pillas D, Ricci L, Dova-Boivin M, Vannak JV, Desamericq G. P648Screening and treatment of familial hypercholesterolemia in a French sample of ambulatory care: a retrospective longitudinal cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Familial hypercholesterolemia (FH) is largely underdiagnosed as there are typically no clinical symptoms prior to the first cardiovascular (CV) event. We conducted a study which utilised ambulatory care electronic medical record (EMRs) to alert physicians to possible cases of FH. Specifically, physicians were alerted to LDL-C levels >190 mg/dL (suggesting a risk of FH) and invited to complete the Dutch Lipid Clinic Network score (DLCN).
Purpose
Describe characteristics, comorbidities and clinical management of patients diagnosed with definite or probable FH in an ambulatory care setting.
Methods
All patients with a DLCN score of definite/probable FH (score higher or equal than 6; index event) between January 2016 and September 2018 were identified in the THIN® database (The Health Improvement Network; an anonymized EMR powered by GERSDATA, a Cegedim Health Data Division). These fully anonymized data were collected by 2000 General Practitioners (GP), 130 cardiologists and 40 endocrinologists, receiving 5.5 million patients regularly in their office. Sociodemographic, laboratory measurements, comorbidities, lipid-lowering therapies (LLT), visits to specialists, LDL-C and hospitalizations were collected and analysed at baseline, and 1, 2, 3, 6 months, and 1 year thereafter.
Results
From 999 anonymous patients with a DLCN score, 98 (10%) FH patients were identified (38 [39%] definite FH, 60 [61%] probable FH) while remaining fully anonymous, 9 (9%) of whom already had genetic testing. Mean (SD) age was 57.4 (14.3) years; 56 (57%) patients were female, half (51/98 [52%]) were diagnosed with pure hypercholesterolemia (ICD-10 code: E78.0) and 9 (9%) had a personal history of CV event. 93 patients (95%) had a LDL-C measurement prior to DLCN assessment (definite FH, 36/38 [95%]; probable FH, 57/60 [95%]). Among screened FH patients, 61.2% had LDL-C between 190 to 250 mg/dL and 16.3% had LDL-C higher than 250 mg/dL. At the time of DLCN assessment, one third (30/98 [31%]) of patients were not receiving any LLT, one third ([35%] 34/98) were receiving statins alone, 19% (19/98) receiving LLT combination with statin, and 15% (15) other LLTs. Moderate statin intensity was prescribed in 20% (20/98) of patients; high intensity statin, 17%, (17/98); low intensity, 10% (10/98). No improvement on LLT use (including use of high statin intensity) was observed over the 12-month follow-up.
Conclusion
This is the first study in France that use EMR to screen possible FH patients and support GPs in identifying patients that need to be treated. Our data highlight the need to screen, diagnosis and treat potential FH patients in ambulatory care settings. Longer follow-up is needed to evaluate the impact of FH assessment on referral to specialists, LLT and clinical outcomes.
Acknowledgement/Funding
Amgen
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Capel F, Bongard V, Malpuech-Brugère C, Karoly E, Michelotti G, Rigaudière JP, Jouve C, Ferrieres J, Marmonier C, Sebedio JL. Analyse des relations entre la consommation de produits laitiers et le syndrome métabolique chez l’homme par métabolomique. NUTR CLIN METAB 2019. [DOI: 10.1016/j.nupar.2019.01.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Jacob S, Broggio D, Derreumaux S, Camilleri J, Lapeyre M, Bruguiere E, Fondard O, Lairez O, Walker V, Bernier MO, Laurier D, Chevelle C, Jimenez G, Ferrieres J. P3505Cardiac radiation exposure due to breast cancer radiotherapy: why mean heart dose is a limited parameter for cardiotoxicity studies? (BACCARAT Study). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gitt AK, Lautsch D, Lautsch D, Horack M, Horack M, Baxter CA, Baxter CA, De Ferrari G, De Ferrari G, Ferrieres J, Ferrieres J. P5383Risk for major adverse cardiovascular events estimated by the TIMI Risk Score for Secondary Prevention TRS2P in patients with coronary artery disease did not impact lipid lowering treatment in clinica. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Esquirol Y, Billette De Villemeur R, Carles C, Marquie JC, Huo Yung Kai S, Ruidavets JB, Bongard V, Ferrieres J. P2543Occupational constraints and all-cause mortality: results for men and women from a 20-year follow-up prospective cohort: the VISAT study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schiele F, Simon T, Puymirat E, Cayla G, Gerbaud E, Ohlmann P, Popovic B, Bresson D, Farah B, Ferrieres J, Meneveau N, Danchin N. P832Temporal changes in quality of care for acute myocardial infarction and relation with 1 year survival: acute cardiac care association quality indicators applied to the FAST-MI registries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Puymirat E, Iliou MC, Ducrocq G, Douard H, Labrunee M, Plastaras P, Chevalereau P, Taldir G, Bataille V, Ferrieres J, Schiele F, Simon T, Danchin N. P1231Clinical impact of cardiac rehabilitation according to the atherothrombotic risk stratification after acute myocardial infarction. The FAST-MI registries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Danchin N, Puymirat E, Elbaz M, Perret T, Tartiere JM, Cottin Y, Fayard M, Mabo P, Champin S, Isaaz K, Ferrieres J, Schiele F, Simon T. P3428Changing profile and outcome of AMI patients with previously known coronary artery disease. The FAST-MI programme. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Danchin N, Puymirat E, Roubille F, Silvain J, Ducrocq G, Soto F, De Poli F, Bataille V, Drouet E, Naccache N, Ferrieres J, Schiele F, Simon T. 6127Type of P2Y12 inhibitor at the acute stage and one-year mortality in acute myocardial infarction. The FAST-MI programme. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gitt AK, Lautsch D, Horack M, Baxter CA, Ferrieres J, De Ferrari G. P781Better LDL-cholesterol-target attainment in patients with ACS and type 2 diabetes - results of DYSIS II ACS. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schiele F, Simon T, Puymirat E, Cayla G, Gerbaud E, Ohlmann P, Popovic B, Bresson D, Farah B, Ferrieres J, Meneveau N, Danchin N, Lemesle G, Martinet M. P973Impact of existing or new-onset atrial fibrillation in a setting of acute myocardial infarction. Insights from the FAST-MI 2005, 2010 and 2015 registries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Puymirat E, Bonaca M, Cayla G, Lemesles G, Dillinger JG, Ducrocq G, Ferrieres J, Schiele F, Simon T, Danchin N. P5348Atherothrombotic risk stratification after acute myocardial infarction: the TIMI Risk Score for Secondary Prevention (TRS-2P) in the light of the FAST-MI registries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ferrieres J, Combis MS, Verdier C, Genoux AL, Gennero I, Hamdi S, Perret B, Ruidavets JB. P5389Big data and severe hypertriglyceridemia: prevalence in 297 909 individuals. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Genoux A, Ruidavets J, Ferrieres J, Perret B, Martinez L. High density lipoprotein particles profile by nuclear magnetic resonance spectroscopy and long term total and cardiovascular mortality in coronary artery patients: The genes study. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Esquirol Y, Ferrieres J, Marquie JC, Huo Yung Kai S, Niezborala M, Berard E, Bongard V, Ruidavets JB. P1548Forehead Wrinkles and risk of all-cause and cardiovascular mortality over 20- year follow-up in working population: VISAT study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Berard E, Bongard V, Haas B, Dallongeville J, Moitry M, Cottel D, Ruidavets JB, Ferrieres J. P4437Prevalence of familial hypercholesterolemia in France. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schiele F, Simon T, Puymirat E, Cayla G, Gerbaud E, Ohlmann P, Popovic B, Bresson D, Farah B, Ferrieres J, Meneveau N, Danchin N. P4490Quality matters: classification of centres by quality of care in acute myocardial infarction using the ESC-Acute Cardiac Care Association quality indicators. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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44
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Roman Degano I, Forne C, Ferrieres J, Kirchberger I, Farmakis D, Tavazzi L, Brosa M, Marrugat J. 1467Cost-effectiveness analysis of increased use of percutaneous coronary intervention in acute coronary syndrome patients from 6 European countries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Puymirat E, Bonaca M, Lemesle G, Furber A, Leborgne S, Angoulvant D, Labeque JN, Orion L, Harbaoui D, Bonelo L, Ferrieres J, Schiele F, Simon T, Danchin N. P6257Missed opportunities with underprescription of appropriate secondary prevention treatment at discharge in AMI patients at high risk. The FAST-MI programme. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Berry M, Galinier M, Delmas C, Fournier P, Desmoulin F, Turkieh A, Mischak H, Mullen W, Barutaut M, Eurlings L, Brunner La Rocca H, Butler J, Roncalli J, Evaristi M, Cohen-Solal A, Escamilla R, Ferrieres J, Koukoui F, Smih F, Rouet P. Discovery and validation of a new biomarker for heart failure diagnostic. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2018. [DOI: 10.1016/j.acvdsp.2018.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ferrieres J, Lautsch D, Velkovski-Rouyer M, Ambegaonkar B, De Ferrari G, Vyas A, Baxter C, Horack M, Bash L, Al Mahmeed W, Chiang F, Keong Poh K, Brudi P, Gitt A. Use of guideline-recommended treatments in 10,661 patients with coronary heart disease: Observational multinational DYSIS II study. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2018. [DOI: 10.1016/j.acvdsp.2017.11.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Appleton KM, Woodside JV, Arveiler D, Haas B, Amouyel P, Montaye M, Ferrieres J, Ruidavets JB, Yarnell JWG, Kee F, Evans A, Bingham A, Ducimetiere P, Patterson CC. A Role for Behavior in the Relationships Between Depression and Hostility and Cardiovascular Disease Incidence, Mortality, and All-Cause Mortality: the Prime Study. Ann Behav Med 2017; 50:582-91. [PMID: 26979997 PMCID: PMC4933737 DOI: 10.1007/s12160-016-9784-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Behavioral factors are important in disease incidence and mortality and may explain associations between mortality and various psychological traits. Purpose These analyses investigated the impact of behavioral factors on the associations between depression, hostility and cardiovascular disease(CVD) incidence, CVD mortality, and all-cause mortality. Methods Data from the PRIME Study (N = 6953 men) were analyzed using Cox proportional hazards models, following adjustment for demographic and biological CVD risk factors, and other psychological traits, including social support. Results Following initial adjustment, both depression and hostility were significantly associated with both mortality outcomes (smallest SHR = 1.24, p < 0.001). Following adjustment for behavioral factors, all relationships were attenuated both when accounting for and not accounting for other psychological variables. Associations with all-cause mortality remained significant (smallest SHR = 1.14, p = 0.04). Of the behaviors included, the most significant contribution to outcomes was found for smoking, but a role was also found for fruit and vegetable intakes and high alcohol consumption. Conclusions These findings demonstrate well-known associations between depression, hostility, and mortality and suggest the potential importance of behaviors in explaining these relationships.
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Bongard V, Ferrieres J, Dallongeville J, Moitry M, Montaye M, Haas B, Ruidavets J. P3635Comparison of short-term and long-term mortality between patients with ST- and non ST-segment elevation myocardial infarction in three French population registries of myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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50
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Grimaldi-Bensouda L, Le Heuzey JY, Davy JM, Touze E, Leys D, Benichou J, Ferrieres J, Abenhaim L. P3619Comparative patterns of use of non-vitamin K antagonist oral anticoagulants and risk of haemorrhage in real life. The Stroke Prevention and Anticoagulants (SPA) study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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