1
|
Yoshioka G, Tanaka A, Sonoda S, Kaneko T, Hongo H, Yokoi K, Natsuaki M, Node K. Importance of reassessment to identify trajectories of chronic transition of clinical indicators in post-myocardial infarction management. Cardiovasc Interv Ther 2024; 39:234-240. [PMID: 38615302 DOI: 10.1007/s12928-024-01000-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 03/30/2024] [Indexed: 04/15/2024]
Abstract
Despite advances in multidisciplinary acute care for myocardial infarction (MI), the clinical need to manage heart failure and elevated mortality risks in the remote phase of MI remains unmet. Various prognostic models have been established using clinical indicators obtained during the acute phase of MI; however, most of these indicators also show chronic changes in the post-MI phase. Although relevant guidelines recommend follow-up assessments of some clinical indicators in the chronic phase, systematic reassessment has not yet been fully established and implemented in a real-world clinical setting. Therefore, clinical evidence of the impact of such chronic transitions on the post-MI prognosis is lacking. We speculate that post-MI reassessment of key clinical indicators and the impact of their chronic transition patterns on long-term prognoses can improve the quality of post-MI risk stratification and help identify residual risk factors. Several recent studies have investigated the impact of the chronic transition of some clinical indicators, such as serum albumin level, mitral regurgitation, and left-ventricular dysfunction, on post-MI prognosis. Interestingly, even in MI survivors with these indicators within their respective normal ranges in the acute phase of MI, chronic transition to an abnormal range was associated with worsening cardiovascular outcomes. On the basis of these recent insights, we discuss the clinical significance of post-MI reassessment to identify the trajectories of several clinical indicators and elucidate the potential residual risk factors affecting adverse outcomes in MI survivors.
Collapse
Affiliation(s)
- Goro Yoshioka
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Shinjo Sonoda
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Tetsuya Kaneko
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Hiroshi Hongo
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Kensuke Yokoi
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Masahiro Natsuaki
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| |
Collapse
|
2
|
Girotra S, Dukes KC, Sperling J, Kennedy K, Del Rios M, Crowe R, Panchal AR, Rea T, McNally BF, Chan PS. Emergency Medical Service Agency Practices and Cardiac Arrest Survival. JAMA Cardiol 2024:2819655. [PMID: 38837166 PMCID: PMC11154368 DOI: 10.1001/jamacardio.2024.1189] [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] [Received: 01/26/2024] [Accepted: 04/05/2024] [Indexed: 06/06/2024]
Abstract
Importance Survival for out-of-hospital cardiac arrest (OHCA) varies widely across emergency medical service (EMS) agencies in the US. However, little is known about which EMS practices are associated with higher agency-level survival. Objective To identify resuscitation practices associated with favorable neurological survival for OHCA at EMS agencies. Design, Setting, and Participants This cohort study surveyed EMS agencies participating in the Cardiac Arrest Registry to Enhance Survival (CARES) with 10 or more OHCAs annually during January 2015 to December 2019; data analyses were performed from April to October 2023. Exposure Survey of resuscitation practices at EMS agencies. Main Outcomes and Measures Risk-standardized rates of favorable neurological survival for OHCA at each EMS agency were estimated using hierarchical logistic regression. Multivariable linear regression then examined the association of EMS practices with rates of risk-standardized favorable neurological survival. Results Of 577 eligible EMS agencies, 470 agencies (81.5%) completed the survey. The mean (SD) rate of risk-standardized favorable neurological survival was 8.1% (1.8%). A total of 7 EMS practices across 3 domains (training, cardiopulmonary resuscitation [CPR], and transport) were associated with higher rates of risk-standardized favorable neurological survival. EMS agencies with higher favorable neurological survival rates were more likely to use simulation to assess CPR competency (β = 0.54; P = .05), perform frequent reassessment (at least once every 6 months) of CPR competency in new staff (β = 0.51; P = .04), use full multiperson scenario simulation for ongoing skills training (β = 0.48; P = .01), perform simulation training at least every 6 months (β = 0.63; P < .001), and conduct training in the use of mechanical CPR devices at least once annually (β = 0.43; P = .04). EMS agencies with higher risk-standardized favorable neurological survival were also more likely to use CPR feedback devices (β = 0.58; P = .007) and to transport patients to a designated cardiac arrest or ST-segment elevation myocardial infarction receiving center (β = 0.57; P = .003). Adoption of more than half (≥4) of the 7 practices was more common at EMS agencies in the highest quartile of favorable neurological survival rates (70 of 118 agencies [59.3%]) vs the lowest quartile (42 of 118 agencies [35.6%]) (P < .001). Conclusions and Relevance In a national registry for OHCA, 7 practices associated with higher rates of favorable neurological survival were identified at EMS agencies. Given wide variability in neurological survival across EMS agencies, these findings provide initial insights into EMS practices associated with top-performing EMS agencies in OHCA survival. Future studies are needed to validate these findings and identify best practices for EMS agencies.
Collapse
Affiliation(s)
- Saket Girotra
- University of Texas Southwestern Medical Center, Dallas
| | | | - Jessica Sperling
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - Kevin Kennedy
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | | | | | - Ashish R. Panchal
- Department of Emergency Medicine, The Ohio State University, Columbus
| | - Thomas Rea
- King County Medic One Emergency Medical Services and Harborview Medical Center, University of Washington, Seattle
| | - Bryan F. McNally
- Emory University Rollins School of Public Health, Atlanta, Georgia
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Paul S. Chan
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| |
Collapse
|
3
|
Elkind MSV, Arnett DK, Benjamin IJ, Eckel RH, Grant AO, Houser SR, Jacobs AK, Jones DW, Robertson RM, Sacco RL, Smith SC, Weisfeldt ML, Wu JC, Jessup M. The American Heart Association at 100: A Century of Scientific Progress and the Future of Cardiovascular Science: A Presidential Advisory From the American Heart Association. Circulation 2024; 149:e964-e985. [PMID: 38344851 DOI: 10.1161/cir.0000000000001213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
In 1924, the founders of the American Heart Association (AHA) envisioned an international society focused on the heart and aimed at facilitating research, disseminating information, increasing public awareness, and developing public health policy related to heart disease. This presidential advisory provides a comprehensive review of the past century of cardiovascular and stroke science, with a focus on the AHA's contributions, as well as informed speculation about the future of cardiovascular science into the next century of the organization's history. The AHA is a leader in fundamental, translational, clinical, and population science, and it promotes the concept of the "learning health system," in which a continuous cycle of evidence-based practice leads to practice-based evidence, permitting an iterative refinement in clinical evidence and care. This advisory presents the AHA's journey over the past century from instituting professional membership to establishing extraordinary research funding programs; translating evidence to practice through clinical practice guidelines; affecting systems of care through quality programs, certification, and implementation; leading important advocacy efforts at the federal, state and local levels; and building global coalitions around cardiovascular and stroke science and public health. Recognizing an exciting potential future for science and medicine, the advisory offers a vision for even greater impact for the AHA's second century in its continued mission to be a relentless force for longer, healthier lives.
Collapse
|
4
|
Armillotta M, Amicone S, Bergamaschi L, Angeli F, Rinaldi A, Paolisso P, Stefanizzi A, Sansonetti A, Impellizzeri A, Bodega F, Canton L, Suma N, Fedele D, Bertolini D, Foà A, Pizzi C. Predictive value of Killip classification in MINOCA patients. Eur J Intern Med 2023; 117:57-65. [PMID: 37596114 DOI: 10.1016/j.ejim.2023.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/20/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Killip classification is a practical clinical tool for risk stratification in patients with acute myocardial infarction (AMI). However, its prognostic role in myocardial infarction with non-obstructive coronary artery (MINOCA) is still poorly explored. Our purpose was to evaluate the prognostic role of high Killip class in the specific setting of MINOCA and compare the results with a cohort of patients with obstructive coronary arteries myocardial infarction (MIOCA). METHODS This study included 2455 AMI patients of whom 255 were MINOCA. We compared the Killip classes of MINOCA with those of MIOCA and evaluated the prognostic impact of a high Killip class, defined if greater than I, on both populations' outcome. Short-term outcomes included in-hospital death, re-AMI and arrhythmias. Long-term outcomes were all-cause mortality, re-AMI, stroke, heart failure (HF) hospitalization and the composite endpoint of MACE. RESULTS Killip class >1 occurred in 25 (9.8%) MINOCA patients compared to 327 (14.9%) MIOCA cases. In MINOCA subjects, a high Killip class was associated with a greater in-hospital mortality (p = 0.002) and, at long term follow-up, with a three-fold increased mortality (p = 0.001) and a four-fold risk of HF hospitalization (p = 0.003). Among MINOCA, a high Killip class was identified as a strong independent predictor of MACE occurrence [HR 2.66, 95% CI (1.25-5.64), p = 0.01] together with older age and worse kidney function while in MIOCA population also left ventricular ejection fraction and troponin value predicted MACE. CONCLUSIONS Killip classification confirmed its prognostic impact on short- and long-term outcomes also in a selected MINOCA population, which still craves for a baseline risk stratification.
Collapse
Affiliation(s)
- Matteo Armillotta
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Sara Amicone
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Luca Bergamaschi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesco Angeli
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Rinaldi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Pasquale Paolisso
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Andrea Stefanizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Impellizzeri
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesca Bodega
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Lisa Canton
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Nicole Suma
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Damiano Fedele
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Davide Bertolini
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alberto Foà
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Carmine Pizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| |
Collapse
|
5
|
Uzendu AI, Spertus JA, Nallamothu BK, Girotra S, Jones PG, McNally BF, Del Rios M, Sasson C, Breathett K, Sperling J, Dukes KC, Chan PS. Cardiac Arrest Survival at Emergency Medical Service Agencies in Catchment Areas With Primarily Black and Hispanic Populations. JAMA Intern Med 2023; 183:1136-1143. [PMID: 37669067 PMCID: PMC10481323 DOI: 10.1001/jamainternmed.2023.4303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/12/2023] [Indexed: 09/06/2023]
Abstract
Importance Black and Hispanic patients are less likely to survive an out-of-hospital cardiac arrest (OHCA) than White patients. Given the central importance of emergency medical service (EMS) agencies in prehospital care, a better understanding of OHCA survival at EMS agencies that work in Black and Hispanic communities and White communities is needed to address OHCA disparities. Objective To examine whether EMS agencies serving catchment areas with primarily Black and Hispanic populations (Black and Hispanic catchment areas) have different rates of OHCA survival than agencies serving catchment areas with primarily White populations (White catchment areas). Design, Setting, and Participants A cohort study including adults with nontraumatic OHCA from January 1, 2015, to December 31, 2019, in the Cardiac Arrest Registry to Enhance Survival was conducted. Data analysis was conducted from August 17, 2022, to July 7, 2023. Exposure Emergency medical service agencies, categorized as working in catchment areas where the combination of Black and Hispanic residents made up more than 50% of the population or where White residents made up more than 50% of the population. Main Outcomes and Measures The unit of analysis was the EMS agency. The primary outcome was agency-level risk-standardized survival rates (RSSRs) to hospital admission for OHCA at each EMS agency, which were calculated using hierarchical logistic regression and compared between agencies serving Black and Hispanic and White catchment areas. Whether differences in OHCA survival were explained by EMS and first responder measures was evaluated with additional adjustment for these factors. Results Among 764 EMS agencies representing 258 342 OHCAs, 82 EMS agencies (10.7%) had a Black and Hispanic catchment area. Overall median age of the patients was 63.0 (IQR, 52.0-75.0) years, 36.1% were women, and 63.9% were men. Overall, the mean (SD) RSSR was 27.5% (3.6%), with lower survival at EMS agencies with Black and Hispanic catchment areas (25.8% [3.6%]) compared with agencies with White catchment areas (27.7% [3.5%]; P < .001). Among the 82 EMS agencies with Black and Hispanic catchment areas, a disproportionately higher number (32 [39.0%]) was in the lowest survival quartile, whereas a lower number (12 [14.6%]) was in the highest survival quartile. Additional adjustment for EMS response times, EMS termination of resuscitation rates, and first responder rates of initiating cardiopulmonary resuscitation or applying an automated external defibrillator before EMS arrival did not meaningfully attenuate differences in RSSRs between agencies with Black and Hispanic compared with White catchment areas (mean [SD] RSSRs after adjustment, 25.9% [3.3%] vs 27.7% [3.1%]; P < .001). Conclusions and Relevance Risk-standardized survival rates for OHCA were 1.9% lower at EMS agencies working in Black and Hispanic catchment areas than in White catchment areas. This difference was not explained by EMS response times, rates of EMS termination of resuscitation, or first responder rates of initiating cardiopulmonary resuscitation or applying an automated external defibrillator. These findings suggest there is a need for further assessment of these discrepancies.
Collapse
Affiliation(s)
- Anezi I. Uzendu
- Saint Luke’s Hospital Mid America Heart Institute, Kansas City, Missouri
- Department of Medicine, University of Missouri–Kansas City, Kansas City
| | - John A. Spertus
- Saint Luke’s Hospital Mid America Heart Institute, Kansas City, Missouri
- Department of Medicine, University of Missouri–Kansas City, Kansas City
| | - Brahmajee K. Nallamothu
- Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Saket Girotra
- University of Texas–Southwestern Medical Center, Dallas
| | - Philip G. Jones
- Saint Luke’s Hospital Mid America Heart Institute, Kansas City, Missouri
| | - Bryan F. McNally
- Emory University School of Medicine, Rollins School of Public Health, Atlanta, Georgia
| | - Marina Del Rios
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Comilla Sasson
- Department of Psychiatry, University of Colorado School of Medicine, Aurora
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora
- American Heart Association, Dallas, Texas
| | - Khadijah Breathett
- Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Indianapolis
| | - Jessica Sperling
- Social Science Research Institute, Duke University, Durham, North Carolina
- Clinical and Translational Science Institute, Durham, North Carolina
| | - Kimberly C. Dukes
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City
- University of Iowa College of Public Health, Iowa City
| | - Paul S. Chan
- Saint Luke’s Hospital Mid America Heart Institute, Kansas City, Missouri
- Department of Medicine, University of Missouri–Kansas City, Kansas City
| |
Collapse
|
6
|
von Lewinski D, Kolesnik E, Aziz F, Benedikt M, Tripolt NJ, Wallner M, Pferschy PN, von Lewinski F, Schwegel N, Holman RR, Oulhaj A, Moertl D, Siller-Matula J, Sourij H. Timing of SGLT2i initiation after acute myocardial infarction. Cardiovasc Diabetol 2023; 22:269. [PMID: 37777743 PMCID: PMC10544140 DOI: 10.1186/s12933-023-02000-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Pharmacological post-MI treatment is routinely initiated at intensive/cardiac care units. However, solid evidence for an early start of these therapies is only available for dual platelet therapy and statins, whereas data on beta blockers and RAAS inhibitors are heterogenous and mainly limited to STEMI and heart failure patients. Recently, the EMMY trial provided the first evidence on the beneficial effects of SGLT2 inhibitors (SGLT2i) when initiated early after PCI. In patients with type 2 diabetes mellitus, SGLT2i are considered "sick days drugs" and it, therefore, remains unclear if very early SGLT2i initiation following MI is as safe and effective as delayed initiation. METHODS AND RESULTS The EMMY trial evaluated the effect of empagliflozin on NT-proBNP and functional and structural measurements. Within the Empagliflozin group, 22 (9.5%) received early treatment (< 24 h after PCI), 98 (42.2%) within a 24 to < 48 h window (intermediate), and 111 (48.1%) between 48 and 72 h (late). NT-proBNP levels declined by 63.5% (95%CI: - 69.1; - 48.1) in the early group compared to 61.0% (- 76.0; - 41.4) in the intermediate and 61.9% (- 70.8; - 45.7) in the late group (n.s.) within the Empagliflozin group with no significant treatment groups-initiation time interaction (pint = 0.96). Secondary endpoints of left ventricular function (LV-EF, e/e`) as well as structure (LVESD and LVEDD) were also comparable between the groups. No significant difference in severe adverse event rate between the initiation time groups was detected. CONCLUSION Very early administration of SGLT2i after acute myocardial infarction does not show disadvantageous signals with respect to safety and appears to be as effective in reducing NT-proBNP as well as improving structural and functional LV markers as initiation after 2-3 days.
Collapse
Affiliation(s)
- Dirk von Lewinski
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Ewald Kolesnik
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Faisal Aziz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Martin Benedikt
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Norbert J Tripolt
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Markus Wallner
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Peter N Pferschy
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Friederike von Lewinski
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Nora Schwegel
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Rury R Holman
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Abderrahim Oulhaj
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, UAE
| | - Deddo Moertl
- Karl Landsteiner University of Health Sciences, 3050, Krems, Austria
- Department of Internal Medicine 3, University Hospital St. Poelten, 3100, St. Poelten, Austria
| | | | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| |
Collapse
|
7
|
Faridi KF, Strom JB, Kundi H, Butala NM, Curtis JP, Gao Q, Song Y, Zheng L, Tamez H, Shen C, Secemsky EA, Yeh RW. Association Between Claims-Defined Frailty and Outcomes Following 30 Versus 12 Months of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: Findings From the EXTEND-DAPT Study. J Am Heart Assoc 2023; 12:e029588. [PMID: 37449567 PMCID: PMC10382113 DOI: 10.1161/jaha.123.029588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023]
Abstract
Background Frailty is rarely assessed in clinical trials of patients who receive dual antiplatelet therapy (DAPT) after percutaneous coronary intervention. This study investigated whether frailty defined using claims data is associated with outcomes following percutaneous coronary intervention, and if there is a differential association in patients receiving standard versus extended duration DAPT. Methods and Results Patients ≥65 years of age in the DAPT (Dual Antiplatelet Therapy) Study, a randomized trial comparing 30 versus 12 months of DAPT following percutaneous coronary intervention, had data linked to Medicare claims (n=1326), and a previously validated claims-based index was used to define frailty. Net adverse clinical events, a composite of all-cause mortality, myocardial infarction, stroke, and major bleeding, were compared between frail and nonfrail patients. Patients defined as frail using claims data (12.0% of the cohort) had higher incidence of net adverse clinical events (23.1%) compared with nonfrail patients (10.7%; P<0.001) at 18-month follow-up and increased risk after multivariable adjustment (adjusted hazard ratio [HR], 2.24 [95% CI, 1.38-3.63]). There were no differences in effects of extended duration DAPT on net adverse clinical events for frail (HR, 1.42 [95% CI, 0.73-2.75]) and nonfrail patients (HR, 1.18 [95% CI, 0.83-1.68]; interaction P=0.61), although analyses were underpowered. Bleeding was highest among frail patients who received extended duration DAPT. Conclusions Among older patients in the DAPT Study, claims-defined frailty was associated with higher net adverse clinical events. Effects of extended duration DAPT were not different for frail patients, although comparisons were underpowered. Further investigation of how frailty influences ischemic and bleeding risks with DAPT are warranted. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00977938.
Collapse
Affiliation(s)
- Kamil F Faridi
- Section of Cardiovascular Medicine, Department of Medicine Yale School of Medicine New Haven CT USA
| | - Jordan B Strom
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine Beth Israel Deaconess Medical Center Boston MA USA
| | - Harun Kundi
- Department of Cardiology Ankara City Hospital Ankara Turkey
| | - Neel M Butala
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine Beth Israel Deaconess Medical Center Boston MA USA
- Cardiology Division, Department of Medicine Massachusetts General Hospital, Harvard Medical School Boston MA USA
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Department of Medicine Yale School of Medicine New Haven CT USA
| | - Qi Gao
- Baim Institute for Clinical Research Boston MA USA
| | - Yang Song
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine Beth Israel Deaconess Medical Center Boston MA USA
| | - Luke Zheng
- Baim Institute for Clinical Research Boston MA USA
| | - Hector Tamez
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine Beth Israel Deaconess Medical Center Boston MA USA
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine Beth Israel Deaconess Medical Center Boston MA USA
- Biogen Cambridge MA USA
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine Beth Israel Deaconess Medical Center Boston MA USA
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine Beth Israel Deaconess Medical Center Boston MA USA
- Baim Institute for Clinical Research Boston MA USA
| |
Collapse
|
8
|
Nedkoff L, Briffa T, Murray K, Gaw J, Yates A, Sanfilippo FM, Nicholls SJ. Risk of early recurrence and mortality in high-risk myocardial infarction patients: A population-based linked data study. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 17:200185. [PMID: 37122877 PMCID: PMC10139974 DOI: 10.1016/j.ijcrp.2023.200185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/18/2022] [Accepted: 03/30/2023] [Indexed: 05/02/2023]
Abstract
Background Survival during the early period following myocardial infarction (MI) has significantly improved although there are limited data on cardiovascular recurrence during this period. Methods We identified all emergency hospitalisations for MI from November 1, 2011 to October 31, 2016 in Western Australia from a linked hospitalisation/mortality dataset. Patients were included if they survived >3 days, had no acute kidney injury, and had ≥1 of: ≥65 years, prior MI, diabetes or peripheral arterial disease. Outcomes were major adverse cardiovascular events (MACE, a composite of CVD death, recurrent MI or stroke), cardiovascular disease (CVD) death, all-cause mortality, recurrent MI and stroke. Cumulative risks at 90-days and 1-year were estimated from Kaplan-Meier analyses and predictors of each outcome from multivariable Cox regression models. Results There were 8024 high-risk MI patients identified (males 61.8%). Median age was 73.7 years (IQR 66.3-82.2). Half of the risk of MACE occurred in the first 90-days post-MI (6.6% vs 12.6% at 1-year) and was underpinned by risk of recurrent MI. Risk was generally higher in women than men (MACE: 6.0% males, 7.7% females, p = 0.0025; CVD mortality: 1.7% males, 3.7% females; all-cause mortality: 2.8% males, 5.6% females, p < 0.0001). Independent predictors of 90-day MACE were increasing age, heart failure history, hypertension and prior stroke. Female sex was not associated with a higher rate of any of the outcomes after multivariable adjustment. Conclusion Half of cardiovascular events in the year following an MI occur within 90-days, demonstrating that reductions in MI burden could be achieved by further targeted intervention in the early period following an MI.
Collapse
Affiliation(s)
- Lee Nedkoff
- The University of Western Australia, M431, 35 Stirling Hwy, Crawley, WA, 6009, Australia
- Corresponding author. School of Population and Global Health, The University of Western Australia, M431, 35 Stirling Hwy, Crawley, Western, 6009, Australia.
| | - Tom Briffa
- The University of Western Australia, M431, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - Kevin Murray
- The University of Western Australia, M431, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - James Gaw
- CSL Behring, 189 – 209 Camp Road, Broadmeadows, Victoria, 3047, Australia
| | - Andrea Yates
- CSL Behring, 189 – 209 Camp Road, Broadmeadows, Victoria, 3047, Australia
| | - Frank M. Sanfilippo
- The University of Western Australia, M431, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - Stephen J. Nicholls
- Victorian Heart Institute, Monash University, Wellington Rd, Clayton, VIC, 3800, Australia
| |
Collapse
|
9
|
Mechanisms of the "No-Reflow" Phenomenon After Acute Myocardial Infarction: Potential Role of Pericytes. JACC Basic Transl Sci 2023; 8:204-220. [PMID: 36908667 PMCID: PMC9998747 DOI: 10.1016/j.jacbts.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022]
Abstract
Pericytes contract during myocardial ischemia resulting in capillary constriction and no reflow. Reversing pericyte contraction pharmacologically reduces no reflow and infarct size. These findings open up an entire new venue of research aimed at altering pericyte function in myocardial ischemia and infarction.
Collapse
|
10
|
Li F, Luo R, Wang XT, Jia JF, Yu XY. Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia. Open Med (Wars) 2023; 18:20220621. [PMID: 36694625 PMCID: PMC9830634 DOI: 10.1515/med-2022-0621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 01/11/2023] Open
Abstract
Our object was to examine how the pre- and post-pandemic COVID-19 impacted the care of acute ST-segment elevation myocardial infarction (STEMI) patients in county hospitals. Using January 20, 2020, as the time point for the control of a unique coronavirus pneumonia epidemic in Jieshou, 272 acute STEMI patients were separated into pre-epidemic (group A, n = 130) and epidemic (group B, n = 142). There were no significant differences between the two groups in terms of mode of arrival, symptom onset-to-first medical contact time, door-to-needle time, door-to-balloon time, maximum hypersensitive cardiac troponin I levels, and in-hospital adverse events (P > 0.05). Emergency percutaneous coronary intervention (PCI) was much less common in group B (57.7%) compared to group A (72.3%) (P = 0.012), and the proportion of reperfusion treatment with thrombolysis was 30.3% in group B compared to 13.1% in group A (P < 0.001). Logistic regression analysis showed that age ≥76 years, admission NT-proBNP levels ≥3,018 pg/ml, and combined cardiogenic shock were independent risk factors for death. Compared with thrombolytic therapy, emergency PCI treatment further reduced the risk of death in STEMI. In conclusion, the county hospitals treated more acute STEMI with thrombolysis during the COVID-19 outbreak.
Collapse
Affiliation(s)
- Feng Li
- Department of Cardiology, Jieshou People’s Hospital, 339 Renmin Road, Jieshou, Fuyang, Anhui, 236500, China
| | - Rong Luo
- Department of Cardiology, Jieshou People’s Hospital, Jieshou, Fuyang, Anhui, 236500, China
| | - Xiao-Ting Wang
- Department of Cardiology, Jieshou People’s Hospital, Jieshou, Fuyang, Anhui, 236500, China
| | - Jun-Feng Jia
- Department of Cardiology, Jieshou People’s Hospital, Jieshou, Fuyang, Anhui, 236500, China
| | - Xue-Ying Yu
- Department of Cardiology, Jieshou People’s Hospital, Jieshou, Fuyang, Anhui, 236500, China
| |
Collapse
|
11
|
Bughin F, Kovacsik H, Jaussent I, Solecki K, Aguilhon S, Vanoverschelde J, Zarqane H, Mercier J, Gouzi F, Roubille F, Dauvilliers Y. Impact of Obstructive Sleep Apnea Syndrome on Ventricular Remodeling after Acute Myocardial Infarction: A Proof-of-Concept Study. J Clin Med 2022; 11:jcm11216341. [PMID: 36362568 PMCID: PMC9656926 DOI: 10.3390/jcm11216341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Obstructive sleep apnea syndrome (OSA) is common in patients with acute myocardial infarction (AMI). Whether OSA impacts on the ventricular remodeling post-AMI remains unclear. We compared cardiac ventricular remodeling in patients assessed by cardiac magnetic resonance (CMR) imaging at baseline and six months after AMI based on the presence and severity of OSA. Methods: This prospective study included 47 patients with moderate to severe AMI. They all underwent CMR at inclusion and at six months after an AMI, and a polysomnography was performed three weeks after AMI. Left and right ventricular remodeling parameters were compared between patients based on the AHI, AHI in REM and NREM sleep, oxygen desaturation index, and daytime sleepiness. Results: Of the 47 patients, 49% had moderate or severe OSA with an AHI ≥ 15/h. No differences were observed between these patients and those with an AHI < 15/h for left ventricular end-diastolic and end-systolic volumes at six months. No association was found for left and right ventricular remodeling parameters at six months or for the difference between baseline and six months with polysomnographic parameters of OSA severity, nor with daytime sleepiness. Conclusions: Although with a limited sample size, our proof-of-concept study does not report an association between OSA and ventricular remodeling in patients with AMI. These results highlight the complexity of the relationships between OSA and post-AMI morbi-mortality.
Collapse
Affiliation(s)
- François Bughin
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHU, 34090 Montpellier, France
- Pneumology Department, Clinique du Millénaire, 34000 Montpellier, France
| | - Hélène Kovacsik
- Department of Interventional and Cardiovascular Imaging, CHU, 34090 Montpellier, France
| | - Isabelle Jaussent
- Institute for Neurosciences of Montpellier INM, University of Montpellier, INSERM, 34000 Montpellier, France
| | - Kamila Solecki
- Cardiology Department, Clinique Beausoleil, 34070 Montpellier, France
| | - Sylvain Aguilhon
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, 34090 Montpellier, France
| | | | - Hamid Zarqane
- Department of Interventional and Cardiovascular Imaging, CHU, 34090 Montpellier, France
| | - Jacques Mercier
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHU, 34090 Montpellier, France
| | - Fares Gouzi
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHU, 34090 Montpellier, France
| | - François Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, 34090 Montpellier, France
| | - Yves Dauvilliers
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, 34090 Montpellier, France
- Correspondence:
| |
Collapse
|
12
|
Larsen AI, Løland KH, Hovland S, Bleie Ø, Eek C, Fossum E, Trovik T, Juliebø V, Hegbom K, Moer R, Larsen T, Uchto M, Rotevatn S. Guideline-Recommended Time Less Than 90 Minutes From ECG to Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction Is Associated with Major Survival Benefits, Especially in Octogenarians: A Contemporary Report in 11 226 Patients from NORIC. J Am Heart Assoc 2022; 11:e024849. [PMID: 36056722 PMCID: PMC9496403 DOI: 10.1161/jaha.122.024849] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Using contemporary data from NORIC (Norwegian Registry of Invasive Cardiology) we investigated the predictive value of patient age and time from ECG diagnosis to sheath insertion (ECG‐2‐sheath) in primary percutaneous coronary intervention for ST‐segment–elevation myocardial infarction (STEMI). Methods and Results Data from 11 226 patients collected from all centers offering 24/7/365 primary percutaneous coronary intervention service were explored. For patients aged <80 years the mortality rates were 5.6% and 7.6% at 30 days and 1 year, respectively. For octogenarians the corresponding rates were 15.0% and 24.2%. The Cox hazard ratio was 2.02 (1.93–2.11, P value <0.0001) per 10 years of patient age. Time from ECG‐2‐sheath was significantly associated with mortality with a 3.6% increase per 30 minutes of time. Using achievement of time goal <90 minutes in patients aged >80 years and mortality at 30 days, mortality was 10.5% and 17.7% for <90 or ≥90 minutes, respectively. The number needed to prevent 1 death was 39 in the whole population and 14 in the elderly. Restricted mean survival gains during median 938 days of follow‐up in patients with ECG‐2‐sheath time <90 minutes were 24 and 76 days for patients aged <80 and ≥80 years, respectively. Conclusions Time from ECG‐diagnosis to sheath insertion is strongly correlated with mortality. This applies especially to octogenarians who derive the most in terms of absolute mortality reduction. Registration URL: https://helsedata.no/en/forvaltere/norwegian‐institute‐of‐public‐health/norwegian‐registry‐of‐invasive‐cardiology/.
Collapse
Affiliation(s)
- Alf Inge Larsen
- Department of Cardiology Stavanger University Hospital Stavanger Norway.,Institute of Clinical Sciences, University of Bergen Bergen Norway
| | - Kjetil Halvorsen Løland
- Norwegian Registry of Invasive Cardiology (NORIC) Haukeland University Hospital Bergen Norway.,Department of Heart Disease Haukeland University Hospital Bergen Norway
| | - Siren Hovland
- Norwegian Registry of Invasive Cardiology (NORIC) Haukeland University Hospital Bergen Norway
| | - Øyvind Bleie
- Department of Heart Disease Haukeland University Hospital Bergen Norway
| | - Christian Eek
- Department of Cardiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Eigil Fossum
- Department of Cardiology Oslo University Hospital Ullevål, Oslo Norway
| | - Thor Trovik
- Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Vibeke Juliebø
- Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Knut Hegbom
- Clinic for Heart Disease St. Olav's University Hospital Trondheim Norway
| | | | | | - Michael Uchto
- Division of Internal Medicine Nordlandssykehuset Bodø Norway
| | - Svein Rotevatn
- Norwegian Registry of Invasive Cardiology (NORIC) Haukeland University Hospital Bergen Norway
| |
Collapse
|
13
|
Mo C, Cheng Y, Pan J, Tan K, Zhang X, Xu J. Association between hospital characteristics and 30-day mortality of patients hospitalized for acute myocardial infarction in Sichuan, China. J Evid Based Med 2022; 15:236-244. [PMID: 36018065 DOI: 10.1111/jebm.12491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/27/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Because acute myocardial infarction (AMI) is a major cause of death, China faces the challenge of improving its quality of care. This study provides context-specific evidence of association between 30-day mortality and hospital characteristics in China to extend the understanding of hospitalized AMI patients. METHODS We conducted a retrospective cohort study of 67,619 hospitalized AMI patients at 372 tertiary and secondary hospitals in Sichuan, China, between January 1, 2018 and December 31, 2020. Using a hierarchical logistic regression model to control risk factors, we explored relationships among 30-day mortality, hospital level, AMI volume, and percutaneous coronary intervention (PCI) timeliness. Locally weighted scatterplot smoothing was used to observe the trends of 30-day mortality with increased AMI volume and PCI timeliness. RESULTS After risk factor adjustment, the 30-day mortality model demonstrated that a lower hospital level and smaller AMI volume were associated with higher 30-day mortality (medium-volume: OR = 1.511, 95% CI (1.195, 1.910); small-volume: OR = 1.636, 95% CI (1.277, 2.096); other tertiary: OR = 1.190, 95% CI (1.037, 1.365); secondary: OR = 1.524, 95% CI (1.289, 1.800)). Similarly, 30-day mortality was higher for patients at hospitals with a low PCI timeliness (low timeliness: OR = 1.318, 95% CI (1.079, 1.610)). Scatterplot smoothing showed hospital 30-day mortality first reduced quickly and gradually stabilized with increased AMI volume and PCI timeliness. CONCLUSION Patients admitted to tertiary grade A hospitals, large-volume hospitals, and high- or medium-timeliness hospitals were more likely to survive at 30 days. Policymakers should focus on improving the outcomes at hospitals without these characteristics.
Collapse
Affiliation(s)
- Chunmei Mo
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Yongzhong Cheng
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Jingping Pan
- Health Information Center of Sichuan Province, Chengdu, P.R. China
| | - Kun Tan
- Health Information Center of Sichuan Province, Chengdu, P.R. China
| | - Xueli Zhang
- Health Information Center of Sichuan Province, Chengdu, P.R. China
| | - Jiuping Xu
- Business School, Sichuan University, Chengdu, P.R. China
| |
Collapse
|
14
|
Cai M, Liu E, Bai P, Zhang N, Wang S, Li W, Lin H, Lin X. The Chasm in Percutaneous Coronary Intervention and In-Hospital Mortality Rates Among Acute Myocardial Infarction Patients in Rural and Urban Hospitals in China: A Mediation Analysis. Int J Public Health 2022; 67:1604846. [PMID: 35872707 PMCID: PMC9302370 DOI: 10.3389/ijph.2022.1604846] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: To determine to what extent the inequality in the ability to provide percutaneous coronary intervention (PCI) translates into outcomes for AMI patients in China.Methods: We identified 82,677 patients who had primary diagnoses of AMI and were hospitalized in Shanxi Province, China, between 2013 and 2017. We applied logistic regressions with inverse probability weighting based on propensity scores and mediation analyses to examine the association of hospital rurality with in-hospital mortality and the potential mediating effects of PCI.Results: In multivariate models where PCI was not adjusted for, rural hospitals were associated with a significantly higher risk of in-hospital mortality (odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.03–1.37). However, this association was nullified (OR: 0.94, 95% CI: 0.81–1.08) when PCI was included as a covariate. Mediation analyses revealed that PCI significantly mediated 132.3% (95% CI: 104.1–256.6%) of the effect of hospital rurality on in-hospital mortality. The direct effect of hospital rurality on in-hospital mortality was insignificant.Conclusion: The results highlight the need to improve rural hospitals’ infrastructure and address the inequalities of treatments and outcomes in rural and urban hospitals.
Collapse
Affiliation(s)
- Miao Cai
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Echu Liu
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
| | - Peng Bai
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nan Zhang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorder, Wuhan, China
| | - Siyu Wang
- Center for Genome Sciences and Systems Biology, School of Medicine, Washington University in St. Louis, Saint Louis, MO, United States
| | - Wei Li
- Department of Data Science, Zhejiang University of Finance and Economics Dongfang College, Haining, China
| | - Hualiang Lin
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaojun Lin
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
- *Correspondence: Xiaojun Lin,
| |
Collapse
|
15
|
Wang Y, Leifheit EC, Krumholz HM. Trends in 10-Year Outcomes Among Medicare Beneficiaries Who Survived an Acute Myocardial Infarction. JAMA Cardiol 2022; 7:613-622. [PMID: 35507330 PMCID: PMC9069341 DOI: 10.1001/jamacardio.2022.0662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Short-term outcomes after acute myocardial infarction (AMI) have improved, but little is known about longer-term outcomes. Objective To evaluate trends in 10-year all-cause mortality and hospitalization for recurrent AMI by demographic subgroups and examine the association between recurrence and mortality. Design, Setting, and Participants Medicare fee-for-service beneficiaries who survived after AMI from 1995 to 2019. Subgroups were defined by age, sex, race, dual Medicare-Medicaid-eligible status, and residence in health priority areas (geographic areas with persistently high adjusted mortality and hospitalization rates). Data were analyzed from October 2020 to February 2022. Exposure Medicare fee-for-service beneficiaries who survived an AMI. Main Outcomes and Measures Ten-year all-cause mortality and hospitalization for recurrent AMI, beginning 30 days from the index AMI admission. Results Of an included 3 982 266 AMI survivors, 1 952 450 (49.0%) were female, and the mean (SD) age was 78.0 (7.4) years. Ten-year mortality and recurrent AMI rates were 72.7% (95% CI, 72.6-72.7) and 27.1% (95% CI, 27.0-27.2), respectively. Adjusted annual reductions were 1.5% (95% CI, 1.4-1.5) for mortality and 2.7% (95% CI, 2.6-2.7) for recurrence. In subgroup analyses balancing patient characteristics, hazard ratios (HRs) for mortality and recurrence were 1.13 (95% CI, 1.12-1.13) and 1.07 (95% CI, 1.06-1.07), respectively, for men vs women; 1.05 (95% CI, 1.05-1.06) and 1.08 (95% CI, 1.07-1.09) for Black vs White patients; 0.96 (95% CI, 0.95-0.96) and 1.00 (95% CI, 1.00-1.01) for other race (including American Indian and Alaska Native, Asian, Hispanic, other race or ethnicity, and unreported) vs White patients; 1.24 (95% CI, 1.24-1.24) and 1.21 (95% CI, 1.20-1.21) for dual Medicare-Medicaid-eligible vs non-dual Medicare-Medicaid-eligible patients; and 1.06 (95% CI, 1.06-1.07) and 1.00 (95% CI, 1.00-1.01) for patients in health priority areas vs other areas. For patients hospitalized in 2007 to 2009, the last 3 years for which full 10-year follow-up data were available, 10-year mortality risk was 13.9% lower than for those hospitalized in 1995 to 1997 (adjusted HR, 0.86; 95% CI, 0.85-0.87) and 10-year recurrence risk was 22.5% lower (adjusted HR, 0.77; 95% CI, 0.76-0.78). Mortality within 10 years after the initial AMI was higher for patients with a recurrent AMI (80.6%; 95% CI, 80.5-80.7) vs those without recurrence (72.4%; 95% CI, 72.3-72.5). Conclusions and Relevance In this study, 10-year mortality and hospitalization for recurrence rates improved over the last decades for patients who survived the acute period of AMI. There were marked differences in outcomes and temporal trends across demographic subgroups, emphasizing the urgent need for prioritization of efforts to reduce inequities in long-term outcomes.
Collapse
Affiliation(s)
- Yun Wang
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Erica C. Leifheit
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| |
Collapse
|
16
|
Rea F, Ronco R, Martini N, Maggioni AP, Corrao G. Cost-Effectiveness of Posthospital Management of Acute Coronary Syndrome: A Real-World Investigation From Italy. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:185-193. [PMID: 35094791 DOI: 10.1016/j.jval.2021.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/25/2021] [Accepted: 07/26/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to assess the cost-effectiveness profile of adherence to recommendations for the community management of patients discharged with a diagnosis of acute coronary syndrome (ACS). METHODS The cohort of 50 282 residents in the Lombardy Region (Italy) who were discharged with a diagnosis of ACS during 2011 to 2015 was followed up until 2018. Adherence to selected recommendations including drug therapies (DTs), outpatient controls, and rehabilitation, experienced during the first year after index discharge, was considered. Adherent and nonadherent cohort members were matched on high-dimensional propensity scores. Composite clinical outcomes (cardiovascular hospital admissions and all-cause mortality) and healthcare costs were assessed for a time horizon of 5 years. Cost-effectiveness profile of adherence to recommendations was measured through the incremental cost-effectiveness ratio, that is, the incremental cost for 1 day free from the composite clinical outcome. RESULTS Adherence to DTs, outpatient controls, and rehabilitation, respectively, regarded 39%, 81%, and 3% of cohort members. Compared with nonadherent patients, those adherent to DTs, outpatient controls, and rehabilitation had (1) a delay in the occurrence of the composite clinical outcome of 50, 43, and 73 days, respectively, and (2) lower (on average, €199 per year for DTs) and higher costs (€292 and €1024 for outpatient controls and rehabilitation). Cost-effectiveness profiles were better for patients with myocardial infarction than those with angina and for patients with more severe clinical complexity than those with milder conditions. CONCLUSIONS Health-related and economic benefits are expected from improving adherence to international guidelines recommendations concerning outpatient treatments and monitoring of patients with ACS.
Collapse
Affiliation(s)
- Federico Rea
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Raffaella Ronco
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
| | - Nello Martini
- Research and Health Foundation (Fondazione ReS [Ricerca e Salute]), Bologna, Italy
| | | | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
17
|
Cipriani A, D’Amico G, Brunetti G, Vescovo GM, Donato F, Gambato M, Dall’Aglio PB, Cardaioli F, Previato M, Martini N, Perazzolo Marra M, Iliceto S, Cacciavillani L, Corrado D, Zorzi A. Electrocardiographic Predictors of Primary Ventricular Fibrillation and 30-Day Mortality in Patients Presenting with ST-Segment Elevation Myocardial Infarction. J Clin Med 2021; 10:jcm10245933. [PMID: 34945229 PMCID: PMC8703328 DOI: 10.3390/jcm10245933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/12/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Primary ventricular fibrillation (PVF) may occur in the early phase of ST-elevation myocardial infarction (STEMI) prior to primary percutaneous coronary intervention (PCI). Multiple electrocardiographic STEMI patterns are associated with PVF and short-term mortality including the tombstone, Lambda, and triangular QRS-ST-T waveform (TW). We aimed to compare the predictive value of different electrocardiographic STEMI patterns for PVF and 30-day mortality. We included a consecutive cohort of 407 STEMI patients (75% males, median age 66 years) presenting within 12 h of symptoms onset. At first medical contact, 14 (3%) showed the TW or Lambda ECG patterns, which were combined in a single group (TW-Lambda pattern) characterized by giant R-wave and downsloping ST-segment. PVF prior to primary PCI occurred in 39 (10%) patients, significantly more often in patients with the TW-Lambda pattern than those without (50% vs. 8%, p < 0.001). For the multivariable analysis, Killip class ≥3 (OR 6.19, 95% CI 2.37–16.1, p < 0.001) and TW-Lambda pattern (OR 9.64, 95% CI 2.99–31.0, p < 0.001) remained as independent predictors of PVF. Thirty-day mortality was also higher in patients with the TW-Lambda pattern than in those without (43% vs. 6%, p < 0.001). However, only LVEF (OR 0.86, 95% CI 0.82–0.90, p < 0.001) and PVF (OR 4.61, 95% CI 1.49–14.3, p = 0.042) remained independent predictors of mortality. A mediation analysis showed that the effect of TW-Lambda pattern on mortality was mediated mainly via the reduced LVEF. In conclusion, among patients presenting with STEMI, the electrocardiographic TW-Lambda pattern was associated with both PVF before PCI and 30-day mortality. Therefore, this ECG pattern may be useful for early risk stratification of STEMI.
Collapse
Affiliation(s)
- Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padova, Italy; (A.C.); (G.B.); (F.D.); (M.G.); (P.B.D.); (F.C.); (N.M.); (M.P.M.); (S.I.); (L.C.); (A.Z.)
| | - Gianpiero D’Amico
- Department of Cardiology, Ospedale dell’Angelo, 30174 Venice, Italy; (G.D.); (G.M.V.); (M.P.)
| | - Giulia Brunetti
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padova, Italy; (A.C.); (G.B.); (F.D.); (M.G.); (P.B.D.); (F.C.); (N.M.); (M.P.M.); (S.I.); (L.C.); (A.Z.)
| | - Giovanni Maria Vescovo
- Department of Cardiology, Ospedale dell’Angelo, 30174 Venice, Italy; (G.D.); (G.M.V.); (M.P.)
| | - Filippo Donato
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padova, Italy; (A.C.); (G.B.); (F.D.); (M.G.); (P.B.D.); (F.C.); (N.M.); (M.P.M.); (S.I.); (L.C.); (A.Z.)
| | - Marco Gambato
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padova, Italy; (A.C.); (G.B.); (F.D.); (M.G.); (P.B.D.); (F.C.); (N.M.); (M.P.M.); (S.I.); (L.C.); (A.Z.)
| | - Pietro Bernardo Dall’Aglio
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padova, Italy; (A.C.); (G.B.); (F.D.); (M.G.); (P.B.D.); (F.C.); (N.M.); (M.P.M.); (S.I.); (L.C.); (A.Z.)
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padova, Italy; (A.C.); (G.B.); (F.D.); (M.G.); (P.B.D.); (F.C.); (N.M.); (M.P.M.); (S.I.); (L.C.); (A.Z.)
| | - Martina Previato
- Department of Cardiology, Ospedale dell’Angelo, 30174 Venice, Italy; (G.D.); (G.M.V.); (M.P.)
| | - Nicolò Martini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padova, Italy; (A.C.); (G.B.); (F.D.); (M.G.); (P.B.D.); (F.C.); (N.M.); (M.P.M.); (S.I.); (L.C.); (A.Z.)
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padova, Italy; (A.C.); (G.B.); (F.D.); (M.G.); (P.B.D.); (F.C.); (N.M.); (M.P.M.); (S.I.); (L.C.); (A.Z.)
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padova, Italy; (A.C.); (G.B.); (F.D.); (M.G.); (P.B.D.); (F.C.); (N.M.); (M.P.M.); (S.I.); (L.C.); (A.Z.)
| | - Luisa Cacciavillani
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padova, Italy; (A.C.); (G.B.); (F.D.); (M.G.); (P.B.D.); (F.C.); (N.M.); (M.P.M.); (S.I.); (L.C.); (A.Z.)
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padova, Italy; (A.C.); (G.B.); (F.D.); (M.G.); (P.B.D.); (F.C.); (N.M.); (M.P.M.); (S.I.); (L.C.); (A.Z.)
- Correspondence:
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padova, Italy; (A.C.); (G.B.); (F.D.); (M.G.); (P.B.D.); (F.C.); (N.M.); (M.P.M.); (S.I.); (L.C.); (A.Z.)
| |
Collapse
|
18
|
De Luca L, Cicala SD, D'Errigo P, Cerza F, Mureddu GF, Rosato S, Badoni G, Seccareccia F, Baglio G. Impact of age, gender and heart failure on mortality trends after acute myocardial infarction in Italy. Int J Cardiol 2021; 348:147-151. [PMID: 34921898 DOI: 10.1016/j.ijcard.2021.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/09/2021] [Accepted: 12/13/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The outcome of patients with acute myocardial infarction (AMI) may vary substantially based on baseline risk. We aimed at analyzing the impact of gender, age and heart failure (HF) on mortality trends, based on a nationwide, comprehensive and universal administrative database of AMI. METHODS This is a nationwide cohort study of patients admitted with AMI from 2009 to 2018 in all Italian hospitals. In-hospital mortality rate (I-MR) and 1-year post-discharge mortality rate (1-Y-MR) were assessed. RESULTS Among the 1,000,965 AMI events included in the analysis, 43.6% occurred in patients aged ≥75 years, 34.7% in females and 21.8% in AMI complicated by HF at the index hospitalization. Both I-MR and 1-Y-MR significantly decreased over time (from 8.87% to 6.72%; mean annual change -0.23%; confidence intervals (CI): - 0.26% to -0.20% and from 12.24% to 10.59%; mean annual change -0.18%; CI: - 0.24% to -0.13%, respectively). This trend was confirmed in younger and elderly AMI patients, in both sexes. In AMI patients complicated by HF, both I-MR and 1-Y-MR were markedly high, regardless of age and gender. CONCLUSIONS This contemporary, nationwide study suggests that I-MR and 1-Y-MR are still elevated, albeit decreasing over time. Elderly patients and those with HF at the time of index admission, present a particularly high risk of fatal events, regardless of gender.
Collapse
Affiliation(s)
- Leonardo De Luca
- Department of Cardiosciences, A.O. San Camillo-Forlanini, Rome, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy.
| | | | - Paola D'Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Francesco Cerza
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Gabriella Badoni
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| |
Collapse
|
19
|
Dattoli-García CA, Jackson-Pedroza CN, Gallardo-Grajeda AL, Gopar-Nieto R, Araiza-Garygordobil D, Arias-Mendoza A. [Infarto agudo de miocardio: revisión sobre factores de riesgo, etiología, hallazgos angiográficos y desenlaces en pacientes jóvenes]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2021; 91:485-492. [PMID: 33471784 PMCID: PMC8641454 DOI: 10.24875/acm.20000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
La enfermedad cardiovascular persiste como primera causa mundial de muerte en los adultos. La población de adultos jóvenes ha cursado con cambios en el estilo de vida con el paso de las décadas, favoreciendo la aparición de ateroesclerosis en etapas más tempranas y como consecuencia la aparición de eventos cardiovasculares de manera más prematura. Se ha identificado que dentro de los factores de riesgo más comunes, la mayoría de ellos son potencialmente modificables. En comparación con adultos mayores, se ha identificado con mayor prevalencia la presencia de etiologías no ateroescleróticas de infarto de miocardio, como la disección coronaria espontánea, alteraciones anatómicas, embolia y espasmo coronarios. Los hallazgos angiográficos y desenlaces son diferentes de acuerdo con el grupo de edad y el sexo. Por dicho motivo realizamos una búsqueda en PubMed de los estudios y registros publicados para el estudio del infarto agudo de miocardio en paciente jóvenes. Con dicha información realizamos la presente revisión con el objetivo de una mejor comprensión de los hallazgos comunes en este grupo y realizar su comparación con grupos de mayor edad.
Collapse
Affiliation(s)
- Carlos A Dattoli-García
- Servicio de Urgencias y Unidad Coronaria, Instituto Nacional de Cardiología, Ciudad de México, México
| | - Cynthia N Jackson-Pedroza
- Servicio de Urgencias y Unidad Coronaria, Instituto Nacional de Cardiología, Ciudad de México, México
| | - Andrea L Gallardo-Grajeda
- Servicio de Urgencias y Unidad Coronaria, Instituto Nacional de Cardiología, Ciudad de México, México
| | - Rodrigo Gopar-Nieto
- Servicio de Urgencias y Unidad Coronaria, Instituto Nacional de Cardiología, Ciudad de México, México
| | - Diego Araiza-Garygordobil
- Servicio de Urgencias y Unidad Coronaria, Instituto Nacional de Cardiología, Ciudad de México, México
| | - Alexandra Arias-Mendoza
- Servicio de Urgencias y Unidad Coronaria, Instituto Nacional de Cardiología, Ciudad de México, México
| |
Collapse
|
20
|
Impacto de las diferencias de sexo y los sistemas de red en la mortalidad hospitalaria de pacientes con infarto agudo de miocardio con elevación del segmento ST. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
21
|
Hobby ARH, Berretta RM, Eaton DM, Kubo H, Feldsott E, Yang Y, Headrick AL, Koch KA, Rubino M, Kurian J, Khan M, Tan Y, Mohsin S, Gallucci S, McKinsey TA, Houser SR. Cortical bone stem cells modify cardiac inflammation after myocardial infarction by inducing a novel macrophage phenotype. Am J Physiol Heart Circ Physiol 2021; 321:H684-H701. [PMID: 34415185 PMCID: PMC8794230 DOI: 10.1152/ajpheart.00304.2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/30/2021] [Accepted: 08/13/2021] [Indexed: 12/14/2022]
Abstract
Acute damage to the heart, as in the case of myocardial infarction (MI), triggers a robust inflammatory response to the sterile injury that is part of a complex and highly organized wound-healing process. Cortical bone stem cell (CBSC) therapy after MI has been shown to reduce adverse structural and functional remodeling of the heart after MI in both mouse and swine models. The basis for these CBSC treatment effects on wound healing are unknown. The present experiments show that CBSCs secrete paracrine factors known to have immunomodulatory properties, most notably macrophage colony-stimulating factor (M-CSF) and transforming growth factor-β, but not IL-4. CBSC therapy increased the number of galectin-3+ macrophages, CD4+ T cells, and fibroblasts in the heart while decreasing apoptosis in an in vivo swine model of MI. Macrophages treated with CBSC medium in vitro polarized to a proreparative phenotype are characterized by increased CD206 expression, increased efferocytic ability, increased IL-10, TGF-β, and IL-1RA secretion, and increased mitochondrial respiration. Next generation sequencing revealed a transcriptome significantly different from M2a or M2c macrophage phenotypes. Paracrine factors from CBSC-treated macrophages increased proliferation, decreased α-smooth muscle actin expression, and decreased contraction by fibroblasts in vitro. These data support the idea that CBSCs are modulating the immune response to MI to favor cardiac repair through a unique macrophage polarization that ultimately reduces cell death and alters fibroblast populations that may result in smaller scar size and preserved cardiac geometry and function.NEW & NOTEWORTHY Cortical bone stem cell (CBSC) therapy after myocardial infarction alters the inflammatory response to cardiac injury. We found that cortical bone stem cell therapy induces a unique macrophage phenotype in vitro and can modulate macrophage/fibroblast cross talk.
Collapse
Affiliation(s)
- Alexander R H Hobby
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Remus M Berretta
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Deborah M Eaton
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Hajime Kubo
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Eric Feldsott
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Yijun Yang
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Alaina L Headrick
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Consortium for Fibrosis Research and Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Keith A Koch
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Consortium for Fibrosis Research and Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Marcello Rubino
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Consortium for Fibrosis Research and Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Justin Kurian
- Center for Metabolic Disease Research, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Mohsin Khan
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Center for Metabolic Disease Research, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Yinfei Tan
- Genomic Facility, Cancer Biology Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Sadia Mohsin
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Pharmacology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Stefania Gallucci
- Department of Microbiology & Immunology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Timothy A McKinsey
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Consortium for Fibrosis Research and Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Steven R Houser
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| |
Collapse
|
22
|
Yadav S, Sethi R, Pradhan A, Vishwakarma P, Bhandari M, Gattani R, Chandra S, Chaudhary G, Sharma A, Dwivedi SK, Narain VS, Rao B, Roy A. 'Routine' versus 'Smart Phone Application Based - Intense' follow up of patients with acute coronary syndrome undergoing percutaneous coronary intervention: Impact on clinical outcomes and patient satisfaction. IJC HEART & VASCULATURE 2021; 35:100832. [PMID: 34235246 PMCID: PMC8250165 DOI: 10.1016/j.ijcha.2021.100832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 02/08/2023]
Abstract
Background Acute coronary syndrome (ACS) refers to the spectrum of clinical presentation of coronary artery disease (CAD). As a routine practice at our institute, following PCI, ACS patients are called for the first follow up after two weeks. This period of two weeks can be full of anxieties, concerns and medical issues. In this study, we planned to assess the feasibility/acceptability of smart phone application (app) based system for patient follow-up and its comparison to routine practice among patients with ACS who have undergone a PCI. Methods A randomized controlled trial (RCT) was conducted over a period of one year from January to December 2017. After the PCI was deemed successful, patients were recruited and enrolled based on the understanding of basic English language and operation of a smart phone. Those who consented to be part of study were then randomly allocated either the conventional follow up group or the intense follow up (routine + smart phone app based follow up) group. First co- primary outcome was composite of clinical outcomes (mortality, myocardial infarction, stroke, target vessel revascularisation, heart failure admission and emergency visit). Second co- primary outcome was patient satisfaction. The overall patient satisfaction was assessed by the patients using a five-point patient satisfaction survey instrument containing five questions with 5 marks each, in which higher scores meant more satisfaction. Secondary outcome was controlled hypertension in hypertensive patients. It was defined as systolic BP less than 130 and diastolic BP less than 80 mmHg. Results A cohort of 228 patients (109 in intense app-based arm; 119 in routine follow up arm) were analyzed. The result showed significant improvement in blood pressure control in hypertensive population in intense app based follow up group (76.2%) when compared to routine follow up group (45%) with p value 0.0062. The satisfaction score was significantly higher in the intense app based follow up (20.7 ± 1.29) as compared to routine follow up (16.5 ± 2.68); p value 0.0001. In the intense app based follow up 72.5% patient felt it was excellent tool (score 21-25) while 27.5% categorized it as good (score 16-20). While the routine follows up was perceived as good by most (91.6%) of the patients. Only 4.2% graded it as excellent and an equal number (4.2%) graded it as a poor way of follow up. Conclusions App based system shows higher satisfaction rate and comparable clinical outcome when compared to traditional hospital based follow up protocol alone. It has a high acceptance rate and thus this system should be explored further to optimize long term patient care.
Collapse
Affiliation(s)
| | - Rishi Sethi
- Department of Cardiology, King George's Medical University, Lucknow, India
| | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, India
| | | | - Monika Bhandari
- Department of Cardiology, King George's Medical University, Lucknow, India
| | | | - Sharad Chandra
- Department of Cardiology, King George's Medical University, Lucknow, India
| | - Gaurav Chaudhary
- Department of Cardiology, King George's Medical University, Lucknow, India
| | - Akhil Sharma
- Department of Cardiology, King George's Medical University, Lucknow, India
| | - S K Dwivedi
- Department of Cardiology, King George's Medical University, Lucknow, India
| | - V S Narain
- Department of Cardiology, King George's Medical University, Lucknow, India
| | - Bhawna Rao
- National AIDS Control Organisation, New Delhi, India
| | - Ambuj Roy
- Department of Cardiology, AIIMS, New Delhi, India
| |
Collapse
|
23
|
Abstract
Purpose of Review Controversy exists whether beta-blockers should be given before primary percutaneous coronary intervention (PCI) or to defer their administration for up to 24 hours. Recent Findings Animal studies, most of them conducted in the 1970s and 1980s, showed evidence that early beta-blocker administration may reduce infarct size. Subsequent human studies had mixed results on infarct size and survival. More specifically, in the current primary PCI era, only four studies evaluated the impact of early intravenous beta-blocker administration after acute myocardial infarction, only two of them before PCI. All studies agree that in hemodynamically stable patients, early intravenous beta-blocker administration is safe and protected against malignant arrhythmias. Nevertheless, results on infarct size and mortality are equivocal. Summary Considering the heterogeneity of currently available data, further studies are still needed to assess the benefit of early injection of metoprolol in STEMI patients in a large double-blinded and randomized design versus placebo.
Collapse
|
24
|
Califf RM, Curtis LH, Harrington RA, Hernandez AF, Peterson ED. Generating evidence for therapeutic effects: the need for well-conducted randomized trials. J Clin Invest 2021; 131:146391. [PMID: 33270604 PMCID: PMC7810467 DOI: 10.1172/jci146391] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Robert M. Califf
- Verily Life Sciences (Alphabet), South San Francisco, California, USA
- Stanford University School of Medicine, Stanford, California, USA
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Lesley H. Curtis
- Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Adrian F. Hernandez
- Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Eric D. Peterson
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| |
Collapse
|
25
|
Faridi KF, Tamez H, Butala NM, Song Y, Shen C, Secemsky EA, Mauri L, Curtis JP, Strom JB, Yeh RW. Comparability of Event Adjudication Versus Administrative Billing Claims for Outcome Ascertainment in the DAPT Study: Findings From the EXTEND-DAPT Study. Circ Cardiovasc Qual Outcomes 2021; 14:e006589. [PMID: 33435731 DOI: 10.1161/circoutcomes.120.006589] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data from administrative claims may provide an efficient alternative for end point ascertainment in clinical trials. However, it is uncertain how well claims data compare to adjudication by a clinical events committee in trials of patients with cardiovascular disease. METHODS We matched 1336 patients ≥65 years old who received percutaneous coronary intervention in the DAPT (Dual Antiplatelet Therapy) Study with the National Cardiovascular Data Registry CathPCI Registry linked to Medicare claims as part of the EXTEND (Extending Trial-Based Evaluations of Medical Therapies Using Novel Sources of Data) Study. Adjudicated trial end points were compared with Medicare claims data with International Classification of Diseases, Ninth Revision codes from inpatient hospitalizations using time-to-event analyses, sensitivity, specificity, positive predictive value, negative predictive value, and kappa statistics. RESULTS At 21-month follow-up, the cumulative incidence of major adverse cardiovascular and cerebrovascular events (combined mortality, myocardial infarction, and stroke) was similar between trial-adjudicated events and claims data (7.9% versus 7.2%, respectively; P=0.50). Bleeding rates were lower using adjudicated events compared with claims (5.0% versus 8.6%, respectively; P<0.001). The sensitivity and positive predictive value of comprehensive billing codes for identifying adjudicated events were 65.6% and 85.7% for myocardial infarction, 61.5% and 47.1% for stroke, and 76.8% and 39.3% for bleeding, respectively. Specificity and negative predictive value for all outcomes ranged from 93.7% to 99.5%. All 39 adjudicated deaths were identified using Medicare data. Kappa statistics assessing agreement between events for myocardial infarction, stroke, and bleeding were 0.73, 0.52, and 0.49, respectively. CONCLUSIONS Claims data had moderate agreement with adjudication for myocardial infarction and poor agreement but high specificity for bleeding and stroke in the DAPT Study. Deaths were identified equivalently. Using claims data in clinical trials could be an efficient way to assess mortality among Medicare patients and may help detect other outcomes, although additional monitoring is likely needed to ensure accurate assessment of events.
Collapse
Affiliation(s)
- Kamil F Faridi
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (K.F.F., J.P.C.).,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston MA (K.F.F., H.T., C.S., E.A.S., J.B.S., R.W.Y.)
| | - Hector Tamez
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston MA (K.F.F., H.T., C.S., E.A.S., J.B.S., R.W.Y.)
| | - Neel M Butala
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (N.M.B., R.W.Y.)
| | - Yang Song
- Baim Institute for Clinical Research, Boston, MA (Y.S., L.M.)
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston MA (K.F.F., H.T., C.S., E.A.S., J.B.S., R.W.Y.)
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston MA (K.F.F., H.T., C.S., E.A.S., J.B.S., R.W.Y.)
| | - Laura Mauri
- Baim Institute for Clinical Research, Boston, MA (Y.S., L.M.).,Brigham and Women's Hospital, Boston, MA (L.M.).,Medtronic, Minneapolis, MN (L.M.)
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (K.F.F., J.P.C.)
| | - Jordan B Strom
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston MA (K.F.F., H.T., C.S., E.A.S., J.B.S., R.W.Y.)
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston MA (K.F.F., H.T., C.S., E.A.S., J.B.S., R.W.Y.).,Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (N.M.B., R.W.Y.)
| |
Collapse
|
26
|
Nezami A, Tarhani F, Elahi S. Evaluation of Ischemic Heart Disease Factors in Hemophilia Patients in Khorramabad. Cardiovasc Hematol Disord Drug Targets 2020; 20:284-288. [PMID: 33256585 DOI: 10.2174/1871529x20666201130105100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Evaluation of risk factors associated with coronary artery disease and cardiac health in hemophilia patients is necessary to prevent the onset of ischemic heart disease. In this study, we evaluated the cardiovascular status of hemophilic patients in Lorestan province for the early onset of ischemic heart disease. METHODS In this cross-sectional descriptive study, a total of 80 patients presenting severe hemophilia, a detailed questionnaire-based investigation was conducted to analyze the prevalence of cardiovascular risk factors in severe hemophilic patients. In patients with hemophilia, body mass index (BMI), blood pressure, diabetes, LDL, cholesterol and HDL, the risk of cardiovascular death was estimated using a predictive risk predictor algorithm of Europe SCORE. RESULTS The mean age of the patients was 25 years, where all the patients were non-diabetic. Echocardiography did not show any wall motion abnormality and changes in the T wave and dysrhythmia were also not seen by ECG. 7 patients had high blood pressure, 11 had abnormal HDL, and 1 had abnormal LDL. In this study, serum LDL and HDL levels were not significantly correlated with age and BMI. Conversely, age and BMI were significantly associated with hypertension. Hypertension was observed in people over the age of 25 years and in overweighed individuals. 78.8% had normal BMI and 21.3% were overweighed. There was no significant correlation between serum LDL, serum HDL, and blood pressure and sex. The levels of abnormal LDL and HDL were higher in men than in women. CONCLUSION ECG findings from our study did not report any significant cardiac abnormalities among hemophilic patients. Cardiovascular risk factors were not significantly correlated in these patients.
Collapse
Affiliation(s)
- Alireza Nezami
- Department of Pediatric, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fariba Tarhani
- Department of Pediatric, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Sina Elahi
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| |
Collapse
|
27
|
Rea F, Ronco R, Pedretti RFE, Merlino L, Corrao G. Better adherence with out-of-hospital healthcare improved long-term prognosis of acute coronary syndromes: Evidence from an Italian real-world investigation. Int J Cardiol 2020; 318:14-20. [PMID: 32593725 DOI: 10.1016/j.ijcard.2020.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients who experience a hospital admission for acute coronary syndromes (ACS) exhibit poor prognosis over the years. The purposes of this study were to evaluate the real-world patterns of out-of-hospital practice in the management of ACS patients and to assess their impact on the risk of selected outcomes. METHODS The cohort of 87,530 residents in the Lombardy Region (Italy) who were newly hospitalised for ACS during 2011-2015 was followed until 2018. Exposure to medical treatment including use of selected drugs, diagnostic procedures and laboratory tests was recorded. The main outcome of interest was re-hospitalisation for cardiovascular (CV) outcomes. Proportional hazards models were fitted to estimate hazard ratio, and 95% confidence intervals (CI), for the exposure-outcome association. Analyses were stratified according to the ACS type. RESULTS The cumulative incidence of re-hospitalisation for CV disease was 33%, 42% and 38% at 5 years after index discharge among STEMI, NSTEMI and unstable angina patients. Within one year from index discharge, between 70% and 80% of patients had at least a prescription of statins, beta-blockers and renin-angiotensin-system blocking agents, underwent ECG and lipid profile examination, and had a cardiologic examination. One patient in five underwent cardiac rehabilitation. Compared with patients who did not adhere to healthcare recommendations, the risk of CV hospital readmission was reduced from 10% (95% CI: 4%-10%) to 23% (12%-32%) among patients who underwent lipid profile examinations and who experienced cardiac rehabilitation. CONCLUSION Close out-of-hospital healthcare must be considered the cornerstone for improving the long-term prognosis of ACS patients.
Collapse
Affiliation(s)
- Federico Rea
- National Center for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
| | - Raffaella Ronco
- National Center for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | | | - Luca Merlino
- National Center for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Epidemiologic Observatory, Lombardy Region Welfare Department, Milan, Italy
| | - Giovanni Corrao
- National Center for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
28
|
Sambola A, Elola FJ, Ferreiro JL, Murga N, Rodríguez-Padial L, Fernández C, Bueno H, Bernal JL, Cequier Á, Marín F, Anguita M. Impact of sex differences and network systems on the in-hospital mortality of patients with ST-segment elevation acute myocardial infarction. ACTA ACUST UNITED AC 2020; 74:927-934. [PMID: 32888884 DOI: 10.1016/j.rec.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/14/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES Network systems have achieved reductions in both time to reperfusion and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI). However, the data have not been disaggregated by sex. The aim of this study was to analyze the influence of network systems on sex differences in primary percutaneous coronary intervention (pPCI) and in-hospital mortality from 2005 to 2015. METHODS The Minimum Data Set of the Spanish National Health System was used to identify patients with STEMI. Logistic multilevel regression models and Poisson regression analysis were used to calculate risk-standardized in-hospital mortality ratios and incidence rate ratios (IRRs). RESULTS Of 324 998 STEMI patients, 277 281 were selected after exclusions (29% women). Even when STEMI networks were established, the use of reperfusion therapy (PCI, fibrinolysis, and CABG) was lower in women than in men from 2005 to 2015: 56.6% vs 75.6% in men and 36.4% vs 57.0% in women, respectively (both P<.001). pPCI use increased from 34.9% to 68.1% in men (IRR, 1.07) and from 21.7% to 51.7% in women (IRR, 1.08). The crude in-hospital mortality rate was higher in women (9.3% vs 18.7%; P<.001) but decreased from 2005 to 2015 (IRRs, 0.97 for men and 0.98 for women; both P < .001). Female sex was an independent risk factor for mortality (adjusted OR, 1.23; P<.001). The risk-standardized in-hospital mortality ratio was lower in women when STEMI networks were in place (16.9% vs 19.1%, P<.001). pPCI and the presence of STEMI networks were associated with lower in-hospital mortality in women (adjusted ORs, 0.30 and 0.75, respectively; both P<.001). CONCLUSIONS Women were less likely to receive pPCI and had higher in-hospital mortality than men throughout the 11-year study period, even with the presence of a network system for STEMI.
Collapse
Affiliation(s)
- Antonia Sambola
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Francisco Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (Fundación IMAS), Madrid, Spain
| | - José Luis Ferreiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nekane Murga
- Consejería de Salud del Gobierno Vasco, Vitoria, Álava, Spain
| | | | - Cristina Fernández
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (Fundación IMAS), Madrid, Spain; Servicio de Medicina Preventiva, Hospital Clínico Universitario San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Héctor Bueno
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (Fundación IMAS), Madrid, Spain; Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ángel Cequier
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Marín
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | - Manuel Anguita
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| |
Collapse
|
29
|
Abstract
PURPOSE OF REVIEW Significant racial and ethnic healthcare disparities exist in the management and outcomes of patients with acute myocardial infarction (AMI). This review will highlight the recent studies focusing on disparities in AMI care and how practice patterns have changed over time, and discuss solutions and future directions to overcome disparities in AMI care. RECENT FINDINGS AMI continues to be a leading cause of morbidity and mortality in the USA. Racial and ethnic disparities continue to be present in the care and outcomes associated with AMI. Non-white individuals continue to receive less guideline-concordant care and experience higher rates of adverse outcomes compared with white individuals. Health policy and quality improvement interventions have helped to narrow the gap; however, ongoing efforts are needed to continue to attempt to eliminate this disparity. Racial and ethnic disparities persist in the presentation, management, and outcomes of patients with AMI. Improvements in care have narrowed some of the inequalities. Ongoing research and efforts directed at improving access to care, eliminating bias in healthcare, and focusing on coronary heart disease prevention are needed to eliminate disparities.
Collapse
|
30
|
Crimmins EM, Zhang YS, Kim JK, Levine ME. Changing Disease Prevalence, Incidence, and Mortality Among Older Cohorts: The Health and Retirement Study. J Gerontol A Biol Sci Med Sci 2020; 74:S21-S26. [PMID: 31724057 DOI: 10.1093/gerona/glz075] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/08/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND This article investigates changes in disease prevalence, incidence, and mortality among four cohorts of older persons in the Health and Retirement Study. METHODS We examine two cohorts initially aged 51 to 61, whom we call younger cohorts, and two older cohorts aged 70 to 80 at the start of observation. Each of the paired cohorts was born about 10 years apart. We follow the cohorts for approximately 10 years. RESULTS The prevalence of cancer, stroke, and diabetes increased in later-born cohorts; while the prevalence of myocardial infarction decreased markedly in both later-born cohorts. The incidence of heart disease, myocardial infarction, and stroke decreased among those in the later-born older cohort; while only the incidence of myocardial infarction decreased in the later-born younger cohort. On the other hand, diabetes incidence increased among those in both later-born cohorts. Death rates among those with heart disease, cancer, and diabetes decreased in the later-born cohorts. The declining incidence of three cardiovascular conditions among those who are over age 70 reflects improving population health and has resulted in stemming the increase in prevalence of people with heart disease and stroke. DISCUSSION While these results provide some important signs of improving population health, especially among those over 70; trends for those less than 70 in the United States are not as positive.
Collapse
Affiliation(s)
- Eileen M Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles
| | - Yuan S Zhang
- Davis School of Gerontology, University of Southern California, Los Angeles
| | - Jung Ki Kim
- Davis School of Gerontology, University of Southern California, Los Angeles
| | - Morgan E Levine
- Department of Pathology, School of Medicine, Yale University, New Haven, Connecticut
| |
Collapse
|
31
|
Homeostatic Chemokines and Prognosis in Patients With Acute Coronary Syndromes. J Am Coll Cardiol 2020; 74:774-782. [PMID: 31395128 DOI: 10.1016/j.jacc.2019.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/05/2019] [Accepted: 06/05/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND The chemokines CCL19 and CCL21 are up-regulated in atherosclerotic disease and heart failure, and increased circulating levels are found in unstable versus stable coronary artery disease. OBJECTIVES The purpose of this study was to evaluate the prognostic value of CCL19 and CCL21 in acute coronary syndrome (ACS). METHODS CCL19 and CCL21 levels were analyzed in serum obtained from ACS patients (n = 1,146) on the first morning after hospital admission. Adjustments were made for GRACE (Global Registry of Acute Coronary Events) score, left ventricular ejection fraction, pro-B-type natriuretic peptide, troponin I, and C-reactive protein levels. RESULTS The major findings were: 1) those having fourth quartile levels of CCL21 on admission of ACS had a significantly higher long-term (median 98 months) risk of major adverse cardiovascular events (MACE) and myocardial infarction in fully adjusted multivariable models; 2) high CCL21 levels at admission were also independently associated with MACE and cardiovascular mortality during short-time (3 months) follow-up; and 3) high CCL19 levels at admission were associated with the development of heart failure. CONCLUSIONS CCL21 levels are independently associated with outcome after ACS and should be further investigated as a promising biomarker in these patients.
Collapse
|
32
|
Balla S, Alqahtani F, Alhajji M, Alkhouli M. Cardiovascular Outcomes and Rehospitalization Rates in Homeless Patients Admitted With Acute Myocardial Infarction. Mayo Clin Proc 2020; 95:660-668. [PMID: 32200979 DOI: 10.1016/j.mayocp.2020.01.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/27/2019] [Accepted: 01/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the in-hospital outcomes and 30-day readmission data in homeless patients admitted with acute myocardial infarction (AMI). METHODS Adult patients (>18 years of age) who were admitted with AMI between January 1, 2015, and December 31, 2016, were identified in the National Readmission Database. Patients were classified into homeless or non-homeless. Baseline characteristics, rates of invasive assessment and revascularization, mortality, 30-day readmission rates, and reasons for readmission were compared between the 2 cohorts. RESULTS A total of 3938 of 1,100,241 (0.4%) index hospitalizations for AMI involved homeless patients. Compared with non-homeless patients, homeless patients were younger (mean age, 57±10 years vs 68±14 years; P<.001) and had a lower prevalence of atherosclerotic risk factors (hypertension, hyperlipidemia, and diabetes) but a higher prevalence of anxiety, depression, and substance abuse. Homeless patients were less likely to undergo coronary angiography (38.1% vs 54%; P<.001), percutaneous coronary intervention (24.1% vs 38.7%; P<.001), or coronary artery bypass grafting (4.9% vs 6.7%; P<.001). Among patients who underwent percutaneous coronary intervention, bare-metal stent use was higher in homeless patients (34.6% vs 12.1%; P<.001). After propensity score matching, homeless patients had similar mortality but higher rates of acute kidney injury, discharge to an intermediate care facility or against medical advice, and longer hospitalizations. Thirty-day readmission rates were significantly higher in homeless patients (22.5% vs 10%; P<.001). Homeless patients had more readmissions for psychiatric causes (18.0% vs 2.0%; P<.001). CONCLUSION Considerable differences in cardiovascular risk profile, in-hospital care, and rehospitalization rates were observed in the homeless compared with non-homeless cohort with AMI. Measures to remove the health care barriers and disparities are needed.
Collapse
Affiliation(s)
- Sudarshan Balla
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown
| | - Fahad Alqahtani
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown
| | - Mohamed Alhajji
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
33
|
Lernfelt G, Mandalenakis Z, Hornestam B, Lernfelt B, Rosengren A, Sundh V, Hansson PO. Atrial fibrillation in the elderly general population: a 30-year follow-up from 70 to 100 years of age. SCAND CARDIOVASC J 2020; 54:232-238. [PMID: 32079431 DOI: 10.1080/14017431.2020.1729399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives. There is limited knowledge of atrial fibrillation (AF) incidence among the very old. Data from longitudinal cohort studies may give us a better insight. The aim of the study was to investigate the incidence rate and prevalence of AF, as well as the impact of AF on mortality, in the general population, from 70 to 100 years of age. Design. This was a population-based prospective cohort study where three representative samples of 70-year-old men and women (n = 2,629) from the Gerontological and Geriatric Populations Studies in Gothenburg (H-70) were included between 1971 and 1982. The participants were examined at age 70 years and were re-examined repeatedly until 100 years of age. AF was diagnosed according to a 12-lead electrocardiogram (ECG) recording at baseline and follow-up examinations, from the Swedish National Patient Register (NPR), or from the Cause of Death Register. Results. The cumulative incidence of AF from 70 to 100 years of age was 65.6% for men and 52.8% for women. Mortality was significantly higher in participants with AF compared with those without, rate ratio (RR) 1.92 (95% CI 1.73-2.14). In a subgroup analysis comprising only participants with AF diagnosed by ECG at screening, the RR for death was 1.29 (95% C.I: 1.03-1.63). Conclusions. Among persons surviving to age 70, the cumulative incidence of AF was over 50% during follow-up. Mortality rate was twice as high in participants with AF compared to participants without AF. Among participants with AF first recorded at a screening examination, the increased risk was only 29%.
Collapse
Affiliation(s)
- Gustaf Lernfelt
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Hornestam
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bodil Lernfelt
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Valter Sundh
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Per-Olof Hansson
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
34
|
Brainin P, Haahr-Pedersen S, Olsen FJ, Holm AE, Fritz-Hansen T, Jespersen T, Gislason G, Biering-Sørensen T. Early Systolic Lengthening in Patients With ST-Segment-Elevation Myocardial Infarction: A Novel Predictor of Cardiovascular Events. J Am Heart Assoc 2020; 9:e013835. [PMID: 31973603 PMCID: PMC7033900 DOI: 10.1161/jaha.119.013835] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Early systolic lengthening (ESL) may occur in ischemic myocardial segments with reduced contractile force. We sought to evaluate the prognostic potential of ESL in patients with ST‐segment–elevation myocardial infarction treated with primary percutaneous coronary intervention. Methods and Results We prospectively enrolled 373 patients with ST‐segment–elevation myocardial infarction treated with primary percutaneous coronary intervention. All patients underwent a speckle tracking echocardiographic examination a median of 2 days (interquartile range, 1–3 days) after the percutaneous coronary intervention. We assessed a novel viability index, the ESL index, defined as follows: [−100×(peak positive systolic strain/peak negative strain in cardiac cycle)]. We also calculated ESL duration, defined as time from onset of QRS complex on the ECG to time of peak positive systolic strain. Both parameters were averaged from 18 myocardial segments. During a median follow‐up of 5.3 years (interquartile range, 2.5–6.0 years), 145 (39%) experienced major adverse cardiovascular events, a composite of incident heart failure, new myocardial infarction, and all‐cause mortality. The ESL index and ESL duration were significantly increased in culprit lesion areas (6.7±6.2% versus 5.0±4.1% and 43±33 ms versus 33±24 ms, respectively; P<0.001 for both). In Cox proportional hazard models, the ESL index (hazard ratio, 1.27 per 1% increase; 95% CI, 1.13–1.43; P<0.001) and ESL duration (hazard ratio, 1.49 per 1‐ms increase; 95% CI, 1.15–1.92; P=0.002) yielded prognostic information on major adverse cardiovascular events. Both associations remained significant after adjusting for clinical, echocardiographic, and invasive confounders. Conclusions Assessment of ESL after primary percutaneous coronary intervention in patients with ST‐segment–elevation myocardial infarction yields independent and significant prognostic information on the future risk of cardiovascular events.
Collapse
Affiliation(s)
- Philip Brainin
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Sune Haahr-Pedersen
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Flemming Javier Olsen
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Anna Engell Holm
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences University of Copenhagen Denmark
| | - Gunnar Gislason
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark.,Department of Biomedical Sciences University of Copenhagen Denmark
| |
Collapse
|
35
|
Hajduk AM, Murphy TE, Geda ME, Dodson JA, Tsang S, Haghighat L, Tinetti ME, Gill TM, Chaudhry SI. Association Between Mobility Measured During Hospitalization and Functional Outcomes in Older Adults With Acute Myocardial Infarction in the SILVER-AMI Study. JAMA Intern Med 2019; 179:1669-1677. [PMID: 31589285 PMCID: PMC6784755 DOI: 10.1001/jamainternmed.2019.4114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/28/2019] [Indexed: 12/17/2022]
Abstract
Importance Many older survivors of acute myocardial infarction (AMI) experience functional decline, an outcome of primary importance to older adults. Mobility impairment has been proposed as a risk factor for functional decline but has not been evaluated to date in older patients hospitalized for AMI. Objective To examine the association of mobility impairment, measured during hospitalization, as a risk marker for functional decline among older patients with AMI. Design, Setting, and Participants Prospective cohort study among 94 academic and community hospitals in the United States. Participants were 2587 hospitalized patients with AMI who were 75 years or older. The study dates were January 2013 to June 2017. Main Outcomes and Measures Mobility was evaluated during AMI hospitalization using the Timed "Up and Go," with scores categorized as preserved mobility (≤15 seconds to complete), mild impairment (>15 to ≤25 seconds to complete), moderate impairment (>25 seconds to complete), and severe impairment (unable to complete). Self-reported function in activities of daily living (ADLs) (bathing, dressing, transferring, and walking around the home) and walking 0.4 km (one-quarter mile) was assessed at baseline and 6 months after discharge. The primary outcomes were worsening of 1 or more ADLs and loss of ability to walk 0.4 km from baseline to 6 months after discharge. The association between mobility impairment and risk of functional decline was evaluated with multivariable-adjusted logistic regression. Results Among 2587 hospitalized patients with AMI, the mean (SD) age was 81.4 (4.8) years, and 1462 (56.5%) were male. More than half of the cohort exhibited mobility impairment during AMI hospitalization (21.8% [564 of 2587] had mild impairment, 16.0% [414 of 2587] had moderate impairment, and 15.2% [391 of 2587] had severe impairment); 12.8% (332 of 2587) reported ADL decline, and 16.7% (431 of 2587) reported decline in 0.4-km mobility. Only 3.8% (30 of 800) of participants with preserved mobility experienced any ADL decline compared with 6.9% (39 of 564) of participants with mild impairment (adjusted odds ratio [aOR], 1.24; 95% CI, 0.74-2.09), 18.6% (77 of 414) of participants with moderate impairment (aOR, 2.67; 95% CI, 1.67-4.27), and 34.7% (136 of 391) of participants with severe impairment (aOR, 5.45; 95% CI, 3.29-9.01). Eleven percent (90 of 800) of participants with preserved mobility declined in ability to walk 0.4 km compared with 15.2% (85 of 558) of participants with mild impairment (aOR, 1.51; 95% CI, 1.04-2.20), 19.0% (78 of 411) of participants with moderate impairment (aOR, 2.03; 95% CI, 1.37-3.02), and 24.6% (95 of 386) of participants with severe impairment (aOR, 3.25; 95% CI, 2.02-5.23). Conclusions and Relevance This study's findings suggest that mobility impairment assessed during hospitalization may be a potent risk marker for functional decline in older survivors of AMI. These findings also suggest that brief, validated assessments of mobility should be part of the care of older hospitalized patients with AMI to identify those at risk for this important patient-centered outcome.
Collapse
Affiliation(s)
- Alexandra M. Hajduk
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Terrence E. Murphy
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mary E. Geda
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - John A. Dodson
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Sui Tsang
- Department of Medicine, NYU Langone Health, New York, New York
| | - Leila Haghighat
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mary E. Tinetti
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
36
|
Singh GM, Becquart N, Cruz M, Acevedo A, Mozaffarian D, Naumova EN. Spatiotemporal and Demographic Trends and Disparities in Cardiovascular Disease Among Older Adults in the United States Based on 181 Million Hospitalization Records. J Am Heart Assoc 2019; 8:e012727. [PMID: 31658854 PMCID: PMC6898811 DOI: 10.1161/jaha.119.012727] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The US population is aging, with concurrent increases in cardiovascular disease (CVD) burdens; however, spatiotemporal and demographic trends in CVD incidence in the US elderly have not been investigated in detail. This study aims to characterize trends from 1991 to 2014 in CVD hospitalizations among US Medicare beneficiaries, aged 65+ years, by single year of age/sex/race/state using records from the US Centers for Medicare & Medicaid, covering 98% of older Americans. Methods and Results We abstracted 181 202 758 US Centers for Medicare & Medicaid hospitalization records indicating CVD in any of 10 diagnosis codes; tabulated total cases of CVD by sex, age, race, state, and calendar year (1991–2014); and normalized hospitalization counts to standardize over data batches. Stratum‐specific hospitalization rates were calculated using US Centers for Medicare & Medicaid records and US Census population counts; a cubic polynomial function was fit to year‐specific distributions of rates by single year of age. Nationwide, CVD‐related hospitalization rates increased from 1991 to 2014. Differences between hospitalization rates at age 65 and 66 years, representing magnitude of healthcare deferral until Medicare onset, increased by 7.49 per 100 people 1991 to 2006 overall, and were largest among blacks and Native Americans. Rates of CVD hospitalizations were consistently highest in the Midwest/Deep South. Evidence of misclassification of race/ethnicity in US Centers for Medicare & Medicaid hospitalization records in the 1990s was noted. Conclusions Trends in CVD‐related hospitalization rates among older Americans highlight the essential need for targeted policies to reduce CVD burdens, to improve reporting of race/ethnicity in large administrative databases, and to enhance access to affordable healthcare.
Collapse
Affiliation(s)
| | - Ninon Becquart
- Tufts Friedman School of Nutrition Science & Policy Boston MA
| | - Melissa Cruz
- Tufts Friedman School of Nutrition Science & Policy Boston MA
| | - Andrea Acevedo
- Department of Community Health Tufts University Medford MA
| | | | - Elena N Naumova
- Tufts Friedman School of Nutrition Science & Policy Boston MA
| |
Collapse
|
37
|
Baldetti L, Beneduce A, Pappalardo F. Primary mechanical unloading in high-risk myocardial infarction: Perspectives in view of a paradigm shift. Int J Cardiol 2019; 293:32-38. [DOI: 10.1016/j.ijcard.2019.05.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/24/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
|
38
|
Elkoustaf RA, Aldaas OM, Batiste CD, Mercer A, Robinson M, Newton D, Burchett R, Cornelius C, Patterson H, Ismail MH. Lifestyle Interventions and Carotid Plaque Burden: A Comparative Analysis of Two Lifestyle Intervention Programs in Patients with Coronary Artery Disease. Perm J 2019; 23:18.196. [PMID: 31634108 DOI: 10.7812/tpp/18.196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The cardioprotective effects of intensive lifestyle regimens in primary prevention have been elucidated; however, there is a paucity of data comparing the effects of different lifestyle regimens in patients with established coronary artery disease (CAD) or CAD equivalent, specifically vis-à-vis carotid plaque regression. METHODS We performed a randomized, single-center, single-blind study in 120 patients with established CAD. Patients were randomly assigned to either 9 months of the Complete Health Improvement Program (CHIP), an outpatient lifestyle enrichment program that focuses on improving dietary choices, enhancing daily exercise, increasing support systems, and decreasing stress; or to 9 months of an ad hoc, nonsequential combination of various healthy living classes offered separately through a health maintenance organization and referred to as the Healthy Heart program. Baseline and 9-month change in carotid intima-media thickness (CIMT) were measured. RESULTS Among 120 participants, data were analyzed for 79, of which 68 (86%) completed the study. Both average CIMT and average maximum CIMT increased over 9 months, but the changes between groups were insignificant. There were marked differences in the mean body mass index favoring the CHIP group (-1.9 [standard deviation = 1.9]; p < 0.001) and statistically significant within-group improvements in blood pressure, triglyceride level, 6-minute walk test result, self-assessment well-being score, and Patient Health Questionnaire-9 score that were not observed between groups. CONCLUSION Neither the CHIP nor Healthy Heart was effective in inducing plaque regression in patients with established CAD after a 9-month period. However, both were effective in improving several CAD risk factors, which shows that the nonsequential offering of healthy lifestyle programs can lead to similar outcomes as a formal, sequential, established program (CHIP) in many aspects. These results have important implications as to how lifestyle changes will be implemented as tertiary prevention measures in the future.
Collapse
Affiliation(s)
| | - Omar M Aldaas
- Department of Medicine, University of California, San Diego, CA
| | | | - Adina Mercer
- Department of Family Medicine, Riverside Medical Center, CA
| | | | - Darlene Newton
- Department of Preventive Medicine, Riverside Medical Center, CA
| | - Raoul Burchett
- Department of Preventive Medicine, Riverside Medical Center, CA
| | | | | | | |
Collapse
|
39
|
|
40
|
Mortality following first-time hospitalization with acute myocardial infarction in Norway, 2001-2014: Time trends, underlying causes and place of death. Int J Cardiol 2019; 294:6-12. [PMID: 31387821 DOI: 10.1016/j.ijcard.2019.07.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/19/2019] [Accepted: 07/28/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Trends on cause-specific mortality following acute myocardial infarction (AMI) are poorly described and no studies have analyzed where do AMI patients die. We analyzed trends in 28-day and one-year mortality following an incident AMI with focus on changes over time in the underlying cause and place of death. METHODS We identified in the 'Cardiovascular Disease in Norway' Project all patients 25+ years, hospitalized with an incident AMI in Norway, 2001-2014. Information on date, underlying cause and place of death was obtained from the Cause of Death Registry. RESULTS Of 144,473 patients included in the study, 11.4% died within first 28 days. The adjusted 28-day mortality declined by 5.2% per year (ptrend < 0.001). Of 118,881 patients surviving first 28 days, 10.1% died within one year. The adjusted one-year CVD mortality declined by 6.2% per year (ptrend < 0.001) while non-CVD mortality increased by 1.4% per year (ptrend < 0.001), mainly influenced by increased risk of dying from neoplasms. We observed a shift over time in the underlying cause of death toward more non-CVD deaths, and in the place of death toward more deaths occurring in nursing homes. CONCLUSIONS We observed a decline in 28-day mortality following an incident AMI hospitalization. One-year CVD mortality declined while one-year risk of dying from non-CVD conditions increased. The resulting shift toward more non-CVD deaths and deaths occurring outside a hospital need to be considered when formulating priorities in treating and preventing adverse events among AMI survivors.
Collapse
|
41
|
Palasubramaniam J, Wang X, Peter K. Myocardial Infarction-From Atherosclerosis to Thrombosis. Arterioscler Thromb Vasc Biol 2019; 39:e176-e185. [PMID: 31339782 DOI: 10.1161/atvbaha.119.312578] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Jathushan Palasubramaniam
- From the Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia (J.P., X.W., K.P.).,Department of Medicine, Monash University, Melbourne, Australia (J.P., X.W., K.P.).,Department of Cardiology, Alfred Hospital, Melbourne, Australia (J.P., K.P.)
| | - Xiaowei Wang
- From the Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia (J.P., X.W., K.P.).,Department of Medicine, Monash University, Melbourne, Australia (J.P., X.W., K.P.)
| | - Karlheinz Peter
- From the Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia (J.P., X.W., K.P.).,Department of Medicine, Monash University, Melbourne, Australia (J.P., X.W., K.P.).,Department of Cardiology, Alfred Hospital, Melbourne, Australia (J.P., K.P.)
| |
Collapse
|
42
|
Radisauskas R, Kirvaitiene J, Bernotiene G, Virviciutė D, Ustinaviciene R, Tamosiunas A. Long-Term Survival after Acute Myocardial Infarction in Lithuania during Transitional Period (1996-2015): Data from Population-Based Kaunas Ischemic Heart Disease Register. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:medicina55070357. [PMID: 31324034 PMCID: PMC6681332 DOI: 10.3390/medicina55070357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/02/2019] [Indexed: 01/14/2023]
Abstract
Background and Objective: There is a lack of reliable epidemiological data on the long-term survival after acute myocardial infarction (AMI) in the Lithuanian population. The aim of the study was to evaluate the long-term (36 months) survival after AMI among persons aged 25–64 years, who had experienced AMI in four time-periods 1996, 2003–2004, 2008, and 2012. Material and Methods: The source of the data was Kaunas population-based Ischemic heart disease (IHD) register. Long-term survival after AMI (36 months) was evaluated using the Kaplan–Meier method. The survival curves significantly differed when p < 0.05. Hazard ratio for all-cause mortality and their 95% CIs, adjusted for baseline characteristics, were estimated with the Cox proportional hazards regression model. Results: The analysis of data on 36 months long-term survival among Kaunas population by sex and age groups showed that the survival rates among men and women were 83.4% and 87.6%, respectively (p < 0.05) and among 25–54 years-old and 55–64 years-old persons, 89.2% and 81.7%, respectively (p < 0.05). The rates of long-term survival of post-AMI Kaunas population were better in past periods than in first period. According to the data of the Kaplan-Meier survival analysis, long-term survival of 25 to 64-year-old post-AMI Kaunas population was without significantly difference in 1996, 2003–2004, 2008 and 2012 (Log-rank = 6.736, p = 0.081). The adjusted risk of all-cause mortality during 36 months among men and 25 to 54-year-old patients was on the average by 35% and 60% lower in 2012 than in 1996, respectively. Conclusion: It was found that 36 months survival post MI among women and younger (25–54 years) persons was significant better compared to men and older (55–64 years) persons. Long-term survival among 55 to 64-year-old post-AMI Kaunas population had a tendency to decrease during last period, while among 25–54 years old persons long-term survival was without significant changes. The results highlight the fact that AMI survivors, especially in youngest age, remain a high-risk group and reinforce the importance of primary and secondary prevention for the improvement of long-term prognosis of AMI patients.
Collapse
Affiliation(s)
- Ricardas Radisauskas
- Department of Environmental and Occupational Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania.
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50103 Kaunas, Lithuania.
| | - Jolita Kirvaitiene
- Department of Environmental and Occupational Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania
| | - Gailutė Bernotiene
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50103 Kaunas, Lithuania
| | - Dalia Virviciutė
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50103 Kaunas, Lithuania
| | - Ruta Ustinaviciene
- Department of Environmental and Occupational Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania
| | - Abdonas Tamosiunas
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50103 Kaunas, Lithuania
- Department of Preventive Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania
| |
Collapse
|
43
|
Malki N, Hägg S, Tiikkaja S, Koupil I, Sparén P, Ploner A. Short-term and long-term case-fatality rates for myocardial infarction and ischaemic stroke by socioeconomic position and sex: a population-based cohort study in Sweden, 1990-1994 and 2005-2009. BMJ Open 2019; 9:e026192. [PMID: 31278093 PMCID: PMC6615790 DOI: 10.1136/bmjopen-2018-026192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Case-fatality rates (CFRs) for myocardial infarction (MI) and ischaemic stroke (IS) have decreased over time due to better prevention, medication and hospital care. It is unclear whether these improvements have been equally distributed according to socioeconomic position (SEP) and sex. The aim of this study is to analyse differences in short-term and long-term CFR for MI and IS by SEP and sex between the periods 1990-1994 to 2005-2009 for the entire Swedish population. DESIGN Population-based cohort study based on Swedish national registers. METHODS We used logistic regression and flexible parametric models to estimate short-term CFR (death before reaching the hospital or on the disease event day) and long-term CFR (1 year case-fatality conditional on surviving short-term) across five distinct SEP groups, as well as CFR differences (CFRDs) between SEP groups for both MI and IS from 1990-1994 to 2005-2009. : Result S: Overall short-term CFR for both MI and IS decreased between study periods. For MI, differences in short-term and long-term CFR between the least and most favourable SEP group were generally stable, except in long-term CFR among women; intermediate SEP groups mostly managed to catch up with the most favourable SEP group. For IS, short-term CFRD generally decreased compared with the most favourable group; but long-term CFRD were mostly stable, except for an increase for older subjects. CONCLUSION Despite a general decline in CFR for MI and IS across all SEP groups and both sexes as well as some reductions in CFRD, we found persistent and even increasing CFRD among the least advantaged SEP groups, older patients and women. We speculate that targeted prevention rather than treatment strategies have the potential to reduce these inequalities.
Collapse
Affiliation(s)
- Ninoa Malki
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sara Hägg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sanna Tiikkaja
- Centre of Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Ilona Koupil
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Ploner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
44
|
Chen L, Han L, Luo J. Selection of percutaneous coronary intervention in elderly patients with acute myocardial infarction in tertiary hospital. Medicine (Baltimore) 2019; 98:e16544. [PMID: 31335736 PMCID: PMC6709021 DOI: 10.1097/md.0000000000016544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To investigate the status of percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI) and analyze the reasons for not receiving PCI.A cohort of 387 consecutive hospitalized AMI patients aged ≥80 years were recruited from 2005 to 2014. Their clinical data were collected and analyzed.Among 387 elderly patients with AMI (190 men and 197 women, mean age 84.1 ± 3.9 years), there were 171 patients with ST-elevation myocardial infarction (STEMI) and 216 patients with non-ST-elevation myocardial infarction (NSTEMI). The emergency and elective PCI treatment rate was 40.6% and 12.1%, respectively, in patients with STEMI; and 1% and 18%, respectively, in patients with NSTEMI. PCI treatment rate of elderly AMI patients enrolled after 2009 showed no significant difference compared to that before 2009 (P > .05). The in-hospital mortality decreased significantly in PCI treatment group. After adjustment for age, sex, and other factors, PCI treatment was identified as the independent protective factors for in-hospital mortality (odds ratio = 0.323, 95% confidence interval 0.147-0.710, P = .005). The main influence factors for not receiving PCI treatment were hemorrhage, severe renal dysfunction, infection, or severe anemia-associated complications, whereas delayed treatment was the important reason for patients not undergoing emergency PCI.PCI treatment is the independent protective factor for in-hospital mortality of elderly patients with AMI. Due to various complications, PCI treatment rate is still low in elderly patients with AMI and has not been improved recently. Paying attention to performing PCI treatment for elderly patients with AMI has positive significance.
Collapse
|
45
|
White HD. Adjunctive antithrombotic therapy with primary percutaneous coronary intervention in ST elevation myocardial infarction: ATOLL in perspective. Eur Heart J 2019; 40:e4-e7. [PMID: 21990262 DOI: 10.1093/eurheartj/ehq317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag, Auckland, New Zealand
| |
Collapse
|
46
|
Wu Y, Li M, Tian Y, Cao Y, Song J, Huang Z, Wang X, Hu Y. Short-term effects of ambient fine particulate air pollution on inpatient visits for myocardial infarction in Beijing, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:14178-14183. [PMID: 30859442 DOI: 10.1007/s11356-019-04728-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 02/27/2019] [Indexed: 06/09/2023]
Abstract
The effects of ambient fine particulate matter (PM2.5) on the incidence of myocardial infarction have been reported, but little is known about this association in China. We conducted a time-series study of ambient PM2.5 concentrations and inpatient visits for myocardial infarction in Beijing. A generalized additive model with a Poisson link was applied to estimate the percentage change in inpatient visits for myocardial infarction following a 10-μg/m3 increase in PM2.5 concentrations. A total of 15,432 inpatient visits for myocardial infarction were identified between January 1, 2010, and June 30, 2012. A 10-μg/m3 increase in PM2.5 concentrations was associated with a 0.46% (P ≤ 0.001) increase in daily inpatient visits for myocardial infarction. Males were more sensitive to the adverse effects, and the association was more significant during the warm season (May through October). Short-term exposure to PM2.5 was associated with increased risk of inpatient visits for myocardial infarction in Beijing. The findings may be useful in developing more accurate targeted interventions.
Collapse
Affiliation(s)
- Yao Wu
- School of Public Health, Peking University, Beijing, 100191, China
| | - Man Li
- School of Public Health, Peking University, Beijing, 100191, China
| | - Yaohua Tian
- School of Public Health, Peking University, Beijing, 100191, China
| | - Yaying Cao
- School of Public Health, Peking University, Beijing, 100191, China
| | - Jing Song
- School of Public Health, Peking University, Beijing, 100191, China
| | - Zhe Huang
- School of Public Health, Peking University, Beijing, 100191, China
| | - Xiaowen Wang
- School of Public Health, Peking University, Beijing, 100191, China
| | - Yonghua Hu
- School of Public Health, Peking University, Beijing, 100191, China.
| |
Collapse
|
47
|
Nakao K, Yasuda S, Nishimura K, Noguchi T, Nakai M, Miyamoto Y, Sumita Y, Shishido T, Anzai T, Ito H, Tsutsui H, Saito Y, Komuro I, Ogawa H. Prescription Rates of Guideline-Directed Medications Are Associated With In-Hospital Mortality Among Japanese Patients With Acute Myocardial Infarction: A Report From JROAD - DPC Study. J Am Heart Assoc 2019; 8:e009692. [PMID: 30909774 PMCID: PMC6509709 DOI: 10.1161/jaha.118.009692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The JROAD‐DPC (Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination) is a nationwide claims database comprised of the Japanese DPC/Per Diem Payment System. This study aimed to investigate the relationship between prescription rates of guideline‐directed medications in each hospital and in‐hospital mortality among patients with acute myocardial infarction. Methods and Results A total of 61 838 Japanese patients from 741 hospitals with acute myocardial infarction between 2012 and 2013 were enrolled. The relationship between prescription rates of 4 guideline‐directed medications for acute myocardial infarction and in‐hospital mortality was analyzed. There were variations in the prescription ratio of β‐blockers on admission (median prescription rate 23% [interquartile range 11% to 38%]) and at discharge (51% [36% to 63%]), and of angiotensin converting enzyme/receptor blocker (60% [47% to 70%]). The highest prescription rate quartile of each medication was associated with a significantly lower mortality compared with the lowest prescription rate quartile (aspirin on admission, incidence rate ratio 0.67 [95% CI 0.61‐0.74], P<0.001; aspirin at discharge, incidence rate ratio 0.50 [95% CI 0.46‐0.55], P<0.001; β‐blocker on admission, 0.83 [0.76‐0.92], P<0.001; β‐blocker at discharge, 0.78 [0.71‐0.85], P<0.001; angiotensin converting enzyme/receptor blocker, 0.68 [0.62‐0.75], P<0.001; statin, 0.63 [0.57‐0.70], P<0.001). The composite prescription score was inversely associated with in‐hospital mortality (β coefficient=−0.48, P<0.001) and was closer to the plateau in the high‐score range (median mortality for composite prescription scores of 6, 15, and 24 were 10.6%, 6.8%, and 4.6%, respectively). Conclusions The prescription rates of guideline‐directed medications for treatment of Japanese acute myocardial infarction patients were inversely associated with in‐hospital mortality.
Collapse
Affiliation(s)
- Kazuhiro Nakao
- 1 National Cerebral and Cardiovascular Center Suita Japan
| | - Satoshi Yasuda
- 1 National Cerebral and Cardiovascular Center Suita Japan
| | | | - Teruo Noguchi
- 1 National Cerebral and Cardiovascular Center Suita Japan
| | | | | | - Yoko Sumita
- 1 National Cerebral and Cardiovascular Center Suita Japan
| | | | - Toshihisa Anzai
- 2 Hokkaido University Graduate School of Medicine Hokkaido Japan
| | - Hiroshi Ito
- 3 Okayama University Medical School Okayama Japan
| | - Hiroyuki Tsutsui
- 4 Department of Cardiovascular Medicine Faculty of Medical Sciences Kyushu University Fukuoka Japan
| | - Yoshihiko Saito
- 5 Nara Medical University School of Medicine Kashihara Japan
| | - Issei Komuro
- 6 Graduate School of Medicine and Faculty of Medicine Tokyo University Tokyo Japan
| | - Hisao Ogawa
- 1 National Cerebral and Cardiovascular Center Suita Japan
| |
Collapse
|
48
|
Krumholz HM, Normand SLT, Wang Y. Twenty-Year Trends in Outcomes for Older Adults With Acute Myocardial Infarction in the United States. JAMA Netw Open 2019; 2:e191938. [PMID: 30874787 PMCID: PMC6484647 DOI: 10.1001/jamanetworkopen.2019.1938] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Medicare and other organizations have focused on improving quality of care for patients with acute myocardial infarction (AMI) over the last 2 decades. However, there is no comprehensive perspective on the evolution of outcomes for AMI during that period, and it is unknown whether temporal changes varied by patient subgroup, hospital, or county. OBJECTIVE To provide a comprehensive evaluation of national trends in inpatient outcomes and costs of AMI during this period. DESIGN, SETTING, AND PARTICIPANTS This cohort study included analysis of data from a sample of 4 367 485 Medicare fee-for-service beneficiaries aged 65 years or older from January 1, 1995, through December 31, 2014, across 5680 hospitals in the United States. Analyses were conducted from January 15 to June 5, 2018. MAIN OUTCOMES AND MEASURES Thirty-day all-cause mortality at the patient, hospital, and county levels. Additional outcomes included 30-day all-cause readmissions; 1-year recurrent AMI; in-hospital mortality; length of hospital stay; 2014 Consumer Price Index-adjusted median Medicare inpatient payment per AMI discharge; and rates of catheterization, percutaneous coronary intervention, and coronary artery bypass graft surgery. RESULTS The cohort included 4 367 485 Medicare fee-for-service patients aged 65 years or older hospitalized for AMI during the study period. Between 1995 and 2014, the mean (SD) age of patients increased from 76.9 (7.2) to 78.2 (8.7) years, the percentage of female patients declined from 49.5% to 46.1%, the percentage of white patients declined from 91.0% to 86.2%, and the percentage of black patients increased from 5.9% to 8.0%. There were declines in AMI hospitalizations (914 to 566 per 100 000 beneficiary-years); 30-day mortality (20.0% to 12.4%; difference, 7.6 percentage points; 95% CI, 7.3-7.8 percentage points); 30-day all-cause readmissions (21.0% to 15.3%; difference, 5.7 percentage points; 95% CI, 5.4-6.0 percentage points); and 1-year recurrent AMI (7.1% to 5.1%; difference, 2.0 percentage points; 95% CI, 1.8-2.2 percentage points). There were increases in the 2014 Consumer Price Index-adjusted median (interquartile range) Medicare inpatient payment per AMI discharge ($9282 [$6969-$12 173] to $11 031 [$8099-$16 861]); 30-day inpatient catheterization (44.2% to 59.9%; difference, 15.7 percentage points; 95% CI, 15.4-16.0 percentage points); and inpatient percutaneous coronary intervention (18.8% to 43.3%; difference, 24.5 percentage points; 95% CI, 24.2-24.7 percentage points). Coronary artery bypass graft surgery rates decreased from 14.4% to 10.2% (difference, 4.2 percentage points; 95% CI, 3.9-4.3 percentage points). There was heterogeneity by hospital and county in the mortality changes over time. CONCLUSIONS AND RELEVANCE This study shows marked improvements in short-term mortality and readmissions, with an increase in in-hospital procedures and payments, for the increasingly smaller number of Medicare beneficiaries with AMI.
Collapse
Affiliation(s)
- Harlan M. Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
| | - Sharon-Lise T. Normand
- Department of Health Care Policy, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Yun Wang
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
- Department of Health Care Policy, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
49
|
Bainey KR, Durham D, Zheng Y, Westerhout CM, Kaul P, Welsh RC. Utilization and Costs of Noninvasive Cardiac Tests After Acute Coronary Syndromes: Insights From the Alberta COAPT Study. CJC Open 2019; 1:76-83. [PMID: 32159087 PMCID: PMC7063613 DOI: 10.1016/j.cjco.2019.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background Although appropriate noninvasive cardiac tests (NICTs) after an acute coronary syndrome (ACS) provide useful prognostic information, inappropriate use leads to inefficient expenditure of existing healthcare resources. By using the Alberta Contemporary Acute Coronary Syndrome Patient Invasive Treatment Strategies (COAPT) Registry, we evaluated the use and costs of NICTs among patients discharged within 1 year after ACS. Methods All patients discharged from the hospital with a primary diagnosis of ACS in Alberta between 2004/2005 and 2015/2016 were included. Frequency of NICTs (stress tests [± imaging] and nonstress imaging tests) was determined from linked provincial databases. Costs were obtained from the Alberta Health Care Insurance Plan Medical Procedure List. Results Of 55,516 patients with ACS, 30,760 had at least 1 NICT (55.4%), with 13,505 (24.3%) having > 1 NICT performed within 1 year. Temporal trends of NICT increased over time (stress tests: P trend < 0.001; nonstress imaging tests: P trend < 0.001). NICT most commonly occurred within the first 4 months after hospital discharge (stress tests at 2 months; nonstress imaging tests at 3-4 months). In 2015/2016, the total estimated costs of NICT were $1.35M, a 22.4% increase from 2004/2005 (1.10M) (P < 0.001), whereas a decrease in incidence of ACS over the same time period was noted (P = 0.008). Conclusions Rates of NICT 1 year after ACS are high and increasing over time. Estimated costs of NICT appear to be escalating out of proportion to the ACS growth. Further investigation is warranted because it is speculative whether the increase in NICT and costs results in clinical benefit after ACS.
Collapse
Affiliation(s)
- Kevin R Bainey
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.,The Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel Durham
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.,The Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Yinggan Zheng
- The Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | | | - Padma Kaul
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.,The Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Robert C Welsh
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.,The Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
50
|
Cimminiello C, Dondi L, Pedrini A, Ronconi G, Calabria S, Piccinni C, Polo Friz H, Martini N, Maggioni AP. Patterns of treatment with antiplatelet therapy after an acute coronary syndrome: Data from a large database in a community setting. Eur J Prev Cardiol 2018; 26:836-846. [PMID: 30477319 DOI: 10.1177/2047487318814970] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS Current guidelines strongly recommend antiplatelet therapy with aspirin plus a P2Y12 receptor inhibitor (dual therapy) for patients with acute coronary syndrome (ACS). To better understand how antiplatelet treatment is prescribed in clinical practice, the aim of this study was to provide a more detailed description of real-world patients with and without antiplatelet treatment after an ACS, their outcomes at one-year follow-up and the related integrated cost. METHODS The ReS database, including more than 12 million inhabitants, was evaluated. During the accrual period ACS patients discharged alive were identified on the basis of ICD-IX-CM code. Antiplatelet drug prescriptions and healthcare costs were analysed over one-year follow-up. RESULTS In 2014, of the 25,129 patients discharged alive after an ACS, 5796 (23%) did not receive any antiplatelet therapy during the first month after hospital discharge. Among them, 3846 (66%) subjects were prescribed an antiplatelet drug subsequently, while 7.7% did not receive any antiplatelet treatment during the whole following year. Dual therapy in the subgroup of patients undergoing a revascularization procedure ( n = 8436) was prescribed to 79.2% of cases and to 46.1% ( n = 4009) of medically managed patients. The patients not treated with an antiplatelet treatment in the first month showed the highest one-year healthcare costs, mostly due to hospital re-admissions. CONCLUSIONS This analysis of a large patient community shows that a considerable proportion of patients remained untreated with antiplatelet treatment after an ACS event. A clearer characterization of these subjects can help to improve the adherence to the current guidelines and recommendations.
Collapse
Affiliation(s)
- Claudio Cimminiello
- 1 Studies and Research Centre, Italian Society of Angiology and Vascular Medicine (Società Italiana di Angiologia e Patologia Vascolare), Milan, Italy
| | | | | | | | | | | | | | | | - Aldo P Maggioni
- 2 ReS (Research & Health) Foundation, Rome, Italy.,4 ANMCO Research Centre, Florence, Italy
| |
Collapse
|