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Bajraktari G, Elezi S, Bytyci I, Ibrahimi P, Abdyli G, Pllana-Pruthi E, Karahoda R, Batalli A, Poniku A, Shatri M, Gashi D, Bajraktari A, Shatri F, Henein MY. The Rationale and Design of the KOSovan Acute Coronary Syndrome (KOS-ACS) Registry. Diagnostics (Basel) 2024; 14:1486. [PMID: 39061623 PMCID: PMC11276365 DOI: 10.3390/diagnostics14141486] [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: 03/29/2024] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 07/28/2024] Open
Abstract
The KOSovan Acute Coronary Syndrome (KOS-ACS) Registry is established as a prospective, continuous, nationwide, web-based registry that is operated online. The KOS-ACS registry is designed with the following objectives: (1) to obtain data on the demographic, clinical, and laboratory characteristics of ACS patients treated in Kosovo; (2) to create a national database with information on health care in ACS patients treated in Kosovo; (3) to identify the national features of associations between ACS characteristics and clinical outcomes, including mortality, complications, the length of hospital stay, and the quality of clinical care; and (4) to propose a practical guide for improving the quality and efficiency of ACS treatment in Kosovo. The Kosovo Society of Cardiology and University of Prishtina will be responsible for the development of the KOS-ACS registry and centralized data analysis at the national level. The KOS-ACS Registry will enroll all patients admitted, at any of the registered clinical centers, with the diagnosis of ACS and who will be clinically managed at any of the Kosovo hospitals. Data on patient demographics, clinical characteristics, previous and hospital drug treatment, and reperfusion therapy will be collected. The type of ACS (unstable angina, NSTEMI, or STEMI) will also be clearly defined. The time from first medical contact to balloon inflation (FMC-to-balloon) and door-to-ballon time will be registered. In-hospital death and complications will be registered. Data on the post-hospital primary outcome (MACE: cardiac death, all-cause mortality, hospitalization, stroke, need for coronary revascularization) of patients, at 30 days and 1 year, will be included in the registry.
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Affiliation(s)
- Gani Bajraktari
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden;
| | - Shpend Elezi
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
| | - Ibadete Bytyci
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden;
| | - Pranvera Ibrahimi
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden;
| | - Genc Abdyli
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Edita Pllana-Pruthi
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Rona Karahoda
- Research Unit, Heimerer College, 10000 Prishtina, Kosovo;
| | - Arlind Batalli
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
| | - Afrim Poniku
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
| | - Mentor Shatri
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Drilon Gashi
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Artan Bajraktari
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Faik Shatri
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Michael Y. Henein
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden;
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Wasilewski M, Vijayakumar A, Szigeti Z, Sathakaran S, Wang KW, Saporta A, Hitzig SL. Barriers and Facilitators to Delivering Inpatient Cardiac Rehabilitation: A Scoping Review. J Multidiscip Healthc 2023; 16:2361-2376. [PMID: 37605772 PMCID: PMC10440091 DOI: 10.2147/jmdh.s418803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Objective The purpose of this scoping review was to summarize the literature on barriers and facilitators that influence the provision and uptake of inpatient cardiac rehabilitation (ICR). Methods A literature search was conducted using PsycINFO, MEDLINE, EMBASE, CINAHL and AgeLine. Studies were included if they were published in English after the year 2000 and focused on adults who were receiving some form of ICR (eg, exercise counselling and training, education for heart-healthy living). For studies meeting inclusion criteria, descriptive data on authors, year, study design, and intervention type were extracted. Results The literature search resulted in a total of 44,331 publications, of which 229 studies met inclusion criteria. ICR programs vary drastically and often focus on promoting physical exercises and patient education. Barriers and facilitators were categorized through patient, provider and system level factors. Individual characteristics and provider knowledge and efficacy were categorized as both barriers and facilitators to ICR delivery and uptake. Team functioning, lack of resources, program coordination, and inconsistencies in evaluation acted as key barriers to ICR delivery and uptake. Key facilitators that influence ICR implementation and engagement include accreditation and professional associations and patient and family-centred practices. Conclusion ICR programs can be highly effective at improving health outcomes for those living with CVDs. Our review identified several patient, provider, and system-level considerations that act as barriers and facilitators to ICR delivery and uptake. Future research should explore how to encourage health promotion knowledge amongst ICR staff and patients.
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Affiliation(s)
- Marina Wasilewski
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Abirami Vijayakumar
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Zara Szigeti
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Sahana Sathakaran
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kuan-Wen Wang
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Adam Saporta
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Sander L Hitzig
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
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Tanaka S, Miyamoto T, Mori Y, Harada T, Tasaki H. Heart rate recovery is useful for evaluating the recovery of exercise tolerance in patients with heart failure and atrial fibrillation. Heart Vessels 2021; 36:1551-1557. [PMID: 33783632 PMCID: PMC8379125 DOI: 10.1007/s00380-021-01839-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/19/2021] [Indexed: 11/25/2022]
Abstract
This study aimed to examine the factors that contribute to improvement of exercise tolerance in patients with heart failure (HF) and atrial fibrillation (AF) following cardiac rehabilitation. Our hypothesis is that parasympathetic values are important for recovering exercise tolerance in those patients. We included 84 consecutive patients with HF and AF (mean age: 69 ± 15 years, 80% men). All of the patients underwent a cardiopulmonary exercise test and had pre and post 5 month cardiac rehabilitation assessed. After 155 ± 11 days and 44 ± 8 sessions, 73 patients (86%) showed an increase in peak oxygen uptake (VO2) and VO2 at the anaerobic threshold. In univariate linear regression analysis, the % change in heart rate recovery, plasma B-type natriuretic peptide levels, resting heart rate, and the minute ventilation /carbon dioxide output slope were significantly related to that of peak VO2 (p < 0.01, p = 0.03, p = 0.02, p < 0.01, respectively). Stepwise multivariate linear regression analysis showed that the % change in heart rate recovery was independently related to that of peak VO2 (p < 0.05). Our results suggest that heart rate recovery is closely associated with recovery of exercise tolerance in patients with HF and AF after CR.
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Affiliation(s)
- Seiya Tanaka
- Department of Cardiovascular Medicine, Kitakyushu Municipal Yahata Hospital, 2-6-2 Ogura, Yahatahigashi-ku, Kitakyushu, Fukuoka, 805-8534, Japan.
| | - Taro Miyamoto
- Department of Cardiovascular Medicine, Kitakyushu Municipal Yahata Hospital, 2-6-2 Ogura, Yahatahigashi-ku, Kitakyushu, Fukuoka, 805-8534, Japan
| | - Yusuke Mori
- Department of Internal Medicine, Kitakyushu Municipal Yahata Hospital, 2-6-2 Ogura, Yahatahigashi-ku, Kitakyushu, Fukuoka, 805-8534, Japan
| | - Takashi Harada
- Department of Cardiovascular Medicine, Kitakyushu Municipal Yahata Hospital, 2-6-2 Ogura, Yahatahigashi-ku, Kitakyushu, Fukuoka, 805-8534, Japan
| | - Hiromi Tasaki
- Department of Cardiovascular Medicine, Kitakyushu Municipal Yahata Hospital, 2-6-2 Ogura, Yahatahigashi-ku, Kitakyushu, Fukuoka, 805-8534, Japan
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Schwaab B, Zeymer U, Jannowitz C, Pittrow D, Gitt A. [Improvement of LDL-C target value achievement through cardiac rehabilitation in patients with acute coronary syndrome: PATIENT-CARE registry]. MMW Fortschr Med 2019; 161:21-24. [PMID: 31313267 DOI: 10.1007/s15006-019-0742-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/28/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND For patients undergoing acute coronary syndrome, participation in cardiac rehabilitation includes, in addition to lifestyle modification, optimal adjustment to secondary preventive medication. As a result, follow-up events can be prevented very effectively. METHOD The PATIENT-CARE registry study examined the treatment of patients during rehabilitation. Of particular interest was whether LDL cholesterol (LDL-C) targets were met. RESULTS The rate of treated patients increased in almost all classes of medication. At discharge, 96.7% of patients received statins, 98.5% antithrombotics and 22.3% antidiabetics. LDL-C was significantly reduced during rehabilitation - on average by 21.3 mg/dl (0.55 mmol/l). 41.9% of the patients achieved the LDL-C target value. CONCLUSION The results show that the optimization of secondary drug prevention in the outpatient sector must be continued unconditionally and consistently.
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Affiliation(s)
- Bernhard Schwaab
- Curschmann Klinik, Rehabilitationskrankenhaus für Kardiologie, Angiologie und Diabetologie, Akademisches Lehrkrankenhaus der Universität zu Lübeck, Saunaring 6, 23669, Timmendorfer Strand, Deutschland.
| | - Uwe Zeymer
- Medizinische Klinik B, Herzzentrum Ludwigshafen und Institut für Klinische Pharmakologie, Technische Universität Dresden, Dresden, Deutschland
| | | | - David Pittrow
- Institut für Klinische Pharmakologie, Technische Universität Dresden, Dresden, Deutschland
| | - Anselm Gitt
- Medizinische Klinik B, Herzzentrum Ludwigshafen und Stiftung IHF - Institut für Herzinfarktforschung, Ludwigshafen/Rhein, Deutschland
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Casper EA, El Wakeel LM, Saleh MA, El-Hamamsy MH. Management of pharmacotherapy-related problems in acute coronary syndrome: Role of clinical pharmacist in cardiac rehabilitation unit. Basic Clin Pharmacol Toxicol 2019; 125:44-53. [PMID: 30739389 DOI: 10.1111/bcpt.13210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/29/2019] [Indexed: 11/30/2022]
Abstract
Acute coronary syndrome (ACS) is one of the leading causes of mortality worldwide and negatively impacts healthcare costs, productivity and quality of life. Polymorbidity and polypharmacy predispose ACS patients to medication discrepancies between cardiologist-prescribed medication and drug use by the patient, drug-related problems (DRPs) and inadequate drug adherence. This study aimed to evaluate the impact of clinical pharmacist-provided services on the outcome of ACS patients. This was a prospective, randomized, controlled study on ACS patients participating in a cardiac rehabilitation programme. Forty ACS patients were randomly assigned to either control group, who received standard medical care, or intervention group, who received standard medical care plus clinical pharmacist-provided services. Services included DRP management, clinical assessment and enforcing the patient education and adherence. For both groups, the following were assessed at baseline and after 3 months: DRPs, adherence (assessed by 8-item Morisky Adherence Questionnaire), patient's knowledge (assessed by Coronary Artery Disease Questionnaire), 36-Short Form Health Survey (SF-36), heart rate, systolic and diastolic blood pressure, low-density lipoprotein (LDL), total cholesterol (TC) and fasting blood glucose (FBG). After 3 months, there was a significant difference between the intervention and control groups in the per cent change of DRPs (median: -100 vs 5.882, P = 0.0001), patient's adherence score (median: 39.13 vs -14.58, P = 0.0001), knowledge score (median: 30.28 vs -5.196, P = 0.0001), SF-36 scores, heart rate (mean: -10.04 vs 6.791, P = 0.0001), diastolic blood pressure (mean: -17.87 vs 10.45, P = 0.0001), systolic blood pressure (mean: -16.22 vs 4.751, P = 0.0001), LDL (median: -25.73 vs -0.2538, P = 0.0071), TC (median: -14.62 vs 4.123, P = 0.0005) and FBG (median: -11.42 vs 5.422, P = 0.0098). Clinical pharmacists can play an important role as part of a cardiac rehabilitation team through patient education and interventions to minimize DRPs.
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Affiliation(s)
- Eman Ahmed Casper
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | | | - Mohamed Ayman Saleh
- Department of Cardiology, Faculty of Medicine, Cardiac Rehabilitation Unit, Ain Shams University Hospitals, Ain Shams University, Cairo, Egypt
| | - Manal Hamed El-Hamamsy
- Department of Clinical Pharmacy, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia Kingdom
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Schwaab B, Zeymer U, Jannowitz C, Pittrow D, Gitt A. Improvement of low-density lipoprotein cholesterol target achievement rates through cardiac rehabilitation for patients after ST elevation myocardial infarction or non-ST elevation myocardial infarction in Germany: Results of the PATIENT CARE registry. Eur J Prev Cardiol 2018; 26:249-258. [DOI: 10.1177/2047487318817082] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims The PATIENT CARE registry aimed to document clinical characteristics of patients during cardiac rehabilitation after myocardial infarction, including the current pharmacological treatment, risk factor modification and achievement of treatment targets for low-density lipoprotein cholesterol (LDL-C). Methods Multicentre, prospective non-interventional study at 20 cardiac rehabilitation in-patient centres across Germany. Results A total of 1408 patients post myocardial infarction were analysed. Patients’ mean age was 62 ± 11 years and 27.0% were women. ST elevation myocardial infarction ( n = 657; 48.7%), and non-ST elevation myocardial infarction ( n = 617; 45.8%) were equally balanced causes for hospitalization, while previous coronary artery bypass grafting was reported in n = 134 patients (9.9%). On average, cardiac rehabilitation began 19 ± 10 days after the index event and lasted for 22 ± 4 days. At discharge, 96.7% of patients received statins, 13.0% another lipid-lowering medication in addition to a statin, 98.5% antithrombotic drugs and 22.3% antidiabetic medication. The rate of patients with LDL-C on target according to the European Society of Cardiology/European Atherosclerosis Society dyslipidaemia guidelines 2011 (<70 mg/dl (1.8 mmol/l) or at least 50% reduction of baseline value) was increased from 21.4% at admission to cardiac rehabilitation to 41.9% at discharge after cardiac rehabilitation. Most patients (95.2%) completed the cardiac rehabilitation and 88% returned to their former work at full time. Conclusion During cardiac rehabilitation, the modifiable cardiovascular risk factors, in particular the LDL-C, were substantially improved in patients after myocardial infarction. The great majority were able to return to work. However, less than 50% reached the LDL-C guideline targets during short-term cardiac rehabilitation.
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Affiliation(s)
- Bernhard Schwaab
- Curschmann Klinik, Kardiologische Rehabilitation, Timmendorfer Strand, Germany
| | - Uwe Zeymer
- Medizinische Klinik B, Herzzentrum Ludwigshafen, Germany
- Stiftung IHF – Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | | | - David Pittrow
- Institut für Klinische Pharmakologie, Technische Universität, Dresden, Germany
| | - Anselm Gitt
- Medizinische Klinik B, Herzzentrum Ludwigshafen, Germany
- Stiftung IHF – Institut für Herzinfarktforschung, Ludwigshafen, Germany
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Younis A, Shaviv E, Nof E, Israel A, Berkovitch A, Goldenberg I, Glikson M, Klempfner R, Beinart R. The role and outcome of cardiac rehabilitation program in patients with atrial fibrillation. Clin Cardiol 2018; 41:1170-1176. [PMID: 29934991 DOI: 10.1002/clc.23001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with diminished cardiac function, and exercise tolerance. HYPOTHESIS We sought to investigate the role of cardiac rehabilitation program (CR) in patients with AF. METHODS The study included 2165 consecutive patients that participated in our CR program between the years 2009 to 2015. All were evaluated by a standard exercise stress test (EST) at baseline, and upon completion of at least 3 months of training. Participants were dichotomized according to baseline fitness and the degree of functional improvement. The combined primary end point was cardiac related hospitalization or all-cause mortality. RESULTS A total of 292 patients had history of AF, with a mean age of 68 ± 9 years old, 76% of which were males. The median predicted baseline fitness of AF patients was significantly lower compared to non-AF patients (103% vs 122%, P < 0.001, respectively). Prominent improvement was achieved in the majority of the patients in both groups (64% among AF patients and 63% among those without AF). Median improvement in fitness between stress tests was significantly higher in patients with AF (124% vs 110%, P < 0.001, respectively). Among AF patients, high baseline fitness was associated with a lower event rates (HR 0.40; 95%CI 0.23-0.70; P = 0.001). Moreover, prominent improvement during CR showed a protective effect (HR 0.83; 95% CI 0.69-0.99; P = 0.04). CONCLUSION In patients with AF participating in CR program, low fitness levels at baseline EST are associated with increased risk of total mortality or cardiovascular hospitalization during long-term follow-up. Improvement on follow-up EST diminishes the risk.
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Affiliation(s)
- Arwa Younis
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ella Shaviv
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Nof
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Israel
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Berkovitch
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Goldenberg
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Heart Research Program, University of Rochester, Rochester, New York
| | - Michael Glikson
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Robert Klempfner
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Beinart
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Limburg, the Netherlands
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Xia W, Feng XY. Fragmented QRS (fQRS) Complex Predicts Adverse Cardiac Events of ST-Segment Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention and Thrombolysis. Med Sci Monit 2018; 24:4634-4640. [PMID: 29974889 PMCID: PMC6065281 DOI: 10.12659/msm.908712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) is an acute and life-threatening disease. Adverse cardiac events (ACEs) are defined as cardiovascular death or worsening congestive heart failure in STEMI patients. The present study investigated the predictive role of fragmented QRS complex (fQRS) in risks of ACEs in STEMI. MATERIAL AND METHODS This study was a retrospective analysis involving patients who underwent percutaneous coronary intervention (PCI) or thrombolysis. STEMI patients were divided into the fQRS group (259 cases) and the non-fQRS group (161 cases). Basic information and clinical parameters were evaluated. ACEs, including hemodynamic instability, electrical instability (ventricular tachycardia event, ventricular fibrillation or atrioventricular heart-block) and death, were observed. The 12-lead ECG was used to obtain fQRS recordings. Thrombolytic recanalization was evaluated to confirm clinical outcomes of PCI and thrombolysis therapy. RESULTS Hemodynamic instability rates, electrical instability rates, and death in the fQRS group were significantly higher compared to the non-fQRS group (P=0.002, 0.000, and 0.010, respectively). PCI triggered significantly fewer ACEs compared to thrombolytic therapy in the fQRS group (P=0.000, 0.000, and 0.019, respectively). The fQRS group had higher thrombolysis failure rates and three-vessel lesion of coronary artery rates compared to the non-fQRS group (P=0.009 and 0.029, respectively). There were no differences between fQRS and non-fQRS groups in death rates of STEMI patients undergoing PCI and thrombolytic therapy. GRACE scores more than 140, EF less than 35%, and fQRS illustrated predictive potential for ACEs of STEMI patients. CONCLUSIONS fQRS is an independent predictor for the adverse cardiac events of STEMI patients undergoing PCI or thrombolysis.
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Affiliation(s)
- Wei Xia
- Department of Cardiology, Tianjin First Center Hospital, Tianjin, China (mainland)
| | - Xiao-Yan Feng
- Dermatological Department, Tianjin Children's Hospital, Tianjin, China (mainland)
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Investigating the differences of body mass index and waist circumference in the follow-up assessment of patients to cardiac rehabilitation with acute coronary syndrome. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2016; 39:1007-1027. [PMID: 27832460 DOI: 10.1007/s13246-016-0471-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/08/2016] [Indexed: 02/07/2023]
Abstract
Obesity management is a key point during cardiac rehabilitation. The effect of new index, waist circumference (WC), in the obesity management of cardiac rehabilitation is not clear yet. Therefore, our study compared the WC index to the body mass index (BMI) in the evaluation of obesity management for the patients with acute coronary syndrome (ACS) in a well-designed cardiac rehabilitation program (CRP). Totally 61 patients were enrolled into our study between October 2013 and January 2014 in our hospital. All these patients were requested to participate in the CRP actively for 6 months. We collected the BMI, WC, vital signs, fasting blood levels, the results from a sub-maximal exercise treadmill test (ETT) and ultrasonic cardiogram (UCG) through a follow-up visit conducted every 1, 3, and 6 months. We used two-tailed Pearson's test and linear regression to analyze the data from our experiment. Our results show that the grouping of obese individuals based on the WC results in the WC being significantly associated with high-density lipoprotein cholesterol (HDL_C), inter-ventricular septal thickness at diastole (IVSd) and left ventricular posterior wall at diastole (LVPwd) after 1 and 3 months of the CRP (HDL_C after1 month of CRP: r = -0.292, P = 0.022; HDL_C after 3 months of CRP: r = -0.289, P = 0.024; IVSd after1 month of CRP: r = 0.451, P = 0.004; IVSd after 3 months of CRP: r = 0.304, P = 0.035; LVPwd after1 month of CRP: r = 0.468, P = 0.002; LVPwd after 3 months of CRP: r = 0.290, P = 0.045). However, no similar regular associations were found when obesity was stratified using the BMI. In other words, WC could be better than the BMI for reflecting the cardiac status. In conclusion, obesity management using WC can benefit the clinical evaluation, diagnosis, treatment, prevention, and prognosis of obese individuals of ACS when participating in the CRP.
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Tabata N, Sueta D, Akasaka T, Arima Y, Sakamoto K, Yamamoto E, Izumiya Y, Yamamuro M, Tsujita K, Kojima S, Kaikita K, Morita K, Oniki K, Saruwatari J, Nakagawa K, Hokimoto S. Helicobacter pylori Seropositivity in Patients with Interleukin-1 Polymorphisms Is Significantly Associated with ST-Segment Elevation Myocardial Infarction. PLoS One 2016; 11:e0166240. [PMID: 27832202 PMCID: PMC5104372 DOI: 10.1371/journal.pone.0166240] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 10/25/2016] [Indexed: 12/23/2022] Open
Abstract
Background Helicobacter pylori infection and interleukin-1 polymorphisms are associated with an increased risk of gastric cancer. We examined the prevalence of Helicobacter pylori seropositivity and interleukin-1 polymorphisms between ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome patients. Methods We recruited consecutive acute coronary syndrome patients, and 101 non-ST-segment elevation acute coronary syndrome patients and 103 ST-segment elevation myocardial infarction patients were enrolled. Interleukin-1 polymorphism analyses were performed for single nucleotide polymorphism in interleukin-1 beta-511 and the variable number of tandem repeats polymorphism in the interleukin-1 receptor antagonist by polymerase chain reaction. Immunoglobulin G antibodies against Helicobacter pylori and high sensitivity C-reactive protein were also measured. Results The rates of the simultaneous presence of interleukin-1 polymorphisms and Helicobacter pylori-seropositivity between non-ST-segment elevation acute coronary syndrome and ST-segment elevation myocardial infarction groups were 25.7% and 42.7%, respectively (P = 0.012). Helicobacter pylori-seropositive subjects with interleukin-1 polymorphisms showed significantly higher levels of high sensitivity C-reactive protein (0.04–0.12 vs. 0.02–0.05; P<0.001). Multivariate logistic regression analysis revealed that the carriage of Helicobacter pylori-seropositivity and interleukin-1 polymorphisms was significantly associated with ST-segment elevation myocardial infarction (odds ratio, 2.32; 95% confidence interval, 1.23–4.37; P = 0.009). The C-statistic of conventional risk factors was 0.68 (P<0.001) and that including Helicobacter pylori-seropositivity and interleukin-1 polymorphisms was 0.70 (P<0.001); continuous net reclassification improvement was 34% (P = 0.0094) and integrated discrimination improvement was 3.0% (P = 0.014). Conclusions The coincidence of Helicobacter pylori-seropositivity and interleukin-1 polymorphisms was significantly associated with higher levels of high sensitivity C-reactive protein and the increased risk of ST-segment elevation myocardial infarction.
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Affiliation(s)
- Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Japan
| | - Tomonori Akasaka
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Japan
| | - Yuichiro Arima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Japan
| | - Kenji Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Japan
| | - Megumi Yamamuro
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Japan
| | - Sunao Kojima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Japan
| | - Kazunori Morita
- Division of Pharmacology and Therapeutics, Graduate School of Medical and Pharmaceutical Sciences, Kumamoto University, Kumamoto City, Japan
| | - Kentaro Oniki
- Division of Pharmacology and Therapeutics, Graduate School of Medical and Pharmaceutical Sciences, Kumamoto University, Kumamoto City, Japan
| | - Junji Saruwatari
- Division of Pharmacology and Therapeutics, Graduate School of Medical and Pharmaceutical Sciences, Kumamoto University, Kumamoto City, Japan
| | - Kazuko Nakagawa
- Division of Pharmacology and Therapeutics, Graduate School of Medical and Pharmaceutical Sciences, Kumamoto University, Kumamoto City, Japan
| | - Seiji Hokimoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Japan
- * E-mail:
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Gitt AK, Zahn R. Hypercholesterinämie – Wo stehen wir heute? Wo wollen wir hin? Herz 2016; 41:413-20. [DOI: 10.1007/s00059-016-4457-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/31/2016] [Indexed: 01/02/2023]
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12
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Gridnev VI, Kiselev AR, Posnenkova OM, Popova YV, Dmitriev VA, Prokhorov MD, Dovgalevsky PY, Oschepkova EV. Objectives and Design of the Russian Acute Coronary Syndrome Registry (RusACSR). Clin Cardiol 2015; 39:1-8. [PMID: 26695366 DOI: 10.1002/clc.22495] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 11/01/2015] [Indexed: 12/21/2022] Open
Abstract
The Russian Acute Coronary Syndrome Registry (RusACSR) is a retrospective, continuous, nationwide, Web-based registry of patients with acute coronary syndromes (ACS). The RusACSR is a database that uses a secure Web-based interface for data entry by individual users. Participation in the RusACSR is voluntary. Any clinical center that provides health care to ACS patients can take part in the RusACSR. The RusACSR enrolls ACS patients who have undergone care in Russian hospitals from February 2008 to the present. Key data elements and methods of data analysis in the RusACSR are presented in this article. Up to 2015, 213 clinical centers from 36 regions of Russia had participated in the RusACSR. Currently, the database contains data on more than 250 000 ACS patients who underwent care from 2008 to 2015. Some current problems are highlighted in this article. The RusACSR is a perspective project for different epidemiologic studies in Russian ACS patients.
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Affiliation(s)
- Vladimir I Gridnev
- Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia
| | - Anton R Kiselev
- Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia
| | - Olga M Posnenkova
- Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia
| | - Yulia V Popova
- Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia
| | - Viktor A Dmitriev
- Department of Registries of Cardiovascular Diseases, Russian Cardiology Research and Production Complex, Moscow, Russia
| | - Mikhail D Prokhorov
- Laboratory of Nonlinear Dynamics Modelling, Saratov Branch of the Institute of Radio Engineering and Electronics of the Russian Academy of Sciences, Saratov, Russia
| | - Pavel Ya Dovgalevsky
- Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia
| | - Elena V Oschepkova
- Department of Registries of Cardiovascular Diseases, Russian Cardiology Research and Production Complex, Moscow, Russia
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Huo Y, Lee SWL, Sawhney JPS, Kim HS, Krittayaphong R, Nhan VT, Alonso-Garcia A, Han YL, Ge J, Chin CT, Ong TK, Jan S, Itoh Y, Vega AM, Pocock S. Rationale, Design, and Baseline Characteristics of the EPICOR Asia Study (Long-tErm follow-uP of antithrombotic management patterns In Acute CORonary Syndrome patients in Asia). Clin Cardiol 2015. [PMID: 26206158 DOI: 10.1002/clc.22431] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In-hospital and postdischarge mortality for acute coronary syndromes (ACS) vary across Asia and remain generally poorer than globally. The relationship between real-life antithrombotic management patterns (AMPs) and ACS-related outcomes in Asia is unclear. METHODS EPICOR Asia (Long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients in Asia) (NCT01361386) is a prospective, multinational, observational study of patients discharged after hospitalization for an ACS, with 2-year follow-up. The aim is to describe short- and long-term (up to 2 years post-index event) AMPs in patients hospitalized for ACS and to record clinical outcomes, healthcare resource use, and self-reported health status. Pre- and in-hospital management, AMPs, and associated outcomes, with particular focus on ischemic and bleeding events, will be recorded during the 2-year follow up. RESULTS Between June 2011 and May 2012, 13 005 patients were enrolled. From these, 12 922 patients surviving an ACS (6616 with STEMI, 2570 with NSTEMI, and 3736 with UA) were eligible for inclusion from 219 hospitals across 8 countries and regions in Asia: China (n = 8214), Hong Kong (n = 177), India (n = 2468), Malaysia (n = 100), Singapore (n = 93), South Korea (n = 705), Thailand (n = 957), and Vietnam (n = 208). CONCLUSIONS EPICOR Asia will provide information regarding clinical management and AMPs for ACS patients in Asia. Impact of AMPs on clinical outcomes, healthcare resource use, and self-reported health status both during hospitalization and up to 2 years after discharge will also be described.
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Affiliation(s)
- Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Stephen W-L Lee
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | | | - Hyo-Soo Kim
- Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | | | - Vo T Nhan
- Department of Medicine, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Angeles Alonso-Garcia
- Cardiovascular Science Research Centre, St. George's University of London, London, United Kingdom
| | - Ya Ling Han
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Shanghai, China
| | - Chee Tang Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore
| | - Tiong K Ong
- Department of Cardiology, Sarawak General Hospital, Kuching, Malaysia
| | - Stephen Jan
- Health Economics Program, The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Yohji Itoh
- Clinical Science Division, AstraZeneca, Osaka, Japan
| | - Ana Maria Vega
- Observational Research Centre, Global Medical Affairs, AstraZeneca, Madrid, Spain
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Reibis R, Jannowitz C, Halle M, Pittrow D, Gitt A, Völler H. Management and outcomes of patients with reduced ejection fraction after acute myocardial infarction in cardiac rehabilitation centers. Curr Med Res Opin 2015; 31:211-9. [PMID: 25325219 DOI: 10.1185/03007995.2014.977854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND We aimed to describe the contemporary management of patients with systolic chronic heart failure (CHF) during a cardiac rehabilitation (CR) stay and present outcomes with focus on lipids, blood pressure, exercise capacity, and clinical events. METHODS Comparison of 3199 patients with moderately or severely impaired left ventricular ejection fraction (low EF, 13.3%) and 20,913 patients with slightly reduced or normal LVEF (normal EF, 86.7%) who underwent an inpatient CR period of about 3 weeks in 2009-2010. RESULTS Patients with low EF compared to those with normal EF were somewhat older (65.1 vs. 63.0 years, p < 0.0001), and more often had risk factors such as diabetes mellitus (39.7% vs. 32.0%, p < 0.0001) or other comorbidities. The overall rate of patients with regular physical activity of at least 90 minutes per week prior to CR was low overall (54.4%), and reduced in patients with low EF compared to those with normal EF (47.7% vs. 55.5%, p < 0.0001). The rate of patients that achieved lower LDL cholesterol (<100 mg/dl), total cholesterol (<200 mg/dl) and triglyceride (<150 mg/dl) values at discharge increased compared to baseline. Mean blood pressure was substantially lower in the low EF group compared to the normal EF group both at baseline (124/75 vs. 130/78 mmHg, p < 0.0001) and at discharge (119/72 vs. 124/74 mmHg, p < 0.0001). Maximum exercise improved substantially in both groups (at baseline 71 vs. 91 Watts, p < 0.0001; at discharge 85 vs. 105 Watts, p < 0.0001). Event rates during CR were low, and only 0.3% in the low EF group died. As limitations to this study, information on brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-pro BNP) and/or cardiac troponin were not documented, and no long-term information was collected beyond the 3-week CR stay. CONCLUSIONS Patients with CHF account for a considerable proportion of patients in CR. Also patients with moderate/severe EF benefited from participation in CR, as their lipid profile and physical fitness improved.
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Affiliation(s)
- Rona Reibis
- Department of Cardiology, Klinik am See , Rüdersdorf , Germany
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