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Lin X, Cai M, Pan J, Liu E, Wang X, Song C, Lin H, Pan J. PM 2.5 chemical components are associated with in-hospital case fatality among acute myocardial infarction patients in China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 284:116898. [PMID: 39181075 DOI: 10.1016/j.ecoenv.2024.116898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 08/14/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
Recent studies have linked the cardiovascular events with the exposure to ambient fine particulate matter (PM2.5); however, the impact of PM2.5 chemical components on acute myocardial infarction (AMI) case fatality remains poorly understood. To address this gap, we included 178,340 hospitalised patients with AMI utilising the inpatient discharge database from Sichuan, Shanxi, Guangxi, and Guangdong, China spanning 2014-2019. We evaluated exposure to PM2.5 and its components (black carbon (BC), organic matter (OM), sulphate (SO42-), nitrate (NO3-), and ammonium (NH4+)) using bilinear interpolation based on the patient's residential address. We used mixed-effects logistic regression models to investigate the associations of PM2.5 and its five components with in-hospital AMI case fatality. Per interquartile range (IQR) increment in short-term exposure (7-day average) to overall PM2.5 (odds ratio (OR): 1.086, 95 % confidence interval (CI): 1.045-1.128), SO42-(1.063, 1.024-1.104), BC (1.055, 1.023-1.089), OM (1.052, 1.019-1.086, and NO3- (1.045, 1.003-1.089) were significantly associated with high risk of in-hospital AMI case fatality. The ORs per IQR increment in long-term exposure (annual average) were 1.323 (95 % CI: 1.255-1.394) for PM2.5, followed by BC (1.271, 1.210-1.335), OM (1.243, 1.188-1.300), SO42- (1.212, 1.157-1.270), NO3- (1.116, 1.075-1.159), and NH4+ (1.068, 1.031-1.106). Our study suggests that PM2.5 chemical components might be important risk factors for in-hospital AMI case fatality, highlighting the importance of targeted reduction of PM2.5 emissions, particularly BC, OM, and SO42-.
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Affiliation(s)
- Xiaojun Lin
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China
| | - Miao Cai
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2nd road, Yuexiu District, Guangzhou, Guangdong 510080, China
| | - Jingping Pan
- Health Information Center of Sichuan Province, No. 39, Wangjiaguai Street, Chengdu, Sichuan 610041, China
| | - Echu Liu
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO 63103, USA
| | - Xiuli Wang
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China
| | - Chao Song
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2nd road, Yuexiu District, Guangzhou, Guangdong 510080, China.
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; School of Public Administration, Sichuan University, No.24 South Section I, Yihuan Road, Chengdu, Sichuan 610065, China.
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Leivas PHS, Triaca LM, Santos AMAD, Jacinto PDA, Tejada CAO. Are heart attacks deadlier on weekends? Evidence of weekend effect in Brazil. CIENCIA & SAUDE COLETIVA 2024; 29:e03892023. [PMID: 39140529 DOI: 10.1590/1413-81232024298.03892023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/28/2023] [Indexed: 08/15/2024] Open
Abstract
This article aims to examine the effects of weekend admission on in-hospital mortality for patients with acute myocardial infarction (AMI) in Brazil. Information from the Hospital Information System of the Unified Health System (SIH/SUS) of urgently admitted patients diagnosed with acute myocardial infarction (AMI) between 2008 and 2018 was used, made available through the Hospital Admission Authorization (AIH). Multivariable logistic regression models, controlling for observable patient characteristics, hospital characteristics and year and hospital-fixed effects, were used. The results were consistent with the existence of the weekend effect. For the model adjusted with the inclusion of all controls, the chance of death observed for individuals hospitalized on the weekend is 14% higher. Our results indicated that there is probably an important variation in the quality of hospital care depending on the day the patient is hospitalized. Weekend admissions were associated with in-hospital AMI mortality in Brazil. Future research should analyze the possible channels behind the weekend effect to support public policies that can effectively make healthcare equitable.
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Affiliation(s)
- Pedro Henrique Soares Leivas
- Programa de Pós-Graduação em Economia Aplicada, Fundação Universidade Federal do Rio Grande. Av. Itália km 8. 96203-900 Rio Grande RS Brasil.
| | - Lívia Madeira Triaca
- Programa de Pós-Graduação em Organizações e Mercados, Universidade Federal de Pelotas. Pelotas RS Brasil
| | | | - Paulo de Andrade Jacinto
- Programa de Pós-Graduação em Desenvolvimento Econômico, Universidade Federal do Paraná. Curitiba PR Brasil
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Liu PPS, Chang HR, Hsu JY, Huang HK, Loh CH, Yeh JI. Association between holiday and weekend admissions and mortality outcomes among patients with acute myocardial infarction receiving percutaneous coronary intervention in Taiwan. Sci Rep 2024; 14:8892. [PMID: 38632335 PMCID: PMC11023946 DOI: 10.1038/s41598-024-59571-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: 10/15/2023] [Accepted: 04/12/2024] [Indexed: 04/19/2024] Open
Abstract
There is a lack of studies that concurrently differentiate the effect of the holiday season from the weekend effect on mortality risk in patients with acute myocardial infarction (AMI). We evaluated the mortality risk among patients admitted with AMI who underwent percutaneous coronary intervention, using data from the Taiwan National Health Insurance Research Database. Adult AMI patients admitted during January and February between 2013 and 2020 were enrolled and classified into the holiday season (using the Chinese New Year holiday seasons as an indicator) (n = 1729), weekend (n = 4725), and weekday (n = 14,583) groups according to the first day of admission. A multivariable logistic regression model was used to assess the risk. With the weekday group or the weekend group as the reference, the holiday season group did not have increased risks of in-hospital mortality (adjusted odds ratio [aOR] 1.15; 95% confidence intervals [CI] 0.93-1.42 or aOR 1.23; 95% CI 0.96-1.56) and 7-day mortality (aOR 1.20; 95% CI 0.90-1.58 or aOR 1.24; 95% CI 0.90-1.70). Stratified and subgroup analyses showed similar trends. We conclude that holiday season-initiated admissions were not associated with higher mortality risks in AMI admission cases than weekday or weekend admissions.
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Affiliation(s)
- Peter Pin-Sung Liu
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
- Center for Healthy Longevity, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Huai-Ren Chang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Cardiology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jin-Yi Hsu
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Huei-Kai Huang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien, 97002, Taiwan
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ching-Hui Loh
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jih-I Yeh
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
- School of Medicine, Tzu Chi University, Hualien, Taiwan.
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien, 97002, Taiwan.
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Matter MA, Candreva A, Stähli BE, Heg D, Klingenberg R, Räber L, Windecker S, Rodondi N, Nanchen D, Mach F, Gencer B, Ruschitzka F, Matter CM, Templin C. Higher 1-year mortality on rest days in patients with acute coronary syndromes and decompensated heart failure-A SPUM-ACS sub-study. Catheter Cardiovasc Interv 2024; 103:286-294. [PMID: 38145467 DOI: 10.1002/ccd.30938] [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: 08/11/2023] [Revised: 10/11/2023] [Accepted: 12/10/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Acute coronary syndromes (ACS) occurring on rest days have been associated with higher mortality, but the current literature remains inconsistent in this regard. This study included ACS patients presenting with acute decompensated heart failure (ADHF) investigating the relationship between time of coronary catheterization and outcomes. METHODS Analyses were performed from the prospective, multicentric Special Program University Medicine Acute Coronary Syndromes and Inflammation (SPUM-ACS) Cohort. Patients were divided into two groups according to time of coronary catheterization on either workdays (Monday, 00:00 to Friday, 23:59) or rest days (Saturday, 00:00 to Sunday, 23:59 and public holidays). ADHF was defined by Killip Class III or IV upon presentation. Patients were followed over 1 year. RESULTS Out of 4787 ACS patients enrolled in the SPUM-ACS Cohort, 207 (4.3%) presented with ADHF. 52 (25.1%) and 155 (74.9%) patients underwent coronary angiography on rest days or workdays, respectively. Baseline characteristics were similar among these groups. ACS patients with ADHF showed increased 1-year mortality on rest days (34.6% vs. 17.4%, p-value = 0.009). After correction for baseline characteristics, including the GRACE 2.0 Score, rest day presentation remained a significant predictor for 1-year mortality (adjusted hazard ratio = 2.42 [95% confidence interval: 1.14-5.17], p-value = 0.022). CONCLUSIONS One-year all-cause mortality was high in ACS patients with ADHF and doubled for patients admitted on rest days. The present data support the association of a rest day effect and long-term patient survival and indicate a need for further investigations.
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Affiliation(s)
- Michael A Matter
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alessandro Candreva
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Barbara E Stähli
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dik Heg
- Clinical Trial Unit, University of Bern, Bern, Switzerland
| | | | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - David Nanchen
- Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - François Mach
- Department of Cardiology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Baris Gencer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of Cardiology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian M Matter
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Lin X, Cai M, Tan K, Liu E, Wang X, Song C, Wei J, Lin H, Pan J. Ambient particulate matter and in-hospital case fatality of acute myocardial infarction: A multi-province cross-sectional study in China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 268:115731. [PMID: 38007949 DOI: 10.1016/j.ecoenv.2023.115731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
The acute myocardial infarction (AMI) outcomes have been extensively linked with ambient particulate matter (PM). However, whether a smaller particle has greater impact and the consequent attributable burden associated with PM of different sizes remain unclear. We conducted a multi-province cross-sectional study among AMI patients using the inpatient discharge datasets from four Chinese provinces (Shanxi, Sichuan, Guangxi, and Guangdong) from 2014 to 2019. Ambient PM exposure for each patient was assessed using the ChinaHighAirPollutants dataset. We employed the mixed-effects logistic regression models to evaluate the association of PM of different sizes (PM1, PM2.5, PM10) on in-hospital case fatality. The potential reducible fractions in in-hospital case fatality were estimated through counterfactual analyses. Of 177,749 participants, 125,501 (70.6 %) were male and the in-hospital case fatality rate was 4.9%. For short-term (7-day average) exposure, the odds ratios (ORs) for PM1, PM2.5, and PM10 (per 10 µg/m3) were 1.052 (95 % confidence interval [CI], 1.032-1.071), 1.026 (95 % CI, 1.014-1.037), and 1.016 (95% CI, 1.008-1.024), respectively. The estimated ORs for long-term exposure (annual average) were 1.303 (95 % CI, 1.252-1.356) for PM1, 1.209 (95 % CI, 1.178-1.241) for PM2.5, 1.157 (95 % CI, 1.134-1.181) for PM10. Short-term exposure to PM1 showed the highest potential reducible fraction (8.5 %, 95 % CI, 5.0-11.7 %), followed by PM2.5 and PM10, while the greatest potential reducible fraction of long-term exposure was observed in PM10 (30.9 %, 95 % CI, 27.2-34.4%), followed by PM2.5 and PM1. In summary, PM with smaller size had a more pronounced impact on in-hospital AMI case fatality, with PM1 exhibiting greater effects than PM2.5 and PM10. Substantial health benefits for AMI patients could be achieved by mitigating ambient PM exposure.
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Affiliation(s)
- Xiaojun Lin
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China
| | - Miao Cai
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2nd road, Yuexiu District, Guangzhou, Guangdong 510080, China
| | - Kun Tan
- Health Information Center of Sichuan Province, No. 39, Wangjiaguai Street, Chengdu, Sichuan 610041, China
| | - Echu Liu
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO 63103, USA
| | - Xiuli Wang
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China
| | - Chao Song
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD 20740, USA.
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2nd road, Yuexiu District, Guangzhou, Guangdong 510080, China.
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; China Center for South Asian Studies, Sichuan University, No.24 South Section I, Yihuan Road, Chengdu, Sichuan 610065, China.
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Yang W, Zeng L, Yang H, Guo F, Zhou D, Cui W, Wu S, Chen C, Zhao J, Wang W, Yang N, Lin H, Li L. Effect of national holidays on health outcomes of patients receiving peritoneal dialysis in a single center over a ten-year period. Ren Fail 2023; 45:2153697. [PMID: 36645059 PMCID: PMC9848312 DOI: 10.1080/0886022x.2022.2153697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND National holidays are associated with high mortality in some diseases, but little is known about patients undergoing peritoneal dialysis (PD). The research aimed to investigate the impact of national holidays on the health outcomes of PD patients. METHODS Over ten years, all episodes of unplanned hospitalization, death, and peritonitis in PD patients were collected in our center. Seven national holidays in China were chosen, and non-holiday days were selected as the control period. The effect of national holidays was observed by comparing the hospitalization, death, and peritonitis rates between holiday and non-holiday groups. RESULTS There were 297 events in all holiday periods and 1247 in non-holiday periods. There is no significant difference in hospitalization rate between holiday and non-holiday groups (32.4% ± 6.4% vs. 29.2% ± 3.4%, p = 0.175). So is the death rate [6.3% (4.8-12.3%) vs.5.0% (4.2-8.9%), p = 0.324] and peritonitis rate [0.19 (0.13-0.53) vs. 0.22 (0.18-0.27), p = 0.445] between the two groups. Significant differences were observed in the distribution of peritonitis causes between the two groups (p = 0.017). The rate of secondary to other infections in the holiday group was significantly higher than in the non-holiday group (25.0 vs. 10.3%, p = 0.015). CONCLUSION Our study suggested no national holiday effect on health outcomes of PD patients based on ten-year data in our center.
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Affiliation(s)
- Wei Yang
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Li Zeng
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Huibin Yang
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Fujia Guo
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Dan Zhou
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China,College of Integrative Medicine, Dalian Medical University, Dalian, China
| | - Wenting Cui
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuran Wu
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Cong Chen
- Graduate School, Dalian Medical University, Dalian, China
| | - Jiayao Zhao
- Graduate School, Dalian Medical University, Dalian, China
| | - Weidong Wang
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ning Yang
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hongli Lin
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China,Hongli Lin Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, 116011, Liaoning Province, China
| | - Longkai Li
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China,CONTACT Longkai Li
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Huang D, Lu Y, Sun Y, Sun W, Huang Y, Tai L, Li G, Chen H, Zhang G, Zhang L, Sun X, Qiu J, Wei Y, Jin H. Effect of weekend versus weekday admission on the mortality of acute ischemic stroke patients in China: an analysis of data from the Chinese acute ischemic stroke treatment outcome registry. Front Neurol 2023; 14:1206846. [PMID: 37528854 PMCID: PMC10389271 DOI: 10.3389/fneur.2023.1206846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/29/2023] [Indexed: 08/03/2023] Open
Abstract
Background Due to disparities in medical resources in rural and urban areas as well as in different geographic regions in China, the effect of weekend versus weekday admission on the outcomes of acute ischemic stroke (AIS) patients is unknown. Our aim was to investigate whether the outcomes of AIS patients differ according to the day of admission in China. Methods The data were extracted from the Chinese Acute Ischemic Stroke Treatment Outcome Registry (CASTOR), a multicenter prospective study database of patients diagnosed with AIS. The chi-square test (χ2) and logistic regression were used to assess mortality for weekday and weekend admissions among AIS patients stratified by rural or urban status and geographic region (including the eastern, northeastern, central, and western regions). Results In total, 9,256 patients were included in this study. Of these patients, 57.2% were classified as urban, and 42.8% were classified as rural. A total of 6,760 (73%) patients were admitted on weekdays, and 2,496 (27%) were admitted on weekends. There was no significant difference in the mortality rate among patients admitted on weekends compared with those admitted on weekdays in urban (7.5% versus 7.4%) or rural areas (8.8% versus 8.1%; p > 0.05). The mortality rate was the highest among patients admitted on weekends and weekdays (11.6% versus 10.3%) in the northeastern area, without statistical significance before and after adjusting for the patients' background characteristics (p > 0.05). In addition, regression analysis revealed that the mortality of patients admitted on weekdays was more likely to be influenced by regional subgroup, hospital level and intravenous thrombolysis than that of patients admitted on weekends. Conclusion The weekend effect was not observed in the mortality of patients with AIS regardless of rural-urban status or geographic region in China.
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Affiliation(s)
- Diandian Huang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yuxuan Lu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yongan Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yining Huang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Liwen Tai
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guozhong Li
- Department of Neurology, First Affiliated Hospital of Harbin Medical University, Neurology, Harbin, China
| | - Huisheng Chen
- Department of Neurology, The General Hospital of Shenyang Military Command, Shenyang, China
| | - Guiru Zhang
- Department of Neurology, Penglai People’s Hospital, Penglai, China
| | - Lei Zhang
- Department of Neurology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xuwen Sun
- Department of Neurology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Jinhua Qiu
- Department of Neurology, Huizhou First Hospital, Huizhou, China
| | - Yan Wei
- Department of Neurology, Harrison International Peace Hospital, Hengshui, China
| | - Haiqiang Jin
- Department of Neurology, Peking University First Hospital, Beijing, China
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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.
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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,
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Cai M, Zhang S, Lin X, Qian Z, McMillin SE, Yang Y, Zhang Z, Pan J, Lin H. Association of Ambient Particulate Matter Pollution of Different Sizes With In-Hospital Case Fatality Among Stroke Patients in China. Neurology 2022; 98:e2474-e2486. [PMID: 35613931 DOI: 10.1212/wnl.0000000000200546] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 03/02/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To characterize the association of ambient particulate matter (PM) pollution of different sizes (PM ≤1 µm in aerodynamic diameter [PM1], PM2.5, and PM10) with in-hospital case fatality among patients with stroke in China. METHODS We collected hospitalizations due to stroke in 4 provinces in China from 2013 to 2019. Seven-day and annual averages of PM prior to hospitalization were estimated using bilinear interpolation and residential addresses. Associations with in-hospital case fatality were estimated using random-effects logistic regression models. Potential reducible fraction and the number of fatalities attributed to PM were estimated using a counterfactual approach. RESULTS Among 3,109,634 stroke hospitalizations (mean age 67.23 years [SD 12.22]; 1,765,644 [56.78%] male), we identified 32,140 in-hospital stroke fatalities (case fatality rate 1.03%). Each 10 µg/m3 increase in 7-day average (short-term) exposure to PM was associated with increased in-hospital case fatality: odds ratios (ORs) were 1.058 (95% CI 1.047-1.068) for PM1, 1.037 (95% CI 1.031-1.043) for PM2.5, and 1.025 (95% CI 1.021-1.029) for PM10. Similar but larger ORs were observed for annual averages (long-term): 1.240 (95% CI 1.217-1.265) for PM1, 1.105 (95% CI 1.094-1.116) for PM2.5, and 1.090 (95% CI 1.082-1.099) for PM10. In counterfactual analyses, PM10 was associated with the largest potential reducible fraction in in-hospital case fatality (10% [95% CI 8.3-11.7] for short-term exposure and 21.1% [19.1%-23%] for long-term exposure), followed by PM1 and PM2.5. DISCUSSION PM pollution is a risk factor for in-hospital stroke-related deaths. Strategies that target reducing PM pollution may improve the health outcomes of patients with stroke.
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Affiliation(s)
- Miao Cai
- From the Department of Epidemiology (M.C., S.Z., Y.Y., Z.Z., H.L.), School of Public Health, Sun Yat-sen University, Yuexiu District, Guangzhou, Guangdong; HEOA Group, West China School of Public Health and West China Fourth Hospital (X.L., J.P.), and Institute for Healthy Cities and West China Research Center for Rural Health Development (X.L., J.P.), Sichuan University, Chengdu, China; and Department of Epidemiology and Biostatistics (Z.Q.) and School of Social Work (S.E.M.), College for Public Health & Social Justice, Saint Louis University, MO
| | - Shiyu Zhang
- From the Department of Epidemiology (M.C., S.Z., Y.Y., Z.Z., H.L.), School of Public Health, Sun Yat-sen University, Yuexiu District, Guangzhou, Guangdong; HEOA Group, West China School of Public Health and West China Fourth Hospital (X.L., J.P.), and Institute for Healthy Cities and West China Research Center for Rural Health Development (X.L., J.P.), Sichuan University, Chengdu, China; and Department of Epidemiology and Biostatistics (Z.Q.) and School of Social Work (S.E.M.), College for Public Health & Social Justice, Saint Louis University, MO
| | - Xiaojun Lin
- From the Department of Epidemiology (M.C., S.Z., Y.Y., Z.Z., H.L.), School of Public Health, Sun Yat-sen University, Yuexiu District, Guangzhou, Guangdong; HEOA Group, West China School of Public Health and West China Fourth Hospital (X.L., J.P.), and Institute for Healthy Cities and West China Research Center for Rural Health Development (X.L., J.P.), Sichuan University, Chengdu, China; and Department of Epidemiology and Biostatistics (Z.Q.) and School of Social Work (S.E.M.), College for Public Health & Social Justice, Saint Louis University, MO.
| | - Zhengmin Qian
- From the Department of Epidemiology (M.C., S.Z., Y.Y., Z.Z., H.L.), School of Public Health, Sun Yat-sen University, Yuexiu District, Guangzhou, Guangdong; HEOA Group, West China School of Public Health and West China Fourth Hospital (X.L., J.P.), and Institute for Healthy Cities and West China Research Center for Rural Health Development (X.L., J.P.), Sichuan University, Chengdu, China; and Department of Epidemiology and Biostatistics (Z.Q.) and School of Social Work (S.E.M.), College for Public Health & Social Justice, Saint Louis University, MO
| | - Stephen Edward McMillin
- From the Department of Epidemiology (M.C., S.Z., Y.Y., Z.Z., H.L.), School of Public Health, Sun Yat-sen University, Yuexiu District, Guangzhou, Guangdong; HEOA Group, West China School of Public Health and West China Fourth Hospital (X.L., J.P.), and Institute for Healthy Cities and West China Research Center for Rural Health Development (X.L., J.P.), Sichuan University, Chengdu, China; and Department of Epidemiology and Biostatistics (Z.Q.) and School of Social Work (S.E.M.), College for Public Health & Social Justice, Saint Louis University, MO
| | - Yin Yang
- From the Department of Epidemiology (M.C., S.Z., Y.Y., Z.Z., H.L.), School of Public Health, Sun Yat-sen University, Yuexiu District, Guangzhou, Guangdong; HEOA Group, West China School of Public Health and West China Fourth Hospital (X.L., J.P.), and Institute for Healthy Cities and West China Research Center for Rural Health Development (X.L., J.P.), Sichuan University, Chengdu, China; and Department of Epidemiology and Biostatistics (Z.Q.) and School of Social Work (S.E.M.), College for Public Health & Social Justice, Saint Louis University, MO
| | - Zilong Zhang
- From the Department of Epidemiology (M.C., S.Z., Y.Y., Z.Z., H.L.), School of Public Health, Sun Yat-sen University, Yuexiu District, Guangzhou, Guangdong; HEOA Group, West China School of Public Health and West China Fourth Hospital (X.L., J.P.), and Institute for Healthy Cities and West China Research Center for Rural Health Development (X.L., J.P.), Sichuan University, Chengdu, China; and Department of Epidemiology and Biostatistics (Z.Q.) and School of Social Work (S.E.M.), College for Public Health & Social Justice, Saint Louis University, MO
| | - Jay Pan
- From the Department of Epidemiology (M.C., S.Z., Y.Y., Z.Z., H.L.), School of Public Health, Sun Yat-sen University, Yuexiu District, Guangzhou, Guangdong; HEOA Group, West China School of Public Health and West China Fourth Hospital (X.L., J.P.), and Institute for Healthy Cities and West China Research Center for Rural Health Development (X.L., J.P.), Sichuan University, Chengdu, China; and Department of Epidemiology and Biostatistics (Z.Q.) and School of Social Work (S.E.M.), College for Public Health & Social Justice, Saint Louis University, MO
| | - Hualiang Lin
- From the Department of Epidemiology (M.C., S.Z., Y.Y., Z.Z., H.L.), School of Public Health, Sun Yat-sen University, Yuexiu District, Guangzhou, Guangdong; HEOA Group, West China School of Public Health and West China Fourth Hospital (X.L., J.P.), and Institute for Healthy Cities and West China Research Center for Rural Health Development (X.L., J.P.), Sichuan University, Chengdu, China; and Department of Epidemiology and Biostatistics (Z.Q.) and School of Social Work (S.E.M.), College for Public Health & Social Justice, Saint Louis University, MO.
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Cai M, Wang Z, Gu H, Dong H, Zhang X, Cui N, Zhou L, Chen G, Zou G. Occurrence and temporal variation of antibiotics and antibiotic resistance genes in hospital inpatient department wastewater: Impacts of daily schedule of inpatients and wastewater treatment process. CHEMOSPHERE 2022; 292:133405. [PMID: 34958787 DOI: 10.1016/j.chemosphere.2021.133405] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
The temporal variation of antibiotics and ARGs as well as the impact of daily schedule of inpatients on their regular occurrence in hospital wastewater (HWW) were previously obscure. In this study, the wastewater of the inpatient department pre- and posttreatment (hydraulic retention time = 8 h) was collected intraday and intraweek. The absolute concentrations of antibiotics/metabolites and ARGs in HWW were analyzed to investigate the temporal variations of their occurrence levels. Fluoroquinolones were the predominant drugs used in the inpatient department (681.30-881.66 ng/mL in the effluent) and the main contaminant in the outlet of the disinfection pond (538.29-671.47 ng/mL). Diurnal variations peaked at 19:00 for most antibiotics and ARGs, while the maximum of them occurred on weekends. Aminoglycoside resistance genes (AMRGs, 21.6-23000 copies/mL) and β-lactam resistance genes (BLGRs, 1.24-8500 copies/mL) were the dominant ARGs before and after treatment processing, respectively (p < 0.05). The significant removal rates (>50%) of most antibiotics and ARGs, as well as the integrase gene intI1 and 16S rRNA gene, were found to be subjected solely to the chloride disinfection process, suggesting the necessity of the self-contained wastewater treatment process. Meanwhile, the statistically significant correlation among antibiotics, ARGs, intI1, and 16S rRNA (p < 0.05) demonstrated that the risk of selective pressure, horizontal transfer and vertical propagation of ARGs in the effluent of the hospital was warranted. Principal component analysis (PCA) showed that the daily schedule of inpatients and wastewater treatment processes could markedly induce fluctuations in antibiotic and ARG levels in HWW, indicating that they should be considered an impact factor for environmental monitoring. This study demonstrated for the first time the temporal variations in the abundance and dissemination of antibiotics and ARGs in a semiclosed zone and provided new insight into the development of assessments of the associated ecological risk and human health.
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Affiliation(s)
- Min Cai
- Eco-environmental Protection Research Institute, Shanghai Academy of Agricultural Science, Shanghai, 201403, PR China; Shanghai Engineering Research Center of Low-carbon Agriculture (SERCLA), Shanghai, 201415, PR China
| | - Zhenglu Wang
- College of Oceanography, Hohai University, Nanjing, Jiangsu, 210024, PR China.
| | - Haotian Gu
- Eco-environmental Protection Research Institute, Shanghai Academy of Agricultural Science, Shanghai, 201403, PR China
| | - Hui Dong
- Agro-food Standards and Testing Technology Institute, Shanghai Academy of Agricultural Science, Shanghai, 201403, PR China
| | - Xu Zhang
- Eco-environmental Protection Research Institute, Shanghai Academy of Agricultural Science, Shanghai, 201403, PR China; Shanghai Engineering Research Center of Low-carbon Agriculture (SERCLA), Shanghai, 201415, PR China
| | - Naxin Cui
- Eco-environmental Protection Research Institute, Shanghai Academy of Agricultural Science, Shanghai, 201403, PR China; Shanghai Engineering Research Center of Low-carbon Agriculture (SERCLA), Shanghai, 201415, PR China
| | - Li Zhou
- Eco-environmental Protection Research Institute, Shanghai Academy of Agricultural Science, Shanghai, 201403, PR China; Shanghai Engineering Research Center of Low-carbon Agriculture (SERCLA), Shanghai, 201415, PR China
| | - Guifa Chen
- Eco-environmental Protection Research Institute, Shanghai Academy of Agricultural Science, Shanghai, 201403, PR China; Shanghai Engineering Research Center of Low-carbon Agriculture (SERCLA), Shanghai, 201415, PR China
| | - Guoyan Zou
- Eco-environmental Protection Research Institute, Shanghai Academy of Agricultural Science, Shanghai, 201403, PR China; Shanghai Engineering Research Center of Low-carbon Agriculture (SERCLA), Shanghai, 201415, PR China.
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Mo Q, Zhuo L, Liao Z, Li R, Chen Y, Geng J. Serum GDF-15 Predicts In-Hospital Mortality and Arrhythmic Risks in Patients With Acute Myocardial Infarction. Clin Appl Thromb Hemost 2022; 28:10760296211063875. [PMID: 35001647 PMCID: PMC8753242 DOI: 10.1177/10760296211063875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This study aims to evaluate the association of serum growth differentiation factor 15 (GDF-15) with in-hospital mortality and arrhythmic risks in patients with acute myocardial infarction (AMI). A total of 296 consecutive patients with AMI were enrolled in our hospital from Jan. 2018 to Dec. 2020. Serum GDF-15 levels were measured at baseline. The primary endpoint was in-hospital all-cause mortality, and the secondary endpoint was major adverse cardiac events (MACEs) during hospitalization, defined as a composite of cardiovascular death, heart failure, sustained ventricular arrhythmias (ventricular tachycardia or ventricular fibrillation), and bleeding. During hospitalization, patients with a higher GDF-15 level had significantly higher incidences of in-hospital mortality (7.4% vs 1.4%; P = .02) and MACEs (9.5% vs 20.9%, P < .01) than those with a lower GDF-15 level. Multivariate logistic regression analysis showed that a higher GDF-15 level was significantly associated with increased risks of in-hospital mortality (OR = 1.92, 95% CI: 1.44-2.50; P < .01) and MACEs (OR = 2.19, 95% CI: 1.56-2.77; P < .01). In conclusion, GDF-15 was associated with the risks of in-hospital mortality and MACEs, indicating that it should be a prognostic biomarker for patients with AMI.
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Affiliation(s)
- Qiuping Mo
- Liuzhou People's Hospital, Liuzhou, Guangxi, China
| | - Liuan Zhuo
- Liuzhou People's Hospital, Liuzhou, Guangxi, China
| | - Zhihong Liao
- Liuzhou People's Hospital, Liuzhou, Guangxi, China
| | - Rongshan Li
- Liuzhou People's Hospital, Liuzhou, Guangxi, China
| | - Yu Chen
- Liuzhou People's Hospital, Liuzhou, Guangxi, China
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Guo K, Ye J, Zhang L, Tian Q, Fan L, Ding Z, Zhou Q, Li X, Zhou Z, Yang L. Effect of the Chinese New Year Public Holiday on the Glycemic Control of T1DM With Intensive Insulin Therapy. Front Endocrinol (Lausanne) 2022; 13:915482. [PMID: 35837316 PMCID: PMC9273873 DOI: 10.3389/fendo.2022.915482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS There is limited evidence that evaluates the glycemic control of type 1 diabetes mellitus (T1DM) during the Chinese New Year public holiday in China. The Chinese New Year public holiday represents various challenges to glycemic control, especially in T1DM patients, in China. We aimed to assess the effect of the Chinese New Year public holiday on several glucose metrics using flash glucose monitoring (FGM) in patients with T1DM. METHODS Complete FGM data for 1 week before, 1 week during and 1 week after the Chinese New Year public holiday were available for 71 T1DM patients treated with multiple daily insulin injection (MDI) therapy (n = 51) or continuous subcutaneous insulin infusion (CSII) treatment (n = 20). The mean age of the study participants was 13 (9, 30) years. Of note, 59.2% of the patients (n = 42) were adults, and 40.8% of the patients (n = 29) were minors. The interval between each two adjacent periods was one week. The indicators of mean glucose, glucose variability and time in different glycemic ranges were analyzed. RESULTS The Chinese New Year public holiday was associated with an increase in mean blood glucose (8.4 ± 1.7 vs. 9.2 ± 2.5; P < 0.001) and time above range (TAR) (27.9% ± 16.6% vs. 35.0% ± 22.3%; P< 0.001) but a decrease in time in range (TIR) (65.1% ± 15.5% vs. 58.0% ± 19.0%; P < 0.001) and coefficient of variation (CV) (65.1% ± 15.5% vs. 58.0% ± 19.0%; P < 0.001). There was no significant difference in time below range (TBR). The glycemic control deteriorated during the Chinese New Year public holiday in our study population regardless of age. Interestingly, in the CSII group, none of the metrics of glucose control significantly changed during the Chinese New Year public holiday. CONCLUSIONS These results suggested that less self-management may worsen glycemic control in the short term, indicating a need for more refined management algorithms during the Chinese New Year public holiday for T1DM patients.
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Matters of the Heart: Case-Crossover Analysis of Myocardial Infarction on Valentine's Day. CJC Open 2021; 3:1075-1078. [PMID: 34505046 PMCID: PMC8413234 DOI: 10.1016/j.cjco.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/14/2021] [Indexed: 11/23/2022] Open
Abstract
We studied the risk of myocardial infarction on Valentine's Day. We conducted a case-crossover study of 51,450 adults with myocardial infarctions in February, 1989-2019. The exposure was Valentine's Day, and the 2 days before and after Valentine's Day. We estimated odds ratios (OR) to compare days when myocardial infarction occurred with neighboring control days. Compared with other days, Valentine's Day was associated with lower odds of myocardial infarction the following day for men (OR 0.91, 95% confidence interval 0.85-0.98), but not for men and women combined (OR 0.95, 95% confidence interval 0.91-1.01). Risk of myocardial infarction in men is lower the day after Valentine's Day.
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An Automated High-Accuracy Detection Scheme for Myocardial Ischemia Based on Multi-Lead Long-Interval ECG and Choi-Williams Time-Frequency Analysis Incorporating a Multi-Class SVM Classifier. SENSORS 2021; 21:s21072311. [PMID: 33810211 PMCID: PMC8037073 DOI: 10.3390/s21072311] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Abstract
Cardiovascular Disease (CVD) is a primary cause of heart problems such as angina and myocardial ischemia. The detection of the stage of CVD is vital for the prevention of medical complications related to the heart, as they can lead to heart muscle death (known as myocardial infarction). The electrocardiogram (ECG) reflects these cardiac condition changes as electrical signals. However, an accurate interpretation of these waveforms still calls for the expertise of an experienced cardiologist. Several algorithms have been developed to overcome issues in this area. In this study, a new scheme for myocardial ischemia detection with multi-lead long-interval ECG is proposed. This scheme involves an observation of the changes in ischemic-related ECG components (ST segment and PR segment) by way of the Choi-Williams time-frequency distribution to extract ST and PR features. These extracted features are mapped to a multi-class SVM classifier for training in the detection of unknown conditions to determine if they are normal or ischemic. The use of multi-lead ECG for classification and 1 min intervals instead of beats or frames contributes to improved detection performance. The classification process uses the data of 92 normal and 266 patients from four different databases. The proposed scheme delivered an overall result with 99.09% accuracy, 99.49% sensitivity, and 98.44% specificity. The high degree of classification accuracy for the different and unknown data sources used in this study reflects the flexibility, validity, and reliability of this proposed scheme. Additionally, this scheme can assist cardiologists in detecting signal abnormality with robustness and precision, and can even be used for home screening systems to provide rapid evaluation in emergency cases.
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