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Yao T, Chen L, Ma J, Hu Z, Chen Y. Stress cardiomyopathy following thyroidectomy in a premenopausal woman with thyroid cancer: case report and review of the literature. Gland Surg 2020; 9:2187-2192. [PMID: 33447569 DOI: 10.21037/gs-20-855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Stress cardiomyopathy (SC) is a poorly recognized heart disease that was initially regarded as a benign condition. Recently, it has been shown that SC may be associated with severe clinical complications including death and that its prevalence is probably underestimated. The disease is characterized by transient systolic and diastolic left ventricular (LV) dysfunction with a variety of wall-motion abnormalities. It predominantly affects postmenopausal women and is often preceded by an emotional or physical trigger, but the condition has also been reported with no evident trigger. The striking preponderance of postmenopausal females suggests a hormonal influence. Potentially, declining oestrogen levels after menopause increase the susceptibility to SC in women. Oestrogens can influence vasomotor tone via up-regulation of endothelial NO synthase. Also, there is evidence that oestrogens can attenuate catecholamine-mediated vasoconstriction and decrease the sympathetic response to mental stress in perimenopausal women. Rare cases of SC following thyroidectomy in premenopausal women have been described. Currently, the pathogenesis of SC remains obscure, several possible hypotheses include catecholamine induced myocardial spasm or catecholamine related myocardial stunning, metabolic disorders and coronary microvascular damage. So prompt diagnosis and optimal management are crucial to obtaining a good outcome for the patient. We report an extremely rare case of SC induced by thyroidectomy in a premenopausal woman with cancer, and share our personal experience by reviewing the literature.
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Affiliation(s)
- Tiezhu Yao
- Department of Cardiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lin Chen
- Department of radiology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Jingtao Ma
- Department of Cardiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhenjie Hu
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Critical Disease Mechanism and intervention, Shijiazhuang, China
| | - Yuhong Chen
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Critical Disease Mechanism and intervention, Shijiazhuang, China
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Meli L, Birk J, Edmondson D, Bonanno GA. Trajectories of posttraumatic stress in patients with confirmed and rule-out acute coronary syndrome. Gen Hosp Psychiatry 2020; 62:37-42. [PMID: 31775067 PMCID: PMC9255559 DOI: 10.1016/j.genhosppsych.2019.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 12/13/2022]
Abstract
Many patients evaluated in the emergency department (ED) for acute coronary syndrome (ACS) develop posttraumatic stress symptoms (PTSS), but little is known about symptom trajectories over time. We estimated longitudinal trajectories of PTSS from ED to 1 year after evaluation for suspected ACS (N = 1000), and the effect of threat perceptions and discharge diagnosis. Participants reported on threat perceptions in the ED, ongoing cardiac threat at 1 month, and PTSS at 1, 6, and 12 months. Latent growth mixture modeling identified 3 PTSS trajectories over 1 year: Resilient (81.75%), Chronic-Worsening (13.69%), and Acute-Recovering (4.56%). Chronic-Worsening and Acute-Recovering classes reported significantly higher ED and cardiac threat perceptions than Resilient class. Discharge diagnosis did not differ (χ2(2) = 2.93, p = .231). PTSS are common following evaluation for suspected ACS, and trajectories vary, but targeting threat perceptions may reduce PTSS and improve clinical course, whether or not patients are ultimately diagnosed with ACS.
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Affiliation(s)
- Laura Meli
- Columbia University, Teachers College, 525 West 120(th) Street, HM330, New York, NY, USA; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168(th) Street, PH-9(th) Floor, New York, NY, USA.
| | - Jeffrey Birk
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168(th) Street, PH-9(th) Floor, New York, NY, USA.
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168(th) Street, PH-9(th) Floor, New York, NY, USA.
| | - George A. Bonanno
- Columbia University, Teachers College, 525 West 120th Street, HM330, New York, NY, USA
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Edmondson D, Birk JL, Ho VT, Meli L, Abdalla M, Kronish IM. A challenge for psychocardiology: Addressing the causes and consequences of patients' perceptions of enduring somatic threat. AMERICAN PSYCHOLOGIST 2018; 73:1160-1171. [PMID: 30525797 PMCID: PMC6619434 DOI: 10.1037/amp0000418] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The enduring somatic threat (EST) model of posttraumatic stress disorder (PTSD) due to life-threatening medical events suggests that PTSD-like symptoms represent patients' sensitization to cues of ongoing threat in the body. In this article, we review research on the prevalence and consequences of such reactions in cardiovascular disease patients, discuss early tests of the EST model, and then report a new test of the EST model in 143 patients enrolled during their first acute coronary syndrome (ACS; i.e., non-ST elevation myocardial infarction or unstable angina-colloquially, "heart attack"). Invasive coronary revascularization procedures are commonly used to reduce secondary ACS risk and may reduce patients' EST, as revascularized patients often report being "cured." We assessed ACS patients' initial threat perceptions during emergency department (ED) evaluation and followed them for 1 month for PTSD symptoms (specific for ACS, by telephone). We compared PTSD symptoms in participants who were revascularized (n = 65), catheterized but not revascularized (n = 35), and medically managed (n = 43). PTSD symptoms were lower for revascularized versus medically managed participants (B = -5.32, 95% confidence interval [-9.77, -0.87]), t(98.19) = -2.37, p = .020. In a multiple regression model adjusted for clinical and psychosocial covariates, the interaction of threat perception in the ED and ACS management group was significant (greater ED threat predicted greater 1-month PTSD symptoms only in medically managed participants). These findings offer further support for the EST model and suggest that psychological interventions to preempt patients' development of EST should be considered in the hospital. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Donald Edmondson
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| | - Jeffrey L Birk
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| | - Vivian T Ho
- Department of Medicine, College of Physicians & Surgeons, Columbia University
| | - Laura Meli
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| | - Marwah Abdalla
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| | - Ian M Kronish
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
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Jiang Q, Liu H, Wang S, Wang J, Tang Y, He Z, Wu F, Huang Z, Cong X, Ding R, Liang C. Circadian locomotor output cycles kaput accelerates atherosclerotic plaque formation by upregulating plasminogen activator inhibitor-1 expression. Acta Biochim Biophys Sin (Shanghai) 2018; 50:869-879. [PMID: 30124738 DOI: 10.1093/abbs/gmy087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Indexed: 11/13/2022] Open
Abstract
To explore the association between clock circadian regulator circadian locomotor output cycles kaput gene (CLOCK) and the forming of atherosclerotic plaques and its underlying mechanisms, mouse aortic endothelial cells (MAECs) and atherosclerosis (AS) mouse model were recruited for our study. The apoE gene knockout mouse was used as the model of AS and we accelerated the formation of unstable plaques through the combination of carotid artery ligation and high-fat (HF) diet administration (0.2% cholesterol, 20% fat). The mRNA and protein expressions of CLOCK in peripheral blood monouclear cells of acute coronary syndrome (ACS) patients or mouse AS model were detected by qPCR, western blot analysis and immunohistochemical staining. The number of adherent cells and atherosclerotic plaques was counted to assess the effects of CLOCK on the progression of ACS, and adherence-associated genes, such as vascular cell adhesion molecule (VCAM)-1, C-C motif chemokine ligand 2 (CCL-2), and CCL-5. The results showed that CLOCK expression was significantly increased in both ACS patients and AS mouse model. The levels of CLOCK, leukemia inhibitory factor (LIF), intercellular adhesion molecule 1 (ICAM-1), perilipin 2 (ADFP), nuclear factor kappa B (NF-κB), and plasminogen activator inhibitor-1 (PAI-1), as well as the number of atherosclerotic plaques were elevated in the AS mouse model, as compared with the control group. Chromatin immunoprecipitation assay showed that CLOCK bound directly to the promoter of PAI-1 gene and CLOCK could positively regulate the expressions of LIF, ICAM-1, ADFP, NF-κB, and PAI-1. Reduction of CLOCK expression would decrease the expressions of VCAM-1, CCL-2, and CCL-5, and the number of adherent cells and atherosclerotic plaques, but these effects were neutralized when PAI-1 was simultaneously overexpressed in either mouse model or MAECs. Our results demonstrate that CLOCK overexpression triggers the formation of atherosclerotic plaques by directly upregulating PAI-1 expression.
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Affiliation(s)
- Qixia Jiang
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hua Liu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Shengyun Wang
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jiamei Wang
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yehua Tang
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhiqing He
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Feng Wu
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhigang Huang
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xiaoliang Cong
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ru Ding
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chun Liang
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Meli L, Alcántara C, Sumner JA, Swan B, Chang BP, Edmondson D. Enduring somatic threat perceptions and post-traumatic stress disorder symptoms in survivors of cardiac events. J Health Psychol 2017; 24:1817-1827. [PMID: 28810445 DOI: 10.1177/1359105317705982] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Post-traumatic stress disorder due to acute cardiovascular events may be uniquely defined by enduring perceptions of somatic threat. We tested whether post-traumatic stress disorder at 1 month post-acute coronary syndrome indeed required both high peritraumatic threat during the acute coronary syndrome and ongoing cardiac threat perceptions. We assessed peritraumatic threat during emergency department enrollment of 284 patients with a provisional acute coronary syndrome diagnosis and cardiac threat perceptions and post-traumatic stress disorder symptoms 1 month post-discharge. In a multiple regression model with adjustment for important covariates, emergency department threat perceptions were associated with higher 1 month post-traumatic stress disorder symptoms only among those with high levels of ongoing cardiac threat.
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Affiliation(s)
- Laura Meli
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, USA
| | | | - Jennifer A Sumner
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, USA
| | - Brendan Swan
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, USA
| | - Bernard P Chang
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, USA
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Liu HC, Yang SY, Liao YT, Chen CC, Kuo CJ. Antipsychotic Medications and Risk of Acute Coronary Syndrome in Schizophrenia: A Nested Case-Control Study. PLoS One 2016; 11:e0163533. [PMID: 27657540 PMCID: PMC5033466 DOI: 10.1371/journal.pone.0163533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 09/09/2016] [Indexed: 11/19/2022] Open
Abstract
Background This study assessed the risk of developing acute coronary syndrome requiring hospitalization in association with the use of certain antipsychotic medications in schizophrenia patients. Methods A nationwide cohort of 31,177 inpatients with schizophrenia between the ages of 18 and 65 years whose records were enrolled in the National Health Insurance Research Database in Taiwan from 2000 to 2008 and were studied after encrypting the identifications. Cases (n = 147) were patients with subsequent acute coronary syndrome requiring hospitalization after their first psychiatric admission. Based on a nested case-control design, each case was matched with 20 controls for age, sex and the year of first psychiatric admission using risk-set sampling. The effects of antipsychotic agents on the development of acute coronary syndrome were assessed using multiple conditional logistic regression and sensitivity analyses to confirm any association. Results We found that current use of aripiprazole (adjusted risk ratio [RR] = 3.68, 95% CI: 1.27–10.64, p<0.05) and chlorpromazine (adjusted RR = 2.96, 95% CI: 1.40–6.24, p<0.001) were associated with a dose-dependent increase in the risk of developing acute coronary syndrome. Although haloperidol was associated with an increased risk (adjusted RR = 2.03, 95% CI: 1.20–3.44, p<0.01), there was no clear dose-dependent relationship. These three antipsychotic agents were also associated with an increased risk in the first 30 days of use, and the risk decreased as the duration of therapy increased. Sensitivity analyses using propensity score-adjusted modeling showed that the results were similar to those of multiple regression analysis. Conclusions Patients with schizophrenia who received aripiprazole, chlorpromazine, or haloperidol could have a potentially elevated risk of developing acute coronary syndrome, particularly at the start of therapy.
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Affiliation(s)
- Hsing-Cheng Liu
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, Taipei Medical University and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shu-Yu Yang
- Department of Pharmacy, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ya-Tang Liao
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, Taipei Medical University and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chian-Jue Kuo
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, Taipei Medical University and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- * E-mail:
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Xanthos PD, Gordon BA, Begg S, Nadurata V, Kingsley MIC. A comparison of age-standardised event rates for acute and chronic coronary heart disease in metropolitan and regional/remote Victoria: a retrospective cohort study. BMC Public Health 2016; 16:391. [PMID: 27169563 PMCID: PMC4865014 DOI: 10.1186/s12889-016-3081-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/04/2016] [Indexed: 11/11/2022] Open
Abstract
Background Acute and chronic coronary heart disease (CHD) pose different burdens on health-care services and require different prevention and treatment strategies. Trends in acute and chronic CHD event rates can guide service implementation. This study evaluated changes in acute and chronic CHD event rates in metropolitan and regional/remote Victoria. Methods Victorian hospital admitted episodes with a principal diagnosis of acute CHD or chronic CHD were identified from 2005 to 2012. Acute and chronic CHD age-standardised event rates were calculated in metropolitan and regional/remote Victoria. Poisson log-link linear regression was used to estimate annual change in acute and chronic CHD event rates. Results Acute CHD age-standardised event rates decreased annually by 2.9 % (95 % CI, −4.3 to −1.4 %) in metropolitan Victoria and 1.7 % (95 % CI, −3.2 to −0.1 %) in regional/remote Victoria. In comparison, chronic CHD age-standardised event rates increased annually by 4.8 % (95 % CI, +3.0 to +6.5 %) in metropolitan Victoria and 3.1 % (95 % CI, +1.3 to +4.9 %) in regional/remote Victoria. On average, age-standardised event rates for regional/remote Victoria were 30.3 % (95 % CI, 23.5 to 37.2 %) higher for acute CHD and 55.3 % (95 % CI, 47.1 to 63.5 %) higher for chronic CHD compared to metropolitan Victoria from 2005 to 2012. Conclusion Annual decreases in acute CHD age-standardised event rates might reflect improvements in primary prevention, while annual increases in chronic CHD age-standardised event rates suggest a need to improve secondary prevention strategies. Consistently higher acute and chronic CHD age-standardised event rates were evident in regional/remote Victoria compared to metropolitan Victoria from 2005 to 2012.
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Affiliation(s)
- Paul D Xanthos
- Discipline of Exercise Physiology, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Brett A Gordon
- Discipline of Exercise Physiology, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Voltaire Nadurata
- Department of Cardiology, Bendigo Health Care Group, Bendigo, Victoria, Australia
| | - Michael I C Kingsley
- Discipline of Exercise Physiology, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.
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Manemann SM, Gerber Y, Chamberlain AM, Dunlay SM, Bell MR, Jaffe AS, Weston SA, Killian JM, Kors J, Roger VL. Acute coronary syndromes in the community. Mayo Clin Proc 2015; 90:597-605. [PMID: 25794453 PMCID: PMC4420654 DOI: 10.1016/j.mayocp.2015.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To measure the incidence of acute coronary syndrome (ACS), defined as first-ever myocardial infarction (MI) or unstable angina (UA); evaluate recent temporal trends; and determine whether survival after ACS has changed over time and differs by type. PATIENTS AND METHODS This was a population surveillance study conducted in Olmsted County, Minnesota (population: 144,248). All persons hospitalized with incident ACS between January 1, 2005, and December 31, 2010, were identified using International Classification of Diseases, Ninth Revision codes, natural language processing of the medical records, and biomarkers. Myocardial infarction was validated by epidemiologic criteria and UA by the Braunwald classification. Patients were followed through June 30, 2013, for death. RESULTS Of 1244 incident ACS cases, 35% (n=438) were UA and 65% (n=806) were MI. The standardized rates (per 100,000) of ACS were 284 (95% CI, 248-319) in 2005 and 184 (95% CI, 157-210) in 2010 (2010 vs 2005: rate ratio, 0.62; 95% CI, 0.53-0.73), indicating a 38% decline (similar for MI and UA). The 30-day case fatality rates did not differ by year of diagnosis but were worse for MI (8.9%; 95% CI, 6.9%-10.9%) compared with UA (1.9%; 95% CI, 0.6%-3.1%). Among 30-day survivors, the risk of death did not differ by ACS type or diagnosis year. CONCLUSION In the community, UA constitutes 35% of ACS. The incidence of ACS has declined in recent years, and trends were similar for UA and MI, reaffirming a substantial decline in all acute manifestations of coronary disease. Survival after ACS did not change over time, but 30-day survival was worse for MI compared with UA.
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Affiliation(s)
| | - Yariv Gerber
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Shannon M Dunlay
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Malcolm R Bell
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Allan S Jaffe
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Susan A Weston
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jill M Killian
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jan Kors
- Department of Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
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Koopman C, Bots ML, van Dis I, Vaartjes I. Shifts in the age distribution and from acute to chronic coronary heart disease hospitalizations. Eur J Prev Cardiol 2014; 23:170-7. [PMID: 25079238 DOI: 10.1177/2047487314544975] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/07/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Shifts in the burden of coronary heart disease (CHD) from an acute to chronic illness have important public health consequences. OBJECTIVE To assess age-sex-specific time trends in rates and characteristics of acute and chronic forms of CHD hospital admissions in the Netherlands. METHODS Using nationwide Dutch registers, we assessed time trends between 1998 and 2007 in hospitalization rates of 188,266 acute myocardial infarction (AMI, ICD-9 410), 294,374 unstable angina (ICD-9 411, 413) and 205,649 chronic forms of CHD (ICD-9 412, 414) admissions. RESULTS Between 1998 and 2007, the age-standardized CHD hospitalization rate declined from 688 to 545 per 100,000 in men and from 281 to 229 per 100,000 in women. Overall, hospitalization rates decreased at younger age (<75 years) but increased in very old age (≥85 years). The annual percentage change in hospitalization rates was larger for AMI (men:-5.1%, women:-4.4%) than for unstable angina patients (men:-2.0%, women:-2.0%). For chronic CHD, the average annual percentage change was +0.7% in men and +2.1% in women. The proportion of chronic CHD in the total of CHD admissions increased between 1998 and 2007 from 29% to 36% in men and from 23% to 30% in women. The proportion of AMI decreased from 30% to 24% in men and from 27% to 22% in women. CONCLUSIONS An increasing proportion of Dutch CHD hospital admissions was for chronic forms of CHD. The age at hospitalization was pushed towards older age: premature CHD admission declined over time and admission rates at very old age increased.
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Affiliation(s)
- Carla Koopman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Dutch Heart Foundation, The Hague, the Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Will JC, Yuan K, Ford E. National trends in the prevalence and medical history of angina: 1988 to 2012. Circ Cardiovasc Qual Outcomes 2014; 7:407-13. [PMID: 24847083 PMCID: PMC4366681 DOI: 10.1161/circoutcomes.113.000779] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 04/11/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence of angina from 1971 to 1994 was relatively flat for whites and blacks. We ask whether the prevalence and medical history of angina have changed during 1988 to 2012. METHODS AND RESULTS We used the National Health and Nutrition Examination Survey data from 1988 to 2004 and the data from the six 2-year surveys from 2001 to 2012. We calculated trends in both crude and standardized prevalence rates for the Rose questionnaire on angina (symptomatology) and a question asking whether the respondent had ever been told by a medical professional that they had angina (medical history). In 2009 to 2012, there were on average 3.4 million (95% confidence interval, 2.8-4.0 million) people aged ≥40 years in the United States each year with angina (Rose questionnaire) and 4.5 million (95% confidence interval, 3.5-5.1 million) people with a medical history of angina. The burden of angina varied across age, race, and sex categories, and the pattern of variation differed by whether symptomatology or medical history was assessed. Statistically significant declines in the rates for both outcomes were noted, for the most part, in people aged ≥65 years. Age and sex standardized rates declined significantly for whites but not for blacks. CONCLUSIONS Rates of angina symptoms and medical history of angina have declined among non-Hispanic whites and among adults aged ≥65 years. Blacks have not experienced these same declines. Clearly, additional study is required to understand these declines and to track the future cost and burden of angina in the US population.
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Affiliation(s)
- Julie C Will
- From the Division for Heart Disease and Stroke Prevention (J.C.W., K.Y.) and Division of Population Health (E.F.), Centers for Disease Control and Prevention, Atlanta, GA.
| | - Keming Yuan
- From the Division for Heart Disease and Stroke Prevention (J.C.W., K.Y.) and Division of Population Health (E.F.), Centers for Disease Control and Prevention, Atlanta, GA
| | - Earl Ford
- From the Division for Heart Disease and Stroke Prevention (J.C.W., K.Y.) and Division of Population Health (E.F.), Centers for Disease Control and Prevention, Atlanta, GA
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12
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Will JC, Loustalot F, Hong Y. National trends in visits to physician offices and outpatient clinics for angina 1995 to 2010. Circ Cardiovasc Qual Outcomes 2014; 7:110-7. [PMID: 24425707 PMCID: PMC4363730 DOI: 10.1161/circoutcomes.113.000450] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 11/20/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND We asked whether visits to physician offices and hospital outpatient clinics for angina have changed over time and whether more frequent use of certain diagnostic techniques or referrals in this setting may account for such changes. METHODS AND RESULTS We combined data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to study visits to physician offices and outpatient departments. We calculated both crude and standardized rates for these visits using a modified version of technical specifications published by the Agency for Healthcare Research and Quality. In 1995 to 1998, there were on average 3.6 million office/clinic visits each year for angina among adults in the United States. By 2007 to 2010, this had declined to 2.3 million visits each year. Angina visit rates per 100,000 declined significantly (P<0.05), with the greatest decline from 1995 through 1998 to 2003 through 2007. Coronary atherosclerotic disease diagnoses also declined after 2002. Both stress testing and referring patients out for care doubled during some study periods. CONCLUSIONS Office and clinic visits for angina have declined over time. This trend parallels findings for both preventable hospitalization and emergency room visits for angina. Previous research's decline in angina hospitalizations is not likely attributable to decreased referrals to hospital and emergency rooms for diagnosis and management. Although changes in International Classification of Diseases, Ninth Revision, Clinical Modification coding guidelines may explain some of the decline in angina and coronary atherosclerotic disease visits, it seems that other factors such as improved treatment or prevention may have played an additional role.
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Affiliation(s)
- Julie C Will
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Will JC, Valderrama AL, Yoon PW. Preventable hospitalizations and emergency department visits for angina, United States, 1995-2010. Prev Chronic Dis 2013; 10:E126. [PMID: 23886045 PMCID: PMC3725848 DOI: 10.5888/pcd10.120322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Preventable hospitalizations for angina have been decreasing since the late 1980s - most likely because of changes in guidance, physician coding practices, and reimbursement. We asked whether this national decline has continued and whether preventable emergency department visits for angina show a similar decline. METHODS We used National Hospital Discharge Survey data from 1995 through 2010 and National Hospital Ambulatory Medical Care Survey data from 1995 through 2009 to study preventable hospitalizations and emergency department visits, respectively. We calculated both crude and standardized rates for these visits according to technical specifications published by the Agency for Healthcare Research and Quality, which uses population estimates from the US Census Bureau as the denominator for the rates. RESULTS Crude hospitalization rates for angina declined from 1995-1998 to 2007-2010 for men and women in all 3 age groups (18-44, 45-64, and ≥65) and age- and sex-standardized rates declined in a linear fashion (P = .02). Crude rates for preventable emergency department visits for angina declined for men and women aged 65 or older from 1995-1998 to 2007-2009. Age- and sex-standardized rates for these visits showed a linear decline (P = .05). CONCLUSION We extend previous research by showing that preventable hospitalization rates for angina have continued to decline beyond the time studied previously. We also show that emergency department visits for the same condition have also declined during the past 15 years. Although these declines are probably due to changes in diagnostic practices in the hospitals and emergency departments, more studies are needed to fully understand the reasons behind this phenomenon.
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Affiliation(s)
- Julie C Will
- Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Moran AE, Oliver JT, Mirzaie M, Forouzanfar MH, Chilov M, Anderson L, Morrison JL, Khan A, Zhang N, Haynes N, Tran J, Murphy A, Degennaro V, Roth G, Zhao D, Peer N, Pichon-Riviere A, Rubinstein A, Pogosova N, Prabhakaran D, Naghavi M, Ezzati M, Mensah GA. Assessing the Global Burden of Ischemic Heart Disease: Part 1: Methods for a Systematic Review of the Global Epidemiology of Ischemic Heart Disease in 1990 and 2010. Glob Heart 2012; 7:315-329. [PMID: 23682350 DOI: 10.1016/j.gheart.2012.10.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Ischemic heart disease (IHD) is the leading cause of death worldwide. The GBD (Global Burden of Disease, Injuries, and Risk Factors) study (GBD 2010 Study) conducted a systematic review of IHD epidemiology literature from 1980 to 2008 to inform estimates of the burden on IHD in 21 world regions in 1990 and 2010. METHODS The disease model of IHD for the GBD 2010 Study included IHD death and 3 sequelae: myocardial infarction, heart failure, and angina pectoris. Medline, EMBASE, and LILACS were searched for IHD epidemiology studies in GBD high-income and low- and middle-income regions published between 1980 and 2008 using a systematic protocol validated by regional IHD experts. Data from included studies were supplemented with unpublished data from selected high-quality surveillance and survey studies. The epidemiologic parameters of interest were incidence, prevalence, case fatality, and mortality. RESULTS Literature searches yielded 40,205 unique papers, of which 1,801 met initial screening criteria. Upon detailed review of full text papers, 137 published studies were included. Unpublished data were obtained from 24 additional studies. Data were sufficient for high-income regions, but missing or sparse in many low- and middle-income regions, particularly Sub-Saharan Africa. CONCLUSIONS A systematic review for the GBD 2010 Study provided IHD epidemiology estimates for most world regions, but highlighted the lack of information about IHD in Sub-Saharan Africa and other low-income regions. More complete knowledge of the global burden of IHD will require improved IHD surveillance programs in all world regions.
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Affiliation(s)
- Andrew E Moran
- Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
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Marzocchi A, Taglieri N, Saia F, Marrozzini C, Rapezzi C, Gallo P, Cortesi P, Guastaroba P, Palmerini T, Moretti C, Di Pasquale G, Sangiorgio P, De Palma R. Incidence, treatment and outcome of acute coronary syndromes: A community-based study in the era of myocardial infarction networks. Int J Cardiol 2012; 157:419-22. [DOI: 10.1016/j.ijcard.2012.03.154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 03/17/2012] [Indexed: 11/30/2022]
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Nedkoff LJ, Briffa TG, Preen DB, Sanfilippo FM, Hung J, Ridout SC, Knuiman M, Hobbs M. Age- and sex-specific trends in the incidence of hospitalized acute coronary syndromes in Western Australia. Circ Cardiovasc Qual Outcomes 2011; 4:557-64. [PMID: 21862718 DOI: 10.1161/circoutcomes.110.960005] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND- The incidence of myocardial infarction has declined during the past 4 decades in many populations. However, there are limited population data measuring trends in acute coronary syndromes (ACS). We therefore examined temporal trends in the incidence of hospitalized ACS by age and sex in a population-based cohort. METHODS AND RESULTS- The Western Australian Data Linkage System, a repository of linked administrative health data, was used to identify 29 421 incident ACS hospitalizations between 1996 and 2007. Poisson log-linear regression models were used to calculate incidence rate changes. Age-standardized incidence rates of ACS declined annually in men by 1.7% (95% confidence interval [CI], -2.1 to -1.3) and in women by 1.6% (95% CI, -2.1 to -1.0). These declining rates were underpinned by annual reductions in the incidence of unstable angina (men, -3.0%; 95% CI, -3.7 to -2.4; women, -2.5; 95% CI, -3.3 to -1.7), whereas annual changes in myocardial infarction incidence were less (men, -1.0%; 95% CI, -1.5 to -0.5; women, -0.8%; 95% CI, -1.6 to 0). However, the overall trends masked age group differences, with ACS incidence increasing annually in 35- to 54-year-old women (2.3%; 95% CI, 1.0 to 3.8), predominantly driven by increasing incidence of myocardial infarction. CONCLUSIONS- The age-standardized incidence of ACS decreased significantly in Western Australia from 1996 to 2007. However, an increase in ACS incidence in women ages 35 to 54 years is troubling and warrants further investigation.
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Affiliation(s)
- Lee J Nedkoff
- School of Population Health, University of Western Australia, Crawley.
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Abstract
The clinical entities that comprise acute coronary syndromes (ACS)-ST-segment elevation myocardial infarction (STEMI), non-STEMI, and unstable angina-have been recognized as widespread causes of death and disability for more than a century. Seminal research in the past 50 years has led to important scientific and medical advances in our understanding of ACS. Rapid modernization of the developing world has led to a pandemic of coronary artery disease and its manifestation as ACS, with profound implications for personal, societal, and global health. Epidemiological studies have provided insight into the changing demographics of ACS, and highlighted the importance of modifiable risk factors and adherence to guideline-recommended therapy.
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Affiliation(s)
- Christian T Ruff
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Abstract
BACKGROUND Hospitalization for angina is commonly considered an ambulatory care sensitive hospitalization and used as a measure of access to primary care. OBJECTIVE To analyze time trends in angina-related hospitalizations and seek possible explanations for an observed, marked decline during 1992 to 1999. RESEARCH DESIGN We analyzed Medicare claims of SEER-Medicare control subjects for occurrence of angina hospital discharges, using the Agency for Healthcare Research and Quality Prevention Quality Indicator (PQI) definition, along with occurrence of related events including angina admissions with revascularization, angina admissions discharged as coronary artery disease (CAD) or myocardial infarction, and overall ischemic heart disease discharges. SUBJECTS Approximately 124,000 cancer-free Medicare beneficiary/ies, with subjects contributing data for 1 to 8 years. RESULTS Angina PQI hospital discharges declined 75% between 1992 and 1999. CAD hospital discharges rose in a reciprocal pattern, while angina discharges with revascularization declined and discharges for myocardial infarction and ischemic heart disease were relatively constant during this time period. CONCLUSIONS The marked decline in angina PQI hospital discharges during 1992-1999 does not appear to represent improvements in access to care or prevention of heart disease, but rather increased coding of more specific discharge diagnoses for CAD. Our findings suggest that angina hospitalization is not a valid measure for monitoring access to care and, more generally, demonstrate the need for careful, periodic re-evaluation of quality measures.
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Pines JM, Pollack CV, Diercks DB, Chang AM, Shofer FS, Hollander JE. The association between emergency department crowding and adverse cardiovascular outcomes in patients with chest pain. Acad Emerg Med 2009; 16:617-25. [PMID: 19549010 DOI: 10.1111/j.1553-2712.2009.00456.x] [Citation(s) in RCA: 214] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES While emergency department (ED) crowding is a worldwide problem, few studies have demonstrated associations between crowding and outcomes. The authors examined whether ED crowding was associated with adverse cardiovascular outcomes in patients with chest pain syndromes (chest pain or related complaints of possible cardiac origin). METHODS A retrospective analysis was performed for patients >or=30 years of age with chest pain syndrome admitted to a tertiary care academic hospital from 1999 through 2006. The authors compared rates of inpatient adverse outcomes from ED triage to hospital discharge, defined as delayed acute myocardial infarction (AMI), heart failure, hypotension, dysrhythmias, and cardiac arrest, which occurred after ED arrival using five separate crowding measures. RESULTS Among 4,574 patients, 251 (4%) patients developed adverse outcomes after ED arrival; 803 (18%) had documented acute coronary syndrome (ACS), and of those, 273 (34%) had AMI. Compared to less crowded times, ACS patients experienced more adverse outcomes at the highest waiting room census (odds ratio [OR] = 3.7, 95% confidence interval [CI] = 1.3 to 11.0) and patient-hours (OR = 5.2, 95% CI = 2.0 to 13.6) and trended toward more adverse outcomes during time of high ED occupancy (OR = 3.1, 95% CI = 1.0 to 9.3). Adverse outcomes were not significantly more frequent during times with the highest number of admitted patients (OR = 1.6, 95% CI = 0.6 to 4.1) or the highest trailing mean length of stay (LOS) for admitted patients transferred to inpatient beds within 6 hours (OR = 1.5, 95% CI = 0.5 to 4.0). Patients with non-ACS chest pain experienced more adverse outcomes during the highest waiting room census (OR = 3.5, 95% CI = 1.4 to 8.4) and patient-hours (OR = 4.3, 95% CI = 2.6 to 7.3), but not occupancy (OR = 1.8, 95% CI = 0.9 to 3.3), number of admitted patients (OR = 0.6, 95% CI 0.4 to 1.1), or trailing LOS for admitted patients (OR = 1.2, 95% CI = 0.6 to 2.0). CONCLUSIONS There was an association between some measures of ED crowding and a higher risk of adverse cardiovascular outcomes in patients with both ACS-related and non-ACS-related chest pain syndrome.
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Affiliation(s)
- Jesse M Pines
- Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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Vaithianathan R, Hockey PM, Moore TJ, Bates DW. Iatrogenic Effects of COX-2 Inhibitors in the US Population. Drug Saf 2009; 32:335-43. [DOI: 10.2165/00002018-200932040-00007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Dickhout JG, Colgan SM, Lhoták S, Austin RC. Increased Endoplasmic Reticulum Stress in Atherosclerotic Plaques Associated With Acute Coronary Syndrome. Circulation 2007; 116:1214-6. [PMID: 17846339 DOI: 10.1161/circulationaha.107.728378] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Malach M, Imperato PJ. Acute myocardial infarction and acute coronary syndrome: then and now (1950-2005). ACTA ACUST UNITED AC 2007; 9:228-34. [PMID: 17085986 DOI: 10.1111/j.1520-037x.2006.05230.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Advances in the prevention, diagnosis, and treatment of acute myocardial infarction (AMI) and acute coronary syndrome (ACS) have been remarkable since the mid-20th century. Even the clinical terminology used to describe some of the various components of ACS have undergone change, while the latter term itself represents a fairly recent addition to the medical lexicon. Although there have been dramatic changes in the diagnostic and therapeutic interventions used and impressive declines in morbidity and mortality, the differential diagnosis and complications of AMI and ACS remain as challenging now as they were a half century ago. This article presents in detail the medical understanding of AMI in the mid-20th century and how physicians of that era managed it and its complications, and contrasts this with current evidence-based knowledge and interventions.
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Affiliation(s)
- Monte Malach
- Department of Medicine, New York University Medical Center, New York, NY, USA.
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Nallamothu BK, Young J, Gurm HS, Pickens G, Safavi K. Recent trends in hospital utilization for acute myocardial infarction and coronary revascularization in the United States. Am J Cardiol 2007; 99:749-53. [PMID: 17350358 DOI: 10.1016/j.amjcard.2006.10.029] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Revised: 10/30/2006] [Accepted: 10/30/2006] [Indexed: 11/17/2022]
Abstract
Medical advances may be shifting patients with coronary artery disease away from the hospital setting despite an aging United States population. We explored this possibility using national inpatient data to estimate the number and population-based rates of hospitalization for acute myocardial infarction (AMI) and coronary revascularization from 2002 to 2005. Our primary data source was the Acute Care Tracker database, a proprietary administrative database that contains data on approximately 6 million discharges per year from 458 hospitals across the United States. Using the Acute Care Tracker database, we estimated the annual number and population-based rates of hospitalization for AMI (transmural, subendocardial) and coronary revascularization (percutaneous coronary intervention [PCI] and coronary artery bypass grafting [CABG]). Hospitalizations for AMI steadily decreased from 661,000 to 591,000 per year between 2002 and 2005, primarily due to decreases in transmural AMI. Hospitalizations for coronary revascularizations during this period varied between 794,000 and 815,000 per year, with the number of PCIs increasing and the number of CABGs decreasing. In addition, rates of hospitalization for AMI decreased from 309 to 266 per 100,000 persons between 2002 and 2005, with rates of transmural AMI decreasing substantially from 118 to 87 per 100,000 persons. Rates of hospitalization for coronary revascularization also decreased from 382 to 358 per 100,000 during this period, primarily due to decreases in CABG. In conclusion, the number and rates of hospitalization for AMI and coronary revascularization in the United States are decreasing.
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Affiliation(s)
- Brahmajee K Nallamothu
- VA Health Services Research and Development Center of Excellence, Ann Arbor VA Medical Center, Ann Arbor, Michigan, USA.
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Goff DC, Brass L, Braun LT, Croft JB, Flesch JD, Fowkes FGR, Hong Y, Howard V, Huston S, Jencks SF, Luepker R, Manolio T, O'Donnell C, Robertson RM, Rosamond W, Rumsfeld J, Sidney S, Zheng ZJ. Essential features of a surveillance system to support the prevention and management of heart disease and stroke: a scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Stroke, and Cardiovascular Nursing and the Interdisciplinary Working Groups on Quality of Care and Outcomes Research and Atherosclerotic Peripheral Vascular Disease. Circulation 2006; 115:127-55. [PMID: 17179025 DOI: 10.1161/circulationaha.106.179904] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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