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Czinege M, Halațiu VB, Nyulas V, Cojocariu LO, Ion B, Mașca V, Țolescu C, Benedek T. Nutritional Status and Recurrent Major Cardiovascular Events Following Acute Myocardial Infarction-A Follow-Up Study in a Primary Percutaneous Coronary Intervention Center. Nutrients 2024; 16:1088. [PMID: 38613121 PMCID: PMC11013633 DOI: 10.3390/nu16071088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/31/2024] [Accepted: 04/06/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Acute myocardial infarction is often accompanied by malnutrition, which is associated with an imbalance between catabolic and anabolic processes. This ultimately leads to cardiac cachexia, which worsens the patient's prognosis. We aimed to assess the correlation between nutritional status, assessed using the controlling nutritional status (CONUT) score, and the rate of major cardiovascular adverse events (MACE). METHODS The present investigation was a non-randomized, prospective, observational study in which 108 patients with acute myocardial infarction were included. Nutritional status was assessed using the CONUT score. Based on the CONUT score, the patients were divided as follows: Group 1-normal or mild nutritional status (CONUT < 3 points, n = 76), and Group 2-moderate to severe nutritional deficiency (CONUT ≥ 3 points, n = 32). Demographic, echocardiographic, and laboratory parameters were obtained for all patients, as well as the MACE rate at 1 and 3 months of follow-up. RESULTS The MACE occurred more frequently in patients with impaired nutritional status at both 1-month follow-up (46.9% versus 9.2%; p < 0.0001) and 3-month follow-up (68.8% versus 10.5%; p < 0.0001). In terms of cardiovascular events, patients with poor nutritional status, with a CONUT score ≥ 3, presented more frequent non-fatal myocardial infarction, stroke, revascularization procedure, and ventricular arrhythmia. Also, the number of cardiovascular deaths was higher in the undernourished group. CONCLUSIONS This study found that patients with poor nutritional status experienced inflammatory status, frailty, and cardiovascular events more often than those with normal nutritional status at 1-month and 3-month follow-up after an acute myocardial infarction.
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Affiliation(s)
- Maria Czinege
- Doctoral School of Medicine and Pharmacy, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania; (M.C.); (B.I.); (V.M.)
| | - Vasile-Bogdan Halațiu
- Department of Physiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
- Clinic of Cardiology, County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (L.-O.C.); (C.Ț.)
| | - Victoria Nyulas
- Department of Informatics and Medical Biostatistics, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
| | - Liliana-Oana Cojocariu
- Clinic of Cardiology, County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (L.-O.C.); (C.Ț.)
| | - Bianca Ion
- Doctoral School of Medicine and Pharmacy, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania; (M.C.); (B.I.); (V.M.)
| | - Violeta Mașca
- Doctoral School of Medicine and Pharmacy, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania; (M.C.); (B.I.); (V.M.)
- Clinic of Cardiology, County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (L.-O.C.); (C.Ț.)
| | - Constantin Țolescu
- Clinic of Cardiology, County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (L.-O.C.); (C.Ț.)
| | - Theodora Benedek
- Department of Cardiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
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2
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Czapári D, Váradi A, Farkas N, Nyári G, Márta K, Váncsa S, Nagy R, Teutsch B, Bunduc S, Erőss B, Czakó L, Vincze Á, Izbéki F, Papp M, Merkely B, Szentesi A, Hegyi P. Detailed Characteristics of Post-discharge Mortality in Acute Pancreatitis. Gastroenterology 2023; 165:682-695. [PMID: 37247642 DOI: 10.1053/j.gastro.2023.05.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/25/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND & AIMS The in-hospital survival of patients suffering from acute pancreatitis (AP) is 95% to 98%. However, there is growing evidence that patients discharged after AP may be at risk of serious morbidity and mortality. Here, we aimed to investigate the risk, causes, and predictors of the most severe consequence of the post-AP period: mortality. METHODS A total of 2613 well-characterized patients from 25 centers were included and followed by the Hungarian Pancreatic Study Group between 2012 and 2021. A general and a hospital-based population was used as the control group. RESULTS After an AP episode, patients have an approximately threefold higher incidence rate of mortality than the general population (0.0404 vs 0.0130 person-years). First-year mortality after discharge was almost double than in-hospital mortality (5.5% vs 3.5%), with 3.0% occurring in the first 90-day period. Age, comorbidities, and severity were the most significant independent risk factors for death following AP. Furthermore, multivariate analysis identified creatinine, glucose, and pleural fluid on admission as independent risk factors associated with post-discharge mortality. In the first 90-day period, cardiac failure and AP-related sepsis were among the main causes of death following discharge, and cancer-related cachexia and non-AP-related infection were the key causes in the later phase. CONCLUSION Almost as many patients in our cohort died in the first 90-day period after discharge as during their hospital stay. Evaluation of cardiovascular status, follow-up of local complications, and cachexia-preventing oncological care should be an essential part of post-AP patient care. Future study protocols in AP must include at least a 90-day follow-up period after discharge.
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Affiliation(s)
- Dóra Czapári
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Center for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Alex Váradi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Department of Metagenomics, University of Debrecen, Debrecen, Hungary; Department of Laboratory Medicine, University of Pécs, Pécs, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary
| | - Gergely Nyári
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Katalin Márta
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Center for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Rita Nagy
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Center for Translational Medicine, Semmelweis University, Budapest, Hungary; Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Brigitta Teutsch
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Center for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Stefania Bunduc
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Fundeni Clinical Institute, Bucharest, Romania
| | - Bálint Erőss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Center for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - László Czakó
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Áron Vincze
- Department of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Ferenc Izbéki
- Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | - Mária Papp
- Department of Gastroenterology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Andrea Szentesi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Center for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary; Translational Pancreatology Research Group, Interdisciplinary Center of Excellence for Research Development and Innovation, University of Szeged, Szeged, Hungary.
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Vega RBM, Mohammadi H, Patel SH, Md ALH, Lockney NA, Lynch JW, Bansal MM, Liang X, Slayton WB, Parsons SK, Hoppe BS, Mendenhall NP. Establishing cost-effective allocation of proton therapy for patients with mediastinal Hodgkin lymphoma. Int J Radiat Oncol Biol Phys 2021; 112:158-166. [PMID: 34348176 DOI: 10.1016/j.ijrobp.2021.07.1711] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 07/09/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE For curative treatment of Hodgkin lymphoma, radiotherapy benefit must be weighed against toxicity. Although more costly, proton radiotherapy reduces dose to healthy tissue, potentially improving the therapeutic ratio compared to photons. We sought to determine the cost-effectiveness of proton versus photon therapy for mediastinal Hodgkin lymphoma (MHL) based on reduced heart disease. METHODS Our model approach was two-fold: (1) Utilize patient-level dosimetric information for a cost-effectiveness analysis using a Markov cohort model. (2) Utilize population-based data to develop guidelines for policy-makers to determine thresholds of proton therapy favorability for a given photon dose. The HD14 trial informed relapse risk; coronary heart disease risk was informed by the Framingham risk calculator modified by the mean heart dose (MHD) from radiation. Sensitivity analyses assessed model robustness and identified the most influential model assumptions. A 30-year-old adult with MHL was the base case using 30.6-Gy proton therapy versus photon intensity-modulated radiotherapy. RESULTS Proton therapy was not cost-effective in the base case for male ($129K/QALY) or female patients ($196/QALY). A 5-Gy MHD decrease was associated with proton therapy incremental cost-effectiveness ratio<$100K/QALY in 40% of scenarios. The hazard ratio associating MHD and heart disease was the most influential clinical parameter. CONCLUSION Proton therapy may be cost-effective a select minority of patients with MHLbased on age, sex, and MHD reduction. We present guidance for clinicians utilizing MHD to aid decision-making for radiotherapy modality.
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Affiliation(s)
- Raymond B Mailhot Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, FL, USA.
| | - Homan Mohammadi
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Samir H Patel
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Adam L Holtzman Md
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, FL, USA
| | - Natalie A Lockney
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, FL, USA
| | - James W Lynch
- Department of Medicine, University of Florida College of Medicine, Gainesville and Jacksonville, FL, USA
| | - Manisha M Bansal
- Department of Pediatrics, Nemours Children's Hospital, Jacksonville, FL, USA
| | - Xiaoying Liang
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, FL, USA
| | - William B Slayton
- Department of Pediatrics, Nemours Children's Hospital, Jacksonville, FL, USA
| | - Susan K Parsons
- Department of Medicine, Tufts University College of Medicine, Boston, MA, USA
| | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Nancy P Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, FL, USA
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Boyanpally A, Cutting S, Furie K. Acute Ischemic Stroke Associated with Myocardial Infarction: Challenges and Management. Semin Neurol 2021; 41:331-339. [PMID: 33851390 DOI: 10.1055/s-0041-1726333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) may co-occur simultaneously or in close temporal succession, with occurrence of one ischemic vascular event increasing a patient's risk for the other. Both employ time-sensitive treatments, and both benefit from expert consultation. Patients are at increased risk of stroke for up to 3 months following AMI, and aggressive treatment of AMI, including use of reperfusion therapy, decreases the risk of AIS. For patients presenting with AIS in the setting of a recent MI, treatment with alteplase, an intravenous tissue plasminogen activator, can be given, provided anterior wall myocardial involvement has been carefully evaluated. It is important for clinicians to recognize that troponin elevations can occur in the setting of AIS as well as other clinical scenarios and that this may have implications for short- and long-term mortality.
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Affiliation(s)
- Anusha Boyanpally
- Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Shawna Cutting
- Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, Rhode Island
| | - Karen Furie
- Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, Rhode Island
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Peters SAE, Colantonio LD, Dai Y, Zhao H, Bittner V, Farkouh ME, Dluzniewski P, Poudel B, Muntner P, Woodward M. Trends in Recurrent Coronary Heart Disease After Myocardial Infarction Among US Women and Men Between 2008 and 2017. Circulation 2020; 143:650-660. [PMID: 32951451 DOI: 10.1161/circulationaha.120.047065] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Rates for recurrent coronary heart disease (CHD) events have declined in the United States. However, few studies have assessed whether this decline has been similar among women and men. METHODS Data were used from 770 408 US women and 700 477 US men <65 years of age with commercial health insurance through MarketScan and ≥66 years of age with government health insurance through Medicare who had a myocardial infarction (MI) hospitalization between 2008 and 2017. Women and men were followed up for recurrent MI, recurrent CHD events (ie, recurrent MI or coronary revascularization), heart failure hospitalization, and all-cause mortality (Medicare only) in the 365 days after MI. RESULTS From 2008 to 2017, age-standardized recurrent MI rates per 1000 person-years decreased from 89.2 to 72.3 in women and from 94.2 to 81.3 in men (multivariable-adjusted P interaction by sex <0.001). Recurrent CHD event rates decreased from 166.3 to 133.3 in women and from 198.1 to 176.8 in men (P interaction <0.001). Heart failure hospitalization rates decreased from 177.4 to 158.1 in women and from 162.9 to 156.1 in men (P interaction=0.001). All-cause mortality rates decreased from 403.2 to 389.5 in women and from 436.1 to 417.9 in men (P interaction=0.82). In 2017, the multivariable-adjusted rate ratios comparing women with men were 0.90 (95% CI, 0.86-0.93) for recurrent MI, 0.80 (95% CI, 0.78-0.82) for recurrent CHD events, 0.99 (95% CI, 0.96-1.01) for heart failure hospitalization, and 0.82 (95% CI, 0.80-0.83) for all-cause mortality. CONCLUSIONS Rates of recurrent MI, recurrent CHD events, heart failure hospitalization, and mortality in the first year after an MI declined considerably between 2008 and 2017 in both men and women, with proportionally greater reductions for women than men. However, rates remain very high, and rates of recurrent MI, recurrent CHD events, and death continue to be higher among men than women.
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Affiliation(s)
- Sanne A E Peters
- The George Institute for Global Health, Imperial College London, UK (S.A.E.P., M.W.).,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands (S.A.E.P.).,The George Institute for Global Health, University of New South Wales, Sydney, Australia (S.A.E.P., M.W.)
| | - Lisandro D Colantonio
- Department of Epidemiology (L.D.C., Y.D., H.Z., B.P., P.M.), University of Alabama at Birmingham
| | - Yuling Dai
- Department of Epidemiology (L.D.C., Y.D., H.Z., B.P., P.M.), University of Alabama at Birmingham
| | - Hong Zhao
- Department of Epidemiology (L.D.C., Y.D., H.Z., B.P., P.M.), University of Alabama at Birmingham
| | - Vera Bittner
- Division of Cardiovascular Disease (V.B.), University of Alabama at Birmingham
| | - Michael E Farkouh
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, ON, Canada (M.E.F.)
| | - Paul Dluzniewski
- Center for Observational Research, Amgen Inc, Thousand Oaks, CA (P.D.)
| | - Bharat Poudel
- Department of Epidemiology (L.D.C., Y.D., H.Z., B.P., P.M.), University of Alabama at Birmingham
| | - Paul Muntner
- Department of Epidemiology (L.D.C., Y.D., H.Z., B.P., P.M.), University of Alabama at Birmingham
| | - Mark Woodward
- The George Institute for Global Health, Imperial College London, UK (S.A.E.P., M.W.).,The George Institute for Global Health, University of New South Wales, Sydney, Australia (S.A.E.P., M.W.).,Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.)
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Wu P, Du Y, Xu Z, Zhang S, Liu J, Aa N, Yang Z. Protective effects of sodium tanshinone IIA sulfonate on cardiac function after myocardial infarction in mice. Am J Transl Res 2019; 11:351-360. [PMID: 30787992 PMCID: PMC6357331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Abstract
Sodium tanshinone IIA sulfonate (STS), a water-soluble derivative of tanshinone IIA, has been used in traditional Chinese medicine for many years. Many experiments have demonstrated that STS has anti-inflammatory, anti-apoptosis and angiogenesis effects. However, it is unclear whether STS has the same beneficial effects on myocardial infarction in vivo. The aim of our experiments was to investigate whether STS could improve cardiac function and prevent myocardial remodeling after myocardial infarction (MI) in mice. The MI model was established by surgical ligation of the left anterior descending (LAD) coronary artery. Then the mice were randomly divided into STS and untreated groups. The results of treatment for 3 weeks showed that STS could increase the survival rate, reduce the release of some inflammatory cytokines, inhibit cell apoptosis and promote angiogenesis. The study presents a new potential treatment method for ischemic heart disease.
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Affiliation(s)
- Peng Wu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University Nanjing, P. R. China
| | - Yingqiang Du
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University Nanjing, P. R. China
| | - Zhihui Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University Nanjing, P. R. China
| | - Sheng Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University Nanjing, P. R. China
| | - Jin Liu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University Nanjing, P. R. China
| | - Nan Aa
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University Nanjing, P. R. China
| | - Zhijian Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University Nanjing, P. R. China
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Plakht Y, Abu Eid A, Gilutz H, Shiyovich A. Trends of Cardiovascular Risk Factors in Patients With Acute Myocardial Infarction: Soroka Acute Myocardial Infarction II (SAMI II) Project. Angiology 2018; 70:530-538. [PMID: 30518230 DOI: 10.1177/0003319718816479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONCLUSIONS The last decade, patients with AMI became older with increased burden of CVRFs. Framingham risk score increased among patients with NSTEMI and decreased in patients with STEMI. These trends impact on risk stratification and secondary prevention programs.
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Affiliation(s)
- Ygal Plakht
- 1 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,2 Soroka University Medical Center, Beer-Sheva, Israel
| | - Abeer Abu Eid
- 1 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Harel Gilutz
- 1 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,2 Soroka University Medical Center, Beer-Sheva, Israel
| | - Arthur Shiyovich
- 3 Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Richman IB, Fairley M, Jørgensen ME, Schuler A, Owens DK, Goldhaber-Fiebert JD. Cost-effectiveness of Intensive Blood Pressure Management. JAMA Cardiol 2018; 1:872-879. [PMID: 27627731 DOI: 10.1001/jamacardio.2016.3517] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Among high-risk patients with hypertension, targeting a systolic blood pressure of 120 mm Hg reduces cardiovascular morbidity and mortality compared with a higher target. However, intensive blood pressure management incurs additional costs from treatment and from adverse events. Objective To evaluate the incremental cost-effectiveness of intensive blood pressure management compared with standard management. Design, Setting, and Participants This cost-effectiveness analysis conducted from September 2015 to August 2016 used a Markov cohort model to estimate cost-effectiveness of intensive blood pressure management among 68-year-old high-risk adults with hypertension but not diabetes. We used the Systolic Blood Pressure Intervention Trial (SPRINT) to estimate treatment effects and adverse event rates. We used Centers for Disease Control and Prevention Life Tables to project age- and cause-specific mortality, calibrated to rates reported in SPRINT. We also used population-based observational data to model development of heart failure, myocardial infarction, stroke, and subsequent mortality. Costs were based on published sources, Medicare data, and the National Inpatient Sample. Interventions Treatment of hypertension to a systolic blood pressure goal of 120 mm Hg (intensive management) or 140 mm Hg (standard management). Main Outcomes and Measures Lifetime costs and quality-adjusted life-years (QALYs), discounted at 3% annually. Results Standard management yielded 9.6 QALYs and accrued $155 261 in lifetime costs, while intensive management yielded 10.5 QALYs and accrued $176 584 in costs. Intensive blood pressure management cost $23 777 per QALY gained. In a sensitivity analysis, serious adverse events would need to occur at 3 times the rate observed in SPRINT and be 3 times more common in the intensive management arm to prefer standard management. Conclusions and Relevance Intensive blood pressure management is cost-effective at typical thresholds for value in health care and remains so even with substantially higher adverse event rates.
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Affiliation(s)
- Ilana B Richman
- Palo Alto VA Health Care System, Palo Alto, California2Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Michael Fairley
- Department of Management Science and Engineering, Stanford University, Stanford, California
| | - Mads Emil Jørgensen
- The Cardiovascular Research Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark5Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Alejandro Schuler
- Center for Biomedical Informatics Research, Stanford University, Stanford, California
| | - Douglas K Owens
- Palo Alto VA Health Care System, Palo Alto, California2Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jeremy D Goldhaber-Fiebert
- Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University School of Medicine, Stanford, California
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Pigoń K, Nowak-Radzik E, Młyńczak T, Banasik G, Nowalany-Kozielska E, Tomasik A. Cost assessment of treatment of acute myocardial infarction and angiographically visible coronary thrombus. J Comp Eff Res 2018; 7:471-481. [PMID: 29376402 DOI: 10.2217/cer-2017-0094] [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: 11/21/2022] Open
Abstract
AIM Study was aimed to assess the real-world costs of manual thrombectomy (MT) in selected ST-segment elevation myocardial infarction patients with intracoronary thrombus (IT). METHODS Study group (IT+) comprised 51 patients with MT applied and control group (IT-) comprised 56 patients without IT who underwent angioplasty alone. Costs comprised hospital care and cost of disposable materials used during primary angioplasty. RESULTS Complex management of patients with IT is more expensive, though allows to achieve clinical outcomes comparable to low-risk ST-segment elevation myocardial infarction patients without IT. CONCLUSION A complex pharmaco-interventional strategy, with glycoprotein IIB/IIIA inhibitor and MT, though more expensive, may prove cost-effective.
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Affiliation(s)
- Katarzyna Pigoń
- Students' Scientific Group at II Department of Cardiology in Zabrze, Faculty of Medicine with Dentistry Division, Medical University of Silesia, Katowice, ul. Skłodowskiej 10, Zabrze 41-800, Poland
| | - Edyta Nowak-Radzik
- Students' Scientific Group at II Department of Cardiology in Zabrze, Faculty of Medicine with Dentistry Division, Medical University of Silesia, Katowice, ul. Skłodowskiej 10, Zabrze 41-800, Poland
| | - Tomasz Młyńczak
- Students' Scientific Group at II Department of Cardiology in Zabrze, Faculty of Medicine with Dentistry Division, Medical University of Silesia, Katowice, ul. Skłodowskiej 10, Zabrze 41-800, Poland
| | - Grzegorz Banasik
- II Department of Cardiology in Zabrze, Faculty of Medicine with Dentistry Division in Zabrze, Medical University of Silesia, Katowice, ul. Skłodowskiej 10, Zabrze 41-800, Poland
| | - Ewa Nowalany-Kozielska
- II Department of Cardiology in Zabrze, Faculty of Medicine with Dentistry Division in Zabrze, Medical University of Silesia, Katowice, ul. Skłodowskiej 10, Zabrze 41-800, Poland
| | - Andrzej Tomasik
- II Department of Cardiology in Zabrze, Faculty of Medicine with Dentistry Division in Zabrze, Medical University of Silesia, Katowice, ul. Skłodowskiej 10, Zabrze 41-800, Poland
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10
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Goodman SG, Nicolau JC, Requena G, Maguire A, Blankenberg S, Chen JY, Granger CB, Grieve R, Pocock SJ, Simon T, Yasuda S, Vega AM, Brieger D. Longer-term oral antiplatelet use in stable post-myocardial infarction patients: Insights from the long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease (TIGRIS) observational study. Int J Cardiol 2017; 236:54-60. [DOI: 10.1016/j.ijcard.2017.02.062] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/13/2017] [Accepted: 02/19/2017] [Indexed: 11/27/2022]
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Shuvy M, Chen S, Vorobeichik D, Krashin E, Shlomo N, Goldenberg I, Pereg D. Temporal trends in management and outcomes of patients with acute coronary syndrome according to renal function. Int J Cardiol 2017; 232:48-52. [DOI: 10.1016/j.ijcard.2017.01.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 11/21/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
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Plakht Y, Gilutz H, Shiyovich A. Ethnical disparities in temporal trends of acute myocardial infarction (AMI) throughout a decade in Israel. Soroka acute myocardial infarction (SAMI-II) project. Int J Cardiol 2016; 214:469-76. [PMID: 27093685 DOI: 10.1016/j.ijcard.2016.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/02/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ethnical disparities in presentation and outcomes following AMI were reported. We evaluated the temporal-trends of AMI hospitalizations and mortality of Bedouins (Muslims) and Jews in Israel. METHODS Retrospective analysis of 15,352 AMI admissions (10,652 patients; 11.3% Bedouins, 88.7% Jews) throughout 2002-2012. The trends in admission rates (AR) were compared using direct age-sex adjustment. The trends of in-hospital mortality (IHM) and 1-year post-discharge mortality (PDM) were adjusted for the patients' characteristics. RESULTS Bedouins were younger (61.7±14.3 vs. 68.8±13.7years, p<0.001), a higher rate of males. Different prevalence of cardiovascular risk factors was found. STEMI presentation, 3-vessel disease and PCI intervention were more frequently in Bedouins than Jews. Adjusted AR was lower among Jews (4.80/1000 and 3.24/1000 in 2002 and 2012 respectively) than in Bedouins (9.63/1000 and 5.13/1000). A significant decrease of adjusted AR was found in both ethnicities (p-for-trend<0.001 both), greater in Bedouins (p-for-disparity=0.017). The overall rate of IHM was higher for Jews (8.7% vs. 5.6%; p=0.001). The decline of IHM was found in both groups: an increase of one-year resulted in AdjOR=0.877; (p-for-trend<0.001) and 0.910 (p-for-trend=0.052) in Jews and Bedouins respectively (p-for-interaction=0.793). The rates of PDM were higher for Jews (13.6% vs. 9.9%; p=0.001). The risk for PDM increased in both groups: AdjOR=1.118; (p-for-trend<0.001) and 1.093; (p-for-trend=0.012) for one-year increase, for Jews and Bedouins respectively (p-for-interaction=0.927). CONCLUSIONS Throughout 2002-2012 Bedouin AMI patients differed from Jews. Adjusted incidence of AMI declined, greater in Bedouins. IHM declined and PDM increased in both groups. A culturally sensitive prevention program is warranted.
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Affiliation(s)
- Ygal Plakht
- Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Harel Gilutz
- Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Arthur Shiyovich
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
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Rott D, Klempfner R, Goldenberg I, Matetzky S, Elis A. Temporal trends in the outcomes of patients with acute myocardial infarction associated with renal dysfunction over the past decade. Eur J Intern Med 2016; 29:88-92. [PMID: 26775181 DOI: 10.1016/j.ejim.2015.12.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/22/2015] [Accepted: 12/23/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with renal dysfunction (RD) who present with acute myocardial infarction (AMI) are at a high risk for subsequent cardiovascular morbidity and mortality. We sought to evaluate changes in the short and long term mortality of AMI patients with RD compared to patients with normal renal function over the last decade. METHODS This study based on 4 bi-annually surveys was performed from 2002 to 2010 and included 9468 AMI patients, that were followed for 1year, of whom 2770 (29%) had reduced estimated GFR ([eGFR]<60ml/min/m(2)). Among patients with reduced eGFR: 1251 patients (45%) were included in the 2002-2005 surveys (early period) and 1519 (55%) in the 2006-2010 surveys (late period). RESULTS Patients with RD were more likely to have advanced cardiovascular disease, multiple comorbidities and higher in-hospital, 30-day, and 1-year mortality rates (8.1%,12.3% and 23% vs. 0.7%, 1.7% and 4%, respectively; all p<0.001). Patients with RD enrolled during the late survey periods were more likely to undergo primary PCI and be discharged with current evidence based medical treatment. 1-year mortality rates were significantly lower among patients with RD who were enrolled during the late vs. early survey periods: 22% vs. 25% respectively; (Log-rank P-value <0.001). Consistently, multivariate analysis showed that patients with RD who were enrolled during the late survey periods displayed a lower adjusted risk for 1-year mortality (HR 0.83; CI[0.70-0.94] P=0.01). CONCLUSIONS Prognosis of patients with RD admitted with AMI has significantly improved over the last decade, possibly due to an improvement of pharmacological and non-pharmacological management.
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Affiliation(s)
- David Rott
- Leviev Heart Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
| | - Robert Klempfner
- Leviev Heart Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Ilan Goldenberg
- Leviev Heart Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Shlomo Matetzky
- Leviev Heart Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avishay Elis
- Department of Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Noguchi K, Sakakibara M, Asakawa N, Tokuda Y, Kamiya K, Yoshitani T, Oba K, Miyauchi K, Nishizaki Y, Ogawa H, Yokoi H, Matsumoto M, Kitakaze M, Kimura T, Matsubara T, Ikari Y, Kimura K, Origasa H, Isshiki T, Morino Y, Daida H, Tsutsui H. Higher Hemoglobin A1c After Discharge Is an Independent Predictor of Adverse Outcomes in Patients With Acute Coronary Syndrome – Findings From the PACIFIC Registry –. Circ J 2016; 80:1607-14. [DOI: 10.1253/circj.cj-15-1126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Keiji Noguchi
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Mamoru Sakakibara
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Naoya Asakawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Yusuke Tokuda
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Kiwamu Kamiya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Takashi Yoshitani
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Koji Oba
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine
| | - Yuji Nishizaki
- Department of Cardiovascular Medicine, Juntendo University School of Medicine
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- National Cerebral and Cardiovascular Center
| | | | - Masayasu Matsumoto
- Department of Clinical Neuroscience and Therapeutics Division of Integrated Medical Science, Graduate School of Biomedical Sciences, Hiroshima University
| | - Masafumi Kitakaze
- Cardiovascular Division, National Cerebral and Cardiovascular Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Hideki Origasa
- Division of Biostatistics and Clinical Epidemiology, School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Takaaki Isshiki
- Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University School of Medicine
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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15
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Plakht Y, Gilutz H, Shiyovich A. Temporal trends in acute myocardial infarction: What about survival of hospital survivors? Disparities between STEMI & NSTEMI remain. Soroka acute myocardial infarction II (SAMI-II) project. Int J Cardiol 2015; 203:1073-81. [PMID: 26638057 DOI: 10.1016/j.ijcard.2015.11.072] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 10/17/2015] [Accepted: 11/08/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contemporary data on trends of acute myocardial infarction (AMI), particularly outcomes of hospital survivors by AMI type is sparse. METHODS Analysis of 11,107 consecutive AMI patients in a tertiary hospital in Israel throughout 2002-2012. The annual incidence of ST-segment elevation (STEMI) and non-ST-segment elevation (NSTEMI) admissions was calculated using age-gender-ethnicity direct adjustment. A multivariate prognostic model was built to evaluate in-hospital and 1-year post-discharge all-cause-mortality, adjusted for patients' risk factors. RESULTS A decline in the adjusted incidence of AMI admissions (per-1000 persons) was documented (2002 vs. 2012) for STEMI: 4.70 vs. 1.38 (p<0.001) and non-significant tendency of increase for NSTEMI: 1.86 vs. 2.37 (p=0.109). The prevalence of most cardiovascular risk-factors, some non-cardiovascular comorbidities and invasive interventions increased. In-hospital mortality declined significantly for STEMI: 10.8% vs. 7.7% (p<0.001) and with no change for NSTEMI: 5.0% vs. 5.5% (p=0.137). Consistently, 1-year post-discharge mortality declined for STEMI: 13% vs. 5.9% (p<0.001) and with a non-significant increase for NSTEMI: 12.6% vs. 17.0% (p=0.377). Adjusting for the risk factors, an increase of one year was associated with a decline of in-hospital mortality for STEMI: AdjOR=0.86 (p<0.001) and for NSTEMI: AdjOR=0.92 (p<0.001). However, the risk for post-discharge mortality increased for STEMI: AdjOR=1.11 (p<0.001) and for NSTEMI: AdjOR=1.12 (p<0.001). CONCLUSIONS Throughout 2002-2012 significant decline in the incidence and of in-hospital mortality of STEMI were found. However, adjusted post-discharge mortality rates increased significantly with time. Measures for improving incidence and outcomes of AMI patients focusing on NSTEMI and hospital-survivors are warranted.
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Affiliation(s)
- Ygal Plakht
- Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Harel Gilutz
- Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Arthur Shiyovich
- Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
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Brown TM, Deng L, Becker DJ, Bittner V, Levitan EB, Rosenson RS, Safford MM, Muntner P. Trends in mortality and recurrent coronary heart disease events after an acute myocardial infarction among Medicare beneficiaries, 2001-2009. Am Heart J 2015; 170:249-55. [PMID: 26299221 DOI: 10.1016/j.ahj.2015.04.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 04/25/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Few contemporary studies examine trends in recurrent coronary heart disease (CHD) events and mortality after acute myocardial infarction (AMI) and whether these trends vary by race or sex. METHODS We used data from the national 5% random sample of Medicare fee-for-service beneficiaries for 1999 to 2010. We included beneficiaries who experienced an AMI (International Classification of Disease [ICD] 9 410.xx, except 410.x2) between January 1, 2001, and December 31, 2009. Each beneficiary's first AMI was included as their index event. Outcomes included all-cause mortality, recurrent AMI, and recurrent CHD events during the 365days after discharge for the index AMI. To examine secular trends, we pooled calendar years into 3 periods (2001-2003, 2004-2006, and 2007-2009). RESULTS Among 48,688 beneficiaries with index AMIs from 2001 to 2009, we observed decreases in the age-adjusted rates for mortality (-3.8% for each 3-year period, 95% CI -6.1% to -1.6%, P trend = .001), recurrent AMI (-15.0%, 95% CI -18.6% to -11.2%, P trend < .001), and recurrent CHD events (-11.1%, 95% CI -14.0% to -8.0%, P trend < .001) in the 365days after the index AMI. In 2007 to 2009, blacks had excess risk relative to whites for mortality and recurrent AMI (black/white incidence rate ratio of 1.38 for mortality [95% CI 1.21-1.57] and 1.38 for recurrent AMI [95% CI 1.07-1.79]). CONCLUSIONS Despite overall favorable trends in lower mortality and recurrent events after AMI, efforts are needed to reduce racial disparities.
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Argyriou G, Vrettou CS, Filippatos G, Sainis G, Nanas S, Routsi C. Comparative evaluation of Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scoring systems in patients admitted to the cardiac intensive care unit. J Crit Care 2015; 30:752-7. [DOI: 10.1016/j.jcrc.2015.04.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 04/02/2015] [Accepted: 04/19/2015] [Indexed: 11/26/2022]
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Pandya A, Sy S, Cho S, Weinstein MC, Gaziano TA. Cost-effectiveness of 10-Year Risk Thresholds for Initiation of Statin Therapy for Primary Prevention of Cardiovascular Disease. JAMA 2015; 314:142-50. [PMID: 26172894 PMCID: PMC4797634 DOI: 10.1001/jama.2015.6822] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The American College of Cardiology and the American Heart Association (ACC/AHA) cholesterol treatment guidelines have wide-scale implications for treating adults without history of atherosclerotic cardiovascular disease (ASCVD) with statins. OBJECTIVE To estimate the cost-effectiveness of various 10-year ASCVD risk thresholds that could be used in the ACC/AHA cholesterol treatment guidelines. DESIGN, SETTING, AND PARTICIPANTS Microsimulation model, including lifetime time horizon, US societal perspective, 3% discount rate for costs, and health outcomes. In the model, hypothetical individuals from a representative US population aged 40 to 75 years received statin treatment, experienced ASCVD events, and died from ASCVD-related or non-ASCVD-related causes based on ASCVD natural history and statin treatment parameters. Data sources for model parameters included National Health and Nutrition Examination Surveys, large clinical trials and meta-analyses for statin benefits and treatment, and other published sources. MAIN OUTCOMES AND MEASURES Estimated ASCVD events prevented and incremental costs per quality-adjusted life-year (QALY) gained. RESULTS In the base-case scenario, the current ASCVD threshold of 7.5% or higher, which was estimated to be associated with 48% of adults treated with statins, had an incremental cost-effectiveness ratio (ICER) of $37,000/QALY compared with a 10% or higher threshold. More lenient ASCVD thresholds of 4.0% or higher (61% of adults treated) and 3.0% or higher (67% of adults treated) had ICERs of $81,000/QALY and $140,000/QALY, respectively. Shifting from a 7.5% or higher ASCVD risk threshold to a 3.0% or higher ASCVD risk threshold was estimated to be associated with an additional 161,560 cardiovascular disease events averted. Cost-effectiveness results were sensitive to changes in the disutility associated with taking a pill daily, statin price, and the risk of statin-induced diabetes. In probabilistic sensitivity analysis, there was a higher than 93% chance that the optimal ASCVD threshold was 5.0% or lower using a cost-effectiveness threshold of $100,000/QALY. CONCLUSIONS AND RELEVANCE In this microsimulation model of US adults aged 45 to 75 years [corrected], the current 10-year ASCVD risk threshold (≥7.5% risk threshold) used in the ACC/AHA cholesterol treatment guidelines has an acceptable cost-effectiveness profile (ICER, $37,000/QALY), but more lenient ASCVD thresholds would be optimal using cost-effectiveness thresholds of $100,000/QALY (≥4.0% risk threshold) or $150,000/QALY (≥3.0% risk threshold). The optimal ASCVD threshold was sensitive to patient preferences for taking a pill daily, changes to statin price, and the risk of statin-induced diabetes.
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Affiliation(s)
- Ankur Pandya
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
| | - Stephen Sy
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
| | - Sylvia Cho
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
| | - Milton C Weinstein
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
| | - Thomas A Gaziano
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts2Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Alnasser SMA, Huang W, Gore JM, Steg PG, Eagle KA, Anderson FA, Fox KAA, Gurfinkel E, Brieger D, Klein W, van de Werf F, Avezum Á, Montalescot G, Gulba DC, Budaj A, Lopez-Sendon J, Granger CB, Kennelly BM, Goldberg RJ, Fleming E, Goodman SG. Late Consequences of Acute Coronary Syndromes: Global Registry of Acute Coronary Events (GRACE) Follow-up. Am J Med 2015; 128:766-75. [PMID: 25554379 DOI: 10.1016/j.amjmed.2014.12.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/01/2014] [Accepted: 12/08/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE Short-term outcomes have been well characterized in acute coronary syndromes; however, longer-term follow-up for the entire spectrum of these patients, including ST-segment-elevation myocardial infarction, non-ST-segment-elevation myocardial infarction, and unstable angina, is more limited. Therefore, we describe the longer-term outcomes, procedures, and medication use in Global Registry of Acute Coronary Events (GRACE) hospital survivors undergoing 6-month and 2-year follow-up, and the performance of the discharge GRACE risk score in predicting 2-year mortality. METHODS Between 1999 and 2007, 70,395 patients with a suspected acute coronary syndrome were enrolled. In 2004, 2-year prospective follow-up was undertaken in those with a discharge acute coronary syndrome diagnosis in 57 sites. RESULTS From 2004 to 2007, 19,122 (87.2%) patients underwent follow-up; by 2 years postdischarge, 14.3% underwent angiography, 8.7% percutaneous coronary intervention, 2.0% coronary bypass surgery, and 24.2% were re-hospitalized. In patients with 2-year follow-up, acetylsalicylic acid (88.7%), beta-blocker (80.4%), renin-angiotensin system inhibitor (69.8%), and statin (80.2%) therapy was used. Heart failure occurred in 6.3%, (re)infarction in 4.4%, and death in 7.1%. Discharge-to-6-month GRACE risk score was highly predictive of all-cause mortality at 2 years (c-statistic 0.80). CONCLUSION In this large multinational cohort of acute coronary syndrome patients, there were important later adverse consequences, including frequent morbidity and mortality. These findings were seen in the context of additional coronary procedures and despite continued use of evidence-based therapies in a high proportion of patients. The discriminative accuracy of the GRACE risk score in hospital survivors for predicting longer-term mortality was maintained.
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Affiliation(s)
- Sami M A Alnasser
- Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Ont., Canada; King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Wei Huang
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester
| | - Joel M Gore
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester
| | - Ph Gabriel Steg
- INSERM U-698, Université Paris 7, Centre Hospitalier Bichat-Claude Bernard, Paris, France
| | - Kim A Eagle
- University of Michigan Health System, Ann Arbor
| | - Frederick A Anderson
- Center for Outcomes Research, University of Massachusetts Medical School, Worcester
| | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | | | - David Brieger
- Concord Hospital and University of Sydney, Sydney, Australia
| | - Werner Klein
- Department of Internal Medicine, Krankenhaus der Barmherzigen Bruder, Teaching Hospital of the Karl Franzens University Graz, Graz, Austria
| | - Frans van de Werf
- Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium
| | - Álvaro Avezum
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil
| | - Gilles Montalescot
- Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière (AP-HP), Univ Paris 06, Paris, France
| | - Dietrich C Gulba
- Department of Cardiology, KKO St. Marien-Hospital, Oberhausen, Germany
| | - Andrzej Budaj
- Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Jose Lopez-Sendon
- Hospital Universitario La Paz, Instituto de Investigación La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | - Robert J Goldberg
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Emily Fleming
- Canadian Heart Research Centre, Toronto, Ont., Canada
| | - Shaun G Goodman
- Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Ont., Canada; Canadian Heart Research Centre, Toronto, Ont., Canada.
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Ford ES, Roger VL, Dunlay SM, Go AS, Rosamond WD. Challenges of ascertaining national trends in the incidence of coronary heart disease in the United States. J Am Heart Assoc 2014; 3:e001097. [PMID: 25472744 PMCID: PMC4338697 DOI: 10.1161/jaha.114.001097] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Earl S. Ford
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (E.S.F.)
| | - Véronique L. Roger
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, RochesterMN (R., S.M.D.)
| | - Shannon M. Dunlay
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, RochesterMN (R., S.M.D.)
| | - Alan S. Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (A.S.G.)
- Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, CA (A.S.G.)
- Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, CA (A.S.G.)
| | - Wayne D. Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC (W.D.R.)
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Hypoxia training attenuates left ventricular remodeling in rabbit with myocardial infarction. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2014; 11:237-44. [PMID: 25278973 PMCID: PMC4178516 DOI: 10.11909/j.issn.1671-5411.2014.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/12/2014] [Accepted: 06/10/2014] [Indexed: 11/21/2022]
Abstract
Objective Previous studies showed that hypoxia preconditioning could protect cardiac function against subsequent myocardial infarction injury. However, the effect of hypoxia on left ventricular after myocardial infarction is still unclear. This study therefore aims to investigate the effects of hypoxia training on left ventricular remodeling in rabbits post myocardial infarction. Methods Adult male rabbits were randomly divided into three groups: group SO (sham operated), group MI (myocardial infarction only) and group MI-HT (myocardial infarction plus hypoxia training). Myocardial infarction was induced by left ventricular branch ligation. Hypoxia training was performed in a hypobaric chamber (having equivalent condition at an altitude of 4000 m, FiO214.9%) for 1 h/day, 5 days/week for four weeks. At the endpoints, vascular endothelial growth factor (VEGF) in the plasma was measured. Infarct size and capillary density were detected by histology. Left ventricular remodeling and function were assessed by echocardiography. Results After the 4-week experiment, compared with the group SO, plasma VEGF levels in groups MI (130.27 ± 18.58 pg/mL, P < 0.01) and MI-HT (181.93 ± 20.29 pg/mL, P < 0.01) were significantly increased. Infarct size in Group MI-HT (29.67% ± 7.73%) was deceased remarkably, while its capillary density (816.0 ± 122.2/mm2) was significantly increased. For both groups MI and MI-HT, left ventricular end-diastolic and end-systolic dimensions were increased whereas left ventricular ejection fraction was decreased. However, compared with group MI, group MI-HT diminished left ventricular end-diastolic (15.86 ± 1.09 mm, P < 0.05) and end-systolic dimensions (12.10 ± 1.20 mm, P < 0.01) significantly and improved left ventricular ejection fraction (54.39 ± 12.74 mm, P < 0.05). Conclusion Hypoxia training may improve left ventricular function and reduce remodeling via angiogenesis in rabbits with MI.
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Bradshaw PJ, Trafalski S, Hung J, Briffa TG, Einarsdóttir K. Outcomes after first percutaneous coronary intervention for acute myocardial infarction according to patient funding source. BMC Health Serv Res 2014; 14:405. [PMID: 25231072 PMCID: PMC4261771 DOI: 10.1186/1472-6963-14-405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 09/15/2014] [Indexed: 11/24/2022] Open
Abstract
Background Disparities in the use of invasive coronary artery revascularisation procedures to manage acute myocardial infarction (AMI) have been found in several developed economies. Factors such as socio-economic status, income and funding source may influence the use of invasive procedures and have also been associated with ongoing care. The objectives of this study were to determine whether outcomes for patients at one and five years after AMI treated with first-ever percutaneous coronary intervention (PCI) were the same for public and privately funded patients. Methods Retrospective, population-based cohort study using linked data to identify 30-day survivors of AMI treated with PCI in the index admission between 1995 and 2008 in Western Australian hospitals. The main outcome measures were admission for another PCI, re-AMI, and all-cause and cardiac mortality at one and five years. Results At one year, private patients were at greater adjusted risk for another PCI (HR 1.62 [1.36 – 1.94]; p < 0.001) than public patients, and more likely to have an additional revascularisation procedure from 90 days to 5 years (HR 1.33 [1.11 – 1.58]; p < 0.001). They were at less risk for all-cause death within five years (HR 0.69 [0.62–0.91]; p = 0.01) with a trend to reduced risk for cardiac death and re-AMI. Conclusions Treatment as a private patient for AMI with first PCI is associated with an increased likelihood of additional coronary revascularisation procedure within 12 months and to five years, and a reduced risk for all-cause mortality to 5 years. While additional procedures were not associated with poorer outcomes, there was no clear relationship between better outcomes and additional procedures. Other lifestyle and health care factors may contribute to the significant reduction in all-cause mortality and the trends to reduced hazard for AMI and cardiac death among private patients.
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Affiliation(s)
- Pamela J Bradshaw
- School of Population Health, The University of Western Australia, 35 Stirling Highway, Perth, WA, Australia.
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van Walraven C. Trends in 1-year survival of people admitted to hospital in Ontario, 1994-2009. CMAJ 2013; 185:E755-62. [PMID: 24082022 DOI: 10.1503/cmaj.130875] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Changes in the long-term survival of people admitted to hospital is unknown. This study examined trends in 1-year survival of patients admitted to hospital adjusted for improved survival in the general population. METHODS One-year survival after admission to hospital was determined for all adults admitted to hospital in Ontario in 1994, 1999, 2004, or 2009 by linking to vital statistics datasets. Annual survival in the general population was determined from life tables for Ontario. RESULTS Between 1994 and 2009, hospital use decreased (from 8.8% to 6.3% of the general adult population per year), whereas crude 1-year mortality among people with hospital admissions increased (from 9.2% to 11.6%). During this time, patients in hospital became significantly older (median age increased from 51 to 58 yr) and sicker (the proportion with a Charlson comorbidity index score of 0 decreased from 68.2% to 60.0%), and were more acutely ill on admission (elective admissions decreased from 47.4% to 42.0%; proportion brought to hospital by ambulance increased from 16.1% to 24.8%). Compared with 1994, the adjusted odds ratio (OR) for death at 1 year in 2009 was 0.78 (95% confidence interval [CI] 0.77-0.79). However, 1-year risk of death in the general population decreased by 24% during the same time. After adjusting for improved survival in the general population, risk of death at 1 year for people admitted to hospital remained significantly lower in 2009 than in 1994 (adjusted relative excess risk 0.81, 95% CI 0.80-0.82). INTERPRETATION After accounting for both the increased burden of patient sickness and improved survival in the general population, 1-year survival for people admitted to hospital increased significantly from 1994 to 2009. The reasons for this improvement cannot be determined from these data.
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Nozzoli C, Beghè B, Boschetto P, Fabbri LM. Identifying and Treating COPD in Cardiac Patients. Chest 2013; 144:723-726. [DOI: 10.1378/chest.13-0915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Brammås A, Jakobsson S, Ulvenstam A, Mooe T. Mortality after ischemic stroke in patients with acute myocardial infarction: predictors and trends over time in Sweden. Stroke 2013; 44:3050-5. [PMID: 23963333 DOI: 10.1161/strokeaha.113.001434] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Acute myocardial infarction (AMI) increases the risk of ischemic stroke, and mortality among these patients is high. Here, we aimed to estimate the 1-year mortality reliably after AMI complicated by ischemic stroke. We also aimed to identify trends over time for mortality during 1998-2008, as well as factors that predicted increased or decreased mortality. METHODS Data for 173 233 unselected patients with AMI were collected from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions registry for 1998-2008. Specifically, we analyzed 1-year follow-up and mortality data for patients with AMI with and without ischemic stroke. Kaplan-Meyer analysis was used to analyze mortality trends over time, and Cox regression analysis was used to identify uni- and multivariate predictors of mortality. RESULTS The 1-year mortality was 36.5% for AMI complicated by ischemic stroke and 18.3% for AMI without stroke. Mortality decreased over time in patients with and without ischemic stroke. The absolute decreases in mortality were 9.4% and 7.5%, respectively. Reperfusion and secondary preventive therapies were associated with a decreased mortality rate. CONCLUSIONS Mortality after AMI complicated by an ischemic stroke is very high but decreased from 1998 to 2008. The increased use of evidence-based therapies explains the improved prognosis.
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Affiliation(s)
- Anna Brammås
- From the Department of Public Health and Clinical Medicine, Umeå University, Sweden (A.B., S.J., T.M.); and Department of Internal Medicine, Section of Cardiology, Östersund Hospital, Sweden (A.U., T.M.)
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Diamond GA, Kaul S. Forbidden fruit: on the analysis of recurrent events in randomized clinical trials. Am J Cardiol 2013; 111:1530-6. [PMID: 23453245 DOI: 10.1016/j.amjcard.2013.01.310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 01/16/2013] [Indexed: 12/19/2022]
Abstract
The conventional analysis of a typical clinical trial focuses on the time to occurrence of the first among a composite set of alternative events such as death or nonfatal myocardial infarction. Subsequent recurrent events are thereby excluded from consideration to ensure that all the observations were mutually exclusive of each other. Thus, not all events occurring during follow-up will be analyzed. Consequently, some investigators are now reporting additional analyses of previously published trials based on a naive comparison of the total number of events-first events plus recurrent events-and are recommending that these additional analyses be routinely conducted in future trials. We have summarized the potential limitations of this proposal and suggest other methods to analyze recurrent events, with a particular focus on kinetic modeling. The application of this approach to several previously published trials illustrates its facility to help elucidate the causal mechanisms underlying empirical demonstrations of safety and efficacy.
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