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Tran VH, Lessard D, Parekh J, Tisminetzky MS, Gore JM, Yarzebski J, Granillo E, Nguyen TT, Goldberg R. Ventricular Tachycardia and Hospital Readmission in Patients Discharged From the Hospital After an Acute Myocardial Infarction. CJC Open 2024; 6:781-789. [PMID: 39022163 PMCID: PMC11250869 DOI: 10.1016/j.cjco.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/09/2024] [Indexed: 07/20/2024] Open
Abstract
Background Although ventricular tachycardia (VT) occurring during hospitalization for an acute myocardial infarction (AMI) increases mortality risk, its relationship with 30-day postdischarge rehospitalization has not been examined. Methods Using data from the Worcester Heart Attack Study, we examined the association between early (during the first 48 hours of admission) and late (after 48 hours from admission) VT with 30-day postdischarge all-cause and cardiovascular disease (CVD)-related rehospitalization while analytically controlling for several demographic and clinical factors. Results The study population consisted of 3534 patients who were hospitalized with an AMI between 2005 and 2015 (average age, 67.2 years; 40.7% women); VT occurred in 452 patients (13.7%), with the majority of instances (81.2%) occurring within 48 hours of admission. The 30-day all-cause rehospitalization rate was 17.3%, with 70.9% of the hospitalizations related to CVD. The odds of rehospitalization were 1.63 times (95% confidence interval [CI] = 0.99-2.69) and 1.12 times (95% CI = 0.83-1.51) higher for patients with AMI who developed late VT and early VT, respectively, compared to patients who did not develop VT. The risk of rehospitalization among patients with late VT was higher (odds ratio = 2.22 (95% CI = 0.79-6.26) in those with ST-segment-elevation AMI, compared to those with non-ST-segment-elevation AMI (odds ratio = 1.45 (95% CI = 0.81-2.57); early VT was not associated with rehospitalization in patients with either AMI subtype. No significant association was present between the occurrence of VT and CVD-related rehospitalization. Conclusions Patients who develop late VT may experience a higher risk of 30-day rehospitalization following hospital discharge for AMI, especially among those with ST-segment-elevation AMI. Larger studies are needed to confirm our findings.
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Affiliation(s)
- Vu Hoang Tran
- Department of Medicine, UMass Memorial Medical Group, Fitchburg, Massachusetts, USA
- Department of Medicine, Univeristy of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, Univeristy of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Jay Parekh
- Department of Medicine, Bridgeport Hospital, Yale New Haven Health, New Haven, Connecticut, USA
| | - Mayra S. Tisminetzky
- Department of Medicine, Univeristy of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Medicine, Bridgeport Hospital, Yale New Haven Health, New Haven, Connecticut, USA
| | - Joel M. Gore
- Department of Medicine, Univeristy of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, Univeristy of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Jorge Yarzebski
- Department of Population and Quantitative Health Sciences, Univeristy of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Edgard Granillo
- Department of Population and Quantitative Health Sciences, Univeristy of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Tuyet T. Nguyen
- Department of Medicine, College of Health Sciences, Vin University, Hanoi, Vietnam
| | - Robert Goldberg
- Department of Population and Quantitative Health Sciences, Univeristy of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Alkatib M, Alkotyfan ARN, Alshaghel MM, Shamiyeh M. Cardiac arrhythmias in STEMI patients in ICU: study on occurrence in first 48 h and correlation with age, sex, infarction site, and risk factors. Ann Med Surg (Lond) 2023; 85:4824-4829. [PMID: 37811071 PMCID: PMC10553150 DOI: 10.1097/ms9.0000000000001264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Acute myocardial infarction (AMI) is one of the leading causes of death in the developed world. The spread of the disease approaches three million people worldwide, with more than one million deaths in the United States annually. Myocardial ischemia and infarction can lead to electrophysiological and metabolic alterations that result in potentially fatal arrhythmias, some of which may be asymptomatic. About 90% of patients with AMI develop some form of arrhythmia during or immediately after the event, and in 25% of patients, these arrhythmias appear within the first 48 h. The most common cause of death in patients with AMI in pre-hospitalization is ventricular tachycardia/ventricular fibrillation (VT/VF). Methods A cross-sectional study targeting 150 patients with myocardial infarction attending tertiary hospital. According to certain acceptance and exclusion criteria. Results The sample consisted of 150 patients who suffered from heart infarction, the mean age of patients in the sample was 59.41 years with a standard deviation of 11.02 years and range of 28-90. Males constituted the largest portion of patients, with 112 males, that is 75%. The study identified that the anterior wall was the most frequent location for myocardial infarction among patients, with 64% of patients experiencing an infarction in this area. Additionally, ventricular fibrillation was the most commonly occurring arrhythmia, affecting 27% of myocardial infarction patients in the study. Recommendations One of the most important recommendations of our study is the necessity of keeping the patient under observation for at least 48 h after myocardial infarction within the hospital to monitor the ECG (Holter) in order to detect arrhythmias. Detection of arrhythmias in every patient with extensive anterior, lateral, or posterior myocardial infarction. And the need to know and take into account ventricular fibrillation and how to manage it in every patient with a heart infarction. And conducting future studies, including a larger number of patients, to study cardiac arrhythmias more precisely.
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Affiliation(s)
- Mahmoud Alkatib
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | | | | | - Marwan Shamiyeh
- Faculty of Medicine, Department of Internal Medicine, Syrian Private University, Damascus, Syria
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Pham HM, Van HD, Hoang LB, Phan PD, Tran VH. Distribution and 24-hour transition of SCAI shock stages and their association with 30-day mortality in acute myocardial infarction. Medicine (Baltimore) 2023; 102:e34689. [PMID: 37713835 PMCID: PMC10508443 DOI: 10.1097/md.0000000000034689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/20/2023] [Indexed: 09/17/2023] Open
Abstract
The Society for Cardiovascular Angiography and Interventions (SCAI) shock classification has been shown to predict mortality in acute myocardial infarction (AMI). However, data on the transition of SCAI stages and their association with mortality after AMI are limited. All patients with AMI admitted to Vietnam National Heart Institute between August 2022 and February 2023 were classified into SCAI stages A, B, and C/D/E at admission and were reevaluated in 24 hours. We used Kaplan-Meier estimate and multivariable Cox regression analysis to assess the association between SCAI stages transition and 30-day mortality. We included 139 patients (median age 69 years, 29.5% female). On admission, 50.4%, 20.1%, and 29.5% of patients were classified as SCAI stage A, B, and C/D/E, respectively. The proportion of patients whose SCAI stage improved, remained stable, or worsened after 24 hours was 14.4%, 66.2%, and 19.4%, respectively. The 30-day mortality in patients with initial SCAI stages A, B, and C/D/E on admission was 2.9%, 21.4%, and 61.0%, respectively (P < .001). The 30-day mortality was 2.4% for patients with baseline SCAI stage A/B who remained unchanged or improved, 30.0% for patients with baseline SCAI stage C/D/E who remained unchanged or improved, and 92.6% for patients with SCAI stage B/C/D/E who worsened at 24 hours after admission (log-rank P < .001). In patients with AMI, evaluating the SCAI stage shock stage on admission and reevaluating after 24 hours added more information about 30-day mortality.
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Affiliation(s)
- Hung Manh Pham
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
| | - Hanh Duc Van
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Long Bao Hoang
- Institute of Gastroenterology and Hepatology, Hanoi, Vietnam
| | - Phong Dinh Phan
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
| | - Vu Hoang Tran
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA
- Department of Medicine, UMass Memorial Medical Group, Worcester, MA
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Sharma R, Chowdhary I, Sharma A. Arrhythmia and its risk factors post myocardial infarction: A prospective study. JOURNAL OF ACUTE DISEASE 2022. [DOI: 10.4103/2221-6189.336578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lee SE, Kim KA, Son KJ, Song SO, Park KH, Park SH, Nam JY. Trends and risk factors in severe hypoglycemia among individuals with type 2 diabetes in Korea. Diabetes Res Clin Pract 2021; 178:108946. [PMID: 34252506 DOI: 10.1016/j.diabres.2021.108946] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 11/24/2022]
Abstract
AIMS Because of the development of new classes of antidiabetic drugs, hypoglycemic events were expected to decrease. We investigated the trends and risk factors for severe hypoglycemia in subjects with type 2 diabetes in Korea. METHODS We conducted repeated cross-sectional analyses using a Korean National Health Insurance Service-National Sample Cohort from 2006 to 2015. Severe hypoglycemia was defined as hospitalization or a visit to an emergency department with diagnosis of hypoglycemia using ICD-10 codes. RESULTS During the study period, the prevalence of type 2 diabetes continuously increased. The percentage of patients prescribed metformin and dipeptidyl peptidase-4 inhibitor increased, while the use of sulfonylurea decreased considerably, especially since 2009. The proportion of patients prescribed ≥3 classes of drugs continually increased. Age-standardized incidence of severe hypoglycemia per 1000 patients with diabetes increased from 6.00 to 8.24 between 2006 and 2010, and then fell to 6.49 in 2015. Predictors of severe hypoglycemia included female, older age, comorbidities, polypharmacy, and sulfonylurea or insulin usage. CONCLUSIONS Trends of severe hypoglycemia were associated with changes in drug classes rather than number of antidiabetic drugs. Relentless efforts to reduce the prescription of drugs with a high risk of hypoglycemia should be implemented, particularly for older women with multiple comorbidities.
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Affiliation(s)
- Seung Eun Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
| | - Kyoung-Ah Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
| | - Kang Ju Son
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul, Republic of Korea.
| | - Sun Ok Song
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
| | - Kyeong Hye Park
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
| | - Se Hee Park
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
| | - Joo Young Nam
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
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Hunt-O'Connor C, Moore Z, Patton D, Nugent L, Avsar P, O'Connor T. The effect of discharge planning on length of stay and readmission rates of older adults in acute hospitals: A systematic review and meta-analysis of systematic reviews. J Nurs Manag 2021; 29:2697-2706. [PMID: 34216502 DOI: 10.1111/jonm.13409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/30/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
AIM To examine the effectiveness of discharge planning on length of stay and readmission rates among older adults in acute hospitals. BACKGROUND Discharge planning takes place in all acute hospital settings in many forms. However, it is unclear how it contributes to reducing patient length of stay in hospital and readmission rates. METHODS Seven systematic reviews were identified and examined. All of the systematic reviews explored the impact of discharge planning on length of stay and readmission rates. RESULTS A limited meta-analysis of the results in relation to length of stay indicates positive finding for discharge planning as an intervention (MD = -0.71(95% CI -1.05,-0.37; p = .0001)). However, further analysis of the broader findings in relation to length of stay indicates inconclusive or mixed results. In relation to readmission rates both meta-analysis and narrative analysis point to a reduced risk for older people where discharge planning has taken place (RR = 0.78 (95% CI: 0.72, 0.84; p = .00001)). The ability to synthesize results however is severely hampered by the diversity of approaches to research in this area. IMPLICATIONS FOR NURSING MANAGEMENT It is unclear what impact discharge planning has on length of stay of older people. Indeed, while nurse mangers will be interested in gauging this impact on throughput and patient flow, it is questionable if length of stay is the correct outcome to measure when studying discharge planning as good discharge planning may increase length of stay. Readmission rates may be a more appropriate outcome measure but standardization of approach needs to be considered in this regard. This would assist nurse managers in assessing the impact of discharge planning processes.
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Affiliation(s)
- Caroline Hunt-O'Connor
- St James's Hospital, Dublin, Ireland.,RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland
| | - Zena Moore
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Lida Institute, Shanghai, China.,Faculty of Medicine and Health Sciences, UGent, Ghent University, Ghent, Belgium.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Fakeeh College of Medical Science, Jeddah, Kingdom of Saudi Arabia.,Skin, Wounds and Trauma Research Centre (SWaT), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Declan Patton
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Fakeeh College of Medical Science, Jeddah, Kingdom of Saudi Arabia.,Skin, Wounds and Trauma Research Centre (SWaT), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Linda Nugent
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Fakeeh College of Medical Science, Jeddah, Kingdom of Saudi Arabia
| | - Pinar Avsar
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Skin, Wounds and Trauma Research Centre (SWaT), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Tom O'Connor
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Lida Institute, Shanghai, China.,Fakeeh College of Medical Science, Jeddah, Kingdom of Saudi Arabia.,Skin, Wounds and Trauma Research Centre (SWaT), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
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Fukutomi M, Nishihira K, Honda S, Kojima S, Takegami M, Takahashi J, Itoh T, Watanabe T, Takenaka T, Ito M, Takayama M, Kario K, Sumiyoshi T, Kimura K, Yasuda S. Difference in the in-hospital prognosis between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction with high Killip class: Data from the Japan Acute Myocardial Infarction Registry. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:503–512. [PMID: 32419479 PMCID: PMC8248829 DOI: 10.1177/2048872620926681] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/26/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND ST-segment elevation myocardial infarction is known to be associated with worse short-term outcome than non-ST-segment elevation myocardial infarction. However, whether or not this trend holds true in patients with a high Killip class has been unclear. METHODS We analyzed 3704 acute myocardial infarction patients with Killip II-IV class from the Japan Acute Myocardial Infarction Registry and compared the short-term outcomes between ST-segment elevation myocardial infarction (n = 2943) and non-ST-segment elevation myocardial infarction (n = 761). In addition, we also performed the same analysis in different age subgroups: <80 years and ≥80 years. RESULTS In the overall population, there were no significant difference in the in-hospital mortality (20.0% vs 17.1%, p = 0.065) between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction groups. Patients <80 years of age also showed no difference in the in-hospital mortality (15.7% vs 15.2%, p = 0.807) between ST-segment elevation myocardial infarction (n = 2001) and non-ST-segment elevation myocardial infarction (n = 453) groups, whereas among those ≥80 years of age, ST-segment elevation myocardial infarction (n = 942) was associated with significantly higher in-hospital mortality (29.3% vs 19.8%, p = 0.001) and in-hospital cardiac mortality (23.3% vs 15.0%, p = 0.002) than non-ST-segment elevation myocardial infarction (n = 308). After adjusting for covariates, ST-segment elevation myocardial infarction was a significant predictor for in-hospital mortality (odds ratio 2.117; 95% confidence interval, 1.204-3.722; p = 0.009) in patients ≥80 years of age. CONCLUSION Among cases of acute myocardial infarction with a high Killip class, there was no marked difference in the short-term outcomes between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in younger patients, while ST-segment elevation myocardial infarction showed worse short-term outcomes in elderly patients than non-ST-segment elevation myocardial infarction. Future study identifying the prognostic factors for the specific anticipation intensive cares is needed in this high-risk group.
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Affiliation(s)
- Motoki Fukutomi
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Japan
| | - Kensaku Nishihira
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Sunao Kojima
- Department of General Internal Medicine 3, Kawasaki Medical School, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Tomonori Itoh
- Division of Cardiology, Iwate Medical University, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Japan
| | | | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | | | - Kazuomi Kario
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Japan
| | | | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
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Shah JA, Naz F, Kumar R, Hassan M, Shah G, Ahmed K, Hussain J, Abid K, Karim M. Incidence of Cardiac Arrhythmias in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention and Associated Outcomes During the First 24 Hours. Cureus 2021; 13:e12599. [PMID: 33585089 PMCID: PMC7871363 DOI: 10.7759/cureus.12599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Acute myocardial infarction (AMI) is the most life-threatening manifestation of coronary artery diseases. The majority of deaths in AMI are due to arrhythmias. Therefore, the aim of this study was to evaluate the incidence and risk factors and outcomes of cardiac arrhythmias in AMI patients undergoing primary percutaneous coronary intervention (PCI) during the first 24 hours of the index hospitalization. Methodology This prospective observational study was conducted at the adult cardiology department of the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Patients undergoing primary PCI were included in this study. All the patients were kept under observation for the first 24 hours of AMI and monitored through telemetry system monitoring and the incidence of cardiac arrhythmias and the outcomes were recorded. Results A total of 110 patients were included; the mean age was 59.6±13.1 years. Most of them were male (70.9%). Arrhythmias were observed in 89.1% of the patients, with 169 episodes. The accelerated idioventricular rhythm was the most common type of arrhythmia (37.3%) followed by sinus tachycardia (36.4%), ventricular tachycardia (22.7%), and complete heart block (20.0%). Lethal arrhythmias were observed in 64.5% (71) of the patients. During the hospital course, 65.5% developed arrhythmias during arrival to balloon time, 30% during the procedure, and 53.6% within 24 hours of the procedure. The in-hospital mortality rate was 15.5% with a significant association with the development of lethal arrhythmias within 24 hours of the procedure (21.1% vs. 5.1%; p=0.026). Conclusions The incidence of arrhythmias within 24 hours of hospitalization is high in patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI, and it has been observed to be associated with an increased rate of in-hospital mortality.
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Affiliation(s)
- Jehangir A Shah
- Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Farah Naz
- Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Rajesh Kumar
- Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Muhammad Hassan
- Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Ghazanfer Shah
- Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Khalil Ahmed
- Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Jamil Hussain
- Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Khadijah Abid
- Research Evaluation Unit, College of Physicians, Karachi, PAK
| | - Musa Karim
- Statistics, National Institute of Cardiovascular Diseases, Karachi, PAK
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Crawshaw J, Bartoli-Abdou JK, Weinman J, McRobbie D, Stebbins M, Brock T, Auyeung V. The transition from hospital to home following acute coronary syndrome: an exploratory qualitative study of patient perceptions and early experiences in two countries. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2020; 29:61-69. [PMID: 33793821 DOI: 10.1093/ijpp/riaa009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/16/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Following acute coronary syndrome (ACS), it is standard practice for stable patients to be discharged as quickly as possible from hospital. If patients are not adequately supported at this time, issues such as readmission can occur. We report findings from an exploratory qualitative study investigating the perceptions and early experiences of patients transitioning from hospitals in the UK and USA to home following ACS. METHODS Within 1 month of discharge, we conducted semi-structured telephone interviews with patients hospitalised for ACS (UK: n = 8; USA: n = 9). Data were analysed using the Framework Method. KEY FINDINGS We identified four superordinate themes. Coping, adjustment and management: Patients were still adjusting to the physical limitations caused by their event but most had begun to implement positive lifestyle changes. Gaps in care transition: Poor communication and organisation postdischarge resulted in delayed follow-up for some patients causing considerable frustration. Quality of care from hospital to home: Patients experienced varied inpatient care quality but had largely positive interactions in primary/community care. Pharmacy input during care transition was viewed favourably in both countries. Medication-taking beliefs and behaviour: Patients reported good initial adherence to treatment but side effects were a concern. CONCLUSIONS ACS patients experienced gaps in care early in the transition from hospital to home. Poor communication and uncoordinated support postdischarge negatively impacted patient experience. Further research is needed to determine how patients' early experiences following ACS can affect longer-term outcomes including healthcare engagement and treatment maintenance.
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Affiliation(s)
- Jacob Crawshaw
- Institute of Pharmaceutical Science, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - John K Bartoli-Abdou
- Institute of Pharmaceutical Science, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - John Weinman
- Institute of Pharmaceutical Science, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | | | - Marilyn Stebbins
- School of Pharmacy, University of California, San Francisco, CA, USA
| | - Tina Brock
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Vivian Auyeung
- Institute of Pharmaceutical Science, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
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Abstract
The US healthcare system is moving into a new era of value-based care, which focuses on delivering safer and higher quality care while reducing costs. Health information exchange (HIE) has been a vital component in this process; however, there has been a lack of awareness and use of HIE among nurse leaders, clinicians, and researchers. The purpose of this article is to provide nurses and administrators with a brief overview of HIE and its impact on care delivery, as well as practical applications using specific case examples.
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11
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Bouabdallaoui N, Tardif JC, Waters DD, Pinto FJ, Maggioni AP, Diaz R, Berry C, Koenig W, Lopez-Sendon J, Gamra H, Kiwan GS, Blondeau L, Orfanos A, Ibrahim R, Grégoire JC, Dubé MP, Samuel M, Morel O, Lim P, Bertrand OF, Kouz S, Guertin MC, L’Allier PL, Roubille F. Time-to-treatment initiation of colchicine and cardiovascular outcomes after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). Eur Heart J 2020; 41:4092-4099. [PMID: 32860034 PMCID: PMC7700755 DOI: 10.1093/eurheartj/ehaa659] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS The COLchicine Cardiovascular Outcomes Trial (COLCOT) demonstrated the benefits of targeting inflammation after myocardial infarction (MI). We aimed to determine whether time-to-treatment initiation (TTI) influences the beneficial impact of colchicine. METHODS AND RESULTS In COLCOT, patients were randomly assigned to receive colchicine or placebo within 30 days post-MI. Time-to-treatment initiation was defined as the length of time between the index MI and the initiation of study medication. The primary efficacy endpoint was a composite of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina requiring coronary revascularization. The relationship between endpoints and various TTI (<3, 4-7 and >8 days) was examined using multivariable Cox regression models. Amongst the 4661 patients included in this analysis, there were 1193, 720, and 2748 patients, respectively, in the three TTI strata. After a median follow-up of 22.7 months, there was a significant reduction in the incidence of the primary endpoint for patients in whom colchicine was initiated < Day 3 compared with placebo [hazard ratios (HR) = 0.52, 95% confidence intervals (CI) 0.32-0.84], in contrast to patients in whom colchicine was initiated between Days 4 and 7 (HR = 0.96, 95% CI 0.53-1.75) or > Day 8 (HR = 0.82, 95% CI 0.61-1.11). The beneficial effects of early initiation of colchicine were also demonstrated for urgent hospitalization for angina requiring revascularization (HR = 0.35), all coronary revascularization (HR = 0.63), and the composite of cardiovascular death, resuscitated cardiac arrest, MI, or stroke (HR = 0.55, all P < 0.05). CONCLUSION Patients benefit from early, in-hospital initiation of colchicine after MI. TRIAL REGISTRATION COLCOT ClinicalTrials.gov number, NCT02551094.
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Affiliation(s)
- Nadia Bouabdallaoui
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | | | - Fausto J Pinto
- Santa Maria University Hospital (CHULN), CAML, CCUL, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | | | - Rafael Diaz
- Estudios Clinicos Latinoamerica, Rosario, Argentina
| | - Colin Berry
- University of Glasgow and NHS Glasgow Clinical Research Facility, Glasgow, UK
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany
| | | | - Habib Gamra
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | - Lucie Blondeau
- The Montreal Health Innovations Coordinating Center (MHICC), Montreal, Canada
| | - Andreas Orfanos
- The Montreal Health Innovations Coordinating Center (MHICC), Montreal, Canada
| | - Reda Ibrahim
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Jean C Grégoire
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Pierre Dubé
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Michelle Samuel
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Pascal Lim
- Department of Cardiology, AP-HP, Hôpital Universitaire Henri-Mondor and INSERM U955, Université Paris-Est Créteil, Créteil, France
| | | | - Simon Kouz
- Centre Hospitalier Régional de Lanaudière, Joliette, Canada
| | | | - Philippe L L’Allier
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
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12
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Würtz M, Grove EL, Corraini P, Adelborg K, Sundbøll J, Komjáthiné Szépligeti S, Horváth-Puhó E, Sørensen HT. Comorbidity and risk of venous thromboembolism after hospitalization for first-time myocardial infarction: A population-based cohort study. J Thromb Haemost 2020; 18:1974-1985. [PMID: 32319179 DOI: 10.1111/jth.14865] [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: 11/01/2019] [Revised: 03/23/2020] [Accepted: 04/17/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Myocardial infarction (MI) is a risk factor for venous thromboembolism (VTE). Although comorbidities affect MI prognosis, it is unclear whether they affect VTE risk after MI. OBJECTIVES We examined the impact of comorbidity on VTE risk after MI. METHODS We used nationwide population-based registries to identify first-time hospitalizations for MI and subsequent occurrence of VTE in Denmark (1995-2013). We included a comparison cohort from the general population matched 5:1 with MI patients by sex, age, and comorbidities. We computed 30-day and 1- to 12-month cumulative risks, rates, and hazard ratios of VTE. We also assessed the interaction between MI and comorbidity, defined as excess VTE risk in patients with both MI and comorbidity, by computing interaction contrasts and attributable fractions relating to the interaction. RESULTS Thirty-day and 1- to 12-month VTE risks were 0.6% and 0.5% in the MI cohort (n = 160 338) and 0.03% and 0.3% in the comparison cohort (n = 792 384). The 30-day hazard ratio for VTE in the MI cohort was 23 (95% confidence interval, 20-27), which decreased during 1-year follow-up. Thirty days after MI, interactions between MI and comorbidity accounted for 16% and 39% of VTE rates in MI patients with low-to-moderate and high comorbidity, respectively. The interactions were driven primarily by hemiplegia and cancer. CONCLUSIONS Thirty-day VTE risk was substantially increased after MI compared with the general population. Although the absolute VTE risk was low, comorbidity substantially increased this risk, especially hemiplegia and cancer. VTE prophylaxis might be indicated in such high-risk patients but warrants further investigation.
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Affiliation(s)
- Morten Würtz
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Priscila Corraini
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Sundbøll
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Diagnostic Centre, Department of Clinical Medicine, Silkeborg Regional Hospital, University Research Clinic for Innovative Patient Pathways, Aarhus University, Silkeborg, Denmark
| | | | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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13
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Jang S, Yeo I, Feldman DN, Cheung JW, Minutello RM, Singh HS, Bergman G, Wong SC, Kim LK. Associations Between Hospital Length of Stay, 30-Day Readmission, and Costs in ST-Segment-Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention: A Nationwide Readmissions Database Analysis. J Am Heart Assoc 2020; 9:e015503. [PMID: 32468933 PMCID: PMC7428974 DOI: 10.1161/jaha.119.015503] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Readmission after ST-segment-elevation myocardial infarction (STEMI) poses an enormous economic burden to the US healthcare system. There are limited data on the association between length of hospital stay (LOS), readmission rate, and overall costs in patients who underwent primary percutaneous coronary intervention for STEMI. Methods and Results All STEMI hospitalizations were selected in the Nationwide Readmissions Database from 2010 to 2014. From the patients who underwent primary percutaneous coronary intervention, we examined the 30-day outcomes including readmission, mortality, reinfarction, repeat revascularization, and hospital charges/costs according to LOS (1-2, 3, 4, 5, and >5 days) stratified by infarct locations. The 30-day readmission rate after percutaneous coronary intervention for STEMI was 12.0% in the anterior wall (AW) STEMI group and 9.9% in the non-AW STEMI group. Patients with a very short LOS (1-2 days) were readmitted less frequently than those with a longer LOS regardless of infarct locations. However, patients with a very short LOS had significantly increased 30-day readmission mortality versus an LOS of 3 days (hazard ratio, 1.91; CI, 1.16-3.16 [P=0.01]) only in the AW STEMI group. Total costs (index admission+readmission) were the lowest in the very short LOS cohort in both the AW STEMI group (P<0.001) and the non-AW STEMI group (P<0.001). Conclusions For patients who underwent primary percutaneous coronary intervention for STEMI, a very short LOS was associated with significantly lower 30-day readmission and lower cumulative cost. However, a very short LOS was associated with higher 30-day mortality compared with at least a 3-day stay in the AW STEMI cohort.
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Affiliation(s)
- Sun‐Joo Jang
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
- Dalio Institute of Cardiovascular ImagingDepartment of RadiologyWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
| | - Ilhwan Yeo
- Division of CardiologyNew York Presbyterian Queens HospitalNew YorkNY
- Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Dmitriy N. Feldman
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
| | - Jim W. Cheung
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
| | - Robert M. Minutello
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
| | - Harsimran S. Singh
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
| | - Geoffrey Bergman
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
| | - S. Chiu Wong
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
| | - Luke K. Kim
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
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14
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Wang TKM, Grey C, Jiang Y, Bullen C, Jackson R, Kerr A. Increases in early discharge following acute coronary syndrome hospitalisations and associated clinical outcomes in New Zealand between 2006 and 2015: ANZACS-QI-43 study. Intern Med J 2020; 51:1312-1320. [PMID: 32447807 DOI: 10.1111/imj.14927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND International guidelines recommend early discharge for uncomplicated acute coronary syndrome (ACS) patients within 3 days; however, there is a paucity of contemporary literature regarding the safety of this strategy. AIMS To report the trends in the proportion of ACS hospitalisations discharged within 3 days and their outcomes in New Zealand. METHODS ACS hospitalisations 2006-2015 using national routinely collected data were categorised by length of stay (LOS) into ≤3, 4-5 and >5 days, excluding deaths during the index admission. Trend analysis of death, cardiovascular and bleeding events and their composites (net adverse clinical events) at 30-day and 1-year post-discharge were performed using generalised linear mixed regression models adjusting for covariates by LOS subgroups. RESULTS Among 130 037 ACS hospitalisations, LOS ≤ 3 days increased from 32% in 2006 to 44% in 2016. This trend was observed for all demographics, ACS subtypes and management strategies. Event rates at 30 days and 1 year were the lowest for the LOS ≤3 days subgroup (all-cause mortality 1.6% and 9.1% respectively). Thirty-day and 1-year all-cause mortality rates were unchanged over time for this subgroup (adjusted odds ratio (95% confidence interval) of 1.011 (0.985-1.038) and 0.991 (0.979-1.003)), while net adverse clinical event rates significantly decreased (0.962 (0.950-0.973) and 0.972 (0.964-0.980) respectively). CONCLUSION There was a substantial increase in early discharge post-ACS over 10 years. These patients were associated with reduction in adverse clinical events up to 1 year and no increase in all-cause mortality. These findings from a comprehensive national register suggest that guideline recommendations on early discharge after uncomplicated ACS are safe and appropriate.
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Affiliation(s)
- Tom Kai Ming Wang
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand
| | - Corina Grey
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Christopher Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rod Jackson
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Andrew Kerr
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand.,Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.,Department of Medicine, University of Auckland, Auckland, New Zealand
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15
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Wang G, Zhao Q, Cheng Q, Zhang X, Tian L, Wu X. Comparison short time discharge with long time discharge following uncomplicated percutaneous coronary intervention for Non-ST elevation myocardial infarction patients. BMC Cardiovasc Disord 2019; 19:109. [PMID: 31088360 PMCID: PMC6518450 DOI: 10.1186/s12872-019-1096-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 05/03/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The rational length of stay following non-complicated percutaneous coronary intervention (PCI) for Non-ST elevation myocardial infarction (NSTEMI) patients remains controversial. Few studies have examined the impact of early discharge on short-term outcomes in NSTEMI patients, but short-time discharge is not uncommon in real world practice. This study examined the impact of short time discharge following non-complicated PCI on 30-day net adverse clinical events in NSTEMI patients. METHODS This retrospective study enrolled 1424 consecutive patients with NSTEMI diagnoses who underwent non-complicated PCI. Of these patients, 432 were discharged early (< 24 h), whereas the remaining 992 NSTEMI patients underwent routine discharge. The primary end points of the study were the net adverse clinical events including major adverse cardiac or cerebral events or access site vascular/bleeding complications within 30 days. The differences between the two groups were analyzed after propensity score matching to reduce selection bias. RESULTS The incidence of crude 30-day net adverse events was numerically higher in the long-time discharge group at 11.6% (115/992) compared with 8.6% (37/432) in the short-time discharge group, although this difference was not significant (P = 0.09). This difference was mainly due to lesser radial access selected in the long-time discharge group (827/932, 83.4% vs. 387/432, 89.5%, P < 0.0005). After PS matching to balance the access difference, there was no significant difference in the incidence of the events mentioned above between two groups. CONCLUSIONS If an NSTEMI patient undergoes PCI without any procedural or hospital complications, short-time discharge after successful PCI would be feasible and safe in selected NSTEMI patients.
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Affiliation(s)
- Guozhong Wang
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China.
| | - Quanming Zhao
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
| | - Qing Cheng
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
| | - Xiaoxia Zhang
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
| | - Lei Tian
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
| | - Xiaofan Wu
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
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16
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Zhao X, Jia Y, Chen H, Yao H, Guo W. Plasma-derived exosomal miR-183 associates with protein kinase activity and may serve as a novel predictive biomarker of myocardial ischemic injury. Exp Ther Med 2019; 18:179-187. [PMID: 31258652 PMCID: PMC6566024 DOI: 10.3892/etm.2019.7555] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 11/08/2018] [Indexed: 12/12/2022] Open
Abstract
Myocardial infarction (MI) is primarily caused by ischemic heart or coronary artery disease and is a major cause of mortality worldwide. Thus, it is necessary to establish reliable biochemical markers for the early diagnosis of MI. MicroRNAs (miRNAs or miR) have been demonstrated to circulate in biological fluids and are enclosed in extracellular vesicles, including exosomes. The current study assessed the differential expression of exosomal miRNAs in the plasma of patients with MI and healthy individuals, and the possible mechanism involved. Plasma-derived exosomes were isolated from patients with MI and healthy control individuals, and vesicles with a membrane were observed using transmission electron microscopy. Furthermore, an exosomal miRNA expression profile was compared between patients with MI and healthy individuals using a miRNA microarray. Significantly differentially expressed miRNAs were validated using reverse transcription-quantitative polymerase chain reaction. To the best of our knowledge, the present study was the first to demonstrate that miR-183 was markedly upregulated in patients with MI compared with healthy individuals. In addition, the relative exosomal miR-183 level increased with the degree of myocardial ischemic injury. Additionally, GO and KEGG analyses demonstrated that miR-183 is primarily involved in cell communication, protein kinase activity regulation and adrenergic signaling in cardiomyocytes. Furthermore, a protein-protein interaction network of all the miR-183 target genes was constructed. The results demonstrated that five core genes (PPP2CB, PPP2CA, PRKCA, PPP2CA, PPP2R5C and PPP2R2A) in the PPI network were also associated with protein kinase activity regulation and adrenergic signaling in cardiomyocytes. Taken together, these data demonstrate that exosomal miR-183 derived from the serum of patients with MI may be a novel diagnostic biomarker involved in the regulation of protein kinase activity. miR-183 may therefore be further developed for clinical use to benefit patients with coronary artery diseases.
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Affiliation(s)
- Xingxing Zhao
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Yongping Jia
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Huanzhen Chen
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Hongmei Yao
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Wenlin Guo
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
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17
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Tran H, Byatt N, Erskine N, Lessard D, Devereaux RS, Saczynski J, Kiefe C, Goldberg R. Impact of anxiety on the post-discharge outcomes of patients discharged from the hospital after an acute coronary syndrome. Int J Cardiol 2019; 278:28-33. [PMID: 30266354 DOI: 10.1016/j.ijcard.2018.09.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Symptoms of anxiety are highly prevalent among survivors of an acute coronary syndrome (ACS), but do not necessarily indicate an anxiety disorder. The extent to which symptoms of anxiety or a diagnosis of this condition impacts hospital readmission and post-discharge mortality among patients with an ACS remains unclear. METHODS We used data from 1909 patients discharged from six hospitals in Massachusetts and Georgia after an ACS. Moderate/severe symptoms of anxiety were defined based on responses to a Generalized Anxiety Disorder questionnaire during the patient's index hospitalization. The diagnosis of an anxiety disorder was based on review of hospital medical records. Multivariable adjusted Poisson regression and Cox proportional-hazards models were used to estimate the risk of 30-day hospital readmissions and 2-year total mortality. RESULTS The mean age of the study population was 61 years, two thirds were men, and 78% were non-Hispanic whites. In this population, 10.4% had a documented diagnosis of an anxiety disorder, 18.8% had moderate/severe symptoms of anxiety, and 70.8% had neither a diagnosis nor symptoms of anxiety. Neither a diagnosis of an anxiety disorder nor symptoms of anxiety were associated with 30-day all-cause or cardiovascular-related rehospitalizations. Patients with an anxiety disorder (multivariable adjusted HR = 1.95, 95%CI = 1.11-3.42) were at greatest risk for dying during the 2-year follow-up period. CONCLUSIONS We identified patients with an anxiety disorder as being at greater risk for dying after hospital discharge for an ACS. Interventions may be more appropriately targeted to those with a history of, rather than acute symptoms of, anxiety.
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Affiliation(s)
- Hoang Tran
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States of America
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Medical School, United States of America
| | - Nathaniel Erskine
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States of America
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States of America
| | - Randolph S Devereaux
- Department of Community Medicine, Mercer University School of Medicine, United States of America
| | - Jane Saczynski
- Department of Pharmacy and Health System Sciences, Northeastern University, United States of America
| | - Catarina Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States of America
| | - Robert Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States of America.
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18
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Tran HV, Gore JM, Darling CE, Ash AS, Kiefe CI, Goldberg RJ. Clinically significant ventricular arrhythmias and progression of depression and anxiety following an acute coronary syndrome. J Psychosom Res 2019; 117:54-62. [PMID: 30482494 DOI: 10.1016/j.jpsychores.2018.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 10/12/2018] [Accepted: 10/18/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depression and anxiety are common and associated with worse clinical outcomes in patients who experience an acute coronary syndrome (ACS). We investigated the association between major ventricular arrhythmias (VAs) with the progression of depression and anxiety among hospital survivors of an ACS. METHODS Patients were interviewed in hospital and by telephone up to 12 months after hospital discharge. The primary outcome was the presence of moderate/severe symptoms of depression and anxiety defined as a Patient Health Questionnaire (PHQ)-9 score ≥ 10 and a Generalized Anxiety Disorder (GAD)-7 score ≥ 10 at baseline and 1 month and PHQ-2 ≥ 3 and GAD-2 ≥ 3 at 3, 6, and 12 months. We used marginal models to examine the association between major VAs and the symptoms of depression or anxiety over time. RESULTS The average age of the study population (n = 2074) was 61.1 years, 33.5% were women, and 78.3% were white. VAs developed in 105 patients (5.1%). Symptoms of depression and anxiety were present in 22.2% and 23.5% of patients at baseline, respectively, and declined to 14.1% and 12.6%, respectively, at 1-month post-discharge. VAs were not significantly associated with the progression of symptoms of depression (adjusted relative risk [aRR] = 1.29, 95% confidence interval [CI] = 0.94-1.77) and anxiety (aRR = 1.22, 95% CI = 0.86-1.72), or with change in average scores of PHQ-2 and GAD-2 over time, both before and after risk adjustment. CONCLUSION The prevalence of symptoms of depression and anxiety was high after an ACS but declined thereafter and may not be associated with the occurrence of major in-hospital VAs.
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Affiliation(s)
- Hoang V Tran
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States; Department of Medicine, Bridgeport Hospital, Yale New Haven Health, United States.
| | - Joel M Gore
- Department of Medicine, University of Massachusetts Medical School, United States
| | - Chad E Darling
- Department of Emergency Medicine, University of Massachusetts Medical School, United States
| | - Arlene S Ash
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States
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19
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Randomized Controlled Trial of Symptom Management Patient Education for People With Acute Coronary Syndrome. J Nurs Care Qual 2018; 34:340-345. [PMID: 30550498 DOI: 10.1097/ncq.0000000000000383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Poorly managed acute coronary syndrome symptoms increase the risk of subsequent cardiovascular events. PURPOSE The aim of this study was to evaluate the effectiveness of symptom management patient education on the knowledge of sublingual nitroglycerin for people with acute coronary syndrome. METHODS A randomized controlled trial was used to evaluate the 3-resource intervention. The study was conducted in a 448-bed Australian public hospital. The instrument used was the modified Sublingual Nitroglycerin Interview Schedule. RESULTS A total of 169 participants completed the study. The intervention group significantly improved their knowledge of sublingual nitroglycerin when compared with the control group (P = .002). CONCLUSION This 3-resource symptom management patient education shows promise in improving sublingual nitroglycerin knowledge for people with acute coronary syndrome.
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McCarthy CP, Vaduganathan M, McEvoy JW. Optimizing the Detection of Left Ventricular Thrombus Following Acute Myocardial Infarction in the Current Era-Reply. JAMA Cardiol 2018; 3:1129. [PMID: 30285031 DOI: 10.1001/jamacardio.2018.3142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Cian P McCarthy
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - John W McEvoy
- Johns Hopkins Coronary Care Unit, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Domínguez-Pérez L, Martín-Asenjo R, Bueno H. Early to bed and early to rise makes a patient healthy, a hospital wealthy, and a doctor wise, or not? Eur J Prev Cardiol 2018; 25:804-806. [PMID: 29658299 DOI: 10.1177/2047487318771775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Laura Domínguez-Pérez
- 1 Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Roberto Martín-Asenjo
- 1 Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Héctor Bueno
- 1 Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,2 Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,3 Facultad de Medicina, Universidad Complutense de Madrid, Spain
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