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Trujillo-Flores D, García-Mendoza JDJ. Atrial fibrillation de novo in acute coronary syndrome. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2024; 94:181-190. [PMID: 38648718 PMCID: PMC11160543 DOI: 10.24875/acm.23000008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/15/2023] [Indexed: 04/25/2024] Open
Abstract
One of the complications during an acute coronary syndrome event is the presence of arrhythmias. Among them, those of the supraventricular type, especially atrial fibrillation, carry a poor prognosis both in the short and long term, being the cause of situations such as cerebrovascular event, ventricular arrhythmias, and increased mortality. The arrhythmia tends to appear in a certain population group with particular risk factors during the index event in approximately 10% of cases. Appropriate treatment at the time of its onset, thanks to the use of drugs that modulate heart rate, rhythm, and anticoagulant management in the most vulnerable groups, will lead to a less bleak outcome for these patients.
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Affiliation(s)
- David Trujillo-Flores
- Servicio de Consulta Externa de Cardiología
- Servicio de Hospitalización de Cardiología
- Servicio de Ecocardiografía
| | - José de J. García-Mendoza
- Departamento de Electrocardiografía. Clínica Hospital Instituto de Seguridad y Servicios Sociales de los Trabajadores al Servicios de los Poderes del Estado de Puebla, Tehuacán, Pue., México
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Health-related quality of life increases after first-time acute myocardial infarction: A population-based study. Zdr Varst 2021; 61:24-31. [PMID: 35111263 PMCID: PMC8776287 DOI: 10.2478/sjph-2022-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 11/04/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Acute myocardial infarction (AMI) affects patients’ health-related quality of life (HRQOL). AMI may decrease HRQOL, thus negatively affecting QOL. However, the improvements in interventional treatment and early rehabilitation after AMI may have a positive effect on HRQOL. Aim We evaluated HRQOL in patients after the first AMI treated in a reference cardiology centre in Poland and assessed which clinical variables affect HRQOL after AMI. Material and methods We prospectively evaluated HRQOL in 60 consecutive patients suffering after their first AMI during the index hospitalisation and again after 6 months, using: (i) MacNew, (ii) World Health Organization Quality of Life (WHOQOL) BREF, and (iii) Short Form (SF) 36. Results As measured by the MacNew questionnaire, global, social, and physical functioning did not change (p≥0.063), whereas emotional functioning improved 6 months after AMI, compared to index hospitalisation (p=0.002). As measured by WHOQOL BREF, physical health, psychological health, and environmental functioning did not change (p≥0.321), whereas social relationships improved 6 months after AMI (p=0.042). As assessed by SF-36, the global HRQOL improved after AMI (p=0.044). Patients with improved HRQOL in SF-36 often had a higher baseline body mass index (p=0.046), dyslipidaemia (p=0.046), and lower left ventricle ejection fraction (LVEF; p=0.013). LVEF<50% was the only variable associated with improved HRQOL in multivariate analysis (OR 4.463, 95% CI 1.045 - 19.059, p=0.043). Conclusions HRQOL increased 6 months after the first AMI, especially in terms of emotional functioning and social relationships. Patients with LVEF<50% were likely to have improved HRQOL.
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Hajduk AM, Murphy TE, Geda ME, Dodson JA, Tsang S, Haghighat L, Tinetti ME, Gill TM, Chaudhry SI. Association Between Mobility Measured During Hospitalization and Functional Outcomes in Older Adults With Acute Myocardial Infarction in the SILVER-AMI Study. JAMA Intern Med 2019; 179:1669-1677. [PMID: 31589285 PMCID: PMC6784755 DOI: 10.1001/jamainternmed.2019.4114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/28/2019] [Indexed: 12/17/2022]
Abstract
Importance Many older survivors of acute myocardial infarction (AMI) experience functional decline, an outcome of primary importance to older adults. Mobility impairment has been proposed as a risk factor for functional decline but has not been evaluated to date in older patients hospitalized for AMI. Objective To examine the association of mobility impairment, measured during hospitalization, as a risk marker for functional decline among older patients with AMI. Design, Setting, and Participants Prospective cohort study among 94 academic and community hospitals in the United States. Participants were 2587 hospitalized patients with AMI who were 75 years or older. The study dates were January 2013 to June 2017. Main Outcomes and Measures Mobility was evaluated during AMI hospitalization using the Timed "Up and Go," with scores categorized as preserved mobility (≤15 seconds to complete), mild impairment (>15 to ≤25 seconds to complete), moderate impairment (>25 seconds to complete), and severe impairment (unable to complete). Self-reported function in activities of daily living (ADLs) (bathing, dressing, transferring, and walking around the home) and walking 0.4 km (one-quarter mile) was assessed at baseline and 6 months after discharge. The primary outcomes were worsening of 1 or more ADLs and loss of ability to walk 0.4 km from baseline to 6 months after discharge. The association between mobility impairment and risk of functional decline was evaluated with multivariable-adjusted logistic regression. Results Among 2587 hospitalized patients with AMI, the mean (SD) age was 81.4 (4.8) years, and 1462 (56.5%) were male. More than half of the cohort exhibited mobility impairment during AMI hospitalization (21.8% [564 of 2587] had mild impairment, 16.0% [414 of 2587] had moderate impairment, and 15.2% [391 of 2587] had severe impairment); 12.8% (332 of 2587) reported ADL decline, and 16.7% (431 of 2587) reported decline in 0.4-km mobility. Only 3.8% (30 of 800) of participants with preserved mobility experienced any ADL decline compared with 6.9% (39 of 564) of participants with mild impairment (adjusted odds ratio [aOR], 1.24; 95% CI, 0.74-2.09), 18.6% (77 of 414) of participants with moderate impairment (aOR, 2.67; 95% CI, 1.67-4.27), and 34.7% (136 of 391) of participants with severe impairment (aOR, 5.45; 95% CI, 3.29-9.01). Eleven percent (90 of 800) of participants with preserved mobility declined in ability to walk 0.4 km compared with 15.2% (85 of 558) of participants with mild impairment (aOR, 1.51; 95% CI, 1.04-2.20), 19.0% (78 of 411) of participants with moderate impairment (aOR, 2.03; 95% CI, 1.37-3.02), and 24.6% (95 of 386) of participants with severe impairment (aOR, 3.25; 95% CI, 2.02-5.23). Conclusions and Relevance This study's findings suggest that mobility impairment assessed during hospitalization may be a potent risk marker for functional decline in older survivors of AMI. These findings also suggest that brief, validated assessments of mobility should be part of the care of older hospitalized patients with AMI to identify those at risk for this important patient-centered outcome.
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Affiliation(s)
- Alexandra M. Hajduk
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Terrence E. Murphy
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mary E. Geda
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - John A. Dodson
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Sui Tsang
- Department of Medicine, NYU Langone Health, New York, New York
| | - Leila Haghighat
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mary E. Tinetti
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Tran HV, Gore JM, Darling CE, Ash AS, Kiefe CI, Goldberg RJ. Hyperglycemia and risk of ventricular tachycardia among patients hospitalized with acute myocardial infarction. Cardiovasc Diabetol 2018; 17:136. [PMID: 30340589 PMCID: PMC6194566 DOI: 10.1186/s12933-018-0779-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/12/2018] [Indexed: 01/08/2023] Open
Abstract
Background Little is known about the association of hyperglycemia with the development of ventricular tachycardia (VT) in patients hospitalized with acute myocardial infarction (AMI) which we examined in the present study. The objectives of this community-wide observational study were to examine the relation between elevated serum glucose levels at the time of hospital admission for AMI and occurrence of VT, and time of occurrence of VT, during the patient’s acute hospitalization. Methods We used data from a population-based study of patients hospitalized with AMI at all central Massachusetts medical centers between 2001 and 2011. Hyperglycemia was defined as a serum glucose level ≥ 140 mg/dl at the time of hospital admission. The development of VT was identified from physicians notes and electrocardiographic findings by our trained team of data abstractors. Results The average age of the study population was 70 years, 58.0% were men, and 92.7% were non-Hispanic whites. The mean and median serum glucose levels at the time of hospital admission were 171.4 mg/dl and 143.0, respectively. Hyperglycemia was present in 51.9% of patients at the time of hospital admission; VT occurred in 652 patients (15.8%), and two-thirds of these episodes occurred during the first 48 h after hospital admission (early VT). After multivariable adjustment, patients with hyperglycemia were at increased risk for developing VT (adjusted OR = 1.48, 95% CI = 1.23–1.78). The presence of hyperglycemia was significantly associated with early (multivariable adjusted OR = 1.39, 95% CI = 1.11–1.73) but not with late VT. Similar associations were observed in patients with and without diabetes and in patients with and without ST-segment elevation AMI. Conclusions Efforts should be made to closely monitor and treat patients who develop hyperglycemia, especially early after hospital admission, to reduce their risk of VT.
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Affiliation(s)
- Hoang V Tran
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.,Department of Medicine, Bridgeport Hospital, Yale New Haven, CT, USA
| | - Joel M Gore
- Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Chad E Darling
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Arlene S Ash
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
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Hariri E, Tisminetzky M, Lessard D, Yarzebski J, Gore J, Goldberg R. Twenty-Five-Year (1986-2011) Trends in the Incidence and Death Rates of Stroke Complicating Acute Myocardial Infarction. Am J Med 2018; 131:1086-1094. [PMID: 29730362 PMCID: PMC6163071 DOI: 10.1016/j.amjmed.2018.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The occurrence of a stroke after an acute myocardial infarction is associated with increased morbidity and mortality rates. However, limited data are available, particularly from a population-based perspective, about recent trends in the incidence and mortality rates associated with stroke complicating an acute myocardial infarction. The purpose of this study was to examine 25-year trends (1986-2011) in the incidence and in-hospital mortality rates of initial episodes of stroke complicating acute myocardial infarction. METHODS The study population consisted of 11,436 adults hospitalized with acute myocardial infarction at all 11 medical centers in central Massachusetts on a biennial basis between 1986 and 2011. RESULTS In this study cohort, 159 patients (1.4%) experienced an acute first-ever stroke during hospitalization for acute myocardial infarction. The proportion of patients with acute myocardial infarction who developed a stroke increased through the 1990s but decreased slightly thereafter. Compared with patients who did not experience a stroke, those who experienced a stroke were significantly older, were more likely to be female, had a previous acute myocardial infarction, had a significant burden of comorbidities, and were more likely to have died (32.1% vs 10.8%) during their index hospitalization. Patients who developed a first stroke in the most recent study years (2003-2011) were more likely to have died during hospitalization than those hospitalized during earlier study years. CONCLUSIONS Although the incidence rates of acute stroke complicating acute myocardial infarction remained relatively stable during the years under study, the in-hospital mortality rates of those experiencing a stroke have not decreased.
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Affiliation(s)
- Essa Hariri
- Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Joel Gore
- Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Robert Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
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Hatleberg CI, Ryom L, El‐Sadr W, Mocroft A, Reiss P, De Wit S, Dabis F, Pradier C, d'Arminio Monforte A, Kovari H, Law M, Lundgren JD, Sabin CA. Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study. J Int AIDS Soc 2018; 21:e25083. [PMID: 29509305 PMCID: PMC5839235 DOI: 10.1002/jia2.25083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 01/29/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION There is paucity of data related to potential gender differences in the use of interventions to prevent and treat cardiovascular disease (CVD) among HIV-positive individuals. We investigated whether such differences exist in the observational D:A:D cohort study. METHODS Participants were followed from study enrolment until the earliest of death, six months after last visit or February 1, 2015. Initiation of CVD interventions [lipid-lowering drugs (LLDs), angiotensin-converting enzyme inhibitors (ACEIs), anti-hypertensives, invasive cardiovascular procedures (ICPs) were investigated and Poisson regression models calculated whether rates were lower among women than men, adjusting for potential confounders. RESULTS Women (n = 12,955) were generally at lower CVD risk than men (n = 36,094). Overall, initiation rates of CVD interventions were lower in women than men; LLDs: incidence rate 1.28 [1.21, 1.35] vs. 2.40 [2.34, 2.46]; ACEIs: 0.88 [0.82, 0.93] vs. 1.43 [1.39, 1.48]; anti-hypertensives: 1.40 [1.33, 1.47] vs. 1.72 [1.68, 1.77] and ICPs: 0.08 [0.06, 0.10] vs. 0.30 [0.28, 0.32], and this was also true for most CVD interventions when exclusively considering periods of follow-up for which individuals were at high CVD risk. In fully adjusted models, women were less likely to receive CVD interventions than men (LLDs: relative rate 0.83 [0.78, 0.88]; ACEIs: 0.93 [0.86, 1.01]; ICPs: 0.54 [0.43, 0.68]), except for the receipt of anti-hypertensives (1.17 [1.10, 1.25]). CONCLUSION The use of most CVD interventions was lower among women than men. Interventions are needed to ensure that all HIV-positive persons, particularly women, are appropriately monitored for CVD and, if required, receive appropriate CVD interventions.
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Affiliation(s)
- Camilla I Hatleberg
- Department of Infectious Diseases Section 2100CHIPUniversity of CopenhagenFinsencentretRigshospitaletCopenhagenDenmark
| | - Lene Ryom
- Department of Infectious Diseases Section 2100CHIPUniversity of CopenhagenFinsencentretRigshospitaletCopenhagenDenmark
| | - Wafaa El‐Sadr
- ICAP‐Columbia University and Harlem HospitalNew YorkNYUSA
| | | | - Peter Reiss
- Academic Medical CenterDepartment of Global Health and Division of Infectious DiseasesUniversity of AmsterdamHIV Monitoring FoundationAmsterdamThe Netherlands
| | - Stephane De Wit
- Division of Infectious DiseasesSaint Pierre University HospitalUniversité Libre de BruxellesBrusselsBelgium
| | - Francois Dabis
- CHU de Bordeaux and INSERM U897Université de BordeauxTalenceFrance
| | | | - Antonella d'Arminio Monforte
- Dipartimento di Scienze della SaluteClinica di Malattie Infettive e TropicaliAzienda Ospedaliera‐Polo Universitario San PaoloMilanItaly
| | - Helen Kovari
- Division of infectious diseases and hospital epidemiologyUniversity hospital ZurichUniversity of ZurichZurichSwitzerland
| | | | - Jens D Lundgren
- Department of Infectious Diseases Section 2100CHIPUniversity of CopenhagenFinsencentretRigshospitaletCopenhagenDenmark
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Kea B, Alligood T, Manning V, Raitt M. A Review of the Relationship of Atrial Fibrillation and Acute Coronary Syndrome. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016; 4:107-118. [PMID: 28090403 DOI: 10.1007/s40138-016-0105-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia encountered by clinicians. Clinical decision-making focuses on reducing ischemic stroke risk in AF patients; however, AF is also associated with an increased risk of acute coronary syndromes (ACS). Patients with ACS and concurrent AF are less likely to receive appropriate therapies and more likely to experience adverse outcomes than ACS patients in sinus rhythm (SR). Clinicians may be able to stratify ACS patients at increased risk of AF development based on clinical characteristics. Evidence supporting specific therapeutic options for prevention of ACS in AF patients or for prevention of AF in ACS patients is limited, however there is some evidence of differing effects among oral anticoagulant regimens in these populations. Investigations of the relationship of AF with the full spectrum of ACS are not well described and should be the focus of future research.
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Affiliation(s)
- Bory Kea
- Assistant Professor, Department of Emergency Medicine, Oregon Health & Science University School of Medicine, Mailcode CR114, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, 503-494-4430 (p), 503-494-8237 (f)
| | - Tahroma Alligood
- Research Associate, Department of Emergency Medicine, Oregon Health & Science University School of Medicine, Doctoral Student, Department of Public Health & Preventive Medicine, OHSU/PSU School of Public Health, Mailcode CR114, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, 503-494-4566
| | - Vincent Manning
- Medical Student (4 Year), Oregon Health & Science University School of Medicine, 4460 SW Scholls Ferry Road, Apt. #3, Portland, OR 97225
| | - Merritt Raitt
- Professor of Medicine, Oregon Health and Science University, Director Electrophysiology Service, VA Health Center System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, 503-220-8262
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Improvements over time in short-term mortality following myocardial infarction in HIV-positive individuals. AIDS 2016; 30:1583-96. [PMID: 26950315 DOI: 10.1097/qad.0000000000001076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Few studies have described mortality and clinical outcomes after myocardial infarction (MI) in the HIV-positive population. This study evaluated changes in short-term mortality after MI in HIV-positive individuals in the D:A:D Study, and investigated possible reasons for any changes seen. DESIGN Prospective cohort study. METHODS Demographic, cardiovascular disease (CVD)/HIV-related characteristics and CVD-related interventions (invasive cardiovascular procedures and drug interventions) were summarized at the time of and following an MI. Associations between calendar year and mortality in the first month after MI were identified using logistic regression with adjustment for confounders, including interventions received in the first month after MI. RESULTS One thousand and eight HIV-positive individuals experiencing an MI over the period 1999-2014 were included. The absolute number of MIs decreased from 214 (1999-2002) to 154 (2011-2014). Whilst the CVD risk profile remained high over time, the HIV status improved. The use of CVD-related interventions after MI appeared to increase over time. The proportion of individuals who died in the first month after MI dropped from 26.6% in 1999-2002 to 8.4% in 2011-2014. Later calendar year was associated with decreased short-term mortality; this effect was attenuated after adjusting for CVD-related interventions received in the first month after MI [odds ratio changed from 0.88 (95% confidence interval 0.83, 0.93) to 0.97 (0.91, 1.02)]. CONCLUSION Improvements in short-term survival after MI appear to be largely driven by improved medical management of CVD risk in HIV-positive individuals after MI. Efforts are still needed to treat CVD risk factors and increase access to CVD-related interventions.
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Chen R, Strait KM, Dharmarajan K, Li SX, Ranasinghe I, Martin J, Fazel R, Masoudi FA, Cooke CR, Nallamothu BK, Krumholz HM. Hospital variation in admission to intensive care units for patients with acute myocardial infarction. Am Heart J 2015; 170:1161-9. [PMID: 26678638 PMCID: PMC5459386 DOI: 10.1016/j.ahj.2015.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/01/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND The treatment for patients with acute myocardial infarction (AMI) was transformed by the introduction of intensive care units (ICUs), yet we know little about how contemporary hospitals use this resource-intensive setting and whether higher use is associated with better outcomes. METHODS We identified 114,136 adult hospitalizations for AMI from 307 hospitals in the 2009 to 2010 Premier database using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. Hospitals were stratified into quartiles by rates of ICU admission for AMI patients. Across quartiles, we examined in-hospital risk-standardized mortality rates and usage rates of critical care therapies for these patients. RESULTS Rates of ICU admission for AMI patients varied markedly among hospitals (median 48%, Q1-Q4 20%-71%, range 0%-98%), and there was no association with in-hospital risk-standardized mortality rates (6% all quartiles, P = .7). However, hospitals admitting more AMI patients to the ICU were more likely to use critical care therapies overall (mechanical ventilation [from Q1 with lowest rate of ICU use to Q4 with highest rate 13%-16%], vasopressors/inotropes [17%-21%], intra-aortic balloon pumps [4%-7%], and pulmonary artery catheters [4%-5%]; P for trend < .05 in all comparisons). CONCLUSIONS Rates of ICU admission for patients with AMI vary substantially across hospitals and were not associated with differences in mortality, but were associated with greater use of critical care therapies. These findings suggest uncertainty about the appropriate use of this resource-intensive setting and a need to optimize ICU triage for patients who will truly benefit.
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Affiliation(s)
- RuiJun Chen
- University of California San Francisco, San Francisco, CA
| | - Kelly M Strait
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Kumar Dharmarajan
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Shu-Xia Li
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | | | | | - Reza Fazel
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Frederick A Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Colin R Cooke
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Brahmajee K Nallamothu
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; Veterans Affairs (VA) Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.
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10
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17-year trends in incidence and prognosis of cardiogenic shock in patients with acute myocardial infarction in western Sweden. Int J Cardiol 2015; 185:256-62. [DOI: 10.1016/j.ijcard.2015.03.106] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/01/2014] [Accepted: 03/07/2015] [Indexed: 11/18/2022]
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Isorni MA, Blanchard D, Teixeira N, le Breton H, Renault N, Gilard M, Lefèvre T, Mulak G, Danchin N, Spaulding C, Puymirat E. Impact of gender on use of revascularization in acute coronary syndromes: The national observational study of diagnostic and interventional cardiac catheterization (ONACI). Catheter Cardiovasc Interv 2015; 86:E58-65. [DOI: 10.1002/ccd.25921] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 03/08/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Marc-Antoine Isorni
- Department of Cardiology; Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes; Paris France
| | - Didier Blanchard
- Department of Cardiology; Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes; Paris France
| | - Nelson Teixeira
- Department of Cardiology; Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes; Paris France
| | - Hervé le Breton
- Department of Cardiology; University Hospital of Rennes; Rennes France
| | - Nisa Renault
- Paris Cardiovascular Research Center PARCC; INSERM U970; Paris France
| | - Martine Gilard
- Department of Cardiology; University Hospital of Brest; Brest France
| | - Thierry Lefèvre
- Department of Cardiology; Institut Hospitalier Jacques Cartier; Massy France
| | | | - Nicolas Danchin
- Department of Cardiology; Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes; Paris France
| | - Christian Spaulding
- Department of Cardiology; Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes; Paris France
- Paris Cardiovascular Research Center PARCC; INSERM U970; Paris France
| | - Etienne Puymirat
- Paris Cardiovascular Research Center PARCC; INSERM U970; Paris France
- Department of Cardiology; Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes; Paris France
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Weeks PA, Sieg A, Paruthi C, Rajapreyar I. Antiplatelet Therapy Considerations in Ischemic Cardiogenic Shock. J Cardiovasc Pharmacol Ther 2015; 20:370-7. [DOI: 10.1177/1074248415571456] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/07/2015] [Indexed: 11/15/2022]
Abstract
Dual antiplatelet therapy with aspirin and a P2Y12 receptor antagonist remains a mainstay in the prevention of ischemic events following coronary stent placement. Significant controversy exists regarding the optimal management of high platelet reactivity despite antiplatelet therapy; however this finding has been consistently associated with poor clinical outcomes including greater risk of stent thrombosis and myocardial infarction. Variability in antiplatelet effects of clopidogrel and prasugrel has been linked to genetic polymorphisms and potential drug–drug interactions. Both of these factors have significant influence on the cytochrome P-450 enzyme system activity of the liver responsible for their biotransformation to the active form of both drugs. Very little has been publicized regarding differences in antiplatelet effects which may be associated with conditions in which the functional capacity of the liver may be temporarily compromised. Patients who present with cardiogenic shock due to acute coronary syndromes have evidence of multiorgan dysfunction including liver dysfunction that may affect the activity of these drugs. This review aims to explore existing evidence and propose additional considerations to the selection of antiplatelet therapy in patients with cardiogenic shock who receive catheter-based revascularization and stent placement.
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Affiliation(s)
- Phillip A. Weeks
- Department of Pharmacy, Memorial Hermann—Texas Medical Center, Houston, TX, USA
| | - Adam Sieg
- Department of Pharmacy, Memorial Hermann—Texas Medical Center, Houston, TX, USA
| | - Christina Paruthi
- Center for Advanced Heart Failure, University of Texas Health Science Center, Houston, TX, USA
| | - Indranee Rajapreyar
- Center for Advanced Heart Failure, University of Texas Health Science Center, Houston, TX, USA
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Viana-Tejedor A, Loughlin G, Fernández-Avilés F, Bueno H. Temporal trends in the use of reperfusion therapy and outcomes in elderly patients with first ST elevation myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 4:461-7. [PMID: 25561687 DOI: 10.1177/2048872614565928] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 12/02/2014] [Indexed: 11/16/2022]
Abstract
AIMS To analyze secular trends in management and short and long-term prognosis of elderly presenting with ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS All patients ≥ 75 years with first STEMI admitted to our Coronary Care Unit between 1988 and 2008 were included. Baseline characteristics, clinical management, in-hospital and post-discharge outcomes in 4 time periods (1988-1993, 1994-1998, 1999-2003, 2004-2008) were compared. The final cohort consisted of 1393 patients. During the study period, there was a significant increase in the use of aspirin, β-blockers and ACE inhibitors. A significant reduction in the development of cardiogenic shock and mechanical complications was noticed. The use of reperfusion therapy increased significantly, due to a wider use of primary percutaneous coronary intervention (PPCI) while 30-days, 1-year and 5-year mortality decreased throughout the 20-year study period (p<0.001). In the multivariable logistic regression model, patients treated with PPCI showed a significantly lower 30-day (OR 0.47, 95% CI, 0.31-0.71), 1-year (OR 0.62, 95% CI 0.43-0.88) and 5-year mortality (OR 0.57, 95% CI 0.41-0.79) while patients receiving fibrinolysis showed a non-significant improvement in 30-day (OR 0.86, 95% CI 0.62-1.49), 1-year (OR 0.86, 95% CI 0.58-1.30) and 5-year mortality (OR 0.82, 95% CI 0.56-1.19). CONCLUSION The use of reperfusion therapy, and particularly of PPCI, for elderly patients suffering from STEMI increased significantly during the study period. This change in therapy was associated with a marked improvement in short and long-term prognosis.
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Affiliation(s)
| | | | | | - Héctor Bueno
- Hospital General Universitario Gregorio Marañón, Spain
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14
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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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15
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Prevalence of comorbidities and their impact on hospital management and short-term outcomes in Vietnamese patients hospitalized with a first acute myocardial infarction. PLoS One 2014; 9:e108998. [PMID: 25279964 PMCID: PMC4184812 DOI: 10.1371/journal.pone.0108998] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/30/2014] [Indexed: 12/19/2022] Open
Abstract
Background Cardiovascular disease is one of the leading causes of morbidity and mortality in Vietnam. We conducted a pilot study of Hanoi residents hospitalized with a first acute myocardial infarction (AMI) at the Vietnam National Heart Institute in Hanoi for purposes of describing the prevalence of cardiovascular (CVD) and non-CVD comorbidities and their impact on hospital management, in-hospital clinical complications, and short-term mortality in these patients. Methods The study population consisted of 302 Hanoi residents hospitalized with a first AMI at the largest tertiary care medical center in Hanoi in 2010. Results The average age of study patients was 66 years and one third were women. The proportions of patients with none, any 1, and ≥ 2 CVD comorbidities were 34%, 42%, and 24%, respectively. Among the CVD comorbidities, hypertension was the most commonly reported (59%). There were decreasing trends in the proportion of patients who were treated with effective cardiac medications and coronary interventions as the number of CVD comorbidities increased. Patients with multiple CVD comorbidities tended to develop acute clinical complications and die at higher rates during hospitalization compared with patients with no CVD comorbidities (Odds Ratio: 1.40; 95% Confidence Interval: 0.40–4.84). Conclusions Our data suggest that patients with multiple cardiac comorbidities tended to experience high in-hospital death rates in the setting of AMI. Full-scale surveillance of Hanoi residents hospitalized with AMI at all Hanoi hospitals is needed to confirm these findings. Effective strategies to manage Vietnamese patients hospitalized with AMI who have multiple comorbidities are warranted to improve their short-term prognosis.
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Chen HY, McManus DD, Saczynski JS, Gurwitz JH, Gore JM, Yarzebski J, Goldberg RJ. Characteristics, treatment practices, and in-hospital outcomes of older adults hospitalized with acute myocardial infarction. J Am Geriatr Soc 2014; 62:1451-9. [PMID: 25116983 PMCID: PMC4135447 DOI: 10.1111/jgs.12941] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine overall and decade-long trends (1999-2009), characteristics, treatment practices, and hospital outcomes in individuals aged 65 and older hospitalized for acute myocardial infarction (AMI) and to describe how these factors varied in the youngest, middle, and oldest-old individuals. DESIGN Retrospective cohort study. SETTING Population-based Worcester Heart Attack Study. MEASUREMENTS Analyses were conducted to examine the sociodemographic and clinical characteristics, cardiac treatments, and hospital outcomes of older adults in three age strata (65-74, 75-84, ≥85). PARTICIPANTS The study sample consisted of 3,851 individuals aged 65 and older hospitalized with AMI every other year between 1999 and 2009; 32% were aged 65 to 74, 43% aged 75 to 84, and 25% aged 85 and older. RESULTS Advancing age was inversely associated with receipt of evidence-based cardiac therapies. After multivariable adjustment, the odds of dying during hospitalization was 1.46 times as high in participants aged 75 to 84 and 1.78 times as high in those aged 85 and older as in those aged 65 to 74. The oldest-old participants had approximately 25% lower odds of a prolonged hospital stay (>3 days) than those aged 65 to 74. Decade-long trends in the principal study outcomes were also examined. Although the oldest-old participants hospitalized for AMI were at the greatest risk of dying, persistent age-related differences were observed in hospital treatment practices. Similar results were observed after excluding participants with a do-not-resuscitate order in their medical records. CONCLUSION Although there are persistent disparities in the care and outcomes of older adults hospitalized with AMI, additional studies are needed to delineate the extent to which less-aggressive care reflects individual preferences and appropriate implementation of palliative care approaches.
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Affiliation(s)
- Han-Yang Chen
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - David D. McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Medicine,University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jane S. Saczynski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
- MeyersPrimary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jerry H. Gurwitz
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
- MeyersPrimary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Joel M. Gore
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Medicine,University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Robert J. Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
- MeyersPrimary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts
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17
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Rosell-Ortiz F, Mellado-Vergel FJ, Fernández-Valle P, González-Lobato I, Martínez-Lara M, Ruiz-Montero MM, Romero-Morales F, Vivar Díaz I, García-Alcántara Á, García del Águila J. Initial complications and factors related to prehospital mortality in acute myocardial infarction with ST segment elevation. Emerg Med J 2014; 32:559-63. [DOI: 10.1136/emermed-2014-203780] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/04/2014] [Indexed: 01/26/2023]
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18
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Basis for Sex-Dependent Outcomes in Acute Coronary Syndrome. Can J Cardiol 2014; 30:713-20. [DOI: 10.1016/j.cjca.2013.08.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 11/20/2022] Open
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19
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Pines JM, Newman D, Pilgrim R, Schuur JD. Strategies For Integrating Cost-Consciousness Into Acute Care Should Focus On Rewarding High-Value Care. Health Aff (Millwood) 2013; 32:2157-65. [DOI: 10.1377/hlthaff.2013.0685] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jesse M. Pines
- Jesse M. Pines ( ) is director of the Office for Clinical Practice Innovation, School of Medicine and Health Sciences, and a professor of emergency medicine and health policy at the George Washington University, in Washington, D.C
| | - David Newman
- David Newman is director of clinical research and an associate professor of emergency medicine at the Icahn School of Medicine at Mount Sinai, in New York City
| | - Randy Pilgrim
- Randy Pilgrim is past chair of the Emergency Department Practice Management Association (EDPMA) and chief medical officer of the Schumacher Group, in Lafayette, Louisiana
| | - Jeremiah D. Schuur
- Jeremiah D. Schuur is an attending physician; chief of the Division of Health Policy Translation; and director of quality, patient safety, and performance improvement, all in the Department of Emergency Medicine, Brigham and Women’s Hospital, in Boston, Massachusetts. He is also an assistant professor of emergency medicine at Harvard Medical School
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Abstract
Heart failure (HF) has been singled out as an epidemic and is a staggering clinical and public health problem, associated with significant mortality, morbidity, and healthcare expenditures, particularly among those aged ≥ 65 years. The case mix of HF is changing over time with a growing proportion of cases presenting with preserved ejection fraction for which there is no specific treatment. Despite progress in reducing HF-related mortality, hospitalizations for HF remain frequent and rates of readmissions continue to rise. To prevent hospitalizations, a comprehensive characterization of predictors of readmission in patients with HF is imperative and must integrate the impact of multimorbidity related to coexisting conditions. New models of patient-centered care that draw on community-based resources to support HF patients with complex coexisting conditions are needed to decrease hospitalizations.
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Affiliation(s)
- Véronique L Roger
- Department of Health Sciences Research and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
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21
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Iyengar SS, Nair T, Hiremath JS, Jadhav U, Katyal VK, Kumbla D, Sathyamurthy I, Jain RK, Srinivasan M. Pharmacologic reperfusion therapy with indigenous tenecteplase in 15,222 patients with ST elevation myocardial infarction - the Indian Registry. Indian Heart J 2013; 65:436-41. [PMID: 23993004 PMCID: PMC3860598 DOI: 10.1016/j.ihj.2013.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/19/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To study the efficacy and safety of single intravenous bolus administration of indigenously developed tenecteplase (TNK-tPA) in the management of patients with ST-elevation myocardial infarction (STEMI) in clinical practice. METHODS Observational, prescription-event monitoring study. RESULTS Data of 15,222 patients who had STEMI and received weight adjusted TNK injection was analyzed. Overall 95.43% patients had clinically successful thrombolysis (CST). In the different subgroups, hypertensives, diabetics, smokers and hyperlipidemic patients had CST rates comparable to the general patient data. CST rates were significantly lower in the elderly patients (>70 years; 92.11%; p < 0.0001), in patients with history of Ischemic Heart Disease (IHD, 93.86%; p = 0.0004) and in patients receiving delayed treatment (>6 h after onset of chest pain; 85.38%; p < 0.0001). CST was significantly higher in patients who received an early thrombolysis (<3 h after onset of chest pain; 96.54%; p = 0.006). Overall mortality was 1.69%, while it was significantly higher in the elderly (4.42%), patients with history of IHD (2.67%), females (2.93%) and in those who received delayed treatment (4.98%). The overall incidences of intracranial hemorrhage (ICH), bleeding excluding ICH, stroke and ventricular tachyarrhythmia were 0.39%, 2.01%, 0.16% and 2.35% respectively. Age >70 years, diabetes, hyperlipidemia and history of IHD were associated with a higher incidence of heart failure, myocardial re-infarction or ventricular tachyarrhythmias. However, incidence of ICH and bleeding other than ICH was comparable amongst all patient subgroups. CONCLUSION This study confirms the safety and efficacy of indigenous tenecteplase in Indian patients with STEMI, including high risk subgroups. It also highlights the fact that delayed treatment denotes denial of benefits of pharmacologic reperfusion therapy.
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Affiliation(s)
- S S Iyengar
- Head, Department of Cardiology, Manipal Heart Institute, Bangalore 56001, India.
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22
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Tharmaratnam D, Nolan J, Jain A. Management of cardiogenic shock complicating acute coronary syndromes. Heart 2013; 99:1614-23. [PMID: 23468511 DOI: 10.1136/heartjnl-2012-302028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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23
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Coles AH, Fisher KA, Darling C, McManus D, Maitas O, Yarzebski J, Gore JM, Lessard D, Goldberg RJ. Recent trends in post-discharge mortality among patients with an initial acute myocardial infarction. Am J Cardiol 2012; 110:1073-7. [PMID: 22762720 DOI: 10.1016/j.amjcard.2012.05.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 05/31/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022]
Abstract
The objectives of this study were to describe contemporary postdischarge death rates of patients hospitalized at all Worcester, Massachusetts, hospitals after initial acute myocardial infarctions (AMIs) and to examine factors associated with a poor prognosis. The medical records of patients discharged from 11 central Massachusetts medical centers after initial AMIs during 2001, 2003, 2005, and 2007 were reviewed, identifying 2,452 patients. This population was composed of predominantly older patients, men (58%), and whites. Overall, the 3-month, 1-year, and 2-year all-cause death rates were 8.9%, 16.4%, and 23.4%, respectively. Over time, reductions in postdischarge mortality were observed in crude as well as multivariate-adjusted analyses. In 2001, the 3-month, 1-year, and 2-year all-cause death rates were 11.1%, 17.1%, and 25.6%, respectively, compared to rates of 7.9%, 12.7%, and 18.6% in patients discharged in 2007. Older age, male gender, hospitalization for a non-ST-segment elevation AMI, renal dysfunction, and preexisting heart failure were associated with an increased risk for dying after hospital discharge. These results suggest that the postdischarge prognosis of patients with initial AMIs has improved, likely reflecting enhanced in-hospital and postdischarge management practices. In conclusion, patients with initial AMIs can also be identified who are at increased risk for dying after hospital discharge, in whom increased surveillance and targeted treatment approaches can be directed.
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Zuckerman IH, Yin X, Rattinger GB, Gottlieb SS, Simoni-Wastila L, Pierce SA, Huang TY, Shenolikar R, Stuart B. Effect of exposure to evidence-based pharmacotherapy on outcomes after acute myocardial infarction in older adults. J Am Geriatr Soc 2012; 60:1854-61. [PMID: 23003000 DOI: 10.1111/j.1532-5415.2012.04165.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To assess the effect of exposure to evidence-based medication after hospital discharge for Medicare beneficiaries with acute myocardial infarction (AMI). DESIGN A discrete-time hazard model was used to estimate time to outcome associated with exposure to four drug classes (angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin-II receptor blockers (ARBs), beta-blockers (BBs), statins, and clopidogrel) used for post-AMI secondary prevention of cardiovascular events and mortality. SETTING Medicare administrative data for a 5% random sample of beneficiaries. PARTICIPANTS Medicare beneficiaries (N = 9,538) hospitalized for an AMI between April 1, 2006, and December 31, 2007, who survived for at least 30 days after discharge. The cohort was followed until death or December 31, 2008. MEASUREMENTS Time-varying exposure was measured as proportion of days covered (PDC) for each quarter during the follow-up period. PDC was classified into five categories (0-0.2, 0.2-0.4, 0.4-0.6, 0.6-0.8, 0.8-1.0). Outcomes were mortality and a composite outcome of death or post-AMI hospitalization. RESULTS Over a median follow-up of 18 months, mean PDC rates ranged from 0.37 (clopidogrel) to 0.50 (statins). When comparing the highest versus lowest categories of exposure, the hazard of the composite outcome was significantly lower for all drug classes except BBs (statins, adjusted hazard ratio (aHR) = 0.71, ACEIs/ARBs, aHR = 0.81, clopidogrel, aHR = 0.85, BBs, aHR = 0.93). All four drug classes were significantly associated with reductions in mortality; the magnitude of effect for the mortality outcome was largest for statins and smallest for BBs. Age modified the effect of statins on mortality. CONCLUSION Use of evidence-based medications for secondary prevention after AMI is suboptimal in the Medicare population, and low exposure rates are associated with significantly higher risk for subsequent hospitalization and death.
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Affiliation(s)
- Ilene H Zuckerman
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD 21201, USA.
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Referral, Enrollment, and Delivery of Cardiac Rehabilitation for Women. CURRENT CARDIOVASCULAR RISK REPORTS 2012. [DOI: 10.1007/s12170-012-0255-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Grau M, Sala C, Sala J, Masia R, Vila J, Subirana I, Ramos R, Elosua R, Brugada R, Marrugat J. Sex-related differences in prognosis after myocardial infarction: changes from 1978 to 2007. Eur J Epidemiol 2012; 27:847-55. [PMID: 22777715 DOI: 10.1007/s10654-012-9712-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 06/20/2012] [Indexed: 01/19/2023]
Abstract
Women with myocardial infarction (MI) have shown a 28-day survival disadvantage compared with men. However, results were less consistent when considering long-term mortality in 28-day survivors. The aim was to estimate the trends for sex-related differences in the three endpoints considered for this study: (1) 28-day mortality or severe ventricular dysfunction (acute pulmonary oedema or cardiogenic shock) during the hospital stay, (2) 28-day mortality and (3) two-year cardiovascular mortality or non-fatal MI in 28-day survivors after a first MI. A cohort of 3,982 consecutive patients with first Q-wave MI admitted to a university tertiary reference hospital between 1978 and 2007 was followed for 2 years. Short-term prognosis improved in women over the studied period; similar rates were observed in both sexes in the 2000s. After adjusting for age, co-morbidities and anterior location of MI, female sex had an odds ratio=1.71 (95% confidence interval [CI] 1.34-2.17) of short-term severe MI or death over the studied period. Overall, sex differences in long-term prognosis remained similar over the studied period (hazard ratio=1.40; 95% CI 1.02-1.91). In conclusion, short-term prognosis improved over the past 30 years for first Q-wave MI patients, becoming similar for both men and women in the most recent decade. Long-term prognosis did not improve in either men or women, indicating that secondary prevention should be reinforced to achieve consistent reductions in the number of cardiovascular events.
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Affiliation(s)
- María Grau
- Program of Research in Inflammatory and Cardiovascular Disorders (RICAD), Cardiovascular Epidemiology and Genetics, IMIM, 88 Dr Aiguader Street, 08003, Barcelona, Spain
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