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Tan J, He Y, Li Z, Xu X, Zhang Q, Xu Q, Zhang L, Xiang S, Tang X, Zhao W. Establishment and Validation of a Non-invasive Diagnostic Nomogram to Identify Heart Failure in Patients With Coronary Heart Disease. Front Cardiovasc Med 2022; 9:875702. [PMID: 35463796 PMCID: PMC9021443 DOI: 10.3389/fcvm.2022.875702] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/16/2022] [Indexed: 12/12/2022] Open
Abstract
Background Heart failure (HF) is an end-stage manifestation of and cause of death in coronary heart disease (CHD). The objective of this study was to establish and validate a non-invasive diagnostic nomogram to identify HF in patients with CHD. Methods We retrospectively analyzed the clinical data of 44,772 CHD patients from five tertiary hospitals. Univariate logistic regression analyses and least absolute shrinkage and selection operator (LASSO) regression analyses were used to identify independent factors. A nomogram based on the multivariate logistic regression model was constructed using these independent factors. The concordance index (C-index), receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and clinical impact curves (CIC) were used to evaluate the predictive accuracy and clinical value of this nomogram. Results The predictive factors in the multivariate model included hypertension, age, and the total bilirubin, uric acid, urea nitrogen, triglyceride, and total cholesterol levels. The area under the curve (AUC) values of the nomogram in the training set, internal validation set, external validation set1, and external validation set2 were 0.720 (95% CI: 0.712-0.727), 0.723 (95% CI: 0.712-0.735), 0.692 (95% CI: 0.674-0.710), and 0.655 (95% CI: 0.634-0.677), respectively. The calibration curves indicated that the nomogram had strong calibration. DCA and CIC indicated that the nomogram can be used as an effective tool in clinical practice. Conclusion The developed predictive model combines the clinical and laboratory factors of patients with CHD and is useful in individualized prediction of HF probability for clinical decision-making during treatment and management.
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Affiliation(s)
- Juntao Tan
- Operation Management Office, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxin He
- Department of Medical Administration, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Zhanbiao Li
- Operation Management Office, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaomei Xu
- Department of Gastroenterology, The Fifth People’s Hospital of Chengdu, Chengdu, China
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhang
- Department of Science and Education, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Xu
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, China
- Library, Chongqing Medical University, Chongqing, China
| | - Lingqin Zhang
- Department of Biomedical Equipment, People’s Hospital of Chongqing Bishan District, Chongqing, China
| | - Shoushu Xiang
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Xuewen Tang
- Department of Cardiology, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Wenlong Zhao
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, China
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Wang B, Xia L, Yu J, Feng Y, Hong J, Wang W. The multiple mediating effects of health literacy and self-care confidence between depression and self-care behaviors in patients with heart failure. Heart Lung 2020; 49:842-847. [PMID: 33011463 DOI: 10.1016/j.hrtlng.2020.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/10/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous researchers have found that depression can influence self-care behaviors of patients with heart failure (HF). However, the specific path of depression on self-care behaviors remains unclear. OBJECTIVES To determine the multiple mediating effects of health literacy and self-care confidence between depression and self-care behaviors in patients with HF. METHODS A cross sectional study on HF patients (n = 310) was conducted at a tertiary hospital in China. The Chinese versions of the Hospital Anxiety and Depression Scale (HADS-D), Health Literacy Scale for Patients with Chronic Disease and Self-care of Heart Failure Index (C-SCHFI) were used to assess depression, health literacy, self-care confidence and self-care behaviors of the HF patients respectively. RESULTS Depression had significant negative correlations with health literacy (r = -0.40, P < 0.01), self-care confidence (r = -0.41, P < 0.01), self-care maintenance (r = -0.18, P < 0.01) and management (r = -0.19, P < 0.01). After controlling for covariates, mediation modeling analysis showed that health literacy and self-care confidence were mediating variables between depression and self-care management and all the three paths were significant. A higher level of depression debilitated health literacy (β = -0.23, P < 0.001), and a higher degree of health literacy was associated with better self-care confidence (β = 0.31, P < 0.001) which contributed to better self-care management (β = 0.43, P < 0.001). Total mediation effect was -0.1940 with 95% CI from -0.2702 to -0.1266. However, self-care confidence did not mediate between depression and self-care maintenance. CONCLUSION Health literacy and self-care confidence exert a multiple mediating effect on the relationship between depression and self-care management. The relationship between variables should be considered when developing the tailored interventions for patients with HF to enhance their self-care behaviors.
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Affiliation(s)
| | - Lili Xia
- School of Nursing, Anhui Medical University, China
| | - Jia Yu
- School of Nursing, Anhui Medical University, China
| | - Yuan Feng
- School of Nursing, Anhui Medical University, China
| | | | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Lai XL, Liu HX, Hu X, Tian JF, Shang JJ, Li X, Zhou Q, Xing WL. Acute Myocardial Infarction in Chinese Medicine Hospitals in China from 2006 to 2013: An Analysis of 2311 Patients from Hospital Data. Chin J Integr Med 2020; 27:323-329. [PMID: 32107728 DOI: 10.1007/s11655-020-3189-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the trends in characteristics, treatments, and outcomes of acute myocardial infarction (AMI) patients in tertiary Chinese medicine (CM) hospitals in China between 2006 and 2013. METHODS This retrospective study was based on two nationwide epidemiological surveys of AMI in tertiary CM hospitals during 2 years (2006 and 2013). Patients admitted to the hospital for AMI were enrolled. Hospital records were used as the data source. Case data were derived regarding baseline characteristics, treatments, and outcomes of patients to assess changes from 2006 to 2013. Logistic regression was used to analyze the relationship between prognosis, general influencing factors of disease, and various treatment measures. RESULTS Totally 26 tertiary CM hospitals in 2006 and 29 tertiary CM hospitals in 2013 (18 were repetitive) were surveyed. A total of 2,311 patients with AMI were enrolled (1,094 cases in 2006 and 1,217 cases in 2013). From 2006 to 2013, the mean age did not significantly change, but the proportion of patients younger than 65 years increased. The prevalence of risk factors such as hypertension, diabetes, and hyperlipidemia also increased. Significant increases were observed in primary percutaneous coronary intervention [20.48% (2006) vs. 24.90% (2013)] and revascularization [36.11% (2006) vs. 52.42% (2013)]. In-hospital mortality decreased from 11.15% in 2006 to 10.60% in 2013. A mortality logistic regression analysis identified reperfusion therapy [odds ratio (OR), 0.222; 95% confidence interval (CI), 0.106-0.464], Chinese patent medicines (OR, 0.394; 95% CI, 0.213-0.727), and CM decoctions (OR, 0.196; 95% CI, 0.109-0.353) as protective factors. CONCLUSION Reperfusion and revascularization capabilities of tertiary CM hospitals have improved significantly, but in-hospital mortality has not significantly decreased. Efforts are needed to improve medical awareness of AMI and expand the use of CM to reduce in-hospital mortality in China.
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Affiliation(s)
- Xiao-Lei Lai
- Department of Cardiovascular, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Hong-Xu Liu
- Department of Cardiovascular, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China.
| | - Xin Hu
- Department of Cardiovascular, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Jing-Feng Tian
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Ju-Ju Shang
- Department of Cardiovascular, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Xiang Li
- Department of Cardiovascular, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Qi Zhou
- Department of Cardiovascular, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Wen-Long Xing
- Department of Cardiovascular, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
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Sulo G, Sulo E, Jørgensen T, Linnenberg A, Prescott E, Tell GS, Osler M. Ischemic heart failure as a complication of incident acute myocardial infarction: Timing and time trends: A national analysis including 78,814 Danish patients during 2000-2009. Scand J Public Health 2019; 48:294-302. [PMID: 30813840 DOI: 10.1177/1403494819829333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aim: Heart failure is a serious complication of acute myocardial infarction leading to poor prognosis. We aimed at exploring time trends of heart failure and their impact on mortality among patients with an incident acute myocardial infarction. Methods: From the National Patient Danish Registry we collected data on all patients hospitalized with an incident of acute myocardial infarction during 2000-2009 and identified cases with in-hospital heart failure (presented on admission or developing heart failure during acute myocardial infarction hospitalization) or post-discharge heart failure (a hospitalization or outpatient visit following acute myocardial infarction discharge), and assessed in-hospital, 30-day and 1-year mortality. Results: Of the 78,814 patients included in the study, 10,248 (13.0%) developed in-hospital heart failure. The odds of in-hospital heart failure declined 0.9% per year (odds ratio=0.991, 95% confidence interval: 0.983-0.999). In-hospital heart failure was associated with 13% (odds ratio=1.13, 95% confidence interval: 1.06-1.20) and 14% (odds ratio=1.14, 95% confidence interval: 1.07-1.20) higher in-hospital and 30-day mortality, respectively. Of the 61,637 patients discharged alive without in-hospital heart failure, 5978 (9.7%) experienced post-discharge heart failure, 4116 (6.7%) were hospitalized and 1862 (3.0%) were diagnosed at outpatient clinics. The risk of heart failure requiring hospitalization declined 5.5% per year (hazard ratio=0.945, 95% confidence interval: 0.934-0.955) whereas the risk of heart failure diagnosed at outpatient clinics increased 13.4% per year (hazard ratio=1.134, 95% confidence interval: 1.115-1.153). Post-discharge heart failure was associated with 239% (hazard ratio=3.39, 95% confidence interval: 3.18-3.63) higher 1-year mortality. Conclusions: In-hospital and post-discharge heart failure requiring hospitalization decreased whereas post-discharge heart failure diagnosed at outpatient clinics increased among incident acute myocardial infarction patients during 2000-2009. The development of heart failure, especially after acute myocardial infarction discharge, indicates a poor prognosis.
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Affiliation(s)
- Gerhard Sulo
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Research Centre for Prevention and Health, Capital Region of Denmark, Denmark
| | - Enxhela Sulo
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Research Centre for Prevention and Health, Capital Region of Denmark, Denmark
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Capital Region of Denmark, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Faculty of Medicine, University of Aalborg, Denmark
| | - Allan Linnenberg
- Research Centre for Prevention and Health, Capital Region of Denmark, Denmark.,Department of Clinical Experimental Research, Rigshospitalet, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg Hospital, University of Copenhagen, Denmark
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Norway
| | - Merete Osler
- Research Centre for Prevention and Health, Capital Region of Denmark, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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5
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Plant LD, Taylor DM, Worland T, Puri A, Ugoni A, Patel SK, Johnson DF, Burrell LM. Development of Acute Decompensated Heart Failure Among Hospital Inpatients: Incidence, Causes and Outcomes. Heart Lung Circ 2017. [PMID: 29519692 DOI: 10.1016/j.hlc.2017.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND We aimed to investigate the incidence, precipitants, and outcomes of acute decompensated heart failure (ADHF) that develops during the inpatient stay. METHODS We undertook a case-control study in the medical, oncology, surgical, and orthopaedic wards of a tertiary referral hospital (February-May, 2016). Patients aged ≥18 years who developed ADHF during their inpatient stay were enrolled as cases. One control patient was matched to each case by age, gender, presenting complaint/surgery performed and co-morbidities. Multivariate regression was employed to determine variables associated with ADHF. RESULTS The incidence of ADHF was 1.0% of patients. Eighty cases were well-matched to 80 controls (p>0.05). ADHF precipitants comprised infection (30%), inappropriate intravenous (IV) fluid and medication management (23.8% and 8.8%, respectively), tachyarrhythmia (12.5%), ischaemic heart disease (8.8%), renal failure (1.3%), and other/unclear causes (15%). Three variables were associated with ADHF: not having English as the preferred language (OR 3.5, 95%CI 1.2-9.8), a history of ischaemic heart disease (OR 3.3, 95%CI 1.2-9.1), and the administration of >2000ml of IV fluid on the day before the ADHF (OR 8.3, 95%CI 1.5-48.0). The day before the ADHF, cases were administered significantly more IV fluids than controls (median 2,757.5 versus 975ml, p=0.001). Medication errors mostly related to failure to restart regular diuretics. Cases had significantly greater length of stay (median 15 versus 6 days, p<0.001) and mortality (12.5% versus 1.3%, p=0.01). CONCLUSIONS New onset ADHF is common and a substantial proportion of cases are iatrogenic. Cases experience significantly increased length of hospital stay, morbidity, and mortality.
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Affiliation(s)
- Luke D Plant
- Department of Emergency Medicine, Austin Hospital, Melbourne, Vic, Australia
| | - David McDonald Taylor
- Department of Emergency Medicine, Austin Hospital, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia.
| | - Thomas Worland
- Department of Medicine, Austin Hospital, Melbourne, Vic, Australia
| | - Arvind Puri
- Department of Medicine, Austin Hospital, Melbourne, Vic, Australia
| | - Antony Ugoni
- Department of Medicine, University of Melbourne, Melbourne, Vic, Australia
| | - Sheila K Patel
- Department of Medicine, University of Melbourne, Melbourne, Vic, Australia; Department of Medicine, Austin Hospital, Melbourne, Vic, Australia
| | - Douglas F Johnson
- Department of Medicine, University of Melbourne, Melbourne, Vic, Australia; Department of Medicine, Austin Hospital, Melbourne, Vic, Australia; Department of Infectious Diseases, Austin Hospital, Melbourne, Vic, Australia
| | - Louise M Burrell
- Department of Medicine, University of Melbourne, Melbourne, Vic, Australia; Department of Medicine, Austin Hospital, Melbourne, Vic, Australia
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6
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Murugiah K, Wang Y, Nuti SV, Li X, Li J, Zheng X, Downing NS, Desai NR, Masoudi FA, Spertus JA, Jiang L, Krumholz HM. Are non-ST-segment elevation myocardial infarctions missing in China? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2017; 3:319-327. [DOI: 10.1093/ehjqcco/qcx025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/25/2017] [Indexed: 12/18/2022]
Abstract
Abstract
Aims
ST-segment elevation myocardial infarctions (STEMI) in China and other low- and middle-income countries outnumber non-ST-segment elevation myocardial infarctions (NSTEMI). We hypothesized that the STEMI predominance was associated with lower biomarker use and would vary with hospital characteristics.
Methods and results
We hypothesized that the STEMI predominance was associated with lower biomarker use and would vary with hospital characteristics. Using data from the nationally representative China PEACE-Retrospective AMI Study during 2001, 2006, and 2011, we compared hospital NSTEMI proportion across categories of use of any cardiac biomarker (CK, CK-MB, or troponin) and troponin, as well as across region, location, level, and teaching status. Among 15 416 acute myocardial infarction (AMI) patients, 14% had NSTEMI. NSTEMI patients were older, more likely female, and to have comorbidities. Median hospital NSTEMI proportion in each study year was similar across categories of any cardiac biomarker use, troponin, region, location, level, and teaching status. For instance, in 2011 the NSTEMI proportion at hospitals without troponin testing was 11.2% [inter quartile range (IQR) 4.4–16.7%], similar to those with ≥ 75% troponin use (13.0% [IQR 8.7–23.7%]) (P-value for difference 0.77). Analysed as continuous variables there was no relationship between hospital NSTEMI proportion and proportion biomarker use. With troponin use there was no relationship in 2001 and 2006, but a modest correlation in 2011 (R = 0.16, P = 0.043). Admissions for NSTEMI increased from 0.3/100 000 people in 2001 to 3.3/100 000 people in 2011 (P-value for trend < 0.001).
Conclusion
STEMI is the dominant presentation of AMI in China, but the proportion of NSTEMI is increasing. Biomarker use and hospital characteristics did not account for the low NSTEMI rate.
Clinical trial registration
www.clinicaltrials.gov (NCT01624883).
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Affiliation(s)
- Karthik Murugiah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 330 Cedar St, Boardman 110, P.O. Box 208056, New Haven, Connecticut 06520-8056, USA
| | - Yongfei Wang
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 330 Cedar St, Boardman 110, P.O. Box 208056, New Haven, Connecticut 06520-8056, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, Connecticut 06510-3330, USA
| | - Sudhakar V. Nuti
- Department of Internal Medicine, Yale University School of Medicine, 330 Cedar St, Boardman 110, P.O. Box 208056, New Haven, Connecticut 06520-8056, USA
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China
| | - Jing Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China
| | - Xin Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China
| | - Nicholas S. Downing
- Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA
| | - Nihar R. Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 330 Cedar St, Boardman 110, P.O. Box 208056, New Haven, Connecticut 06520-8056, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, Connecticut 06510-3330, USA
| | - Frederick A. Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Campus Box B132, 12401 East 17th Avenue, Room 522, Aurora, Colorado 80045, USA
| | - John A. Spertus
- Saint Luke’s Mid America Heart Institute/University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, Missouri 64111, USA
| | - Lixin Jiang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China
| | - Harlan M. Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 330 Cedar St, Boardman 110, P.O. Box 208056, New Haven, Connecticut 06520-8056, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, Connecticut 06510-3330, USA
- Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, SHM I-456 P.O. Box 208088, New Haven, Connecticut 06520, USA
- Department of Health Policy and Management, Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven CT 06520-8034, USA
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Hao Y, Liu J, Liu J, Smith SC, Huo Y, Fonarow GC, Ma C, Ge J, Taubert KA, Morgan L, Guo Y, Zhang Q, Wang W, Zhao D. Rationale and design of the Improving Care for Cardiovascular Disease in China (CCC) project: A national effort to prompt quality enhancement for acute coronary syndrome. Am Heart J 2016; 179:107-15. [PMID: 27595685 DOI: 10.1016/j.ahj.2016.06.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 06/01/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND A sizeable gap exists between guideline recommendations for treatment of acute coronary syndrome (ACS) and application of these recommendations in clinical practice. The CCC-ACS project is a novel national quality enhancement registry designed to help medical care providers bridge this gap, thereby improving clinical outcomes for ACS patients in China. METHODS AND RESULTS The CCC-ACS project uses data collection, analysis, feedback, rapid-cycle improvement, and performance recognition to extend the use of evidence-based guidelines throughout the health care system and improve cardiovascular health. The project was launched in 2014, with 150 centers recruited representing the diversity of care for ACS patients in tertiary hospitals across China. Clinical information for patients with ACS is collected via a Web-based data collecting platform, including patients' demographics, medical history, symptoms on arrival, in-hospital treatment and procedures, in-hospital outcomes, and discharge medications for secondary prevention. Improvement in adherence to guideline recommendations is facilitated through monthly benchmarked hospital quality reports, recognition of hospital quality achievement, and regular webinars. As of April 16, 2016, a total of 35,616 ACS cases have been enrolled. CONCLUSIONS The CCC-ACS is a national hospital-based quality improvement program, aiming to increase adherence to ACS guidelines in China and improve patient outcomes.
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Affiliation(s)
- Yongchen Hao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jing Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jun Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Sidney C Smith
- Division of Cardiology, University of North Carolina, Chapel Hill, NC
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Gregg C Fonarow
- Geffen School of Medicine at University of California, Los Angeles, CA
| | - Changsheng Ma
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kathryn A Taubert
- Department of Global Strategies, American Heart Association, Dallas, TX
| | - Louise Morgan
- International Quality Improvement Department, American Heart Association, Dallas, TX
| | - Yang Guo
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Qian Zhang
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Wei Wang
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
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Heart failure in low- and middle-income countries: background, rationale, and design of the INTERnational Congestive Heart Failure Study (INTER-CHF). Am Heart J 2015; 170:627-634.e1. [PMID: 26386785 DOI: 10.1016/j.ahj.2015.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/02/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although heart failure (HF) has been referred to as a global epidemic, most HF information comes from high-income countries, with little information about low-income countries (LIC) and middle-income countries (MIC) in Africa, Asia, the Middle East, and South America, which make up the majority of the world's population. METHODS The INTERnational Congestive Heart Failure Study is a cohort study of 5,813 HF patients enrolled in 108 centers in 16 LIC and MIC. At baseline, data were recorded on sociodemographic and clinical risk factors, HF etiology, laboratory variables, management, and barriers to evidence-based HF care at the patient, physician, and system levels. We sought to enroll consecutive and consenting patients ≥18 years of age with a clinical diagnosis of HF seen in outpatient clinics (2/3 of patients) or inpatient hospital wards (1/3 of patients). Patients were followed up at 6 and 12 months post-enrollment to record clinical status, treatments, and clinical outcomes such as death and hospitalizations. In the 5,813 enrolled HF patients, the mean age was 59 ± 15 years, 40% were female, 62% had a history of hypertension, 30% had diabetes, 21% had prior myocardial infarction, 64% were recruited from outpatient clinics, 36% lived in rural areas, and 29% had HF with preserved left ventricular ejection fraction. CONCLUSIONS This unique HF registry aims to systematically gather information on sociodemographic and clinical risk factors, etiologies, treatments, barriers to evidence-based care, and outcomes of HF in LIC and MIC. This information will help improve the management of HF globally.
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9
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Guo Y, Zhao D, Liu J. Epidemiological Study of Heart Failure in China. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2015. [DOI: 10.15212/cvia.2015.0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Chen Z, Ding Z, Wang X, Zhang X, Ma G. Reduced heart function predicts drug-taking compliance and two-year prognosis in chinese patients with stable premature coronary artery disease. J Clin Med Res 2014; 7:154-60. [PMID: 25584100 PMCID: PMC4285061 DOI: 10.14740/jocmr2045w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/11/2022] Open
Abstract
Background The purpose of this study was to determine the association between heart function, compliance with drug administration, and the mid-term prognosis in Chinese patients with stable premature coronary artery disease (CAD) (male < 55 years and female < 65 years). Methods The study included 512 patients with stable premature CAD. An estimated glomerular filtration rate (eGFR) calculated using the MDRD formula, baseline clinical characteristics, use of medications for coronary secondary prevention therapies (aspirin, β-blocker, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers, or statins), and 2-year follow-up results, in particular major adverse cardiac events (MACEs), were collected and analyzed. Results Patients with reduced left ventricular ejection fraction (LVEF) (18.75%) were more prevalent among men, smokers, those with type 2 diabetes, with a family history of cardiovascular disease (CVD), and with higher white blood cells counts ((8.88 ± 0.35) × 109/L vs. (6.90 ± 0.17) × 109/L) (all P < 0.05) compared to those with preserved LVEF. There was no significant difference between creatinine or eGFR values in the two groups with reduced and preserved LVEF (all P > 0.05). Patients with LVEF < 50% in the MACEs group had a lower ratio of optimal drug administration compared to the MACEs-free group (Z = -0.228, P = 0.820 and Z = -2.167, P = 0.03 respectively). Patients with reduced LVEF had a significantly higher ratio of composite MACEs than patients with preserved LVEF during 2-year follow-up (47.13% vs. 33.50%, P < 0.05). Conclusions Stable premature CAD patients with reduced LVEF have more risk factors, lower medication compliance, and worse 2-year outcomes than those with preserved LVEF.
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Affiliation(s)
- Zhong Chen
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai 200233,China
| | - Zhen Ding
- Department of Cardiology, Zhenjiang First People's Hospital, Zhenjiang 212002, China
| | - Xin Wang
- Department of Cardiology, The Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Nanjing 210009, China
| | - Xiaofeng Zhang
- Department of Cardiology, The Affiliated Nanjing Second Hospital of Southeast University, Nanjing 210009, China
| | - Genshan Ma
- Department of Cardiology, The Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Nanjing 210009, China
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Current practice on the management of acute coronary syndrome in China. Int J Cardiol 2013; 169:1-6. [DOI: 10.1016/j.ijcard.2013.08.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 08/29/2013] [Indexed: 11/18/2022]
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