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Fernández MS, Silva Melchor L, Martínez-Sellés M, Viana Tejedor A, Aguilar R, Lopez de Sa Areses E, Martín Asenjo R. Early approach to LDL-related risk after acute coronary syndrome: The OPTA Project. Expert Rev Cardiovasc Ther 2023:1-6. [PMID: 37144281 DOI: 10.1080/14779072.2023.2211266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Hyperlipidemia is the main underlying cause of atherosclerotic cardiovascular disease. Reducing low-density lipoprotein (LDL) cholesterol to recommended targets after an acute coronary syndrome (ACS) is of utmost importance as it is associated with a reduction of mortality and further cardiovascular events. Unfortunately, there are considerable gaps between guideline recommendations and clinical practice. In addition, the approach to treatment of this population is very heterogeneous, even in specialized cardiovascular units. Some easy-to-implement strategies may help to optimize the management of these patients. AREAS COVERED The OPTA Project was developed to identify these gaps and to provide recommendations to improve and harmonize the management of patients with ACS, with a specific focus on lipids. EXPERT OPINION Five areas of interest were defined: 1) evaluation of cardiovascular risk at admission, 2) development of a strategy to effectively and rapidly reduce LDL cholesterol levels, 3) determining LDL cholesterol goals (<55 mg/dL or stricter) and follow-up, 4) data collection during hospitalization, and 5) standardized discharge report. Specific recommendations are given to reduce inequalities, following the targets "the lower, the better" and "the earlier, the better".
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Affiliation(s)
| | - Lorenzo Silva Melchor
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda-Madrid, Spain
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital Universitario Gregorio Marañon, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Ana Viana Tejedor
- Department of Cardiology, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Rio Aguilar
- Department of Cardiology. Hospital Universitario de la Princesa, Universidad Autonoma de Madrid, Spain
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Baldeón Conde C, Royuela Martínez N, García Ibarbia C, Guerra Ruiz A, Olavarri Miguel I, Cobo Belaustegui M, Alio Lavín B, González Vilchez F, de la Torre Hernández J, Hernández Hernández J. Grado de consecución de los objetivos lipídicos a largo plazo en una cohorte de pacientes con síndrome coronario agudo en práctica clínica real. Rev Clin Esp 2023. [DOI: 10.1016/j.rce.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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3
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Baldeón Conde C, Royuela Martínez N, García Ibarbia C, Guerra Ruiz AR, Olavarri Miguel I, Cobo Belaustegui M, Alio Lavín B, González Vilchez FJ, de la Torre Hernández JM, Hernández Hernández JL. Achievement of long-term lipid targets in a cohort of patients with acute coronary syndrome in real-world clinical practice. Rev Clin Esp 2023; 223:223-230. [PMID: 36933696 DOI: 10.1016/j.rceng.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/04/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION AND OBJECTIVES According to the recent European epidemiological studies, the degree of lipid control in patients with very high vascular risk is suboptimal. This study analyzes the epidemiological characteristics, cardiovascular risk factors, lipid profile, recurrence, and degree of achievement of long-term lipid targets, according to the ESC/EAS Guidelines, in a cohort of patients with acute coronary syndrome (ACS) in a real-world clinical practice setting. METHODS This work is a retrospective cohort study of patients diagnosed with ACS admitted to the Coronary Unit of a tertiary hospital from January 1, 2012 to December 31, 2015 and followed-up on until March 2022. RESULTS A total of 826 patients were studied. During the follow-up period, greater prescribing of combined lipid-lowering therapy was observed, mainly high- and moderate-intensity statins and ezetimibe. At 24 months after the ACS, 33.6% of living patients had LDL levels <70 mg/dl and 9.3% had LDL levels <55 mg/dl. At the end of the follow-up (101 [88-111] months), the corresponding figures were 54.5% and 21.1%. Some 22.1% of patients had a recurrent coronary event and only 24.6% achieved an LDL level <55 mg/dl. CONCLUSIONS Achievement of the LDL targets recommended by the ESC/EAS guidelines is suboptimal in patients with ACS, both at two years and in the long-term (7-10 years), especially in patients with recurrent ACS.
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Affiliation(s)
- C Baldeón Conde
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain.
| | - N Royuela Martínez
- Servicio de Cardiología, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain
| | - C García Ibarbia
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain; Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, Spain; Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - A R Guerra Ruiz
- Servicio de Análisis Clínicos, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain
| | - I Olavarri Miguel
- Servicio de Cardiología, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain; Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - M Cobo Belaustegui
- Servicio de Cardiología, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain; Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - B Alio Lavín
- Servicio de Análisis Clínicos, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain; Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - F J González Vilchez
- Servicio de Cardiología, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain; Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - J M de la Torre Hernández
- Servicio de Cardiología, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain; Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, Spain; Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - J L Hernández Hernández
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain; Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, Spain; Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
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The Association of Sex with Unplanned Cardiac Readmissions following Percutaneous Coronary Intervention in Australia: Results from a Multicentre Outcomes Registry (GenesisCare Cardiovascular Outcomes Registry). J Clin Med 2022; 11:jcm11226866. [PMID: 36431346 PMCID: PMC9692358 DOI: 10.3390/jcm11226866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background and aim: Unplanned cardiac readmissions in patients with percutaneous intervention (PCI) is very common and is seen as a quality indicator of in-hospital care. Most studies have reported on the 30-day cardiac readmission rates, with very limited information being available on 1-year readmission rates and their association with mortality. The aim of this study was to investigate the impact of biological sex at 1-year post-PCI on unplanned cardiac readmissions. Methods and results: Patients enrolled into the GenesisCare Cardiovascular Outcomes Registry (GCOR-PCI) from December 2008 to December 2020 were included in the study. A total of 13,996 patients completed 12 months of follow-up and were assessed for unplanned cardiac readmissions. All patients with unplanned cardiac readmissions in the first year of post-PCI were followed in year 2 (post-PCI) for survival status. The rate of unplanned cardiac readmissions was 10.1%. Women had a 29% higher risk of unplanned cardiac readmission (HR 1.29, 95% CI 1.11 to 1.48; p = 0.001), and female sex was identified as an independent predictor of unplanned cardiac readmissions. Any unplanned cardiac readmission in the first year was associated with a 2.5-fold higher risk of mortality (HR 2.50, 95% CI 1.67 to 3.75; p < 0.001), which was similar for men and women. Conclusion: Unplanned cardiac readmissions in the first year post-PCI was strongly associated with increased all-cause mortality. Whilst the incidence of all-cause mortality was similar between women and men, a higher incidence of unplanned cardiac readmissions was observed for women, suggesting distinct predictors of unplanned cardiac readmissions exist between women and men.
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Sáez-Jiménez R, Esteban-Hernández J, Herreros B, Huelmos A, Guijarro C, Guijarro C, Belinchón JC, Aranda C, Herreros B, González Anglada I, Téllez M, Huelmos AI, López-Bescós L, Sánchez C, Barriga F, Gutiérrez M, Puras E, Casas ML, Tolón R. La albuminuria y la enfermedad polivascular mejoran la capacidad predictiva de los modelos multivariados después de un evento cardiovascular agudo. Cohorte AIRVAG. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Aubiniere-Robb L, Reid G, Murphy A. Primary percutaneous coronary intervention in patients aged 85 years or older: a retrospective analysis of outcomes. J R Coll Physicians Edinb 2021; 51:13-18. [PMID: 33877128 DOI: 10.4997/jrcpe.2021.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Primary percutaneous coronary intervention (PPCI) is the first-line treatment for acute ST-elevation myocardial infarction (STEMI). Evidence of benefit from PPCI in the elderly is sparse. Our aim was to evaluate survival outcomes in patients aged ≥85 years who undergo PPCI for STEMI. METHODS Clinical data were collected retrospectively on all patients aged ≥85 years who were referred and accepted for PPCI to our centre between 2013 and 2018. RESULTS One hundred and forty-three patients received PPCI. Median hospital stay was seven days. One hundred and thirty-one patients survived admission. One-year mortality was 33.5%. Age and baseline renal function were independent predictors of one-year mortality. Median survival was 2.55 years. CONCLUSION Advanced age alone should not be used as an exclusion criterion for PPCI; rather, a personalised approach that takes into account all clinically relevant patient factors should guide PCI decision-making. Our findings suggest that PPCI as first-line treatment for STEMI in the very old should be considered routinely.
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Affiliation(s)
| | - George Reid
- General Medicine, Inverclyde Royal Hospital, Glasgow, UK
| | - Aengus Murphy
- Department of Cardiology, University Hospital Monklands, Airdrie, UK
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Sáez-Jiménez R, Esteban-Hernández J, Herreros B, Huelmos A, Guijarro C. Albuminuria and polyvascular disease improve multivariate predictive models after an acute cardiovascular event. The AIRVAG cohort. Rev Clin Esp 2021; 222:138-151. [PMID: 34147423 DOI: 10.1016/j.rceng.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS There is no consensus regarding risk stratification tools for secondary prevention in atherosclerotic cardiovascular disease. Our aim was to compare the discriminative performance of the Framingham, REGICOR, SCORE, and REACH risk functions and the Bohula-TIMI and SMART risk scores, as well as to assess the potential added value of other clinical variables for the prediction of recurrent events in patients with established vascular disease. METHODS A cohort of 269 patients with established vascular disease (52.8% coronary, 32% cerebrovascular, 15.2% PAD) was included. The survival functions of risk groups (low/medium/high) according to commonly used cutoff points for each function/score were compared, and hazard ratios for each were estimated using Cox regression. We calculated Δ Harrell's C statistic, cat-NRI, and cNRI after adding new predictors to a base model including age, sex, total cholesterol, current smoking status, hypertension, and diabetes. RESULTS After six years of follow-up (median 4.82 years), 61 events occurred (23%). High-risk groups had a higher risk of recurrent event: SMART (HR: 3.17 [1.55-6.5]), Framingham (HR: 3.08 [1.65-5.75]), REGICOR (HR: 2.71 [1.39-5.27]), SCORE (HR: 2.14 [1.01-4.5], REACH (HR: 5.74 [2.83-11.7]), B-TIMI (HR: 3.68 [0.88-15.3]). Polyvascular disease (three territories HR: 5.6 [2.2-14.25]), albuminuria (HR: 3.55 [2.06-6.11]), and heart failure (HR: 3.11 [1.34-7.25]) also increased risk. Discrimination (Harrell's C) was low but improved after adding albuminuria and polyvascular disease. Both variables also improved the performance of the base model (cNRI.326 [.036; .607]). CONCLUSIONS The Framingham, REGICOR, SCORE, and REACH functions and the B-TIMI and SMART scores showed low yet similar performance in secondary prevention. Albuminuria and polyvascular disease improved the predictive performance of major classical cardiovascular risk factors.
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Affiliation(s)
- R Sáez-Jiménez
- Centro de Atención Primaria Presentación Sabio, Móstoles, Madrid, Spain; Área de Salud Pública y Medicina Preventiva, Facultad de Medicina, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - J Esteban-Hernández
- Área de Salud Pública y Medicina Preventiva, Facultad de Medicina, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - B Herreros
- Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - A Huelmos
- Servicio de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - C Guijarro
- Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Madrid, Spain; Facultad de Medicina, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Bernal-Jiménez MÁ, Calle-Pérez G, Gutiérrez-Barrios A, Gheorghe L, Solano-Mulero AM, Rodríguez-Martín A, Tur JA, Vázquez-García R, Santi-Cano MJ. Lifestyle and Treatment Adherence Intervention after a Coronary Event Based on an Interactive Web Application (EVITE): Randomized Controlled Clinical Trial Protocol. Nutrients 2021; 13:1818. [PMID: 34071782 PMCID: PMC8226528 DOI: 10.3390/nu13061818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
Coronary heart disease is one of the main causes of morbimortality around the world. Patients that survive a coronary event suffer a high risk of readmission, relapse and mortality, attributed to the sub-optimal control of cardiovascular risk factors (CVRF), which highlights the need to improve secondary prevention strategies aimed at improving their lifestyle and adherence to treatment. Through a randomized controlled clinical trial, this study aims to evaluate the effect of an intervention involving an online health application supported by a mobile telephone or tablet (mHealth) on lifestyle (diet, physical activity, and tobacco consumption) and treatment adherence among people with coronary heart disease after percutaneous coronary intervention. The sample will comprise 240 subjects (120 in each arm: intervention and usual care). They are assessed immediately and nine months after their hospital discharge about sociodemographic, clinical, CVRF, lifestyle, and treatment adherence characteristics. The educative intervention, involving a follow-up and self-monitoring, will be performed using an online mHealth tool consisting of an application for mobile phones and tablets. The quantitative primary outcomes from the two groups will be compared using an analysis of covariance (ANCOVA) adjusted for age and gender. A multivariate analysis will be performed to examine the association of the intervention with lifestyle habits, the control of CVRFs, and outcomes after discharge in terms of the use of health services, emergency visits, cardiovascular events and readmissions.
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Affiliation(s)
- María Ángeles Bernal-Jiménez
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (M.Á.B.-J.); (A.R.-M.)
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
| | - Germán Calle-Pérez
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Cardiology Unit, Puerta del Mar Hospital, 11009 Cadiz, Spain;
| | - Alejandro Gutiérrez-Barrios
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Cardiology Unit, Puerta del Mar Hospital, 11009 Cadiz, Spain;
| | - Livia Gheorghe
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Cardiology Unit, Puerta del Mar Hospital, 11009 Cadiz, Spain;
| | | | - Amelia Rodríguez-Martín
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (M.Á.B.-J.); (A.R.-M.)
- Biomedicine, Biotechnology and Public Health Department, University of Cadiz, 11003 Cádiz, Spain
| | - Josep A. Tur
- Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands, IDISBA & CIBEROBN, 07122 Palma de Mallorca, Spain;
| | - Rafael Vázquez-García
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Cardiology Unit, Puerta del Mar Hospital, 11009 Cadiz, Spain;
| | - María José Santi-Cano
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (M.Á.B.-J.); (A.R.-M.)
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Research Group on Nutrition, Molecular, Pathophysiological and Social Issues, University of Cádiz, 11009 Cádiz, Spain
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Raffee LA, Alawneh KZ, Ibdah RK, Rawashdeh SI, Zoghoul S, Ewais AS, Al-Mistarehi AH. Prevalence, Clinical Characteristics, and Risk Among Patients with Ischemic Heart Disease in the Young Jordanian Population. Open Access Emerg Med 2020; 12:389-397. [PMID: 33235526 PMCID: PMC7678703 DOI: 10.2147/oaem.s272961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/27/2020] [Indexed: 01/18/2023] Open
Abstract
PURPOSE This study aims to evaluate the prevalence of ischemic heart disease (IHD) among the young population in Jordan. We examined the risk factors that might be involved in disease incidence. Clinical characteristics, patients' living standards, and various other risk factors were considered to conduct the study. METHODS A retrospective study was conducted at King Abdullah University Hospital. Data were collected from patients who visited this hospital between January 2013 and December 2017. Only young Jordanian adults of age <50 years were included in this study. The data of 358 patients were purposively collected and analyzed (as per the determined inclusion criteria), where information related to their baseline characteristics, clinical characteristics, and related biochemical assays was reviewed. RESULTS This study showed a high prevalence of IHD among young males in Jordan. It also revealed that increased age, smoking, hypertension, unfavorable lipid profile, and obesity were the major possible risk factors for the occurrence of disease. These patients were initially diagnosed with either unstable angina or acute myocardial infarction. Initial WBCs count, particularly monocytes differential, was high in about one-third of patients, besides cardiac biomarkers. CONCLUSION The high incidence of IHD was noticed among young individuals. We suggest that more efforts should be instigated for reducing the high prevalence of IHD by adopting a healthy lifestyle, preventive attitude, and nutritious food intake.
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Affiliation(s)
- Liqaa A Raffee
- Department of Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khaled Z Alawneh
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rashid K Ibdah
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sukaina I Rawashdeh
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sohaib Zoghoul
- Medical Education Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Abdel Salam Ewais
- Department of Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdel-Hameed Al-Mistarehi
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Pedrosa RC. Short Editorial: Distinct Prognostic Competence between the Clinical and Anatomical Models in Acute Coronary Syndromes: Comparison by Type of Outcome. Arq Bras Cardiol 2020; 115:226-228. [PMID: 32876189 PMCID: PMC8384282 DOI: 10.36660/abc.20200758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Roberto Coury Pedrosa
- Departamento de Cardiologia, Hospital Universitário Clementino Fraga Filho / Instituto do Coração Edson Saad - Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
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Willems R, Pil L, Lambrinou CP, Kivelä J, Wikström K, Gonzalez-Gil EM, De Miguel-Etayo P, Nánási A, Semánová C, Van Stappen V, Cardon G, Tsochev K, Iotova V, Chakarova N, Makrilakis K, Dafoulas G, Timpel P, Schwarz P, Manios Y, Annemans L. Methodology of the health economic evaluation of the Feel4Diabetes-study. BMC Endocr Disord 2020; 20:14. [PMID: 32164685 PMCID: PMC7066818 DOI: 10.1186/s12902-019-0471-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/09/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The clinical and economic burden of type 2 diabetes mellitus on society is rising. Effective and efficient preventive measures may stop the increasing prevalence, given that type 2 diabetes mellitus is mainly a lifestyle-driven disease. The Feel4Diabetes-study aimed to tackle unhealthy lifestyle (unhealthy diet, lack of physical activity, sedentary behaviour, and excess weight) of families with a child in the first grades of elementary school. These schools were located in regions with a relatively low socio-economic status in Belgium, Bulgaria, Finland, Greece, Hungary and Spain. Special attention was paid to families with a high risk of developing type 2 diabetes mellitus. METHODS The aim of this paper is to describe the detailed methodology of the intervention's cost-effectiveness analysis. Based on the health economic evaluation of the Toybox-study, both a decision analytic part and a Markov model have been designed to assess the long-term (time horizon of 70 year with one-year cycles) intervention's value for money. Data sources used for the calculation of health state incidences, transition probabilities between health states, health state costs, and health state utilities are listed. Intervention-related costs were collected by questionnaires and diaries, and attributed to either all families or high risk families only. CONCLUSIONS The optimal use of limited resources is pivotal. The future results of the health economic evaluation of the Feel4Diabetes-study will contribute to the efficient use of those resources.
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Affiliation(s)
- Ruben Willems
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Entrance 42 – Floor 4, 9000 Ghent, Belgium
| | - Lore Pil
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Entrance 42 – Floor 4, 9000 Ghent, Belgium
| | - Christina-Paulina Lambrinou
- Department of Nutrition and Dietetics, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
| | - Jemina Kivelä
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie 166, 00271 Helsinki, Finland
| | - Katja Wikström
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie 166, 00271 Helsinki, Finland
| | - Esther M. Gonzalez-Gil
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, 50009 Zaragoza, Spain
- Institute of Nutrition and Food Technology, Center of Biomedical Research, University of Granada, Granada, Spain
| | - Pilar De Miguel-Etayo
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, 50009 Zaragoza, Spain
- Instituto Agroalimentario de Aragon (IA2), Zaragoza, Spain
- Instituto de Investigacion Sanitaria Aragón (IIS Aragon), University of Zaragoza, Zaragoza, Spain
- Centro de Investigacion Biomedica en Red de Fisiopatologia de la Obesidad y Nutricion (CIBERObn), University of Zaragoza, Zaragoza, Spain
| | - Anna Nánási
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, 400 Hungary
| | - Csilla Semánová
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, 400 Hungary
| | - Vicky Van Stappen
- Department of Movement and Sports Sciences, Ghent University, Campus Dunant, Watersportlaan 2, 9000 Ghent, Belgium
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Campus Dunant, Watersportlaan 2, 9000 Ghent, Belgium
| | - Kaloyan Tsochev
- Department of Paediatrics, Medical University Varna, 1 Hr. Smirnenski Blvd, 9010 Varna, Bulgaria
| | - Violeta Iotova
- Department of Paediatrics, Medical University Varna, 1 Hr. Smirnenski Blvd, 9010 Varna, Bulgaria
| | - Nevena Chakarova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, Bulgaria
| | | | - George Dafoulas
- National and Kapodistrian University of Athens, 17 Ag. Thoma St, 11527 Athens, Greece
| | - Patrick Timpel
- Department for Precention and Care of Diabetes, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Peter Schwarz
- Department for Precention and Care of Diabetes, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technische Universitat Dresden, Dresden, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
| | - Lieven Annemans
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Entrance 42 – Floor 4, 9000 Ghent, Belgium
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Bernal JL, Barrabés JA, Íñiguez A, Fernández-Ortiz A, Fernández-Pérez C, Bardají A, Elola FJ. Datos clínicos y administrativos en la investigación de resultados del síndrome coronario agudo en España. Validez del Conjunto Mínimo Básico de Datos. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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13
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Li M, Li C, Chen S, Sun Y, Hu J, Zhao C, Qiu R, Zhang X, Zhang Q, Tian G, Shang H. Potential Effectiveness of Chinese Patent Medicine Tongxinluo Capsule for Secondary Prevention After Acute Myocardial Infarction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Pharmacol 2018; 9:830. [PMID: 30123126 PMCID: PMC6085586 DOI: 10.3389/fphar.2018.00830] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/10/2018] [Indexed: 01/28/2023] Open
Abstract
Background: Chinese patent medicine Tongxinluo capsule (TXL) is commonly used for cardio-cerebrovascular diseases. Previous research had demonstrated that TXL exhibited great clinical effects on the treatment of acute myocardial infarction (AMI), however there is a lack of systematic review. The purpose of this study was to evaluate the potential effectiveness and safety of TXL for secondary prevention in patients with AMI. Method: We searched 6 databases to identify relevant randomized controlled trials (RCTs) from inceptions to December 30, 2017. Two review authors independently assessed the methodological quality and analyzed data by the RevMan 5.3 software. The publication bias was assessed through funnel plot and Begg's test. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used for evaluating the quality of evidence. Results: We included 19 RCTs in this review and performed a meta-analysis based on 16 studies. There were statistical differences of TXL treatment group in reducing primary cardiovascular events (cardiac death [RR = 0.27, 95%CI: 0.08~0.95, I2 = 0%], recurrent myocardial reinfarction [RR = 0.38, 95%CI: 0.20~0.74, I2 = 0%], arrhythmia [RR = 0.44, 95%CI: 0.30~0.66, I2 = 0%], recurrent angina pectoris [RR = 0.34, 95%CI: 0.17~0.69, I2 = 0%]). TXL could improve cardiac function (LVEF [MD = 4.10, 95%CI: 3.95~4.25, I2 = 0%]), regulate blood lipid TC [MD = -0.66, 95%CI: -0.94 ~ -0.37, I2 = 74%], TG [MD = -0.38, 95%CI: -0.62 ~ -0.14, I2 = 70%], LDL-C[-0.40, 95%CI: -0.65 ~ -0.16, I2 = 88%), decrease the level of hs-CRP (4-week: MD = -0.78, 95%CI: -0.97 ~ -0.60, I2 = 20%; Over 4-week: MD = -1.36, 95%CI: -1.55 ~ -1.17, I2 = 20%). However, TXL has little effects on revascularization [RR = 0.45, 95%CI: 0.13~1.56, I2 = 0%], recurrent heart failure (RR = 0.83, 95%CI: 0.27~2.57, I2 = 0%), and HDL-C (MD = 0.14, 95%CI: 0.00 ~0.29, I2 = 73%). Furthermore, TXL treatment group was more prone to suffer gastrointestinal discomfort. Conclusion: Chinese patent medicine TXL seemed beneficial for secondary prevention after AMI. This potential benefit needs to be further assessed through more rigorous RCTs. Systematic review registration number in the PROSPERO register: CRD42017068417.
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Affiliation(s)
- Min Li
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chengyu Li
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shiqi Chen
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yang Sun
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jiayuan Hu
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chen Zhao
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong
| | - Ruijin Qiu
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoyu Zhang
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qin Zhang
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Guihua Tian
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hongcai Shang
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute of Integration of Traditional Chinese and Western Medicine, Guangzhou Medical University, Guangzhou, China
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Bernal JL, Barrabés JA, Íñiguez A, Fernández-Ortiz A, Fernández-Pérez C, Bardají A, Elola FJ. Clinical and Administrative Data on the Research of Acute Coronary Syndrome in Spain. Minimum Basic Data Set Validity. ACTA ACUST UNITED AC 2018; 72:56-62. [PMID: 29747944 DOI: 10.1016/j.rec.2018.01.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 01/17/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Health outcomes research is done from clinical registries or administrative databases. The aim of this work was to evaluate the concordance of the Minimum Basic Data Set (MBDS) with the DIOCLES (Descripción de la Cardiopatía Isquémica en el Territorio Español) registry and to analyze the implications of use of the MBDS in the study of acute coronary syndrome in Spain. METHODS Through indirect identifiers, DIOCLES was linked with MBDS and unique matches were selected. Some of most relevant variables for risk adjustment of in-hospital mortality due to acute myocardial infarction were considered. Kappa coefficient was used to evaluate the concordance; sensitivity, specificity and positive and negative predictive values to measure the validity of the MBDS, and the area under ROC (receiver operating characteristic) curve to calculate its discrimination. The results were compared among hospitals quintiles according to their contribution to DIOCLES. The influence of unmatched episodes on results was assessed by a sensitivity analysis, using looser linking criteria. RESULTS Overall, 1539 (60.85%) unique matches were achieved. The prevalence was higher in DIOCLES (acute myocardial infarction: 71.09%; Killip 3-4: 9.17%; cerebrovascular accident: 0.97%; thrombolysis: 8.64%; angioplasty: 61.92% and coronary bypass: 1.75%) than in the MBDS (P < .001). The agreement level observed was almost perfect (κ = 0.863). The MBDS showed a sensitivity of 85.10% and a specificity of 98.31%. Most results were confirmed by using sensitivity analysis (79.95% episodes matched). CONCLUSIONS The MBDS can be a useful tool for outcomes research of acute coronary syndrome in Spain. The contrast of DIOCLES and MBDS with medical records could verify their validity.
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Affiliation(s)
- José Luis Bernal
- Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain; Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain.
| | - José A Barrabés
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Vall d'Hebron, Institut de Recerca (VHIR), CIBER-CV, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Andrés Íñiguez
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Antonio Fernández-Ortiz
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain; Fundación Interhospitalaria de Investigación Cardiovascular, Madrid, Spain
| | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Alfredo Bardají
- Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universidad Rovira Virgili, Tarragona, Spain
| | - Francisco Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Elola Consultores, Madrid, Spain
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Montero-Balosa MC, Fernández-Urrusuno R, Vilches-Arenas A. The Effect of Monthly Medication on Mortality After a Coronary Event. J Cardiovasc Pharmacol Ther 2017; 23:192-199. [PMID: 28978235 DOI: 10.1177/1074248417732833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM The aim of this study was to analyze how the consumption of medication over time affects the survival rate in patients with a coronary event and whether there is a gender difference. METHODS The study included 804 patients admitted to 4 hospitals with a coronary event during 2007. Monitoring after coronary event was carried out during 2007 and every 6 months in the subsequent 2 years (2008 and 2009) throughout the review of the clinical history of the patient. The main outcome was the analysis of mortality after the coronary event. Kaplan-Meier survival curves were plotted to calculate the time to death, comparing women versus men for 4 medication groups: aspirin, statins, β-blockers, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs). A Cox regression model was used for the final mortality analysis. RESULTS During the follow-up time, 172 deaths were assessed. Each month of treatment with aspirin, statins, β-blockers, or ACEI/ARB was associated with a decrease in mortality between 13.0% and 0.5% (univariate analysis). The Kaplan-Meier method revealed a significant reduction in mortality after the coronary event for each month of treatment with aspirin (men), statins (men), and β-blockers (both men and women). No significant effect in survival was observed in either gender with ACEI/ARB treatment. The final multivariable model (Cox regression) showed that the taking of aspirin, statins, β-blockers, or ACEI/ARB is able to reduce mortality rates up to 7.0% (aspirin) throughout each month of treatment after a coronary event without any influence of gender. CONCLUSION Aspirin, statins, β-blockers, and ACEI/ARB revealed a protective character with each month of treatment throughout the follow-up period, in terms of risk reduction of death. Aspirin and statins showed the maximum benefit, followed by ACEI/ARB and β-blockers.
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Affiliation(s)
- María C Montero-Balosa
- 1 Primary Care Pharmacy Service, Aljarafe-Sevilla Norte Primary Care District, Andalusian Health Service, Seville, Spain
| | - Rocío Fernández-Urrusuno
- 1 Primary Care Pharmacy Service, Aljarafe-Sevilla Norte Primary Care District, Andalusian Health Service, Seville, Spain
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16
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Fournier S, Iten L, Marques-Vidal P, Boulat O, Bardy D, Beggah A, Calderara R, Morawiec B, Lauriers N, Monney P, Iglesias JF, Pascale P, Harbaoui B, Eeckhout E, Muller O. Circadian rhythm of blood cardiac troponin T concentration. Clin Res Cardiol 2017; 106:1026-1032. [DOI: 10.1007/s00392-017-1152-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 08/07/2017] [Indexed: 11/29/2022]
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17
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Análisis inmunohistológico del aspirado intracoronario en pacientes con IAMCEST: implicaciones clínicas de los hallazgos anatomopatológicos. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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18
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Rodriguez-Padial L, Elola FJ, Fernández-Pérez C, Bernal JL, Iñiguez A, Segura JV, Bertomeu V. Patterns of inpatient care for acute myocardial infarction and 30-day, 3-month and 1-year cardiac diseases readmission rates in Spain. Int J Cardiol 2017; 230:14-20. [DOI: 10.1016/j.ijcard.2016.12.121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 11/26/2016] [Accepted: 12/17/2016] [Indexed: 11/30/2022]
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19
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Ribas N, García-García C, Meroño O, Recasens L, Pérez-Fernández S, Bazán V, Salvatella N, Martí-Almor J, Bruguera J, Elosua R. Secondary prevention strategies after an acute ST-segment elevation myocardial infarction in the AMI code era: beyond myocardial mechanical reperfusion. BMC Cardiovasc Disord 2017; 17:54. [PMID: 28173757 PMCID: PMC5297147 DOI: 10.1186/s12872-017-0493-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The AMI code is a regional network enhancing a rapid and widespread access to reperfusion therapy (giving priority to primary angioplasty) in patients with acute ST-segment elevation myocardial infarction (STEMI). We aimed to assess the long-term control of conventional cardiovascular risk factors after a STEMI among patients included in the AMI code registry. DESIGN AND METHODS Four hundred and fifty-four patients were prospectively included between June-2009 and April-2013. Clinical characteristics were collected at baseline. The long-term control of cardiovascular risk factors and cardiovascular morbidity/mortality was assessed among the 6-months survivors. RESULTS A total of 423 patients overcame the first 6 months after the STEMI episode, of whom 370 (87%) underwent reperfusion therapy (363, 98% of them, with primary angioplasty). At 1-year follow-up, only 263 (62%) had adequate blood pressure control, 123 (29%) had LDL-cholesterol within targeted levels, 126/210 (60%) smokers had withdrawn from their habit and 40/112 (36%) diabetic patients had adequate glycosylated hemoglobin levels. During a median follow-up of 20 (11-30) months, cumulative mortality of 6 month-survivors was 6.1%, with 9.9% of hospital cardiovascular readmissions. The lack of assessment of LDL and HDL-cholesterol were significantly associated with higher mortality and cardiovascular readmission rates. CONCLUSIONS Whereas implementation of the AMI code resulted in a widespread access to rapid reperfusion therapy, its long-term therapeutic benefit may be partially counterbalanced by a manifestly suboptimal control of cardiovascular risk factors. Further efforts should be devoted to secondary prevention strategies after STEMI.
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Affiliation(s)
- Núria Ribas
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain. .,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. .,Medicine Department, Program in Internal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Cosme García-García
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Oona Meroño
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Lluís Recasens
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Silvia Pérez-Fernández
- IMIM (Hospital del Mar Medical Research Institute). Cardiovascular Epidemiology and Genetics Group (EGEC), REGICOR Study Group, Barcelona, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Víctor Bazán
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain
| | - Neus Salvatella
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Julio Martí-Almor
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jordi Bruguera
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Roberto Elosua
- IMIM (Hospital del Mar Medical Research Institute). Cardiovascular Epidemiology and Genetics Group (EGEC), REGICOR Study Group, Barcelona, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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The polypill approach - An innovative strategy to improve cardiovascular health in Europe. BMC Pharmacol Toxicol 2017; 18:10. [PMID: 28166827 PMCID: PMC5294740 DOI: 10.1186/s40360-016-0102-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/27/2016] [Indexed: 12/21/2022] Open
Abstract
Background Cardiovascular disease (CVD) is a major cause of disability and premature death. Despite European guidelines advocating the use of medical therapies in CVD, many patients still do not achieve the guideline-recommended treatment, which highlights the need for change and innovations in this field. This requirement has been widely recognised by the national ministries of health, several European cardiology societies, and the European Parliament, who support the initiation of strategies to improve and promote cardiovascular health. Discussion One of the key risk factors to recurrent cardiovascular events is the lack of adherence to medication and this has been added to the agenda of the European Commission. With the intention to improve treatment adherence in CVD, polypills have been investigated and numerous studies demonstrate that they significantly improve medication adherence, which contributes to the improvement of health outcomes. In Europe, the first cardiovascular polypill, developed by a public-private partnership (CNIC-Ferrer), recently became available for general prescription as a therapy for CVD prevention. This polypill significantly improves adherence, preventing fatal and non-fatal cardiovascular events, and appears to be a cost-effective strategy to improve sustainability of the health care systems in CVD. Conclusions Given the importance of urgent and simple solutions to restraining the pandemic nature of CVD, the polypill approach should therefore be considered by physicians and public health systems as an available and innovative option to improve cardiovascular health.
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Blasco A, Bellas C, Goicolea L, Muñiz A, Abraira V, Royuela A, Mingo S, Oteo JF, García-Touchard A, Goicolea FJ. Immunohistological Analysis of Intracoronary Thrombus Aspirate in STEMI Patients: Clinical Implications of Pathological Findings. ACTA ACUST UNITED AC 2016; 70:170-177. [PMID: 27745858 DOI: 10.1016/j.rec.2016.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 07/04/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Thrombus aspiration allows analysis of intracoronary material in patients with ST-segment elevation myocardial infarction. Our objective was to characterize this material by immunohistology and to study its possible association with patient progress. METHODS This study analyzed a prospective cohort of 142 patients undergoing primary angioplasty with positive coronary aspiration. Histological examination of aspirated samples included immunohistochemistry stains for the detection of plaque fragments. The statistical analysis comprised histological variables (thrombus age, degree of inflammation, presence of plaque), the patients' clinical and angiographic features, estimation of survival curves, and logistic regression analysis. RESULTS Among the histological markers, only the presence of plaque (63% of samples) was associated with postinfarction clinical events. Factors associated with 5-year event-free survival were the presence of plaque in the aspirate (82.2% vs 66.0%; P = .033), smoking (82.5% smokers vs 66.7% nonsmokers; P = .036), culprit coronary artery (83.3% circumflex or right coronary artery vs 68.5% anterior descending artery; P = .042), final angiographic flow (80.8% II-III vs 30.0% 0-I; P < .001) and left ventricular ejection fraction ≥ 35% at discharge (83.7% vs 26.7%; P < .001). On multivariable Cox regression analysis with these variables, independent predictors of event-free survival were the presence of plaque (hazard ratio, 0.37; 95%CI, 0.18-0.77; P = .008), and left ventricular ejection fraction (hazard ratio, 0.92; 95%CI, 0.88-0.95; P < .001). CONCLUSIONS The presence of plaque in the coronary aspirate of patients with ST elevation myocardial infarction may be an independent prognostic marker. CD68 immunohistochemical stain is a good method for plaque detection.
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Affiliation(s)
- Ana Blasco
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Carmen Bellas
- Departamento de Anatomía Patológica, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Leyre Goicolea
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Ana Muñiz
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Víctor Abraira
- Departamento de Estadística, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Royuela
- Departamento de Estadística, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Susana Mingo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Juan Francisco Oteo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Arturo García-Touchard
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Schlyter M, Östman M, Engström G, André-Petersson L, Tydén P, Leosdottir M. Personality factors and depression as predictors of hospital-based health care utilization following acute myocardial infarction. Eur J Cardiovasc Nurs 2016; 16:318-325. [DOI: 10.1177/1474515116666780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mona Schlyter
- Department of Cardiology, Skåne University Hospital and Lund University, Lund and Malmö, Sweden
- Faculty of Health and Society, Malmö University, Sweden
| | | | - Gunnar Engström
- Cardiovascular Epidemiology Research Group, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | | | - Patrik Tydén
- Department of Cardiology, Skåne University Hospital and Lund University, Lund and Malmö, Sweden
| | - Margrét Leosdottir
- Department of Cardiology, Skåne University Hospital and Lund University, Lund and Malmö, Sweden
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Xanthine Oxidase Inhibitor, Allopurinol, Prevented Oxidative Stress, Fibrosis, and Myocardial Damage in Isoproterenol Induced Aged Rats. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:478039. [PMID: 26137187 PMCID: PMC4475550 DOI: 10.1155/2015/478039] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/09/2015] [Accepted: 05/12/2015] [Indexed: 01/07/2023]
Abstract
We evaluated the preventive effect of allopurinol on isoproterenol (ISO) induced myocardial infarction in aged rats. Twelve- to fourteen-month-old male Long Evans rats were divided into three groups: control, ISO, and ISO + allopurinol. At the end of the study, all rats were sacrificed for blood and organ sample collection to evaluate biochemical parameters and oxidative stress markers analyses. Histopathological examinations were also conducted to assess inflammatory cell infiltration and fibrosis in heart and kidneys. Our investigation revealed that the levels of oxidative stress markers were significantly increased while the level of cellular antioxidants, catalase activity, and glutathione concentration in ISO induced rats decreased. Treatment with allopurinol to ISO induced rats prevented the elevated activities of AST, ALT, and ALP enzymes, and the levels of lipid peroxidation products and increased reduced glutathione concentration. ISO induced rats also showed massive inflammatory cells infiltration and fibrosis in heart and kidneys. Furthermore, allopurinol treatment prevented the inflammatory cells infiltration and fibrosis in ISO induced rats. In conclusion, the results of our study suggest that allopurinol treatment is capable of protecting heart of ISO induced myocardial infarction in rats probably by preventing oxidative stress, inflammation, and fibrosis.
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Disability-adjusted Life Years Lost to Ischemic Heart Disease in Spain. ACTA ACUST UNITED AC 2015; 68:968-75. [PMID: 25887346 DOI: 10.1016/j.rec.2014.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 11/21/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES The health indicator disability-adjusted life years combines the fatal and nonfatal consequences of a disease in a single measure. The aim of this study was to evaluate the burden of ischemic heart disease in 2008 in Spain by calculating disability-adjusted life years. METHODS The years of life lost due to premature death were calculated using the ischemic heart disease deaths by age and sex recorded in the Spanish National Institute of Statistics and the life-table in the 2010 Global Burden of Disease study. The years lived with disability, calculated for acute coronary syndrome, stable angina, and ischemic heart failure, used hospital discharge data and information from population studies. Disability weights were taken from the 2010 Global Burden of Disease study. We calculated crude and age standardized rates (European Standard Population). Univariate sensitivity analyses were performed. RESULTS In 2008, 539 570 disability-adjusted life years were lost due to ischemic heart disease in Spain (crude rate, 11.8/1000 population; standardized, 8.6/1000). Of the total years lost, 96% were due to premature death and 4% due to disability. Among the years lost due to disability, heart failure accounted for 83%, stable angina 15%, and acute coronary syndrome 2%. In the sensitivity analysis, weighting by age was the factor that changed the results to the greatest degree. CONCLUSIONS Ischemic heart disease continues to have a huge impact on the health of our population, mainly because of premature death. The results of this study provide an overall vision of the epidemiologic situation in Spain and could serve as the basis for evaluating interventions targeting the acute and chronic manifestations of cardiac ischemia.
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Kirchberger I, Hunger M, Stollenwerk B, Seidl H, Burkhardt K, Kuch B, Meisinger C, Holle R. Effects of a 3-year nurse-based case management in aged patients with acute myocardial infarction on rehospitalisation, mortality, risk factors, physical functioning and mental health. a secondary analysis of the randomized controlled KORINNA study. PLoS One 2015; 10:e0116693. [PMID: 25811486 PMCID: PMC4374800 DOI: 10.1371/journal.pone.0116693] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 12/11/2014] [Indexed: 01/01/2023] Open
Abstract
Background Home-based secondary prevention programs led by nurses have been proposed to facilitate patients’ adjustment to acute myocardial infarction (AMI). The objective of this study was to conduct secondary analyses of the three-year follow-up of a nurse-based case management for elderly patients discharged from hospital after an AMI. Methods In a single-centre randomized two-armed parallel group trial of hospitalized patients with AMI ≥65 years, patients hospitalized between September 2008 and May 2010 in the Hospital of Augsburg, Germany, were randomly assigned to case management or usual care. The case-management intervention consisted of a nurse-based follow-up for three years including home visits and telephone calls. Study endpoints were time to first unplanned readmission or death, clinical parameters, functional status, depressive symptoms and malnutrition risk. Persons who assessed three-year outcomes and validated readmission data were blinded. The intention-to-treat approach was applied to the statistical analyses which included Cox Proportional Hazards models. Results Three hundred forty patients were allocated to receive case-management (n = 168) or usual care (n = 172). During three years, in the intervention group there were 80 first unplanned readmissions and 6 deaths, while the control group had 111first unplanned readmissions and 3 deaths. The intervention did not significantly affect time to first unplanned readmission or death (Hazard Ratio 0.89, 95% confidence interval (CI) 0.67–1.19; p = 0.439), blood pressure, cholesterol level, instrumental activities of daily life (IADL) (only for men), and depressive symptoms. However, patients in the intervention group had a significantly better functional status, as assessed by the HAQ Disability Index, IADL (only for women), and hand grip strength, and better SCREEN-II malnutrition risk scores than patients in the control group. Conclusions A nurse-based management among elderly patients with AMI did not significantly affect time to unplanned readmissions or death during a three-year follow-up. However, the results indicate that functional status and malnutrition risk can be improved. Trial registration Current Controlled Trials ISRCTN02893746
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Affiliation(s)
- Inge Kirchberger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
- * E-mail:
| | - Matthias Hunger
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Björn Stollenwerk
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Hildegard Seidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Katrin Burkhardt
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
| | - Bernhard Kuch
- Department of Internal Medicine I—Cardiology, Central Hospital of Augsburg, Augsburg, Germany
- Department for Internal Medicine/Cardiology, Donau-Ries-Kliniken, Nördlingen, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
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Petriz JLF, Gomes BFDO, Rua BS, Azevedo CF, Hadlich MS, Mussi HTP, Taets GDC, Nascimento EMD, Pereira BDB, Silva NADSE. Assessment of myocardial infarction by cardiac magnetic resonance imaging and long-term mortality. Arq Bras Cardiol 2014; 104:159-68. [PMID: 25424161 PMCID: PMC4375660 DOI: 10.5935/abc.20140177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 08/11/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cardiac magnetic resonance imaging provides detailed anatomical information on infarction. However, few studies have investigated the association of these data with mortality after acute myocardial infarction. OBJECTIVE To study the association between data regarding infarct size and anatomy, as obtained from cardiac magnetic resonance imaging after acute myocardial infarction, and long-term mortality. METHODS A total of 1959 reports of "infarct size" were identified in 7119 cardiac magnetic resonance imaging studies, of which 420 had clinical and laboratory confirmation of previous myocardial infarction. The variables studied were the classic risk factors - left ventricular ejection fraction, categorized ventricular function, and location of acute myocardial infarction. Infarct size and acute myocardial infarction extent and transmurality were analyzed alone and together, using the variable named "MET-AMI". The statistical analysis was carried out using the elastic net regularization, with the Cox model and survival trees. RESULTS The mean age was 62.3 ± 12 years, and 77.3% were males. During the mean follow-up of 6.4 ± 2.9 years, there were 76 deaths (18.1%). Serum creatinine, diabetes mellitus and previous myocardial infarction were independently associated with mortality. Age was the main explanatory factor. The cardiac magnetic resonance imaging variables independently associated with mortality were transmurality of acute myocardial infarction (p = 0.047), ventricular dysfunction (p = 0.0005) and infarcted size (p = 0.0005); the latter was the main explanatory variable for ischemic heart disease death. The MET-AMI variable was the most strongly associated with risk of ischemic heart disease death (HR: 16.04; 95%CI: 2.64-97.5; p = 0.003). CONCLUSION The anatomical data of infarction, obtained from cardiac magnetic resonance imaging after acute myocardial infarction, were independently associated with long-term mortality, especially for ischemic heart disease death.
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Affiliation(s)
| | | | | | | | - Marcelo Souza Hadlich
- Instituto do Coração Edson Saad, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Esteban MR, Montero SM, Sánchez JJA, Hernández HP, Pérez JJG, Afonso JH, Pérez DCR, Díaz BB, de León AC. Acute coronary syndrome in the young: clinical characteristics, risk factors and prognosis. Open Cardiovasc Med J 2014; 8:61-7. [PMID: 25152777 PMCID: PMC4141177 DOI: 10.2174/1874192401408010061] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/20/2014] [Accepted: 06/06/2014] [Indexed: 12/18/2022] Open
Abstract
Background: To describe the characteristics of patients ≤40 years of age hospitalized for acute coronary syndrome, analyze the risk factors and identify the variables associated with prognosis. Methods: Case series of patients admitted between 2003 and 2012 inclusive in a tertiary hospital (123 consecutive cases admitted between 2003 and 2012), and case-control study (369 controls selected from the general population matched for sex and age with cases, at a ratio of 3:1). Outcome variables: Mortality, likelihood of survival without readmission for heart-related problems, extent of coronary disease as determined by coronary angiography and cardiovascular risk factors. Results: Mean age was 35.4±4.8 years and 83.7% of the participants were men. Myocardial infarction with abnormal Q wave (48%) and single-vessel involvement (44.7%) predominated. Intrahospital mortality was 1.6%. For the 108 patients eventually included in the follow-up, likelihood of readmission-free survival after 60 months was 69.3±4.8%. In the case group 36% of the patients admitted to using cocaine. Compared to controls, the prevalence in patients was higher for smoking (74.8 vs 33.1%, p<0001), diabetes (14.6% vs 5.1%, p=0.001), low HDL-cholesterol (82.9 vs 34.1%, p<0.001) and obesity (30.0 vs 20.3%, p=0.029). Decreased left ventricular ejection fraction (odds ratio=2.2, p=0.033) and smoking (odds ratio=7.8, p=0.045) were associated with readmission for coronary syndrome. Conclusion: Acute coronary syndrome in people younger than 40 years is associated with diabetes and unhealthy lifestyle: smoking, sedentary behavior (low HDL-cholesterol), cocaine use and obesity. The readmission rate is high, and readmission is associated with smoking and decreased ejection fraction.
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Affiliation(s)
| | - Sara M Montero
- Unidad de Medicina Intensiva, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - José J A Sánchez
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Del C R Pérez
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Buenaventura B Díaz
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio C de León
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain ; Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
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Sanz G, Castellano JM, Fuster V. Polypill: chimera or reality? ACTA ACUST UNITED AC 2014; 67:689-92. [PMID: 25172063 DOI: 10.1016/j.rec.2014.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 05/13/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Ginés Sanz
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
| | - José M Castellano
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiovascular Institute, Mount Sinai School of Medicine, New York, United States
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiovascular Institute, Mount Sinai School of Medicine, New York, United States
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Lopez-de-Andres A, Jimenez-García R, Hernandez-Barrera V, Perez-Farinos N, de Miguel-Yanes JM, Mendez-Bailon M, Jimenez-Trujillo I, de Miguel AG, Pino CG, Carrasco-Garrido P. National trends in utilization and outcomes of coronary revascularization procedures among people with and without type 2 diabetes in Spain (2001-2011). Cardiovasc Diabetol 2014; 13:3. [PMID: 24383412 PMCID: PMC3881504 DOI: 10.1186/1475-2840-13-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 12/18/2013] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Diabetes is associated with a high risk of death due to coronary artery disease (CAD). People with diabetes suffering from CAD are frequently treated with revascularization procedures. We aim to compare trends in the use and outcomes of coronary revascularization procedures in diabetic and non-diabetic patients in Spain between 2001 and 2011. METHODS We identified all patients who had undergone coronary revascularization procedures, percutaneous coronary interventions (PCI) and coronary artery bypass graft (CABG) surgeries, using national hospital discharge data. Discharges were grouped by diabetes status: type 2 diabetes and no diabetes. The incidence of discharges attributed to coronary revascularization procedures were calculated stratified by diabetes status. We calculated length of stay and in-hospital mortality (IHM). We apply joinpoint log-linear regression to identify the years in which changes in tendency occurred in the use of PCI and CABG in diabetic and non-diabetic patients. Multivariate analysis was adjusted by age, sex, year and comorbidity (Charlson comorbidity index). RESULTS From 2001 to 2011, 434,108 PCIs and 79,986 CABGs were performed. According to the results of the joinpoint analysis, we found that sex and age-adjusted use of PCI increased by 31.4% per year from 2001 to 2003, by 15.9% per year from 2003 to 2006 and by 3.8% per year from 2006 to 2011 in patients with diabetes. IHM among patients with diabetes who underwent a PCI did not change significantly over the entire study period (OR 0.99; 95% CI 0.97-1.00).Among patients with diabetes who underwent a CABG, the sex and age-adjusted CABG incidence rate increased by 10.4% per year from 2001 to 2003, and then decreased by 1.1% through 2011. Diabetic patients who underwent a CABG had a 0.67 (95% CI 0.63-0.71) times lower probability of dying during hospitalization than those without diabetes. CONCLUSIONS The annual percent change in PCI procedures increased in diabetic and non-diabetic patients. Higher comorbidity and the female gender are associated with a higher IHM in PCI procedures. In diabetic and non-diabetic patients, we found a decrease in the use of CABG procedures. IHM was higher in patients without diabetes than in those with diabetes.
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Affiliation(s)
- Ana Lopez-de-Andres
- Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Rodrigo Jimenez-García
- Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Valentin Hernandez-Barrera
- Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Napoleon Perez-Farinos
- Agencia Española de Seguridad Alimentaria y Nutrición, Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, Spain
| | | | | | - Isabel Jimenez-Trujillo
- Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Angel Gil de Miguel
- Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Carmen Gallardo Pino
- Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Pilar Carrasco-Garrido
- Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
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García-González P, Fácila Rubio L, Montagud V, Chacón-Hernández N, Fabregat-Andrés Ó, Morell S. Predictores de hospitalización prolongada en cardiología. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.05.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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García-García C, Molina L, Subirana I, Sala J, Bruguera J, Arós F, Fiol M, Serra J, Marrugat J, Elosua R. Diferencias en función del sexo en las características clínicas, tratamiento y mortalidad a 28 días y 7 años de un primer infarto agudo de miocardio. Estudio RESCATE II. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.06.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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García-González P, Fácila Rubio L, Montagud V, Chacón-Hernández N, Fabregat-Andrés Ó, Morell S. Predictors of prolonged hospitalization in cardiology. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2014; 67:62-63. [PMID: 24774269 DOI: 10.1016/j.rec.2013.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/28/2013] [Indexed: 06/03/2023]
Affiliation(s)
- Pilar García-González
- Servicio de Cardiología, Consorcio Hospitalario General Universitario de Valencia, Valencia, Spain
| | - Lorenzo Fácila Rubio
- Servicio de Cardiología, Consorcio Hospitalario General Universitario de Valencia, Valencia, Spain.
| | - Vicente Montagud
- Servicio de Cardiología, Consorcio Hospitalario General Universitario de Valencia, Valencia, Spain
| | - Natalia Chacón-Hernández
- Servicio de Cardiología, Consorcio Hospitalario General Universitario de Valencia, Valencia, Spain
| | - Óscar Fabregat-Andrés
- Servicio de Cardiología, Consorcio Hospitalario General Universitario de Valencia, Valencia, Spain
| | - Salvador Morell
- Servicio de Cardiología, Consorcio Hospitalario General Universitario de Valencia, Valencia, Spain
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García-García C, Molina L, Subirana I, Sala J, Bruguera J, Arós F, Fiol M, Serra J, Marrugat J, Elosua R. Sex-based differences in clinical features, management, and 28-day and 7-year prognosis of first acute myocardial infarction. RESCATE II study. ACTA ACUST UNITED AC 2013; 67:28-35. [PMID: 24774261 DOI: 10.1016/j.rec.2013.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 06/18/2013] [Indexed: 01/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES To analyze sex-based differences in clinical characteristics, management, and 28-day and 7-year prognosis after a first myocardial infarction. METHODS Between 2001 and 2003, 2042 first myocardial infarction patients were consecutively registered in 6 Spanish hospitals. Clinical characteristics, management, and 28-day case-fatality were prospectively recorded. Seven-year vital status was also ascertained by data linkage with the National Mortality Index. RESULTS The registry included 449 women and 1593 men with a first myocardial infarction. Compared with men, women were older, had a higher prevalence of hypertension and diabetes, and were more likely to receive angiotensin-converting enzyme (ACE) inhibitors but were less likely to receive beta-blockers or thrombolysis. No differences were observed in use of invasive procedures. More women had non-ST-segment elevation and unclassified myocardial infarction than men (37.9% vs 31.3% and 9.8% vs 6.1%, respectively; both P<.001). Case-fatality at 28 days was similar in women and men (5.57% vs 4.46%; P=.39). After multivariate adjustment, the odds ratio of 28-day mortality for men was 1.06 (95% confidence interval: 0.49-2.27; P=.883) compared with women. After multivariate adjustment, men had higher 7-year mortality than women, hazard ratio 1.93 (95% confidence interval: 1.46-2.56; P<.001). CONCLUSIONS There are demographic and clinical differences between men and women with a first myocardial infarction. The short-term prognosis of a first myocardial infarction in this century is similar in both sexes. However, the long-term vital prognosis after a first myocardial infarction is worse in men than in women. These results are observed in both ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction events.
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Affiliation(s)
- Cosme García-García
- Departamento de Cardiología, Hospital del Mar, Barcelona, Spain; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; Departamento de Medicina Interna, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Lluís Molina
- Departamento de Cardiología, Hospital del Mar, Barcelona, Spain; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, Barcelona, Spain
| | - Isaac Subirana
- CIBER en Epidemiología y Salud Pública, Barcelona, Spain; Grupo de Genética y Epidemiología Cardiovascular, Institut Municipal d'Investigació Mèdica, Barcelona, Spain
| | - Joan Sala
- Departamento de Cardiología, Hospital Josep Trueta, Girona, Spain
| | - Jordi Bruguera
- Departamento de Cardiología, Hospital del Mar, Barcelona, Spain; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Fernando Arós
- Departamento de Cardiología, Hospital Txagurritxu, Vitoria, Álava, Spain
| | - Miquel Fiol
- Departamento de Cardiología, Hospital Son Espases, Palma de Mallorca, Spain; CIBER en Obesidad y Nutrición, Barcelona, Spain
| | - Jordi Serra
- Departamento de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jaume Marrugat
- Grupo de Genética y Epidemiología Cardiovascular, Institut Municipal d'Investigació Mèdica, Barcelona, Spain
| | - Roberto Elosua
- Grupo de Genética y Epidemiología Cardiovascular, Institut Municipal d'Investigació Mèdica, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, Barcelona, Spain
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Meisinger C, Stollenwerk B, Kirchberger I, Seidl H, Wende R, Kuch B, Holle R. Effects of a nurse-based case management compared to usual care among aged patients with myocardial infarction: results from the randomized controlled KORINNA study. BMC Geriatr 2013; 13:115. [PMID: 24168465 PMCID: PMC3871021 DOI: 10.1186/1471-2318-13-115] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/15/2013] [Indexed: 11/17/2022] Open
Abstract
Background Transition from hospital to home is a critical period for older persons with acute myocardial infarction (AMI). Home-based secondary prevention programs led by nurses have been proposed to facilitate the patients’ adjustment to AMI after discharge. The objective of this study was to evaluate the effects of a nurse-based case management for elderly patients discharged after an AMI from a tertiary care hospital. Methods In a single-centre randomized two-armed parallel group trial of patients aged 65 years and older hospitalized with an AMI between September 2008 and May 2010 in the Hospital of Augsburg, Germany, patients were randomly assigned to a case management or a control group receiving usual care. The case-management intervention consisted of a nurse-based follow-up for one year including home visits and telephone calls. Key elements of the intervention were to detect problems or risks and to give advice regarding a wide range of aspects of disease management (e.g. nutrition, medication). Primary study endpoint was time to first unplanned readmission or death. Block randomization per telephone call to a biostatistical center, where the randomization list was kept, was performed. Persons who assessed one-year outcomes and validated readmission data were blinded. Statistical analysis was based on the intention-to-treat approach and included Cox Proportional Hazards models. Results Three hundred forty patients were allocated to receive case-management (n=168) or usual care (n=172). The analysis is based on 329 patients (intervention group: n=161; control group: n=168). Of these, 62% were men, mean age was 75.4 years, and 47.1% had at least either diabetes or chronic heart failure as a major comorbidity. The mean follow-up time for the intervention group was 273.6 days, and for the control group it was 320.6 days. During one year, in the intervention group there were 57 first unplanned readmissions and 5 deaths, while the control group had 75 first unplanned readmissions and 3 deaths. With respect to the endpoint there was no significant effect of the case management program after one year (Hazard Ratio 1.01, 95% confidence interval 0.72-1.41). This was also the case among subgroups according to sex, diabetes, living alone, and comorbidities. Conclusions A nurse-based management among elderly patients with AMI had no significant influence on the rate of first unplanned readmissions or death during a one-year follow-up. A possible long-term influence should be investigated by further studies. Clinical trial registration ISRCTN02893746
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Affiliation(s)
- Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
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Carrasco-Chinchilla F, Muñoz-García AJ, Domínguez-Franco A, Millán-Vázquez G, Guerrero-Molina A, Ortiz-García C, Enguix-Armada A, Alonso-Briales JH, Hernández-García JM, de Teresa-Galván E, Jiménez-Navarro MF. Remote ischaemic postconditioning: does it protect against ischaemic damage in percutaneous coronary revascularisation? Randomised placebo-controlled clinical trial. Heart 2013; 99:1431-7. [PMID: 23850844 DOI: 10.1136/heartjnl-2013-304172] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Determine whether remote ischaemic postconditioning (RIP) protects against percutaneous coronary intervention-related myocardial infarction (PCI-MI). DESIGN Single-centre, randomised, blinded to the researchers, clinical trial. ClinicalTrials.gov (NCT 01113008). SETTING Tertiary hospital centre. PATIENTS 232 patients underwent elective PCI for stable or unstable angina. INTERVENTIONS Patients were randomised to RIP (induction of three 5-min cycles of ischaemia in the arm after the PCI) versus placebo. MAIN OUTCOME MEASURES The primary outcome measure was the peak 24-h troponin I level. PCI-MI was defined by an elevation of troponin values >3 or >5 of the 99th percentile according to the classical or the new definition. The secondary outcome measure was hospital admission, PCI for stable angina or acute coronary syndrome and mortality after 1 year of follow-up. The use of RIP in diabetic patients was specifically studied. RESULTS The mean age was 64.6 years, and 42% were diabetic. The peak troponin in the RIP patients was 0.476 vs 0.478 ng/mL (p=0.99). PCI-MI occurred in 36% of the RIP patients versus 30.8% in the placebo group (p=0.378). Diabetic RIP patients had more PCI-MI (new definition): OR 2.7; 95% CI 1.10 to 6.92; p=0.027. The secondary outcome measure was seen in 11.7% of the RIP patients versus 10.8% in the placebo group (p=0.907). CONCLUSIONS RIP did not reduce the damage associated with elective PCI or cardiovascular events during the follow-up. The diabetic population who underwent RIP had more PCI-MI.
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Affiliation(s)
- Fernando Carrasco-Chinchilla
- Área del Corazón del Hospital Clínico Universitario Virgen de la Victoria, Fundación IMABIS, RECAVA, Málaga, Spain
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Jiménez-Candil J, Díaz-Castro Ó, Barrabés JA, García de la Villa B, Bodí Peris V, López Palop R, Fernández-Ortiz A, Martínez-Sellés M. Actualización en cardiopatía isquémica y cuidados críticos cardiológicos. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Jiménez-Candil J, Díaz-Castro Ó, Barrabés JA, García de la Villa B, Bodí Peris V, López Palop R, Fernández-Ortiz A, Martínez-Sellés M. Update on ischemic heart disease and critical care cardiology. ACTA ACUST UNITED AC 2013; 66:198-204. [PMID: 24775454 DOI: 10.1016/j.rec.2012.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 10/23/2012] [Indexed: 11/19/2022]
Abstract
This article summarizes the main developments reported during the year 2012 concerning ischemic heart disease, together with the most relevant innovations in the management of acute cardiac patients.
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Affiliation(s)
- Javier Jiménez-Candil
- Servicio de Cardiología, IBSAL-Hospital Universitario de Salamanca, Universidad de Salamanca, Salamanca, Spain.
| | - Óscar Díaz-Castro
- Servicio de Cardiología, Complejo Hospitalario Universitario do Mexoeiro, Vigo, Pontevedra, Spain
| | - José A Barrabés
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Vicente Bodí Peris
- Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain
| | - Ramón López Palop
- Servicio de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Antonio Fernández-Ortiz
- Servicio de Cardiología, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea de Madrid, Madrid, Spain
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Fácila L, Núñez J, Sanchis J, Cordero A, Fabregat-Andrés O, Morell S. High-density lipoproteins after acute coronary syndromes: evaluation of residual risk. Rev Esp Cardiol 2012; 66:65-6. [PMID: 22835495 DOI: 10.1016/j.recesp.2012.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 05/06/2012] [Indexed: 11/25/2022]
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Vrints CJM. Improving quality of care of acute myocardial infarction: more focus needed on long-term optimal medical treatment and secondary prevention. Rev Esp Cardiol 2012; 65:401-2. [PMID: 22425437 DOI: 10.1016/j.recesp.2011.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 12/01/2011] [Indexed: 11/25/2022]
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