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de Santiago González C, Ciudad Martín J, García Alonso MM. [Risk factor control, lifestyle intervention, and prescribed medication in a cohort of patients with ischemic heart disease]. Semergen 2024; 50:102175. [PMID: 38301397 DOI: 10.1016/j.semerg.2023.102175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/09/2023] [Accepted: 12/17/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The aim of this study was to analyze the recommended prevention measures in our health area for patients discharged after a myocardial infarction. METHODS This was a retrospective descriptive study that selected patients with acute coronary syndrome in our health area in the previous calendar year. Control of the risk factors observed at the time of the coronary event and at 1 year and medication prescribed 1 year after the episode were studied. Variables including age, sex, control of dyslipidemia, hypertension or diabetes mellitus, adherence to treatment and lifestyle habits were analyzed. RESULTS Risk factor control was insufficient and sometimes even unassessed at the time of infarction. Although a slight improvement was perceived, control remained insufficient 1 year later. Moreover, patients, particularly women, were undertreated: one fifth (20%) more men were receiving appropriate treatment than women year after the myocardial event. CONCLUSIONS An additional effort must be made compared to what is currently being done, both by specialists in Hospital Care and Primary Care, to carry out good control of risk factors, meaning the control of certain diseases such as diabetes, high blood pressure or dyslipidemia, as well as habits or lifestyles that increase the probability of suffering a cardiovascular event. Furthermore, it is important to avoid these cardiovascular diseases and their relapse to reinforce adherence to the prescribed treatments.
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Affiliation(s)
- C de Santiago González
- Medicina familiar y Comunitaria, Centro de Salud de Alaejos, Área de Atención Primaria de Valladolid Este, Valladolid, España.
| | - J Ciudad Martín
- Medicina Familiar y Comunitaria, Hospital Clínico de Valladolid y Área de Atención Primaria de Valladolid Este, Valladolid, España
| | - M M García Alonso
- Medicina Familiar y Comunitaria, Centro de Salud de Circunvalación, Gerencia de Atención Primaria de Valladolid Este, Valladolid, España
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Santos S, Manito N, Sánchez-Covisa J, Hernández I, Corregidor C, Escudero L, Rhodes K, Nordon C. Risk of severe cardiovascular events following COPD exacerbations: results from the EXACOS-CV study in Spain. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00194-4. [PMID: 38936468 DOI: 10.1016/j.rec.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/11/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION AND OBJECTIVES This real-world study-the first of its kind in a Spanish population-aimed to explore severe risk for cardiovascular events and all-cause death following exacerbations in a large cohort of patients with chronic obstructive pulmonary disease (COPD). METHODS We included individuals with a COPD diagnosis code between 2014 and 2018 from the BIG-PAC health care claims database. The primary outcome was a composite of a first severe cardiovascular event (acute coronary syndrome, heart failure decompensation, cerebral ischemia, arrhythmia) or all-cause death following inclusion in the cohort. Time-dependent Cox proportional hazards models estimated HRs for associations between exposed time periods (1-7, 8-14, 15-30, 31-180, 181-365, and >365 days) following an exacerbation of any severity, and following moderate or severe exacerbations separately (vs unexposed time before a first exacerbation following cohort inclusion). RESULTS During a median follow-up of 3.03 years, 18 901 of 24 393 patients (77.5%) experienced ≥ 1 moderate/severe exacerbation, and 8741 (35.8%) experienced the primary outcome. The risk of a severe cardiovascular event increased following moderate/severe COPD exacerbation onset vs the unexposed period, with rates being most increased during the first 1 to 7 days following exacerbation onset (HR, 10.10; 95%CI, 9.29-10.97) and remaining increased >365 days after exacerbation onset (HR, 1.65; 95%CI, 1.49-1.82). CONCLUSIONS The risk of severe cardiovascular events or death increased following moderate/severe exacerbation onset, illustrating the need for proactive multidisciplinary care of patients with COPD to prevent exacerbations and address other cardiovascular risk factors.
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Affiliation(s)
- Salud Santos
- Servicio de Neumología, Hospital Universitario de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nicolás Manito
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | - Kirsty Rhodes
- Real World Science & Analytics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | - Clementine Nordon
- Epidemiology Medical Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
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Lozano I, Vegas JM, Rondan J. Frailty and P2Y12 Inhibitors: Does The Best Approach Need to Be Black or White? Am J Cardiol 2024; 213:186. [PMID: 38142879 DOI: 10.1016/j.amjcard.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Iñigo Lozano
- Department of Cardiology, Hospital Cabueñes, Gijón, Spain.
| | - Jose M Vegas
- Department of Cardiology, Hospital Cabueñes, Gijón, Spain
| | - Juan Rondan
- Department of Cardiology, Hospital Cabueñes, Gijón, Spain
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Lunardi M, Mamas MA, Mauri J, Molina CM, Rodriguez-Leor O, Eggington S, Pietzsch JB, Papo NL, Walleser-Autiero S, Baumbach A, Maisano F, Ribichini FL, Mylotte D, Barbato E, Piek JJ, Wijns W, Naber CK. Predicted clinical and economic burden associated with reduction in access to acute coronary interventional care during the COVID-19 lockdown in two European countries. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:25-35. [PMID: 37286294 DOI: 10.1093/ehjqcco/qcad025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/13/2023] [Accepted: 05/11/2023] [Indexed: 06/09/2023]
Abstract
AIMS As a consequence of untimely or missed revascularization of ST-elevation myocardial infarction (STEMI) patients during the COVID-19 pandemic, many patients died at home or survived with serious sequelae, resulting in potential long-term worse prognosis and related health-economic implications.This analysis sought to predict long-term health outcomes [survival and quality-adjusted life-years (QALYs)] and cost of reduced treatment of STEMIs occurring during the first COVID-19 lockdown. METHODS AND RESULTS Using a Markov decision-analytic model, we incorporated probability of hospitalization, timeliness of PCI, and projected long-term survival and cost (including societal costs) of mortality and morbidity, for STEMI occurring during the first UK and Spanish lockdowns, comparing them with expected pre-lockdown outcomes for an equivalent patient group.STEMI patients during the first UK lockdown were predicted to lose an average of 1.55 life-years and 1.17 QALYs compared with patients presenting with a STEMI pre-pandemic. Based on an annual STEMI incidence of 49 332 cases, the total additional lifetime costs calculated at the population level were £36.6 million (€41.3 million), mainly driven by costs of work absenteeism. Similarly in Spain, STEMI patients during the lockdown were expected to survive 2.03 years less than pre-pandemic patients, with a corresponding reduction in projected QALYs (-1.63). At the population level, reduced PCI access would lead to additional costs of €88.6 million. CONCLUSION The effect of a 1-month lockdown on STEMI treatment led to a reduction in survival and QALYs compared to the pre-pandemic era. Moreover, in working-age patients, untimely revascularization led to adverse prognosis, affecting societal productivity and therefore considerably increasing societal costs.
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Affiliation(s)
- Mattia Lunardi
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Ireland
- Division of Cardiology, University Hospital of Verona, Verona, Italy
| | - Mamas A Mamas
- Keele Cardiovascular Research, Keele University, Stoke on Trent, UK
| | - Josepa Mauri
- Gerència de Processos Integrats de Salut. Àrea Assistencial. Servei Català de la Salut. Generalitat de Catalunya, Barcelona, Spain
- Institut del Cor, Hospital Universiari Germans Trias i Pujol, Badalona, Spain
| | - Carmen Medina Molina
- Registry of Myocardial Infarction, Catalan Health Service, Catalunyia, Barcelona, Spain
| | | | - Simon Eggington
- Health Economics, Policy and Reimbursement, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | | | - Natalie L Papo
- Health Economics, Policy and Reimbursement, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | - Silke Walleser-Autiero
- Health Economics, Policy and Reimbursement, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK
| | - Francesco Maisano
- Valve Center OSR, Cardiac Surgery IRCCS San Raffaele Hospital, Vita Salute University UniSR, Milano, Italy
| | | | - Darren Mylotte
- Galway University Hospital, SAOLTA Healthcare Group and University of Galway, Galway, Ireland
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa, Roma, Italy
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef, Amsterdam, the Netherlands
| | - William Wijns
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Ireland
| | - Christoph K Naber
- Department of Internal Medicine I, Cardiology and Intensive Care, Klinikum Wilhelmshaven, Wilhelmshaven, Germany
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Arispe INSR, Sol J, Gil AC, Trujillano J, Bravo MO, Torres OY. Comparison of heart, grace and TIMI scores to predict major adverse cardiac events from chest pain in a Spanish health care region. Sci Rep 2023; 13:17280. [PMID: 37828141 PMCID: PMC10570310 DOI: 10.1038/s41598-023-44214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 10/05/2023] [Indexed: 10/14/2023] Open
Abstract
Acute non-traumatic chest pain (ANTCP) is the second cause of consultation in the Emergency department (ED). About 70% of all Acute Myocardial Infarctions present as non persistent ST-elevation acute coronary syndrome (NSTE-ACS) in the electrocardiogram. Our aim was to compare whether the HEART risk score is more effective than the GRACE and TIMI scores for the diagnosis and prognosis of Major Adverse Cardiac Events (MACE) at six weeks in patients with ANTCP and NSTE-ACS. A prospective cohort study was conducted with patients with ANTCP that attended an ED and a Primary Care Emergency Center (PCEC) from April 2018 to December 2020. The primary outcome was MACE at six weeks. Diagnostic performance was calculated for each scale as the Area under the Receiver Operating Characteristic (ROC) curve (AUC), sensitivity (SE), specificity (SP), and predictive values (PV). Qualitative variables were compared using the Chi-square test, and continuous variables were compared using the nonparametric Kruskal-Wallis test. We adjusted a logistic regression for risk groups, age, and gender to determine the effect of the HEART, GRACE, and TIMI scores on MACE. The degree of agreement (kappa index) was calculated in the categorical classification of patients according to the three risk scales. Cox proportional hazards regressions were performed for each scale and were compared using partial likelihood ratio tests for non-nested models. From a sample of 317 patients with ANTCP, 14.82% had MACE at six weeks. The AUC was 0.743 (95% CI 0.67-0.81) for the HEART score, 0.717 (95% CI 0.64-0.79) for the TIMI score, and 0.649 (95% CI 0.561-0.738) for the GRACE score. The HEART scale identified low-risk patients with a higher SE and negative PV than the GRACE and TIMI scores. The HEART scale was better than the GRACE and TIMI scores at diagnosing and predicting MACE at six weeks in patients with ANTCP and probable NSTE-ACS. It was also a reliable tool for risk stratification in low-risk patients. Its application is feasible in EDs and PCECs, avoiding the need for complementary tests and their associated costs without compromising patient health.
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Affiliation(s)
- Iris N San Román Arispe
- Centre d' Urgències en AtencióPrimària. InstitutCatalà de La Salut (ICS), Lleida, Spain
- Multidisciplinary Research Group in Primary Care Therapeutics and Interventions (RETICAP), Fundació Institut Universitari per a La Recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Lleida, Spain
| | - Joaquim Sol
- Atenció Primària, Institut Català de La Salut, Lleida, Spain
- Metabolic Physiopathology Research Group, Experimental Medicine Department, Lleida University-Lleida Biochemical Research Institute (UdL-IRB Lleida), Lleida, Spain
- Research Support Unit, Fundació Institut Universitari recerca l'Atenció Primària Salut Jordi Gol i Gorina (IDIAPJGol), Lleida, Spain
| | - Ana Celma Gil
- Centre d' Urgències en AtencióPrimària. InstitutCatalà de La Salut (ICS), Lleida, Spain
| | - Javier Trujillano
- Intensive Care Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
- Medicine and Surgery Department, Universidad de Lleida, Lleida, Spain
| | - Marta Ortega Bravo
- Multidisciplinary Research Group in Primary Care Therapeutics and Interventions (RETICAP), Fundació Institut Universitari per a La Recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Lleida, Spain
- Centro de Atención Primaria Almacelles, InstitutCatalà de La Salut (ICS), Lleida, Spain
- Clinical Ultrasound Research Group in Primary Care (GRECOCAP), Fundació Institut Universitari Per a La Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAP Jordi Gol), Lleida, Spain
| | - Oriol Yuguero Torres
- Medicine and Surgery Department, Universidad de Lleida, Lleida, Spain.
- ERLab Research On Emergencies, IRB Lleida, Lleida, Spain.
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Lozano Gómez H, Rodríguez García A, Rodríguez Esteban MÁ, López Ferraz C, Murcia Hernández MDP, Fernández Zapata A, Villarreal Tello E, Ruiz Ruiz J, Fraile Gutiérrez V, Socias Crespi L, Pallas Beneyto LA, Villanueva Anadón B, Porcar Rodado E, Araiz Burdio JJ. Design of a new mortality indicator in acute coronary syndrome on admission to the Intensive Care Unit. Med Intensiva 2023; 47:501-515. [PMID: 37076405 DOI: 10.1016/j.medine.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/23/2023] [Accepted: 02/02/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To design a mortality indicator in acute coronary syndrome (ACS) in the intensive care unit (ICU). DESIGN A multicenter, observational descriptive study was carried out. PARTICIPANTS Patients with ACS admitted to the ICUs included in the ARIAM-SEMICYUC registry between January 2013 and April 2019. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Demographic parameters, time of access to the healthcare system, and clinical condition. Revascularization therapy, drugs and mortality were analyzed. Cox regression analysis was performed, followed by the design of a neural network. A receiver operating characteristic curve (ROC) was plotted to calculate the power of the new score. Lastly, the clinical utility or relevance of the ARIAM indicator (ARIAM's) was assessed using a Fagan test. RESULTS A total of 17,258 patients were included in the study, with a mortality rate of 3.5% (n = 605) at discharge from the ICU. The variables showing statistical significance (P < .001) were entered into the supervised predictive model, an artificial neural network. The new ARIAM's yielded a mean of 0.0257 (95%CI: 0.0245-0.0267) in patients discharged from the ICU versus 0.27085 (95%CI: 0.2533-0.2886) in those who died (P < .001). The area under the ROC curve of the model was 0.918 (95%CI: 0.907-0.930). Based on the Fagan test, the ARIAM's showed the mortality risk to be 19% (95%CI: 18%-20%) when positive and 0.9% (95%CI: 0.8%-1.01%) when negative. CONCLUSIONS A new mortality indicator for ACS in the ICU can be established that is more accurate and reproducible, and periodically updated.
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Affiliation(s)
- Herminia Lozano Gómez
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - Adrián Rodríguez García
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Cristina López Ferraz
- Complejo Hospitalario Universitario Nuestra Sra. de la Candelaria (Sta. Cruz de Tenerife), Spain
| | | | | | | | | | | | | | | | | | | | - Juan José Araiz Burdio
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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de Burgos-Lunar C, Del Cura-Gonzalez I, Cárdenas-Valladolid J, Gómez-Campelo P, Abánades-Herranz JC, Lopez-de-Andres A, Sotos-Prieto M, Iriarte-Campo V, Fuentes-Rodriguez CY, Gómez-Coronado R, Salinero-Fort MA. Validation of diagnosis of acute myocardial infarction and stroke in electronic medical records: a primary care cross-sectional study in Madrid, Spain (the e-MADVEVA Study). BMJ Open 2023; 13:e068938. [PMID: 37308273 DOI: 10.1136/bmjopen-2022-068938] [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: 06/14/2023] Open
Abstract
OBJECTIVES To validate the diagnoses of acute myocardial infarction (AMI) and stroke recorded in electronic medical records (EMR) and to estimate the population prevalence of both diseases in people aged ≥18 years. DESIGN Cross-sectional validation study. SETTING 45 primary care centres. PARTICIPANTS Simple random sampling of diagnoses of AMI and stroke (International Classification of Primary Care-2 codes K75 and K90, respectively) registered by 55 physicians and random age-matched and sex-matched sampling of the records that included in primary care EMRs in Madrid (Spain). PRIMARY AND SECONDARY OUTCOME MEASURES Sensitivity, specificity, positive and negative predictive values and overall agreement were calculated using the kappa statistic. Applied gold standards were ECGs, brain imaging studies, hospital discharge reports, cardiology reports and neurology reports. In the case of AMI, the ESC/ACCF/AHA/WHF Expert Consensus Document was also used. Secondary outcomes were the estimated prevalence of both diseases considering the sensitivity and specificity obtained (true prevalence). RESULTS The sensitivity of a diagnosis of AMI was 98.11% (95% CI, 96.29 to 99.03), and the specificity was 97.42% (95% CI, 95.44 to 98.55). The sensitivity of a diagnosis of stroke was 97.56% (95% CI, 95.56 to 98.68), and the specificity was 94.51% (95% CI, 91.96 to 96.28). No differences in the results were found after stratification by age and sex (both diseases). The prevalence of AMI and stroke was 1.38% and 1.27%, respectively. CONCLUSION The validation results show that diagnoses of AMI and stroke in primary care EMRs constitute a helpful tool in epidemiological studies. The prevalence of AMI and stroke was lower than 2% in the population aged over 18 years.
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Affiliation(s)
- Carmen de Burgos-Lunar
- Departamento Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Comunidad de Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain
| | - Isabel Del Cura-Gonzalez
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain
- Research Support Unit, Primary Health Care Management, Madrid, Madrid, Spain
| | - Juan Cárdenas-Valladolid
- Research Support Unit, Primary Health Care Management, Madrid, Madrid, Spain
- Facultad de Ciencias de la Salud, Universidad Alfonso X el Sabio Facultad de Ciencias de la Salud, Villanueva de la Canada, Madrid, Spain
| | | | | | - Ana Lopez-de-Andres
- Department of Public Health and Maternal and Child, Complutense University of Madrid Faculty of Medicine, Madrid, Comunidad de Madrid, Spain
| | | | - Victor Iriarte-Campo
- MADIABETES Research Group, Foundation for Biomedical Research and Innovation in Primary Care of the Community of Madrid, Madrid, Spain
| | | | - Rafael Gómez-Coronado
- Departamento Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Comunidad de Madrid, Spain
| | - Miguel A Salinero-Fort
- Institute for Health Research (IdIPAZ), Hospital La Paz, Madrid, Madrid, Spain
- MADIABETES Research Group, Foundation for Biomedical Research and Innovation in Primary Care of the Community of Madrid, Madrid, Spain
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Ariza-Solé A, Mateus-Porta G, Formiga F, Garcia-Blas S, Bonanad C, Núñez-Gil I, Vergara-Uzcategui C, Díez-Villanueva P, Bañeras J, Badia-Molins C, Aboal J, Carreras-Mora J, Gabaldón-Pérez A, Parada-Barcia JA, Martínez-Sellés M, Comín-Colet J, Raposeiras-Roubin S. Extended use of dual antiplatelet therapy among older adults with acute coronary syndromes and associated variables: a cohort study. Thromb J 2023; 21:32. [PMID: 36944967 PMCID: PMC10031931 DOI: 10.1186/s12959-023-00476-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 03/12/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Current guidelines recommend extending the use of dual antiplatelet therapy (DAPT) beyond 1 year in patients with an acute coronary syndrome (ACS) and a high risk of ischaemia and low risk of bleeding. No data exist about the implementation of this strategy in older adults from routine clinical practice. METHODS We conducted a Spanish multicentre, retrospective, observational registry-based study that included patients with ACS but no thrombotic or bleeding events during the first year of DAPT after discharge and no indication for oral anticoagulants. High bleeding risk was defined according to the Academic Research Consortium definition. We assessed the proportion of cases of extended DAPT among patients 65 ≥ years that went beyond 1 year after hospitalisation for ACS and the variables associated with the strategy. RESULTS We found that 48.1% (928/1,928) of patients were aged ≥ 65 years. DAPT was continued beyond 1 year in 32.1% (298/928) of patients ≥ 65; which was a similar proportion as with their younger counterparts. There was no significant correlation between a high bleeding risk and DAPT duration. Contrastingly, there was a strong correlation between the extent of coronary disease and DAPT duration (p < 0.001). Other variables associated with extended DAPT were a higher left ventricle ejection fraction, a history of heart failure and a prior stent thrombosis. CONCLUSION There was no correlation between age and extended use of DAPT beyond 1 year in older patients with ACS. DAPT was extended in about one-third of patients ≥ 65 years. The severity of the coronary disease, prior heart failure, left ventricle ejection fraction and prior stent thrombosis all correlated with extended DAPT.
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Affiliation(s)
- Albert Ariza-Solé
- Cardiology Department, Bioheart Grup de Malalties Cardiovasculars, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Feixa Llarga s/n. 08907, Barcelona, Spain.
| | - Gemma Mateus-Porta
- Cardiology Department, Bioheart Grup de Malalties Cardiovasculars, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Feixa Llarga s/n. 08907, Barcelona, Spain
| | - Francesc Formiga
- Geriatrics Unit. Internal Medicine Department, Hospital Universitari de Bellvitge. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Garcia-Blas
- Cardiology Department, Department of Medicine, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Clara Bonanad
- Cardiology Department, Department of Medicine, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Iván Núñez-Gil
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Jordi Bañeras
- Cardiology Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Clara Badia-Molins
- Cardiology Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Jaime Aboal
- Cardiology Department, Hospital Josep Trueta, Girona, Spain
| | | | - Ana Gabaldón-Pérez
- Cardiology Department, Department of Medicine, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | | | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, CIBERCV. Universidad Europea. Universidad Complutense, Madrid, Spain
| | - Josep Comín-Colet
- Cardiology Department, Bioheart Grup de Malalties Cardiovasculars, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Feixa Llarga s/n. 08907, Barcelona, Spain
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9
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Martín Pérez S, Arrobas Velilla T, Fabiani de la Iglesia J, Vázquez Rico I, Varo Sánchez G, León-Justel A. Geostatistical analysis from the clinical laboratory in cardiovascular prevention for primary care. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2023; 35:75-84. [PMID: 36184300 DOI: 10.1016/j.arteri.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 04/21/2023]
Abstract
INTRODUCTION AND OBJECTIVES Cardiovascular diseases continue to lead the ranking of mortality in Spain. The implementation of geostatistical analysis techniques in the clinical laboratory are innovative tools that allow the design of new strategies in primary prevention of cardiovascular disease. The aim of this study was to study the prevalence and geolocation of severe dyslipidemia in the health areas under study in order to implement prevention strategies in primary care. A retrospective cohort study of low-density protein-bound cholesterol, triglyceride and lipoprotein (a) levels in the years 2019 and 2020 were carried out. In addition, a geostatistical analysis was performed including representation in choropleth maps and the detection of clustering clusters, using geographic information in zip code format included in the demographic data of each analytic. RESULTS The analytical data included in the study were triglycerides (n=365,384), low density protein-bound cholesterol (n=289,594) and lipoprotein to lipoprotein (a) (n=502). Areas with the highest and lowest percentage of cases were identified for the established cut-off points of LDL-C>190mg/dL and TG>150mg/dL. Two clustering clusters with statistical significance were detected for cLDL>190mg/dL and a total of 6 clusters for TG values>150mg/dL. CONCLUSIONS The detection of clusters, as well as the representation of choropleth maps, can be of great help in detecting geographic areas that require greater attention to intervene and improve cardiovascular risk.
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Affiliation(s)
- Salomón Martín Pérez
- Laboratorio de Nutrición y Riesgo Cardiovascular, Unidad de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - Teresa Arrobas Velilla
- Laboratorio de Nutrición y Riesgo Cardiovascular, Unidad de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - Ignacio Vázquez Rico
- Laboratorio de Análisis Clínicos, Unidad de Lípidos, Hospital Juan Ramón Jiménez, Huelva, España
| | - Gema Varo Sánchez
- Laboratorio de Análisis Clínicos, Hospital comarcal Riotinto, Huelva, España
| | - Antonio León-Justel
- Unidad de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, España
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10
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Vasić A, Vasiljević Z, Mickovski-Katalina N, Mandić-Rajčević S, Soldatović I. Temporal Trends in Acute Coronary Syndrome Mortality in Serbia in 2005-2019: An Age-Period-Cohort Analysis Using Data from the Serbian Acute Coronary Syndrome Registry (RAACS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14457. [PMID: 36361340 PMCID: PMC9659020 DOI: 10.3390/ijerph192114457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cardiovascular diseases ranked first in terms of the number of deaths in Serbia in 2019, with 52,663 deaths. One fifth of those were from ischemic heart disease (IHD), and half of IHD deaths were from acute coronary syndrome (ACS). We present the ACS mortality time trend in Serbia during a 15-year period using the latest available data, excluding the COVID-19 pandemic. METHODS The data on patients who died of ACS in the period from 2005 to 2019 were obtained from the National Statistics Office and processed at the Department of Prevention and Control of Non-communicable Diseases of the Institute of Public Health of Serbia. Number of deaths, crude mortality rates (CR) and age-standardized mortality rates (ASR-E) for the European population were analyzed. Using joinpoint analysis, the time trend in terms of annual percentage change (APC) was analyzed for the female and male population aged 0 to 85+. Age-period-cohort modeling was used to estimate age, cohort and period effects in ACS mortality between 2005 and 2019 for age groups in the range 20 to 90. RESULTS From 2005 to 2019 there were 90,572 deaths from ACS: 54,202 in men (59.8%), 36,370 in women (40.2%). Over the last 15 years, the number of deaths significantly declined: 46.7% in men, 49.5% in women. The annual percentage change was significant: -4.4% in men, -5.8% in women. Expressed in terms of APC, for the full period, the highest significant decrease in deaths was seen in women aged 65-69, -8.5%, followed by -7.6% for women aged 50-54 and 70-74. In men, the highest decreases were recorded in the age group 50-54, -6.7%, and the age group 55-59, -5.7%. In all districts there was significant decline in deaths in terms of APC for the full period in both genders, except in Zlatibor, Kolubara and Morava, where increases were recorded. In addition, in Bor and Toplica almost no change was observed over the full period for both genders. CONCLUSIONS In the last 15 years, mortality from ACS in Serbia declined in both genders. The reasons are found in better diagnostic and treatment through an organized network for management of ACS patients. However, there are districts where this decline was small and insignificant or was offset in recent years by an increase in deaths. In addition, there is space for improvement in the still-high mortality rates through primary prevention, which at the moment is not organized.
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Affiliation(s)
- Ana Vasić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | | | | | - Stefan Mandić-Rajčević
- Institute of Social Medicine, School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivan Soldatović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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11
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Risk Assessment after ST-Segment Elevation Myocardial Infarction: Can Biomarkers Improve the Performance of Clinical Variables? J Clin Med 2022; 11:jcm11051266. [PMID: 35268358 PMCID: PMC8910980 DOI: 10.3390/jcm11051266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023] Open
Abstract
Introduction: Myocardial infarction with ST-segment elevation (STEMI) is the coronary artery disease associated with the highest risk of morbimortality; however, this risk is heterogeneous, usually being evaluated by clinical scores. Risk assessment is a key factor in personalized clinical management of patients with this disease. Aim: The aim of this study was to assess whether some new cardiac biomarkers considered alone, combined in a multibiomarker model or in association with clinical variables, improve the short- and long-term risk stratification of STEMI patients. Materials and Methods: This was a retrospective observational study of 253 patients with STEMI. Blood samples were obtained before or during the angiography. The assessed biomarkers were C-terminal fragment of insulin-like growth factor binding protein-4 (CT-IGFBP4), high sensitive cardiac troponin T (hs-cTnT), N-terminal fragment of probrain natriuretic peptide (NT-proBNP), and growth differentiation factor 15 (GDF-15); they reflect different cardiovascular (CV) physiopathological pathways and underlying pathologies. We registered in-hospital and follow-up mortalities and their causes (cardiovascular and all-cause) and major adverse cardiac events (MACE) during a two year follow-up. Discrimination, survival analysis, model calibration, and reclassification of the biomarkers were comprehensively evaluated. Results and Discussion: In total, 55 patients (21.7%) died, 33 in-hospital and 22 during the follow-up, most of them (69.1%) from CV causes; 37 MACE occurred during follow-up. Biomarkers showed good prognostic ability to predict mortality, alone and combined with the multibiomarker model. A predictive clinical model based on age, Killip–Kimball class, estimated glomerular filtration rate (eGFR), and heart rate was derived by multivariate analysis. GDF-15 and NT-proBNP significantly improved risk assessment of the clinical model, as shown by discrimination, calibration, and reclassification of all the end-points except for all-cause mortality. The combination of NT-proBNP and hs-cTnT improved CV mortality prediction. Conclusions: GDF-15 and NT-proBNP added value to the usual risk assessment of STEMI patients.
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Córdoba-Soriano JG, Gutiérrez-Díez A, Del Blanco BG, Núñez J, Amat-Santos IJ, Oteo JF, Romaguera R, Gallardo-López A, Lozano Ruíz-Poveda F, Baello P, Aguar P, Jerez-Valero M, Jiménez-Díaz VA, Serra B, Cascon JD, Morales-Ponce FJ, Portero-Portaz JJ, Melehi El Assali D, Cerrato-García P, Jiménez-Mazuecos J. Bioactive or Drug Eluting Stents in 75 years or older patients: The BIODES-75 Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 42:114-120. [DOI: 10.1016/j.carrev.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/03/2022] [Indexed: 11/27/2022]
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13
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Usefulness of Cardiac Computed Tomography in Coronary Risk Prediction: A Five-Year Follow-Up of the SPICA Study (Secure Prevention with Imaging of the Coronary Arteries). J Clin Med 2022; 11:jcm11030533. [PMID: 35159985 PMCID: PMC8836950 DOI: 10.3390/jcm11030533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 02/05/2023] Open
Abstract
Accurate identification of individuals at high coronary risk would reduce acute coronary syndrome incidence and morbi-mortality. We analyzed the effect on coronary risk prediction of adding coronary artery calcification (CAC) and Segment Involvement Score (SIS) to cardiovascular risk factors. This was a prospective cohort study of asymptomatic patients recruited between 2013–2017. All participants underwent a coronary computed tomography angiography to determine CAC and SIS. The cohort was followed-up for a composite endpoint of myocardial infarction, coronary angiography and/or revascularization (median = five years). Discrimination and reclassification of the REGICOR function with CAC/SIS were examined with the Sommer’s D index and with the Net reclassification index (NRI). Nine of the 251 individuals included had an event. Of the included participants, 94 had a CAC = 0 and 85 a SIS = 0, none of them had an event. The addition of SIS or of SIS and CAC to the REGICOR risk function significantly increased the discrimination capacity from 0.74 to 0.89. Reclassification improved significantly when SIS or both scores were included. CAC and SIS were associated with five-year coronary event incidence, independently of cardiovascular risk factors. Discrimination and reclassification of the REGICOR risk function were significantly improved by both indexes, but SIS overrode the effect of CAC.
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14
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Arispe INSR, Mora JRM, Torres OY, Bravo MO. A retrospective HEART risk score comparation of acute non-traumatic chest pain patients in an emergency department in Spain. Sci Rep 2021; 11:23268. [PMID: 34853373 PMCID: PMC8636492 DOI: 10.1038/s41598-021-02682-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 10/12/2021] [Indexed: 11/09/2022] Open
Abstract
Non traumatic chest pain is the second most common cause of attention at the Emergency Departments (ED). The objective is to compare the effectiveness of HEART risk score and the risk of having a Major Adverse Cardiovascular Event (MACE) during the following 6 weeks in ‘Acute Non-traumatic Chest Pain’ (ANTCP) patients of an ED in Lleida (Spain). The ANTCP patient cohort was defined using medical data from January 2015 to January 2016. A retrospective study was performed among 300 ANTCP patients. Diagnostic accuracy to predict MACE, HEART risk score effectiveness and patient risk stratification were analysed on the ANTCP Cohort. HEART risk score was conducted on ANTCP Cohort data and patients were stratified as low-risk (n = 116, 38.7%), moderate-risk (n = 164, 54.7%) and high-risk (n = 20, 6.7%); differently from the assessment performed by 'Current Emergency Department Guidelines’ (CEDG) on the same patients: low risk and discharge (n = 56, 18.7%), medium risk and need of complementary tests (n = 137, 45.7%) and high risk and hospital admission (n = 107, 35.7%).The incidence of MACE was 2.5%, 20.7% and 100% in low, moderate and high-risk, respectively. Discrimination and accuracy indexes were moderate (AUC = 0.73, 95% confidence interval: 0.67–0.80). Clustering moderate-high risk groups by MACE incidence showed an 89.5% of sensitivity. Data obtained from this study suggests that HEART risk score stratified better ‘acute non-traumatic chest pain’ (ANTCP) patients in an Emergency Department (ED) compared with ‘Current Emergency Department Guidelines’ (CEDG) at the Hospital Universitari Arnau de Vilanova (HUAV). HEART score would reduce the number of subsequent consultations, unnecessary admissions and complementary tests. Trial registration: Retrospectively registered.
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Affiliation(s)
- Iris Nathalie San Román Arispe
- Centre d'Urgències d' Atenció Primària (CUAP) Lleida, Institut Català de la Salut (ICS), Av. Prat de la Riba, 56, 25004, Lleida, Spain. .,Research Group in Therapies in Primary Care (GRETAPS), Lleida, Spain. .,Grupo Transversal de Urgencias y Emergencias, IRB Lleida, Lleida, Spain. .,Servicio de Urgencias del Hospital Universitario Arnau de Vilanova, Lleida, Spain.
| | - Josep Ramón Marsal Mora
- Research Support Unit Lleida, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Lleida, Spain.,Unidad de Epidemiología del Servicio de Cardiología, CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Hospital Valld'Hebrón, Barcelona, Spain
| | - Oriol Yuguero Torres
- Grupo Transversal de Urgencias y Emergencias, IRB Lleida, Lleida, Spain.,Servicio de Urgencias del Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Marta Ortega Bravo
- Research Support Unit Lleida, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Lleida, Spain.,Research Group in Therapies in Primary Care (GRETAPS), Lleida, Spain
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15
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[Incidence of ischemic heart disease in the HERMEX study and its association with classical cardiovascular risk factors]. Semergen 2021; 48:88-95. [PMID: 34702607 DOI: 10.1016/j.semerg.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/06/2021] [Accepted: 09/11/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Knowledge about the incidence of coronary heart disease in our country is scarce and its sources are not comparable. Our aim was to determine the incidence of ischemic heart disease in a population cohort in a 7 years of follow-up, as well as the risk associated with the different classical cardiovascular risk factors. METHODS Cohort study with a population sample of 2833 subjects, selected by the simple random method in a population between 25 and 79, from the Don Benito - Villanueva de la Serena (Badajoz) health area, response rate was 80.5%. All episodes of angina pectoris, lethal and non-lethal myocardial infarction were collected in individuals with no previous history of cardiovascular disease. Cumulative incidences and incidence rates adjusted per 100,000 person-years by sex and overall were calculated. RESULTS From 2833 initial cohort participants, 103 were excluded due to a history of cardiovascular disease and 61 for losses, 2669 completed the follow-up (94.2%). The median follow-up was 6.9 years (IR 6.5-7.5), 56.4% women; 59 events were recorded. The overall incidence rate of ischemic heart disease was 327 cases/100,000 person-years, corresponding to 470 cases/100,000 for men and 211 cases/100,000 people-years for women. The classical cardiovascular risk factors that were associated with a higher risk of presenting events in the follow-up were dyslipidemia and arterial hypertension, in addition to male sex and age. CONCLUSIONS The incidence of ischemic heart disease in the urban-rural population of Extremadura is high. The classical cardiovascular risk factors most strongly associated with events were dyslipidemia, and arterial hypertension.
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16
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Cepas-Guillén PL, Echarte-Morales J, Caldentey G, Gómez EM, Flores-Umanzor E, Borrego-Rodriguez J, Llagostera M, Viana Tejedor A, Vidal P, Benito-Gonzalez T, Quiroga X, Ortiz AF, Freixa X, Pérez de Prado A, Sanz FN, Fernández-Vázquez F, Sabate M. Outcomes of Nonagenarians With Acute Coronary Syndrome. J Am Med Dir Assoc 2021; 23:81-86.e4. [PMID: 34197794 DOI: 10.1016/j.jamda.2021.04.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/23/2021] [Accepted: 04/22/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Nonagenarians are a fast-growing age group among cardiovascular patients, but data about their management and prognosis after an acute coronary syndrome (ACS) is scarce. This study aimed to analyze characteristics of nonagenarian patients with ACS and to compare in-hospital and 1-year clinical outcomes between those treated with medical treatment (MT) alone and those receiving percutaneous coronary intervention (PCI). DESIGN Multicenter observational study. SETTING AND PARTICIPANTS We included consecutive nonagenarian patients with ACS admitted at 4 academic centers between 2005 and 2018. Only patients with type 1 myocardial infarction were included. METHODS Standardized definitions of all patient-related variables, clinical diagnoses, and hospital complications and outcomes were used. The primary endpoint was 1-year all-cause mortality. Long-term survival was compared between patients undergoing PCI and those managed with MT alone. Given differences in baseline characteristics could substantially interfere in outcomes, 3 sensitivity analyses were performed to adjust for confounders. RESULTS A total of 680 nonagenarians were included (59% females). Of them, 373 (55%) patients presented with non-ST-segment elevation ACS (NSTE-ACS) and 307 (45%) with ST-segment elevation myocardial infarction (STEMI). A coronary angiogram was performed in 115 (31%) of NSTE-ACS and in 182 (60%) of STEMI patients with subsequent PCI in 81 (22%) and 156 (51%), respectively. Overall mortality rates were 17% in-hospital and 39% at 1-year follow-up. PCI was independently associated with a decreased risk of 1-year all-cause death [hazard ratio (HR) 0.57, 95% confidence interval (CI) 0.35, 0.95; P < .05], mainly observed in those patients without disability (HR 0.59, 95% CI 0.37, 0.94; P < .01) and lower Killip class (HR 0.50, 95% CI 0.28, 0.89; P < .001). CONCLUSIONS AND IMPLICATIONS The prognosis of nonagenarians after an ACS was associated with comorbidities and the therapeutic approach. Although PCI appeared to be a safe and effective strategy, it is still necessary to refine the decision-making process in this high-risk population group.
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Affiliation(s)
- Pedro Luis Cepas-Guillén
- Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | | | | | - Eduardo Flores-Umanzor
- Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | | | - Ana Viana Tejedor
- Cardiology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Pablo Vidal
- Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Xavier Quiroga
- Cardiology Department, Hospital del Mar, Barcelona, Spain
| | | | - Xavier Freixa
- Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | | | | | - Manel Sabate
- Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
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17
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[Effects of home-based strength training during COVID-19 lockdown in acute coronary syndrome]. Rehabilitacion (Madr) 2021; 56:11-19. [PMID: 33958199 PMCID: PMC8045452 DOI: 10.1016/j.rh.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVE Cardiac rehabilitation has the highest level of recognition in medical guideline references. The rise of COVID-19 pandemic, particularly during the first months of strict containment, cause to temporally stop most of the ongoing programs. We studied the effects of an interdisciplinary phase II secondary prevention in patients diagnosed with a recent acute coronary syndrome with the use of new technologies, home-exercise and telemedicine. METHODS Between the 2nd and 11th of March 2020, we included 37 patients with recent acute coronary syndrome (76.4%), low-risk and preserved systolic function and underwent a 12-week treatment. A dynamic muscle toning with overload domiciliary training program was applied, in addition to nutritional counselling, as well as psychological and educational therapy. RESULTS Of the initial cohort, 30 patients finished. At the end of the program, we observed and increased functional capacity over the 6-min walking test (+47.13m; 95% CI: 32.82-61.45, P<.001), and improvement to the subjective feeling of dyspnoea on the modified Borg scale (-0.5 units; 95% CI: -0.76 to -0.24, P=.001), and an improvement over both initial and final training systolic blood pressure (-6.67mmHg; 95% CI: -10.98 to -2.35, P=.004) (-7mmHg; 95% CI: -12.86 to -1.14, P=.021). We also observed an increase in the level of physical activity during leisure time in the IPAQ questionnaire (+1162.93min/week; 95% CI: 237.36-2088.5, P=.016), and in the Mediterranean eating habits on the PREDIMED test (+2.1units; 95% CI: 1.32-2.28, P<.001). CONCLUSIONS After three months of a domiciliary cardiac rehabilitation program, patients increased their functional capacity, feeling of dyspnoea, blood pressure and eating habits. Domiciliary telemedicine cardiac rehabilitation program produces an improvement in the patient after acute coronary syndrome.
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Lizano-Díez I, Paz Ruiz S. Analysis of the Financial Impact of Using Cangrelor on the Safety and Efficacy Outcomes in Patients Undergoing Percutaneous Coronary Intervention in Whom Oral Therapy with P2Y 12 Inhibitors is Not Feasible or Desirable, in Spain. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:77-87. [PMID: 33536769 PMCID: PMC7850430 DOI: 10.2147/ceor.s290377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/01/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Cangrelor is an intravenous, direct-acting, reversible P2Y12 inhibitor indicated for the reduction of thrombotic cardiovascular events in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) in whom oral P2Y12 inhibitors are not feasible or desirable. The objective was to assess the financial impact of introducing cangrelor into the hospital formulary in Spain. Patients and Methods A budget impact model was developed to calculate the cost difference between two scenarios (without and with cangrelor) to treat CAD patients undergoing PCI in whom oral P2Y12 inhibitors are not feasible or desirable, over 3 years. Intravenous P2Y12 inhibitor (cangrelor), oral P2Y12 inhibitors (clopidogrel, prasugrel, and ticagrelor), and glycoprotein IIb-IIIa inhibitors (GPIs) for bail-out use were considered. Epidemiological, efficacy (thrombotic events including cardiac death), safety (bleeding events), and costs (€, 2019) data were based on Spanish registries, clinical trials, and meta-analyses. One-way sensitivity analysis established the effect of uncertainty on results. Results For years 1, 2, and 3, the target population to receive cangrelor was 607, 1,822, and 3,340 patients, and cangrelor uptake was 23.70%, 58.30%, and 51.30%, respectively. The 3-year budget impact was 1,021,717€ varying from 50,245€ in year 1 to 599,272€ in year 3. The results were sensitive to the number of patients treated with GPIs in Spanish hospitals. Conclusion Based on our results, the financial effort needed to introduce the use of cangrelor in patients undergoing PCI in whom antiplatelet therapy with oral P2Y12 inhibitors is not feasible or desirable barely exceeds one million € over three years, in Spain.
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19
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Diabetes mellitus, revascularization and outcomes in elderly patients with myocardial infarction-related cardiogenic shock. J Geriatr Cardiol 2020; 17:604-611. [PMID: 33224179 PMCID: PMC7657943 DOI: 10.11909/j.issn.1671-5411.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background The prognostic role of diabetes mellitus (DM) in elderly patients with myocardial infarction-related cardiogenic shock (MI-CS) remains controversial. Little information exists about the impact of intensive cardiac care unit (ICCU) and revascularization on outcomes of elderly patients with MI-CS. We aimed to assess the prognostic impact of DM according to age in patients with MI-CS, and to analyze the impact ICCU management and revascularization on in-hospital mortality in MI-CS patients at older ages. Methods Discharge episodes with diagnosis of CS associated with MI were selected from the Spanish National Health System's Basic Data Set. Centers were classified according to their availability of ICCU. Main outcome measured was in-hospital mortality. Results A total of 23, 590 episodes of MI-CS were identified, of whom 12, 447 (52.8%) were in patients aged ≥ 75 years. The impact of DM on in-hospital mortality was different among age subgroups. While in younger patients, DM was associated to a higher mortality risk (0.52 vs. 0.47, OR = 1.12, 95% CI: 1.06-1.18, χ2 < 0.001), this association became non-significant in older patients (0.76 vs. 0.81, χ2 = 0.09). Adjusted mortality rate of MI-CS aged ≥ 75 years was lower in patients admitted to hospitals with ICCU (adjusted mortality rate: 74.2% vs. 77.7%, P < 0.001) and in patients undergoing revascularization (74.9% vs. 77.3%, P < 0.001). Conclusions Prognostic impact of DM in patients with MI-CS was different according to age, with a significantly lower impact at older ages. The availability of ICCU and revascularization were associated with better outcomes in these complex patients.
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20
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Fernández-Bergés D, Degano IR, Gonzalez Fernandez R, Subirana I, Vila J, Jiménez-Navarro M, Perez-Fernandez S, Roqué M, Bayes-Genis A, Fernandez-Aviles F, Mayorga A, Bertomeu-Gonzalez V, Sanchis J, Rodríguez Esteban M, Sanchez-Hidalgo A, Sanchez-Insa E, Elorriaga A, Abu Assi E, Nuñez A, Garcia Ruiz JM, Morrondo Valdeolmillos P, Bosch-Portell D, Lekuona I, Carrillo-Lopez A, Zamora A, Vega-Hernandez B, Alameda Serrano J, Rubert C, Ruiz-Valdepeñas L, Quintas L, Rodríguez-Padial L, Vaquero J, Martinez Dolz L, Barrabes JA, Sanchez PL, Sionis A, Martí-Almor J, Elosua R, Lidon RM, Garcia-Dorado D, Marrugat J. Benefit of primary percutaneous coronary interventions in the elderly with ST segment elevation myocardial infarction. Open Heart 2020; 7:openhrt-2019-001169. [PMID: 32747454 PMCID: PMC7402007 DOI: 10.1136/openhrt-2019-001169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/21/2020] [Accepted: 06/02/2020] [Indexed: 02/01/2023] Open
Abstract
Objective Primary percutaneous coronary intervention (P-PCI) has demonstrated its efficacy in patients with ST segment elevation myocardial infarction (STEMI). However, patients with STEMI ≥75 years receive less P-PCI than younger patients despite their higher in-hospital morbimortality. The objective of this analysis was to determine the effectiveness of P-PCI in patients with STEMI ≥75 years. Methods We included 979 patients with STEMI ≥75 years, from the ATención HOspitalaria del Síndrome coronario study, a registry of 8142 consecutive patients with acute coronary syndrome admitted at 31 Spanish hospitals in 2014–2016. We calculated a propensity score (PS) for the indication of P-PCI. Patients that received or not P-PCI were matched by PS. Using logistic regression, we compared the effectiveness of performing P-PCI versus non-performance for the composite primary event, which included death, reinfarction, acute pulmonary oedema or cardiogenic shock during hospitalisation. Results Of the included patients, 81.5 % received P-PCI. The matching provided two groups of 169 patients with and without P-PCI. Compared with its non-performance, P-PCI presented a composite event OR adjusted by PS of 0.55 (95% CI 0.34 to 0.89). Conclusions Receiving a P-PCI was significantly associated with a reduced risk of major intrahospital complications in patients with STEMI aged 75 years or older.
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Affiliation(s)
- Daniel Fernández-Bergés
- Unidad de Investigación, Hospital Don Benito-Villanueva, Don Benito, Spain .,Instituto Universitario de Investigación Biosanitaria de Extremadura, Badajoz, Spain
| | - Irene R Degano
- Institut Hospital del Mar d' Investigacions Mediques, Barcelona, Spain
| | | | - Isaac Subirana
- Institut Hospital del Mar d' Investigacions Mediques, Barcelona, Spain.,CIBERESP de Epidemiologia y Salud Publica, Barcelona, Spain
| | - Joan Vila
- Institut Hospital del Mar d' Investigacions Mediques, Barcelona, Spain.,CIBERESP de Epidemiologia y Salud Publica, Barcelona, Spain
| | | | - Silvia Perez-Fernandez
- CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mediques, Barcelona, Spain
| | | | - Antoni Bayes-Genis
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Antonio Mayorga
- Department of Cardiology, Hospital Universitario Gregorio Marañón, Madrid, Madrid, Spain
| | | | - Juan Sanchis
- Cardiology Department, Hospital Clinico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Marcos Rodríguez Esteban
- Department of Cardiology, Hospital Universitario Nuestra Senora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Esther Sanchez-Insa
- Department of Cardiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Ane Elorriaga
- Department of Cardiology, Hospital Universitario de Basurto, Bilbao, Bilbao, Spain
| | - Emad Abu Assi
- Department of Cardiology, Hospital Álvaro Junqueiro de Vigo, Pontevedra, Vigo, Spain
| | - Alberto Nuñez
- Department of Cardiology, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | | | | | - Daniel Bosch-Portell
- Department of Cardiology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Iñaki Lekuona
- Department of Cardiology, Hospital Galdakao-Usansolo, Galdacano, Spain
| | | | | | | | | | | | | | | | | | - Jessica Vaquero
- Hospital Universitario Araba sede Txagorritxu, Vitoria-Gasteiz, Spain
| | | | - Jose A Barrabes
- Department of Cardiology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Pedro L Sanchez
- Department of Cardiology, Hospital Universitario Salamanca, Salamanca, Spain
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Universitat de Barcelona, Barcelona, Spain
| | - Julio Martí-Almor
- Department of Medicine, Department of Cardiology, Hospital del Mar. Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Roberto Elosua
- Institut Hospital del Mar d' Investigacions Mediques, Barcelona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.,Universitat de Vic, Barcelona, Spain
| | | | | | - Jaume Marrugat
- Institut Hospital del Mar d' Investigacions Mediques, Barcelona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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Bonanad Lozano C, Díez-Villanueva P, Blas SG, Ayesta A, Ibars S, Ariza-Solé A, Ferreiro JL, Moreno R, Roldán I, Marín F, Carol Ruiz A, García Pardo H, Sanchís J, Cruz-González I, Anguita M, Cequier Á, Ruiz García J, Martínez-Sellés M. [Impact of antithrombotic treatment and geriatric syndromes in octogenarians with atrial fibrillation and ischaemic heart disease. Atrial Fibrillation and Ischemic Heart Disease in the Elderly]. Rev Esp Geriatr Gerontol 2020; 55:338-342. [PMID: 32718577 DOI: 10.1016/j.regg.2020.05.008] [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: 04/03/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The prevalence of atrial fibrillation (AF) and ischaemic heart disease (IHC) increases with age. They coexist in up to 20% of octogenarian patients, a situation that poses a therapeutic challenge. Trials that have addressed this scenario, which included a low percentage of octogenarians, showed that double therapy (single antiplatelet + anticoagulation) compared to triple therapy (double antiplatelet + anticoagulation) was associated with less bleeding events, especially with direct oral anticoagulants. These studies did not have sufficient power to detect differences in ischaemic events. On the other hand, prevalent characteristics in the elderly, such as geriatric syndromes, were not assessed in these studies, and are not usually evaluated in clinical practice. Accordingly, their prognostic impact remains unknown in this clinical context. METHODS Observational, prospective, and multicentre study that will include patients ≥ 80 years with AF and IHC in Spain. Baseline characteristics and geriatric syndromes will be assessed, as well as the choice of antithrombotic treatment. The primary endpoint is cardiovascular and overall mortality at one and three years follow-up. RESULTS This study will assess both characteristics and prognosis of octogenarian patients with AF and IHC in Spain, the factors involved in the choice of antithrombotic treatment, and the incidence of ischaemic and haemorrhagic events during the short- and long-term follow-up. CONCLUSION This study will contribute to improve the knowledge in terms of safety and efficacy of the different therapeutic options in older patients with AF and IHC, as well as their prognostic impact.
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Affiliation(s)
| | | | - Sergio García Blas
- Servicio de Cardiología, Hospital Clínico Universitario, Valencia, España
| | - Ana Ayesta
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, España
| | - Sonia Ibars
- Servicio de Cardiología, Hospital Universitario Mutua Terrasa, Barcelona, España
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Universitario de Bellvitge (IDIBELL, CIBER-CV), L'Hospitalet de Llobregat, Barcelona, España
| | - José Luis Ferreiro
- Servicio de Cardiología, Hospital Universitario de Bellvitge (IDIBELL, CIBER-CV), L'Hospitalet de Llobregat, Barcelona, España
| | - Raúl Moreno
- Servicio de Cardiología, Hospital Universitario La Paz (IdiPaz-CIBER-CV), Madrid, España
| | - Inmaculada Roldán
- Servicio de Cardiología, Hospital Universitario La Paz (IdiPaz-CIBER-CV), Madrid, España
| | - Francisco Marín
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca, CIBERCV), Murcia, España
| | - Antoni Carol Ruiz
- Servicio de Cardiología, Hospital Sant Joan Despí Moisès Broggi, Barcelona, España
| | - Héctor García Pardo
- Servicio de Cardiología, Hospital Universitario Río Hortega, Valladolid, España
| | - Juan Sanchís
- Servicio de Cardiología, Hospital Clínico Universitario, Valencia, España
| | | | - Manuel Anguita
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España
| | - Ángel Cequier
- Servicio de Cardiología, Hospital Universitario de Bellvitge (IDIBELL, CIBER-CV), L'Hospitalet de Llobregat, Barcelona, España
| | - Juan Ruiz García
- Servicio de Cardiología, Hospital Universitario Torrejón, Madrid, España
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Cepas-Guillén PL, Sabate M. Unravelling the best management strategy for older patients with acute coronary syndrome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:478-479. [PMID: 32551845 DOI: 10.1177/2048872620937157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Manel Sabate
- Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, Spain
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23
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Comparative Effects of High-Intensity Interval Training vs Moderate-Intensity Continuous Training in Phase III of a Tennis-Based Cardiac Rehabilitation Program: A Pilot Randomized Controlled Trial. SUSTAINABILITY 2020. [DOI: 10.3390/su12104134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the present study was to investigate the effects of two tennis-based cardiac rehabilitation programs using two protocols: high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) in the body composition, physical fitness, heart rate variability, and health-related quality of life. It was performed as a single-blinded randomized controlled trial of 21 people with acute coronary syndrome. The 12-week cardiac rehabilitation program consisted of three sessions per week of 60 min with the main part consisting of 10 sets of 15 s with 15 s of active recovery at 85%–90% of their maximum heart rate or 40 min at 70%–85% of their maximum heart rate in the HIIT and the MICT groups, respectively. Results show that both cardiac rehabilitation programs improved the agility and the mental components of the health-related quality of life (p-value < 0.05). The HIIT protocol also showed a significant improvement in the flexibility of upper and lower limbs (p-value < 0.05). Moreover, significant group × time interaction was found in the handgrip strength in favor of the HIIT group (p-value = 0.035). Nevertheless, no significant effects on cardiorespiratory fitness or heart rate variability were found. Importantly, no adverse event was detected, so HIIT appears to be a safe and effective alternative for the rehabilitation of patients with acute coronary syndrome.
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Diabetes mellitus is not independently associated with mortality in elderly patients with ST-segment elevation myocardial infarction. Insights from the Codi Infart registry. Coron Artery Dis 2020; 31:1-6. [DOI: 10.1097/mca.0000000000000821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Ariza-Solé A, Lorente V, Formiga F, López-Palop R, Sanchís J, Marín F, Vidán MT, Martínez-Sellés M, Sánchez-Salado JC, Garay A, Guerrero C, Bueno H, Alegre O, Abu-Assi E, Cequier À. Prognostic impact of anemia according to frailty status in elderly patients with acute coronary syndromes. J Cardiovasc Med (Hagerstown) 2020; 21:27-33. [DOI: 10.2459/jcm.0000000000000884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ahrens I, Averkov O, Zúñiga EC, Fong AYY, Alhabib KF, Halvorsen S, Abdul Kader MABSK, Sanz‐Ruiz R, Welsh R, Yan H, Aylward P. Invasive and antiplatelet treatment of patients with non-ST-segment elevation myocardial infarction: Understanding and addressing the global risk-treatment paradox. Clin Cardiol 2019; 42:1028-1040. [PMID: 31317575 PMCID: PMC6788484 DOI: 10.1002/clc.23232] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/27/2019] [Accepted: 07/06/2019] [Indexed: 12/14/2022] Open
Abstract
Clinical guidelines for the treatment of patients with non-ST-segment elevation myocardial infarction (NSTEMI) recommend an invasive strategy with cardiac catheterization, revascularization when clinically appropriate, and initiation of dual antiplatelet therapy regardless of whether the patient receives revascularization. However, although patients with NSTEMI have a higher long-term mortality risk than patients with ST-segment elevation myocardial infarction (STEMI), they are often treated less aggressively; with those who have the highest ischemic risk often receiving the least aggressive treatment (the "treatment-risk paradox"). Here, using evidence gathered from across the world, we examine some reasons behind the suboptimal treatment of patients with NSTEMI, and recommend approaches to address this issue in order to improve the standard of healthcare for this group of patients. The challenges for the treatment of patients with NSTEMI can be categorized into four "P" factors that contribute to poor clinical outcomes: patient characteristics being heterogeneous; physicians underestimating the high ischemic risk compared with bleeding risk; procedure availability; and policy within the healthcare system. To address these challenges, potential approaches include: developing guidelines and protocols that incorporate rigorous definitions of NSTEMI; risk assessment and integrated quality assessment measures; providing education to physicians on the management of long-term cardiovascular risk in patients with NSTEMI; and making stents and antiplatelet therapies more accessible to patients.
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Affiliation(s)
- Ingo Ahrens
- Augustinerinnen Hospital, Academic Teaching HospitalUniversity of CologneCologneGermany
| | - Oleg Averkov
- Pirogov Russian National Research Medical UniversityMoscowRussia
| | | | - Alan Y. Y. Fong
- Department of CardiologySarawak Heart CentreKota SamarahanMalaysia
| | - Khalid F. Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac CentreCollege of Medicine, King Saud UniversityRiyadhSaudi Arabia
| | | | | | | | - Robert Welsh
- Mazankowski Alberta Heart Institute and University of AlbertaEdmontonAlbertaCanada
| | | | - Philip Aylward
- South Australian Health and Medical Research InstituteFlinders University and Medical CentreAdelaideAustralia
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27
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Variabilidad interhospitalaria del tratamiento del síndrome coronario agudo en el estudio ATHOS. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Masana L, Plana N. Update of therapeutic planning tables oriented towards obtaining therapeutic objectives. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2019; 31:271-277. [PMID: 31296342 DOI: 10.1016/j.arteri.2019.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/05/2019] [Accepted: 04/11/2019] [Indexed: 02/07/2023]
Abstract
This is the fourth update of the therapeutic planning tables. These tables are a simple desktop tool, to help in determining the most appropriate oral cholesterol-lowering therapy for patient. This can either be with monotherapy or combination therapy (statins plus ezetimibe), taking into account the patient LDL cholesterol (LDL-C) and the therapeutic objective to be achieved. These therapeutic indications are based on 2 fundamental principles: the causality of LDL-C, and that the effect of cardiovascular protection depends on the decrease in LDL-C. It is based on a colour code that indicates the drugs that have the necessary power to meet the therapeutic objectives of the patient. We provide some recommendations on the strategy to follow to implement the most effective treatment. It is assessed up to what levels a decrease in LDL-C can be expected by adding a PCSK9 inhibitor.
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Affiliation(s)
- Lluís Masana
- Unidad de Medicina Vascular y Metabolismo, Hospital Universitario Sant Joan, Universitat Rovira i Virgili, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Tarragona, España.
| | - Núria Plana
- Unidad de Medicina Vascular y Metabolismo, Hospital Universitario Sant Joan, Universitat Rovira i Virgili, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Tarragona, España
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Mate Redondo C, Rodríguez-Pérez MC, Domínguez Coello S, Pedrero García AJ, Marcelino Rodríguez I, Cuevas Fernández FJ, Almeida González D, Brito Díaz B, Rodríguez Esteban M, Cabrera de León A. Mortalidad hospitalaria de 415.798 pacientes con IAM: 4 años antes en Canarias que en el conjunto de España. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Masana L. Treating dyslipidemia: something more than giving statins. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2019; 31:119-120. [PMID: 31014747 DOI: 10.1016/j.arteri.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/15/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Luis Masana
- Unitat de Medicina Vascular i Metabolisme, Hospital Universitari Sant Joan, Universitat Rovira i Virgili, Institut d'Investigació Sanitària Pere Virgili (IISPV), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Reus, Tarragona, España.
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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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Subirana I, Fernández Avilés F, Elosua R, Lidón RM, García-Dorado D, Marrugat J. Interhospital Variability in Acute Coronary Syndrome Management in the ATHOS Study. ACTA ACUST UNITED AC 2018; 72:691-693. [PMID: 30553803 DOI: 10.1016/j.rec.2018.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/19/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Isaac Subirana
- Grupo REGICOR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBERESP de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Fernández Avilés
- CIBERCV de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain; Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Roberto Elosua
- Grupo REGICOR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBERCV de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosa-María Lidón
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain; Unidad Coronaria, Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - David García-Dorado
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain; Unidad Coronaria, Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jaume Marrugat
- Grupo REGICOR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBERCV de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain.
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Sambola A, Anguita M, Giné M. Is There a Gender Gap in Spanish Cardiology? ACTA ACUST UNITED AC 2018; 72:195-197. [PMID: 30448028 DOI: 10.1016/j.rec.2018.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/20/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Antonia Sambola
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Manuel Anguita
- Departamento de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Mireia Giné
- Departamento de Gestión Financiera, IESE Business School, Barcelona, Spain; Wharton Research Data Services (WRDS), Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Navarro-Valverde C, Quesada-Gómez JM, Pérez-Cano R, Fernández-Palacín A, Pastor-Torres LF. Effect of calcifediol treatment on cardiovascular outcomes in patients with acute coronary syndrome and percutaneous revascularization. Med Clin (Barc) 2018; 151:345-352. [PMID: 29306481 DOI: 10.1016/j.medcli.2017.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/06/2017] [Accepted: 11/09/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Vitamin D deficiency has been consistently linked with cardiovascular diseases. However, results of intervention studies are contradictory. The aim of this study was to evaluate the effect of treatment with calcifediol (25(OH)D3) on the cardiovascular system of patients with non-ST-elevation acute coronary syndrome after percutaneous coronary intervention. PATIENTS AND METHODS A prospective study assessing≥60-year-old patients with non-ST-elevation acute coronary syndrome, coronary artery disease and percutaneous revascularisation. We randomly assigned 41 patients (70.6±6.3 years) into 2 groups: Standard treatment+25(OH)D3 supplementation or standard treatment alone. Major adverse cardiovascular events (MACE) were evaluated at the conclusion of the 3-month follow-up period. 25(OH)D levels were analysed with regard to other relevant analytical variables and coronary disease extent. RESULTS Basal levels of 25(OH)D≤50nmol/L were associated with multivessel coronary artery disease (RR: 2.6 [CI 95%:1.1-7.1], P=.027) and 25(OH)D≤50nmol/L+parathormone ≥65pg/mL levels correlated with increased risk for MACE (RR: 4 [CI 95%: 1.1-21.8], P=.04]. One MACE was detected in the supplemented group versus five in the control group (P=.66). Among patients with 25(OH)D levels≤50nmol/L at the end of the study, 28.6% had MACE versus 0% among patients with 25(OH)D>50nmol/L (RR: 1,4; P=.037). CONCLUSIONS Vitamin D deficiency plus secondary hyperparathyroidism may be an effective predictor of MACE. A trend throughout the follow up period towards a reduction in MACE among patients supplemented with 25(OH)D3 was detected. 25(OH)D levels≤50nmol/L at the end of the intervention period were significantly associated with an increased number of MACE, hence, 25(OH)D level normalisation could improve cardiovascular health in addition to bone health.
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Affiliation(s)
| | - Jose M Quesada-Gómez
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, España; RETICEF & CIBER de Fragilidad y Envejecimento Saludable (CIBERFES), España
| | - Ramón Pérez-Cano
- Unidad de Metabolismo Óseo, Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Virgen Macarena. Departamento de Medicina, Universidad de Sevilla, España
| | | | - Luis F Pastor-Torres
- Unidad de Gestión Clínica de Cardiología, Hospital Universitario Virgen de Valme, Sevilla, España
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Vázquez-Oliva G, Zamora A, Ramos R, Marti R, Subirana I, Grau M, Dégano IR, Marrugat J, Elosua R. Tasas de incidencia y mortalidad, y letalidad poblacional a 28 días del infarto agudo de miocardio en adultos mayores. Estudio REGICOR. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Mate Redondo C, Rodríguez-Pérez MC, Domínguez Coello S, Pedrero García AJ, Marcelino Rodríguez I, Cuevas Fernández FJ, Almeida González D, Brito Díaz B, Rodríguez Esteban M, Cabrera de León A. Hospital Mortality in 415 798 AMI Patients: 4 Years Earlier in the Canary Islands Than in the Rest of Spain. ACTA ACUST UNITED AC 2018; 72:466-472. [PMID: 30042007 DOI: 10.1016/j.rec.2018.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/09/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES The Canary Islands has the highest mortality from diabetes in Spain. The aim of this study was to determine possible differences in mortality due to acute myocardial infarction (AMI) during hospital admission between this autonomous community and the rest of Spain, as well as the factors associated with this mortality and the population fraction attributable to diabetes. METHODS Cross-sectional study of hospital admissions for AMI in Spain from 2007 to 2014, registered in the Minimum Basic Data Set. RESULTS A total of 415 798 AMI were identified. Canary Island patients (16 317) were younger than those living in the rest of Spain (63.93 ± 13.56 vs 68.25 ± 13.94; P < .001) and death occurred 4 years earlier in the archipelago (74.03 ± 11.85 vs 78.38 ± 11.10; P < .001). This autonomous community had the highest prevalence of smoking (44% in men and 23% in women); throughout Spain, AMI occurred 13 years earlier in smokers than in nonsmokers. Patients in the Canary Islands had the highest mortality rates whether they had diabetes (8.7%) or not (7.6%), and they also showed the highest fraction of AMI mortality attributable to diabetes (9.4; 95%CI, 4.8-13.6). After adjustment for type of AMI, diabetes, dyslipidemia, hypertension, smoking, cocaine use, renal failure, sex and age, the Canary Islands showed the highest risk of mortality vs the rest of Spain (OR = 1.25; 95%CI, 1.17-1.33; P < .001) and it was one of the autonomous communities showing no significant improvement in the risk of mortality due to AMI during the study period. CONCLUSIONS Mortality due to AMI during hospital admission is higher in the Canary Islands than in the rest of Spain.
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Affiliation(s)
- Carmen Mate Redondo
- Servicio de Medicina Preventiva, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - María Cristo Rodríguez-Pérez
- Unidad de Investigación de Atención Primaria, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Santiago Domínguez Coello
- Unidad de Investigación de Atención Primaria, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Arturo J Pedrero García
- Servicio de Medicina Preventiva, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Itahisa Marcelino Rodríguez
- Unidad de Investigación de Atención Primaria, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Francisco J Cuevas Fernández
- Unidad de Investigación de Atención Primaria, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Delia Almeida González
- Unidad de Investigación de Atención Primaria, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Buenaventura Brito Díaz
- Unidad de Investigación de Atención Primaria, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Marcos Rodríguez Esteban
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Antonio Cabrera de León
- Unidad de Investigación de Atención Primaria, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain; Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain.
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Forcadell MJ, Vila-Córcoles A, de Diego C, Ochoa-Gondar O, Satué E. Incidence and mortality of myocardial infarction among Catalonian older adults with and without underlying risk conditions: The CAPAMIS study. Eur J Prev Cardiol 2018; 25:1822-1830. [PMID: 30019923 DOI: 10.1177/2047487318788396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Population-based data about the epidemiology of acute myocardial infarction is limited. This study investigated incidence and mortality of acute myocardial infarction in older adults with specific underlying chronic conditions and evaluated the influence of these conditions in developing acute myocardial infarction. DESIGN AND METHODS This was a population-based cohort study involving 27,204 individuals ≥ 60 years of age in Tarragona (Catalonia, Spain). Data on all cases of hospitalised acute myocardial infarction were collected from 1 December 2008-30 November 2011. Incidence rates and 30-day mortality were estimated according to age, sex, chronic illnesses and underlying conditions. Multivariable Cox regression analysis was used to calculate hazard ratios and to estimate the association between baseline conditions and risk of developing acute myocardial infarction. RESULTS The incidence of acute myocardial infarction was 475 per 100,000 person-years. Maximum rates appeared among individuals with history of coronary artery disease (2839 per 100,000), chronic severe nephropathy (1407 per 100,000), atrial fibrillation (1226 per 100,000), chronic heart disease (1149 per 100,000), history of stroke (1147 per 100,000) and diabetes mellitus (914 per 100,000). Thirty-day mortality was 15.3% overall, reaching 31.6% among patients over 80 years. In the multivariable analysis, history of coronary artery disease, age > 70 years, sex male, chronic heart disease, history of stroke, atrial fibrillation, diabetes mellitus and hypertension emerged as significantly associated with an increased risk of acute myocardial infarction. CONCLUSIONS The incidence and mortality of acute myocardial infarction remain considerable in our setting. Considering classical major risk factors, diabetes mellitus and hypertension were the underlying conditions most strongly associated with an increased risk in our study population.
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Affiliation(s)
- M José Forcadell
- 1 Primary Health Care Service 'Camp de Tarragona', Institut Catala de la Salut, Spain.,2 Unitat de Suport a la Recerca of Tarragona, Institut Universitari d'Investigacio en Atencio Primaria Jordi Gol (IDIAP Jordi Gol), Spain
| | - Angel Vila-Córcoles
- 1 Primary Health Care Service 'Camp de Tarragona', Institut Catala de la Salut, Spain.,2 Unitat de Suport a la Recerca of Tarragona, Institut Universitari d'Investigacio en Atencio Primaria Jordi Gol (IDIAP Jordi Gol), Spain
| | - Cinta de Diego
- 1 Primary Health Care Service 'Camp de Tarragona', Institut Catala de la Salut, Spain
| | - Olga Ochoa-Gondar
- 1 Primary Health Care Service 'Camp de Tarragona', Institut Catala de la Salut, Spain.,2 Unitat de Suport a la Recerca of Tarragona, Institut Universitari d'Investigacio en Atencio Primaria Jordi Gol (IDIAP Jordi Gol), Spain
| | - Eva Satué
- 2 Unitat de Suport a la Recerca of Tarragona, Institut Universitari d'Investigacio en Atencio Primaria Jordi Gol (IDIAP Jordi Gol), Spain
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Riesgo de eventos fatales/no fatales en pacientes con enfermedad coronaria/infarto agudo de miocardio previo y tratamiento con antiinflamatorios no esteroideos. Semergen 2018; 44:355-363. [DOI: 10.1016/j.semerg.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/08/2017] [Accepted: 07/04/2017] [Indexed: 01/07/2023]
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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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Navarro-Patón R, Freire-Tellado M, Basanta-Camiño S, Barcala-Furelos R, Arufe-Giraldez V, Rodriguez-Fernández J. Efecto de 3 métodos de enseñanza en soporte vital básico en futuros maestros de Educación Primaria. Un diseño cuasiexperimental. Med Intensiva 2018; 42:207-215. [DOI: 10.1016/j.medin.2017.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/09/2017] [Accepted: 06/12/2017] [Indexed: 11/28/2022]
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Pontes C, Marsal JR, Elorza JM, Aragón M, Prieto-Alhambra D, Morros R. Analgesic Use and Risk for Acute Coronary Events in Patients With Osteoarthritis: A Population-based, Nested Case-control Study. Clin Ther 2018; 40:270-283. [PMID: 29398161 DOI: 10.1016/j.clinthera.2017.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Recent controversies on the safety profiles of opioids and paracetamol (acetaminophen) have led to changes in clinical guidance on osteoarthritis (OA) management. We studied the existing association between the use of different OA drug therapies and the risk for acute coronary events. METHODS A cohort of patients with clinically diagnosed OA (according to ICD-10 codes) was identified in the SIDIAP database. Within the cohort, cases with incident acute coronary events (acute myocardial infarction or unstable angina) between 2008 and 2012 were identified using ICD-10 codes and data from hospital admission. Controls were matched 3:1 to acute coronary event-free patients matched by sex, age (±5 years), geographic area, and years since OA diagnosis (±2 years). Linked pharmacy dispensation data were used for assessing exposure to drug therapies. Multivariate conditional logistic regression models were fitted to estimate adjusted odds ratios of acute coronary events. FINDINGS Totals of 5663 cases and 16,989 controls were studied. Previous morbidity and cardiovascular risk were higher in cases than in controls, with no significant differences in type or number of joints with OA. Multivariate adjusted analyses showed increased risks (odds ratio; 95% CI) related to the use of diclofenac (1.16; 1.06-1.27), naproxen (1.25; 1.04-1.48), and opioid analgesics (1.13; 1.03-1.24). No significant associations were observed with cyclooxygenase-2 selective NSAIDs, topical NSAIDs, glucosamine, chondroitin sulfate, paracetamol, or metamizole. IMPLICATIONS In patients with clinically diagnosed OA, the use of nonselective NSAIDs or opioid analgesics is associated with an increased risk for acute coronary events. These risks should be considered when selecting treatments of OA in patients at high cardiovascular risk.
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Affiliation(s)
- Caridad Pontes
- Departament de Farmacologia, de Terapèutica i de Toxicologia, Universitat Autònoma de Barcelona, Barcelona, Spain; Hospital de Sabadell, Institut Universitari Parc Taulí. Sabadell, Spain
| | - Josep Ramon Marsal
- Unitat de Suport a la Recerca de Lleida, IDIAP Jordi Gol, Lleida, Spain; Unitat d'Epidemiologia del Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Josep Maria Elorza
- Institut d'Investigació d'Atenció Primària Jordi Gol, Barcelona, Spain; CAP Ripollet, Servei d'Atenció Primària Vallés Occidental, Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut; Barcelona, Spain
| | - Maria Aragón
- Institut d'Investigació d'Atenció Primària Jordi Gol, Barcelona, Spain
| | - Daniel Prieto-Alhambra
- URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain; Musculoskeletal Epidemiology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Rosa Morros
- Departament de Farmacologia, de Terapèutica i de Toxicologia, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut d'Investigació d'Atenció Primària Jordi Gol, Barcelona, Spain.
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López-Messa JB, Andrés-de Llano JM, López-Fernández L, García-Cruces J, García-Crespo J, Prieto González M. Evolución de las tasas de hospitalización y mortalidad hospitalaria por enfermedades cardiovasculares agudas en Castilla y León, 2001-2015. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.03.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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López-Messa JB, Andrés-de Llano JM, López-Fernández L, García-Cruces J, García-Crespo J, Prieto González M. Trends in Hospitalization and Mortality Rates Due to Acute Cardiovascular Disease in Castile and León, 2001 to 2015. ACTA ACUST UNITED AC 2018; 71:95-104. [DOI: 10.1016/j.rec.2017.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 04/26/2017] [Indexed: 02/01/2023]
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Eficacia de una estrategia combinada para mejorar el control del colesterol unido a lipoproteínas de baja densidad en pacientes con hipercolesterolemia. Ensayo clínico aleatorizado. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Kamel MG, El-Qushayri AE, Thach TQ, Huy NT. Cardiovascular mortality trends in non-Hodgkin's lymphoma: a population-based cohort study. Expert Rev Anticancer Ther 2017; 18:91-100. [PMID: 29192533 DOI: 10.1080/14737140.2018.1409626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Non-Hodgkin's lymphoma (NHL) survivors are at a higher risk of cardiovascular diseases (CVDs). METHODS A population-based study was conducted to investigate the cardiovascular mortality trends to identify NHL survivors at the highest risk. RESULTS The CVDs mortality was the second most common cause of death (13.07%) after NHL. There were more patients ≥ 60 years old in the cardiovascular group (87.2%), P < 0.001. Patients who died from CVDs had the best survival while patients who died from NHL had a significantly lower mean survival. The overall survival rate was 92.4%. Consistently, older age, unmarried, male patients, not recently diagnosed with NHL and not receiving radiation and/or surgery were associated with a worse survival across all models. The black race and stage IV only had a worse cardiovascular specific survival (CVSS). CONCLUSIONS Although the CVSS improved over time, the mortality from the CVDs is still the second most common cause of death after NHL. Older age, not married, black, male patients, not recently diagnosed with NHL, with an advanced stage and not receiving radiation and/or surgery were associated with a worse survival. Risk factor modification along with CVDs screening should be intensified in NHL patients with these mortality predictors.
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Affiliation(s)
| | | | - Tran Quang Thach
- b University of Medicine and Pharmacy , Ho Chi Minh City , Vietnam
| | - Nguyen Tien Huy
- c Evidence Based Medicine Research Group & Faculty of Applied Sciences , Ton Duc Thang University , Ho Chi Minh City , Vietnam.,d Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences , Nagasaki University , Nagasaki , Japan
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Vázquez-Oliva G, Zamora A, Ramos R, Marti R, Subirana I, Grau M, Dégano IR, Marrugat J, Elosua R. Acute Myocardial Infarction Population Incidence and Mortality Rates, and 28-day Case-fatality in Older Adults. The REGICOR Study. ACTA ACUST UNITED AC 2017; 71:718-725. [PMID: 29174866 DOI: 10.1016/j.rec.2017.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Our aims were to determine acute myocardial infarction (AMI) incidence and mortality rates, and population and in-hospital case-fatality in the population older than 74 years; variability in clinical characteristics and AMI management of hospitalized patients, and changes in the incidence and mortality rates, case-fatality, and management by age groups from 1996 to 1997 and 2007 to 2008. METHODS A population-based AMI registry in Girona (Catalonia, Spain) including individuals with suspected AMI older than 34 years. RESULTS The incidence rate increased with age from 169 and 28 cases/100 000 per year in the group aged 35 to 64 years to 2306 and 1384 cases/100 000 per year in the group aged 85 to 94 years, in men and women, respectively. Population case-fatality also increased with age, from 19% in the group aged 35 to 64 years to 84% in the group aged 85 to 94 years. A lower population case-fatality was observed in the second period, mainly explained by a lower in-hospital case-fatality. The use of invasive procedures and effective drugs decreased with age but increased in the second period in all ages up to 84 years. CONCLUSIONS Acute myocardial infarction incidence, mortality, and case-fatality increased exponentially with age. There is still a gap in the use of invasive procedures and effective drugs between younger and older patients.
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Affiliation(s)
- Gabriel Vázquez-Oliva
- Departament de Cardiologia, Hospital Sant Joan de Déu, Fundació Althaia, Manresa, Barcelona, Spain; Facultat de Medicina, Universitat de Girona, Girona, Spain
| | - Alberto Zamora
- Facultat de Medicina, Universitat de Girona, Girona, Spain; Unitat de Risc Vascular, Hospital de Blanes, Corporació de Salut del Maresme i la Selva, Blanes, Girona, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Rafel Ramos
- Facultat de Medicina, Universitat de Girona, Girona, Spain; Grup de Recerca ISV, Unitat de Recerca en Atenció Primària, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain; Atenció Primària, Serveis Atenció Primària, Institut Català de la Salut (ICS), Girona, Spain
| | - Ruth Marti
- Grup de Recerca ISV, Unitat de Recerca en Atenció Primària, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Isaac Subirana
- Grup de Epidemiologia i Genètica Cardiovascular, Grup del estudi REGICOR (REgistre GIroní del COR). IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - María Grau
- CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain; Grup de Epidemiologia i Genètica Cardiovascular, Grup del estudi REGICOR (REgistre GIroní del COR). IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain
| | - Irene R Dégano
- CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain; Grup de Epidemiologia i Genètica Cardiovascular, Grup del estudi REGICOR (REgistre GIroní del COR). IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain; Facultat de Medicina, Universitat de Vic-Central de Cataluña, Vic, Barcelona, Spain
| | - Jaume Marrugat
- CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain; Grup de Epidemiologia i Genètica Cardiovascular, Grup del estudi REGICOR (REgistre GIroní del COR). IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.
| | - Roberto Elosua
- CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain; Grup de Epidemiologia i Genètica Cardiovascular, Grup del estudi REGICOR (REgistre GIroní del COR). IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain; Facultat de Medicina, Universitat de Vic-Central de Cataluña, Vic, Barcelona, Spain.
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Rioboo Lestón L, Abu-Assi E, Raposeiras-Roubin S, Cobas-Paz R, Caneiro-Queija B, Rodríguez-Rodríguez JM, Íñiguez-Romo A. Prognostic usefulness of an age-adapted equation for renal function assessment in older patients with acute coronary syndrome. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2017; 7:703-709. [PMID: 28920703 DOI: 10.1177/2048872617730040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Renal dysfunction negatively impacts survival in acute coronary syndrome patients. The Berlin Initiative Study creatinine-based (BIScrea) equation has recently been proposed for renal function assessment in older persons. However, up to now it is unknown if the superiority of the new BIScrea equation, with respect to the most recommended chronic kidney disease epidemiology collaboration creatinine-based (CKD-EPIcrea) formula, would translate into better risk prediction of adverse events in older patients with acute coronary syndrome. OBJECTIVES: To study the impact of using estimated glomerular filtration rate calculated according to the BIScrea and CKD-EPIcrea equations on mortality in acute coronary syndrome patients aged 70 years and over. METHODS: Retrospectively, between 2011 and 2016, a total of 2008 patients with acute coronary syndrome (64% men; age 79±7 years) were studied. Follow-up was 18±10 months. Measures of performance were evaluated using continuous data and stratifying patients into three estimated glomerular filtration rate subgroups: ≥60, 59.9-30 and <30 mL/min/1.73 m2. RESULTS: The two formulas afforded independent prognostic information over follow-up. However, risk prediction was most accurate using the BIScrea formula as evaluated by Cox proportional hazards models (hazard ratio (for each 10 mL/min/1.73 m2 decrease) 1.47 vs. 1.27 with the CKD-EPI equation; P<0.001 for comparison), c-statistic values (0.69 vs. 0.65, respectively; P=0.04 for comparison) and Bayesian information criterion. Net reclassification improvement based on the estimated glomerular filtration rate categories significantly favoured BIScrea +9 (95% confidence interval 2-16%; P=0.02). CONCLUSIONS: Our findings suggest that the BIScrea formula may improve death risk prediction more than the CKD-EPIcrea formula in older patients with acute coronary syndrome.
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Affiliation(s)
| | - Emad Abu-Assi
- Cardiology Department, Hospital Álvaro-Cunqueiro, Spain
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Alonso Salinas GL, Sanmartin M, Pascual Izco M, Rincon LM, Pastor Pueyo P, Marco Del Castillo A, Garcia Guerrero A, Caravaca Perez P, Recio-Mayoral A, Camino A, Jimenez-Mena M, Zamorano JL. Frailty is an independent prognostic marker in elderly patients with myocardial infarction. Clin Cardiol 2017; 40:925-931. [PMID: 28712144 DOI: 10.1002/clc.22749] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/28/2017] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) patients are increasingly older. Conventional prognostic scales include chronological age but do not consider vulnerability. In elderly patients, a frail phenotype represents a better reflection of biological age. HYPOTHESIS This study aims to determine the prevalence of frailty and its influence on patients age ≥75 years with ACS. METHODS Patients age ≥75 years admitted due to type 1 myocardial infarction were included in 2 tertiary hospitals, and clinical data were collected prospectively. Frailty was defined at admission using the previously validated Survey of Health Ageing and Retirement in Europe Frailty Index (SHARE-FI) tool. The primary endpoint was the combination of death or nonfatal myocardial reinfarction during a follow-up of 6 months. Major bleeding (hemoglobin decrease ≥3 g/dL or transfusion needed) and readmission rates were also explored. RESULTS A total of 234 consecutive patients were included. Frail patients (40.2%) had a higher-risk profile, based on higher age and comorbidities. On multivariate analysis, frailty was an independent predictor of the combination of death or nonfatal myocardial reinfarction (adjusted hazard ratio [aHR]: 2.54, 95% confidence interval [CI]: 1.12-5.79), an independent predictor of the combination of death, nonfatal myocardial reinfarction, or major bleeding (aHR: 2.14, 95% CI: 1.13-4.04), and an independent predictor of readmission (aHR: 1.80, 95% CI: 1.00-3.22). CONCLUSIONS Frailty phenotype at admission is common among elderly patients with ACS and is an independent predictor for severe adverse events. It should be considered in future risk-stratification models.
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Affiliation(s)
| | - Marcelo Sanmartin
- Cardiology Department, Hospital Ramón y Cajal, University of Alcalá, Madrid, Spain
| | - Marina Pascual Izco
- Cardiology Department, Hospital Ramón y Cajal, University of Alcalá, Madrid, Spain
| | - Luis Miguel Rincon
- Cardiology Department, Hospital Ramón y Cajal, University of Alcalá, Madrid, Spain
| | - Pablo Pastor Pueyo
- Cardiology Department, Hospital Ramón y Cajal, University of Alcalá, Madrid, Spain
| | | | | | | | | | - Asuncion Camino
- Cardiology Department, Hospital Ramón y Cajal, University of Alcalá, Madrid, Spain
| | - Manuel Jimenez-Mena
- Cardiology Department, Hospital Ramón y Cajal, University of Alcalá, Madrid, Spain
| | - José Luis Zamorano
- Cardiology Department, Hospital Ramón y Cajal, University of Alcalá, Madrid, Spain
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Párraga-Martínez I, Escobar-Rabadán F, Rabanales-Sotos J, Lago-Deibe F, Téllez-Lapeira JM, Villena-Ferrer A, Blasco-Valle M, Ferreras-Amez JM, Morena-Rayo S, Del Campo-Del Campo JM, Ayuso-Raya MC, Pérez-Pascual JJ. Efficacy of a Combined Strategy to Improve Low-density Lipoprotein Cholesterol Control Among Patients With Hypercholesterolemia: A Randomized Clinical Trial. ACTA ACUST UNITED AC 2017; 71:33-41. [PMID: 28652127 DOI: 10.1016/j.rec.2017.05.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 03/15/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Several interventions can improve low-density lipoprotein cholesterol (LDL-C) control. Our main objective was to evaluate the efficacy of a combined intervention to improve LDL-C control in patients with hypercholesterolemia. The study also assessed the efficacy of the intervention in improving adherence (pharmacological, diet, and exercise). METHODS A multicenter, parallel group, randomized clinical trial (primary care) was conducted in 358 adults diagnosed with hypercholesterolemia, whether receiving prior drug therapy or not. We compared 178 participants who received the combined intervention (written material, self-completed registration cards, and messages to mobile telephones) with 178 controls. The main outcome variable was the proportion of participants with adequate LDL-C control (target levels of the European guidelines on dyslipidemia and cardiovascular risk) at 24 months. RESULTS At 24 months, the mean reduction in LDL-C was significantly higher in the intervention group (23.8mg/dL [95%CI, 17.5-30.1]) than in the control group (14.6mg/dL [95%CI, 8.9-20.4]; P=.034). The mean LDL-C decrease was 13.1%±28.6%. At 1 year, the proportion of participants with adequate control was significantly higher in the intervention group than in the control group (43.7% vs 30.1%; P=.011; RR, 1.46). Adherence was significantly higher in the intervention group, both to drug therapy (77.2% vs 64.1%; P=.029) and exercise (64.9% vs 35.8; P<.001), but not to diet. CONCLUSIONS The combined intervention significantly reduced LDL-C (by more than 13% at 2 years) and improved the degree of LDL-C control in patients with hypercholesterolemia at 1 year.
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Affiliation(s)
- Ignacio Párraga-Martínez
- Centro de Salud de La Roda, Gerencia de Atención Integrada de Albacete, Servicio de Salud de Castilla-La Mancha, Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain.
| | | | | | - Fernando Lago-Deibe
- Centro de Salud de Sárdoma, Servicio de Salud de Galicia, Vigo, Pontevedra, Spain
| | | | - Alejandro Villena-Ferrer
- Centro de Salud de San Clemente, Servicio de Salud de Castilla-La Mancha, San Clemente, Cuenca, Spain
| | | | - José M Ferreras-Amez
- Servicio de Urgencias, Hospital Royo Villanova, Servicio Aragonés de Salud, Zaragoza, Spain
| | - Susana Morena-Rayo
- Centro de Salud Hellín 2, Servicio de Salud de Castilla-La Mancha, Hellín, Albacete, Spain
| | | | | | - José J Pérez-Pascual
- Centro de Salud Zona IV, Servicio de Salud de Castilla-La Mancha, Albacete, Spain
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