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Oliveira BAS, Castro GZ, Ferreira GLM, Guimarães FG. CML-Cardio: a cascade machine learning model to predict cardiovascular disease risk as a primary prevention strategy. Med Biol Eng Comput 2023; 61:1409-1425. [PMID: 36719564 DOI: 10.1007/s11517-022-02757-z] [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: 01/27/2022] [Accepted: 12/22/2022] [Indexed: 02/01/2023]
Abstract
Cardiovascular diseases are among the leading causes of mortality worldwide, with more than 23 million related deaths per year by 2030, according to the World Heart Federation. Although most of these diseases may be prevented, population awareness strategies are still ineffective. In this context, we propose the CML-Cardio tool, a machine learning application to automate the risk classification process of developing CVDs. For this, researchers in our group collected data on diabetes, blood pressure, and other risk factors in a private company. Our final model consists of a cascade system to handle highly imbalanced data. In the first stage, a binary model is responsible for predicting whether a patient has a low risk of developing CVDs or if has a risk that needs attention. In this step, we use six algorithms: logistic regression, SVM, random forest, XGBoost, CatBoost, and multilayer perceptron. The better results presented an average accuracy of 0.86 ± 0.03 and f-score of 0.85 ± 0.04. We interpret each feature's impact on the models' output and validate the subsystem for the next step. In the second stage, we use an anomaly detection model to learn the intermediate risk patterns present in the instances that need attention. The cascade model presented an average accuracy of 0.80 ± 0.07 and f-score of 0.70 ± 0.07. Finally, we develop the CML-Cardio prototype of an actual application as a primary prevention strategy. Graphical abstract In this work, we propose the CML-Cardio tool, a cascade machine learning method to classify cardiovascular disease risk.
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Affiliation(s)
- Bruno Alberto Soares Oliveira
- Graduate Program in Electrical Engineering, Universidade Federal de Minas Gerais, Avenue Antônio Carlos 6627, Belo Horizonte, 31270-901, Minas Giraes, Brazil
| | - Giulia Zanon Castro
- Graduate Program in Electrical Engineering, Universidade Federal de Minas Gerais, Avenue Antônio Carlos 6627, Belo Horizonte, 31270-901, Minas Giraes, Brazil.
| | | | - Frederico Gadelha Guimarães
- Graduate Program in Electrical Engineering, Universidade Federal de Minas Gerais, Avenue Antônio Carlos 6627, Belo Horizonte, 31270-901, Minas Giraes, Brazil
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Cinza Sanjurjo S, Llisterri Caro J, Barquilla García A, Polo García J, Velilla Zancada S, Rodríguez Roca G, Micó Pérez R, Martín Sánchez V, Prieto Díaz M. Descripción de la muestra, diseño y métodos del estudio para la identificación de la población española de riesgo cardiovascular y renal (IBERICAN). Semergen 2020; 46:4-15. [DOI: 10.1016/j.semerg.2019.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 11/29/2022]
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Cequier Á, Ariza-Solé A, Elola FJ, Fernández-Pérez C, Bernal JL, Segura JV, Iñiguez A, Bertomeu V. Impacto en la mortalidad de diferentes sistemas de asistencia en red para el tratamiento del infarto agudo de miocardio con elevación del segmento ST. La experiencia de España. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.07.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Socias L, Frontera G, Rubert C, Carrillo A, Peral V, Rodriguez A, Royo C, Ferreruela M, Torres J, Elosua R, Bethencourt A, Fiol M. Análisis comparativo de 2 registros de infarto agudo de miocardio tras una década de cambios. Estudio IBERICA (1996-1998) y Código Infarto-Illes Balears (2008-2010). Med Intensiva 2016; 40:541-549. [DOI: 10.1016/j.medin.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 04/11/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
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Cequier Á, Ariza-Solé A, Elola FJ, Fernández-Pérez C, Bernal JL, Segura JV, Iñiguez A, Bertomeu V. Impact on Mortality of Different Network Systems in the Treatment of ST-segment Elevation Acute Myocardial Infarction. The Spanish Experience. ACTA ACUST UNITED AC 2016; 70:155-161. [PMID: 27600863 DOI: 10.1016/j.rec.2016.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES To analyze the association between the development of network systems of care for ST-segment elevation myocardial infarction (STEMI) in the autonomous communities (AC) of Spain and the regional rate of percutaneous coronary intervention (PCI) and in-hospital mortality. METHODS From 2003 to 2012, data from the minimum basic data set of the Spanish taxpayer-funded health system were analyzed, including admissions from general hospitals. Diagnoses of STEMI and related procedures were codified by the International Diseases Classification. Discharge episodes (n = 302 471) were distributed in 3 groups: PCI (n = 116 621), thrombolysis (n = 46 720), or no reperfusion (n = 139 130). RESULTS Crude mortality throughout the evaluation period was higher for the no-PCI or thrombolysis group (17.3%) than for PCI (4.8%) and thrombolysis (8.6%) (P < .001). For the aggregate of all communities, the PCI rate increased (21.6% in 2003 vs 54.5% in 2012; P < .001) with a decrease in risk-standardized mortality rates (10.2% in 2003; 6.8% in 2012; P < .001). Significant differences were observed in the PCI rate across the AC. The development of network systems was associated with a 50% increase in the PCI rate (P < .001) and a 14% decrease in risk-standardized mortality rates (P < .001). CONCLUSIONS From 2003 to 2012, the PCI rate in STEMI substantially increased in Spain. The development of network systems was associated with an increase in the PCI rate and a decrease in in-hospital mortality.
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Affiliation(s)
- Ángel Cequier
- Sociedad Española de Cardiología, Madrid, Spain; Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Albert Ariza-Solé
- Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco J Elola
- Sociedad Española de Cardiología, Madrid, Spain; Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | | | - José L Bernal
- Servicio de Control de Gestión, Hospital 12 de Octubre, Madrid, Spain
| | - José V Segura
- Centro de Investigación Operativa, Instituto Universitario de Investigación (IUI), Universidad Miguel Hernández, Alicante, Spain
| | - Andrés Iñiguez
- Sociedad Española de Cardiología, Madrid, Spain; Servicio de Cardiología, Hospital Álvaro Cunquerio, Vigo, Pontevedra, Spain
| | - Vicente Bertomeu
- Sociedad Española de Cardiología, Madrid, Spain; Servicio de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
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Fitó M, Melander O, Martínez JA, Toledo E, Carpéné C, Corella D. Advances in Integrating Traditional and Omic Biomarkers When Analyzing the Effects of the Mediterranean Diet Intervention in Cardiovascular Prevention. Int J Mol Sci 2016; 17:E1469. [PMID: 27598147 PMCID: PMC5037747 DOI: 10.3390/ijms17091469] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 08/08/2016] [Accepted: 08/26/2016] [Indexed: 12/17/2022] Open
Abstract
Intervention with Mediterranean diet (MedDiet) has provided a high level of evidence in primary prevention of cardiovascular events. Besides enhancing protection from classical risk factors, an improvement has also been described in a number of non-classical ones. Benefits have been reported on biomarkers of oxidation, inflammation, cellular adhesion, adipokine production, and pro-thrombotic state. Although the benefits of the MedDiet have been attributed to its richness in antioxidants, the mechanisms by which it exercises its beneficial effects are not well known. It is thought that the integration of omics including genomics, transcriptomics, epigenomics, and metabolomics, into studies analyzing nutrition and cardiovascular diseases will provide new clues regarding these mechanisms. However, omics integration is still in its infancy. Currently, some single-omics analyses have provided valuable data, mostly in the field of genomics. Thus, several gene-diet interactions in determining both intermediate (plasma lipids, etc.) and final cardiovascular phenotypes (stroke, myocardial infarction, etc.) have been reported. However, few studies have analyzed changes in gene expression and, moreover very few have focused on epigenomic or metabolomic biomarkers related to the MedDiet. Nevertheless, these preliminary results can help to better understand the inter-individual differences in cardiovascular risk and dietary response for further applications in personalized nutrition.
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Affiliation(s)
- Montserrat Fitó
- Cardiovascular Risk and Nutrition Research (REGICOR Group), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain.
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain.
| | - Olle Melander
- Department of Clinical Sciences, Lund University, 22100 Lund, Sweden.
- Department of Internal Medicine, Skåne University Hospital, 22241 Lund, Sweden.
| | - José Alfredo Martínez
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain.
- Department of Nutrition and Food Sciences, University of Navarra, 31009 Pamplona, Spain.
| | - Estefanía Toledo
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain.
- Department of Preventive Medicine and Public Health, University of Navarra, 31009 Pamplona, Spain.
| | - Christian Carpéné
- INSERM U1048, Institute of Metabolic and Cardiovascular Diseases (I2MC), Rangueil Hospital, 31442 Toulouse, France.
| | - Dolores Corella
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain.
- Department of Preventive Medicine and Public Health, University of Valencia, 46010 Valencia, Spain.
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Ferreira-González I, Carrillo X, Martín V, de la Torre Hernández JM, Baz JA, Navarro Manchón J, Masotti M, Cequier Á, Cárdenas M, Alfonso Manterola F. Variabilidad interhospitalaria en la prescripción tras un síndrome coronario agudo: hallazgos del estudio ACDC. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ferreira-González I, Carrillo X, Martín V, de la Torre Hernández JM, Baz JA, Navarro Manchón J, Masotti M, Cequier Á, Cárdenas M, Alfonso Manterola F. Interhospital Variability in Drug Prescription After Acute Coronary Syndrome: Insights From the ACDC Study. ACTA ACUST UNITED AC 2016; 69:117-24. [DOI: 10.1016/j.rec.2015.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/20/2015] [Indexed: 11/24/2022]
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Rivera-Fernández R, Arias-Verdú MD, García-Paredes T, Delgado-Rodríguez M, Arboleda-Sánchez JA, Aguilar-Alonso E, Quesada-García G, Vera-Almazán A. Prolonged QT interval in ST-elevation myocardial infarction and mortality. J Cardiovasc Med (Hagerstown) 2016; 17:11-9. [DOI: 10.2459/jcm.0000000000000015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Cequier Á, García-Altés A. Transparencia y comparación de resultados para la sostenibilidad del sistema sanitario. Med Clin (Barc) 2015; 144:449-51. [DOI: 10.1016/j.medcli.2015.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/18/2015] [Accepted: 01/21/2015] [Indexed: 01/15/2023]
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Sicras-Mainar A, Rejas-Gutiérrez J, Navarro-Artieda R, Ibánez-Nolla J. Effect of smoking status on healthcare costs and resource utilization in patients with type 2 diabetes in routine clinical practice: a retrospective nested case-control economic study. Eur Addict Res 2014; 20:94-104. [PMID: 24192535 DOI: 10.1159/000355171] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 08/13/2013] [Indexed: 11/19/2022]
Abstract
AIM To compare healthcare resource utilization and costs according to smoking status in patients with type 2 diabetes in clinical practice. METHODS A retrospective cohort nested case-control study was designed. Cases were current smokers, while 2 types of controls (former smokers and never smokers) were matched (2 controls per case) for age, sex, duration of diabetes and burden of comorbidity using data from medical records. Noninstitutionalized diabetics of both genders, aged>18 years and seen consecutively over a 5-year period before the index date, were enrolled. Analysis compared healthcare resource utilization, loss of productivity due to sick leave and corresponding costs. RESULTS In total, 2,490 medical records were analyzed, i.e. 498 cases, 996 former smokers and 996 never smokers. Mean age was 63.4 years (64.9% male). Smokers had higher glycosylated hemoglobin levels (7.4 vs. 7.2 and 7.2%, respectively; p=0.013) and a lower degree of metabolic control (49.2 vs. 54.7 and 55.8%; p=0.036). Smokers had higher average annual costs (EUR 3,583) than former smokers (EUR 2,885; p<0.001) and never smokers (EUR 2,183; p<0.001). CONCLUSIONS Diabetic smoker patients had lower metabolic control, higher health resource utilization and more sick leave, resulting in higher healthcare costs and lost productivity compared with both former and never smoker diabetics.
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Bertomeu V, Cequier Á, Bernal JL, Alfonso F, Anguita MP, Muñiz J, Barrabés JA, García-Dorado D, Goicolea J, Elola FJ. Mortalidad intrahospitalaria por infarto agudo de miocardio. Relevancia del tipo de hospital y la atención dispensada. Estudio RECALCAR. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.06.008] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bertomeu V, Cequier Á, Bernal JL, Alfonso F, Anguita MP, Muñiz J, Barrabés JA, García-Dorado D, Goicolea J, Elola FJ. In-hospital mortality due to acute myocardial infarction. relevance of type of hospital and care provided. RECALCAR study. ACTA ACUST UNITED AC 2013; 66:935-42. [PMID: 24774106 DOI: 10.1016/j.rec.2013.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 06/07/2013] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES To investigate the relationship between in-hospital mortality due to acute myocardial infarction and type of hospital, discharge service, and treatment provided. METHODS Retrospective analysis of 100 993 hospital discharges with a principal diagnosis of myocardial infarction in hospitals of the Spanish National Health Service. In-hospital mortality was adjusted for risk following the models of the Institute for Clinical Evaluative Sciences (Canada) and the Centers for Medicare & Medicaid Services (United States). RESULTS Hospital characteristics are relevant to explain the variation in the individual probability of dying from myocardial infarction (median odds ratio: 1.3561). The risk-adjusted in-hospital mortality in cluster 3 and especially in cluster 4 hospitals (500 beds to 1000 beds and medium-high complexity) was significantly lower than in hospitals with less than 200 beds. Cluster 5 (more than 1000 beds), which includes a diverse group of hospitals, had a higher mortality rate than clusters 3 and 4. The adjusted mortality in the groups with the best and worst outcomes was 6.74% (cluster 4) and 8.49% (cluster 1), respectively. Mortality was also lower when the cardiology unit was responsible for the discharge or when angioplasty had been performed. CONCLUSIONS The typology of the hospital, treatment in a cardiology unit, and percutaneous coronary intervention are significantly associated with the survival of a patient hospitalized for myocardial infarction. We recommend that the Spanish National Health Service establish health care networks that favor percutaneous coronary intervention and the participation of cardiology units in the management of patients with acute myocardial infarction.
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Affiliation(s)
- Vicente Bertomeu
- Servicio de Cardiología, Hospital San Juan, Universidad Miguel Hernández, Alicante, Spain
| | - Ángel Cequier
- Àrea de Malalties del Cor, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José L Bernal
- Control de Gestión, Hospital 12 de Octubre, Madrid, Spain
| | - Fernando Alfonso
- Departamento de Cardiología Intervencionista, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Javier Muñiz
- Instituto de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain
| | - José A Barrabés
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - David García-Dorado
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Javier Goicolea
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
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Socioeconomic differences in incidence and relative survival after a first acute myocardial infarction in the Basque Country, Spain. GACETA SANITARIA 2012; 26:16-23. [DOI: 10.1016/j.gaceta.2011.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 06/27/2011] [Accepted: 06/28/2011] [Indexed: 11/18/2022]
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Sex differences in relative survival and prognostic factors in patients with a first acute myocardial infarction in Guipuzcoa, Spain. Rev Esp Cardiol 2010; 63:649-59. [PMID: 20515622 DOI: 10.1016/s1885-5857(10)70139-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES To determine 28-day and 5-year survival rates in patients who have experienced a first acute myocardial infarction and to identify prognostic factors for survival. METHODS This study involved 1,677 patients with a first acute myocardial infarction who were treated at a hospital in Guipuzcoa, Spain between 1997 and 2000. RESULTS Women were approximately 10 years older than men, presented more often with diabetes and hypertension, were in a less favorable clinical condition, and consumed fewer medical resources, but were less likely to smoke. Survival rates at 28 days and 5 years were higher in men over 60 years of age. In the period from 29 days to 5 years, the relative survival rate was higher in men from all age groups. Factors associated with short- and long-term survival varied between the sexes. Disease severity in the acute phase and, later on, age were associated with survival in both men and women, whereas the effect of other variables differed between the sexes. CONCLUSIONS Myocardial infarction is a condition associated with high mortality in the acute phase. There is an interaction between sex and age that affects survival after an acute myocardial infarction. A number of factors are associated with poor short- and long-term prognoses in both sexes.
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Fernández-Raga M, Tomás C, Fraile R. Human mortality seasonality in Castile-León, Spain, between 1980 and 1998: the influence of temperature, pressure and humidity. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2010; 54:379-392. [PMID: 20107841 DOI: 10.1007/s00484-009-0289-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Revised: 10/25/2009] [Accepted: 11/27/2009] [Indexed: 05/28/2023]
Abstract
This study was carried out in the region of Castile and Leon, Spain, from 1980 to 1998 and analyzes the relationship between the number of monthly deaths caused by cardiovascular, respiratory and digestive diseases and three meteorological variables: temperature, pressure and humidity. One of the innovations in this study is the application of principal component analysis in a way that differs from its usual application: one single series representing the whole region was constructed for each meteorological variable from the series of eight weather stations. Annual and seasonal mortality trends were also studied. Cardiovascular diseases are the leading cause of death in Castile and Leon. The mortality related to cardiovascular, respiratory and digestive systems shows a statistically significant rising trend across the study period (an annual increase of 6, 16 and 4 per thousand, respectively). The pressure at which mortality is lowest is approximately the same for all causes of death (about 915 hPa), but temperature values vary greatly (16.8-19.7 degrees C for the mean, 10.9-18.1 degrees C for the minimum, and 24.1-27.2 degrees C for the maximum temperature). The most comfortable temperatures for patients with cardiovascular diseases (16.8 degrees C) are apparently lower than those for patients with respiratory diseases (18.1 degrees C), which are, in turn, lower than in the case of diseases of the digestive system (19.7 degrees C). Finally, the optimal humidity for patients with respiratory diseases is the lowest (24%) among the diseases, and the highest (51%) corresponds to diseases of the digestive system, while the optimal relative humidity for the cardiovascular system is 45%.
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Affiliation(s)
- María Fernández-Raga
- Departamento de Física, Facultad de CC Biológicas y Ambientales, Universidad de León, 24071, León, Spain
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Machón M, Basterretxea M, Martínez-Camblor P, Aldasoro E, San Vicente JM, Larrañaga N. Diferencias por sexo en la supervivencia relativa y los factores pronósticos de pacientes con un primer infarto agudo de miocardio en Guipúzcoa. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70157-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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APACHE-II score and Killip class for patients with acute myocardial infarction. Intensive Care Med 2010; 36:1579-86. [PMID: 20333355 DOI: 10.1007/s00134-010-1832-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 01/09/2010] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To analyse the influence on the prognosis of intensive care unit (ICU) patients with acute myocardial infarction (AMI): prognostic index score, Killip class, AMI site, thrombolysis and other variables that might improve prognostic capacity and functioning of the APACHE-II index. DESIGN Cohort study using prospectively gathered ARIAM project data. SETTING ICUs from 129 Spanish hospitals. PATIENTS ICU-admitted AMI patients in ARIAM database during 4-year period were retrospectively studied. MEASUREMENTS AND MAIN RESULTS The sample comprised 6,458 patients, 76.8% males, age 64.97 +/- 12.56 years, APACHE-II score 9.49 +/- 7.03 points and ICU mortality 8.9%. Mortality was higher for females (p < 0.001), anterior AMI site (p < 0.001), previous AMI (p < 0.001), delay-to-hospital arrival >180 min (p = 0.003) and non-receipt of thrombolysis (p = 0.015). ICU mortality was related to age (p < 0.001) and APACHE-II score (p < 0.001). In multivariate analysis, it was related to APACHE-II (OR 1.16), age (OR 1.05), gender (OR 1.64), previous AMI (OR 1.57), anterior AMI (OR 2.05) and delay >180 min (OR 1.37). Killip class, gathered in 1,893 patients, was significantly associated with ICU mortality, and two predictive models were constructed for this group using multivariate analysis. Area under ROC curve was 0.94 in one (Killip class, age, gender, APACHE-II) versus 0.92 in the other (same variables without APACHE-II). CONCLUSIONS APACHE-II score and Killip class are useful for assessing the severity of patients with AMI and are complementary. Each can be used with a few commonly gathered clinical variables to construct prognostic models to assess severity. Their joint application yields a model with excellent discrimination capacity.
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[Comorbidity and health resources use in smokers. An analysis from a primary care setting]. Rev Clin Esp 2010; 210:109-17. [PMID: 20152965 DOI: 10.1016/j.rce.2009.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 06/29/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND To ascertain the morbidity profile, achievement of the clinical control objectives, resources use and the incidence of cardiovascular events (CVE) in smoking subjects in Primary Care settings (PC). METHODS Retrospective multicentric study. All smoker subjects older than thirty years attended in any of five PC settings were included. A comparative cohort was established with non-smokers. Primary measures were: presence of CVE, age, gender, Charlson index, history/co-morbidity and clinics parameters and direct costs (fixed and variable; visits, drugs, diagnostic test and referrals). Multiple logistic regression analysis and ANCOVA models were applied for models correction, P<0.05. RESULTS 55,653 patients were included. 20.8% (95% confidence intervals [CI]:20.5-21.1%) were smokers. Non-smokers were younger (48.2 versus 55.9 years), with more men (60.8%), P<0.01; and a similar Charlson index (0.3 versus 0.3; P=NS). The proportion of smokers in hypertensive population was 18.8% and in diabetics 9.6%. CVE presence in smokers were 4.9% versus 4.2% and the accumulated incidence/annual of 14.2 per thousand versus 12.5 per thousand, P<0.028. Smokers showed higher levels of serum triglycerides (136.3 mg/dl) and LDL-cholesterol (128.0 mg/dl, P<0.001). Smoking habit was independent related to the alcoholism (Odds ratio, OR=5.3) and the EPOC (OR=2.5), in presence of CVE (OR=1.2, P<0.001). Adjusted direct costs non differences showed: euro660.10 versus euro654.11, P=NS (in all components). CONCLUSIONS CVE annual incidence in smoking subjects was greater, with a minor average of age. Smokers presented a similar number of co-morbidities and total/patient costs. Clinical control objectives should be better in Primary prevention of the cardiovascular risk factors. To give up smoking should be the best strategy to diminish CVE incidence.
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Gómez M, Valle V, Arós F, Sanz G, Sala J, Fiol M, Bruguera J, Elosua R, Molina L, Martí H, Covas MI, Rodríguez-Llorián A, Fitó M, Suárez-Pinilla MA, Amezaga R, Marrugat J. Oxidized LDL, lipoprotein (a) and other emergent risk factors in acute myocardial infarction (FORTIAM study). Rev Esp Cardiol 2009; 62:373-82. [PMID: 19401122 DOI: 10.1016/s1885-5857(09)71664-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES To determine the prevalence of acute myocardial infarction (AMI) without classical risk factors, and to ascertain whether affected patients exhibit a higher prevalence of emergent risk factors and whether the presence of specific emergent risk factors influence prognosis at 6 months. METHODS The FORTIAM (Factores Ocultos de Riesgo Tras un Infarto Agudo de Miocardio) study is a multicenter cohort study that includes 1371 AMI patients who were admitted within 24 hours of symptom onset. Strict definitions were used for classical risk factors and the concentrations of the following markers were determined: lipoprotein (a) [Lp(a)], oxidized low-density lipoprotein (oxLDL), high-sensitivity C-reactive protein, fibrinogen, homocysteine and antibody to Chlamydia. The end-points observed during the 6-month follow-up were death, angina and re-infarction. RESULTS The prevalence of AMI without classical risk factors was 8.0%. The absence of classical risk factors did not affect the 6-month prognosis. The only emergent risk factors independently associated with a poorer prognosis were the Lp(a) and oxLDL concentrations. Cut-points were determined using smoothing splines: 60 mg/ dL for Lp(a) and 74 U/L for oxLDL. The associated hazard ratios, adjusted for age, sex and classical risk factors, were 1.40 (95% confidence interval, 1.06-1.84 ) and 1.48 (95% confidence interval, 1.06-2.06), respectively. CONCLUSIONS The proportion of AMI patients without classical risk factors was low and their prognosis was similar to that in other AMI patients. Both oxLDL and Lp(a) concentrations were independently associated with a poorer 6-month prognosis, irrespective of the presence of classical risk factors.
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Affiliation(s)
- Miquel Gómez
- Servicio de Cardiología, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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de la Villa Redondo BG. Implicaciones del registro REACH para el cardiólogo. Med Clin (Barc) 2009; 132 Suppl 2:15-20. [DOI: 10.1016/s0025-7753(09)71747-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gómez M, Valle V, Arós F, Sanz G, Sala J, Fiol M, Bruguera J, Elosua R, Molina L, Martí H, Isabel Covas M, Rodríguez-Llorián A, Fitó M, Suárez-Pinilla MA, Amezaga R, Marrugat J. LDL oxidada, lipoproteína(a) y otros factores de riesgo emergentes en el infarto agudo de miocardio (estudio FORTIAM). Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)70894-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Novella B, Alonso M, Rodriguez-Salvanés F, Susi R, Reviriego B, Escalante L, Suárez C, Gabriel R. Incidencia a diez años de infarto de miocardio fatal y no fatal en la población anciana de Madrid. Rev Esp Cardiol 2008. [DOI: 10.1157/13127845] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Alonso JJ, Sanz G, Guindo J, García-Moll X, Bardají A, Bueno H. Unidades coronarias de cuidados intermedios: base racional, infraestructura, equipamiento e indicaciones de ingreso. Rev Esp Cardiol 2007. [DOI: 10.1157/13101644] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cabadés O’callaghan A. El registro REGICOR y la epidemiología del infarto de miocardio en España: se hace camino al andar. Rev Esp Cardiol 2007. [DOI: 10.1157/13101636] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sanfélix G, Peiró S, Gosalbes Soler V, Cervera Casino P. [The secondary prevention of ischaemic heart disease in Spain. A systematic review of observational studies]. Aten Primaria 2007; 38:250-7. [PMID: 17020708 PMCID: PMC7669101 DOI: 10.1157/13092980] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the use of ischaemic heart disease (IHD) secondary prevention measures in the Spanish National Health System. DESIGN Systematic review of observational studies with information on the use of preventive treatment and measures in the prevention of secondary IHD. SETTING Primary care and specialised out-patient clinics. DATA SOURCES Medline search and complementary searches of studies published between 1995 and 2004 with a description of the use secondary prevention measures on hospital discharge or in the follow up after discharge. SELECTION OF STUDIES A total of 125 references were found after the MEDLINE search, 13 of which were selected after an independent review by 2 researchers. The complementary sources provided 9 more studies giving a total of 22. DATA EXTRACTION One researcher extracted information on the characteristics of the study and the results variables, which were independently verified by a second evaluator. RESULTS. In the 22 studies found, a high level of variation was shown in the different treatment rates: anti-aggregants (at discharge, 72%-97.1%; follow-up, 46.4%-93.8%); beta-blockers (at discharge, 29%-68.3%; follow-up, 22.4%-59.0%); drugs with action on the renin-angiotensin system (at discharge, 16.2%-52.2%; follow-up, 6.1%-53.1%); lipid lowering drugs (at discharge, 6.7%-88.7%; follow-up, 24.5%-89.5%). The treatment rates showed a progressive improvement over time during the period studied. CONCLUSIONS In the period 1994-2003 treatment rates in the secondary prevention of IHD have increased, although there is still much room for improvement.
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Affiliation(s)
| | - Salvador Peiró
- Escuela Valenciana de Estudios de la Salud. Valencia. España
- Fundación Instituto de Investigación en Servicios de Salud. Valencia. España
- Correspondencia: S. Peiró. EVES. Juan de Garay, 21. 46017 Valencia. España.
| | | | - Pedro Cervera Casino
- Fundación Instituto de Investigación en Servicios de Salud. Valencia. España
- Servicio de Farmacia de Atención Primaria del Área 12. Denia (Alicante). España
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Aldasoro E, Calvo M, Esnaola S, Hurtado de Saracho I, Alonso E, Audicana C, Arós F, Lekuona I, Arteagoitia JM, Basterretxea M, Marrugat J. Diferencias de género en el tratamiento de revascularización precoz del infarto agudo de miocardio. Med Clin (Barc) 2007; 128:81-5. [PMID: 17288920 DOI: 10.1016/s0025-7753(07)72497-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Clinical variability in myocardial infarction (MI) regarding age, comorbidities and atypical symptoms could determine gender differences in inhospital care. This study analyzes the magnitude and determinants of differences between men and women in early reperfusion therapy in people hospitalized after MI. PATIENTS AND METHOD 2,836 patients who arrived to hospital with MI were studied (IBERICA-Basque Country study). The relative risk (RR) of receiving early reperfusion for men versus women, adjusted by age, clinical characteristics, risk factors, and pre-hospital delay was estimated. The effect decomposition methodology and the log binomial regression were applied. RESULTS 29% of patients were women with a median age of 77 years. The RR of revascularization in men compared to women was different according to age. When factors such as hypertension diabetes, Killip III-IV at admission and atypical symptoms were taken into account, statistically significant differences between sexes were not detected at 45 years old (RR=0.91; 95% CI=0.77-1.07). However, for 64 years old and over, the RR of reperfusion was 1.24 (95% CI=1.05-1.47). Both the differences by sex and the sex-age interaction were no longer statistically significant after adjusting by pre-hospital delay. CONCLUSIONS The delay to receive medical care in elderly women is responsible of gender differences in early reperfusion. It is necessary to analyze the reasons for treatment-seeking delay.
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O'Callaghan AC. The REGICOR Registry and the Epidemiology of Myocardial Infarction in Spain: Forging a Path. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1885-5857(07)60165-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fitch-Warner K, García de Yébenes MJ, Lázaro y de Mercado P, Belaza-Santurde J. Variabilidad entre comunidades autónomas en el uso de tres tecnologías cardiovasculares. Rev Esp Cardiol 2006. [DOI: 10.1157/13096594] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Antoñanzas Villar F, Pinillos García M. Equidad y variabilidad del uso de las tecnologías médicas. Rev Esp Cardiol 2006. [DOI: 10.1157/13096586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gallego-Luis R, Ruiz-García A, Gordillo-López F, Díaz-Puente M, Esteban J, Gil de Miguel A. [Study of unmatched cases and controls: hyperhomocysteinaemia and chronic ischaemic cardiopathy]. Aten Primaria 2006; 37:325-31. [PMID: 16733005 PMCID: PMC7679868 DOI: 10.1157/13086709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the extent of the association between hyperhomocysteinaemia and chronic ischaemic heart disease. DESIGN Unmatched, case-control (1:3) study. SETTING Pintores Health Centre, Area 10, Primary Care, Madrid, Spain. PARTICIPANTS Patients of the health centre over 35 with chronic ischaemic heart disease or without it. METHOD Consecutive, non-randomized sample. Analysis of cases and controls with chi2 test and odds ratio (OR). The quantitative variables were analysed with the Student's t test. RESULTS The 76.32% (87/114) of cases had 2 or more cardiovascular risk factors versus 33.56% (99/265) in the control group (P<.0001). Average homocysteinaemia was 10.07 micromol/L (SD, 3.64) in the control group; and 12.74 (SD, 4.59) in the cases group. The difference between the averages (2.67 micromol/L; 95% CI, 1.82-3.52) was significant (P<.001). The difference (16.07%; 95% CI, 6.91-25.23) in hyperhomocysteinaemia (> or =15 micromol/L) between cases (28.95%, 33/114) and controls (12.88%, 38/295) was significant (P=.0001), with an association between hyperhomocysteinaemia and chronic ischaemic heart disease (OR=2.76; 95% CI, 1.62-4.68). This association increased (OR=3.26; 95% CI, 2.07-5.13) when hyperhomocysteinaemia was taken as > or =12 micromol/L, with a significant difference of 27% (95% CI, 16.59-37.41) (P<.0001) between cases (51.75%, 59/114) and controls (24.75%, 73/295). CONCLUSIONS The risk factor of hyperhomocysteinaemia > or =15 micromol/L was significantly associated (OR=2.76) with chronic ischaemic heart disease. This association was greater (OR=3.26) when hyperhomocysteinaemia was taken as > or =12 micromol/L.
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Affiliation(s)
- R. Gallego-Luis
- Unidad de Lípidos y Prevención Cardiovascular. Área 10 Atención Primaria IMSALUD. Madrid. España
| | - A. Ruiz-García
- Unidad de Lípidos y Prevención Cardiovascular. Área 10 Atención Primaria IMSALUD. Madrid. España
- Correspondencia: A. Ruiz-García. EAP Las Ciudades. Palestina, s/n. 28903 Getafe. Madrid. España.
| | - F.J. Gordillo-López
- Unidad de Lípidos y Prevención Cardiovascular. Área 10 Atención Primaria IMSALUD. Madrid. España
| | - M.V. Díaz-Puente
- Unidad de Lípidos y Prevención Cardiovascular. Área 10 Atención Primaria IMSALUD. Madrid. España
| | - J. Esteban
- Unidad de Docencia e Investigación en Medicina Preventiva y Salud Pública. Facultad de Ciencias de la Salud. Universidad Rey Juan Carlos. Madrid. España
| | - A. Gil de Miguel
- Unidad de Docencia e Investigación en Medicina Preventiva y Salud Pública. Facultad de Ciencias de la Salud. Universidad Rey Juan Carlos. Madrid. España
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Cosín Aguilar J, Hernándiz Martínez A, Rodríguez Padial L, Zamorano Gómez JL, Arístegui Urrestarazu R, Armada Peláez B, Aguilar Llopis A, Masramon Morell X. [Assessment of cardiovascular risk in population groups. Comparison of Score system and Framingham in hypertensive patients]. Rev Clin Esp 2006; 206:182-7. [PMID: 16750089 DOI: 10.1157/13086798] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Calculation of cardiovascular risk in populations allows for developing and assessing of intervention programs and adapting health resources. While the Framingham System has been used in the past, a group of European researchers have proposed a different method called the Score project. The purpose of this paper is to compare the value of both methods for assessing cardiovascular risk. METHODS In 6,775 evaluable hypertensive patients distributed over the 17 Spanish autonomous communities (ACs), the 10-year risk of experiencing a coronary event (CR) was calculated using the Framingham equation, while risk of coronary death (RCD) and vascular death (RVD) was calculated using the Score project system, both at baseline and after one year of blood pressure control with amlodipine at the required dose. A comparison was made of the capacity to detect risk differences by both methods between populations with known different risks, and in the same population as a result of blood pressure control. RESULTS Both the Score and the Framingham systems detected the significant decrease in both CR and RCD or RVD at one year of application of the CORONARIA study protocol. Risk decrease measured by any of the two methods was significant (p < 0.05) overall, by genders, and by ACs. However, the Score System, unlike the Framingham system, could not detect the reported differences in the mortality risk for coronary and vascular disease between the ACs of the North and the South-East parts of Spain.
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Bladé-Creixenti J, Pascual-Moron I, Gómez-Sorribes A, Daniel-Diez J, Piñol-Moreso JL. [Impact on cardiovascular health results of the introduction of the clinical governance contract into primary care in Tarragona]. Aten Primaria 2006; 37:51-5. [PMID: 16545303 PMCID: PMC8149152 DOI: 10.1157/13083941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The objectives of this study are: 1) to determine the improvement in the cardiovascular health of the population after the introduction of the clinical governance contract for primary care team professionals in Tarragona-Reus and the Terres de l'Ebre area (Tarragona province, Spain); 2) to identify the factors predictive of better cardiovascular health after the introduction of the clinical governance contract. The introduction of the clinical governance contract, which is based on professional leadership, feed-back of care information, and monitoring of indicators of cardiovascular risk based on scientific evidence and concretised in clinical practice guidelines, will improve the cardiovascular health results of the reference population. Improvements in indicators of procedure and result are specified in "Material and methods." DESIGN This is a before-and-after, multi-centre study. SETTING Primary health care. PARTICIPANTS Thirty health centres (all the primary care Centres in the area). MAIN MEASUREMENTS Characteristics of the centre. Variables in procedures: indicators of good care practice, calculation of cardiovascular risk, application of clinical practice guidelines (hypertension, diabetes, lipaemia, tobacco and cardiovascular risk) and quality standards for drug prescription. Result variables: cardiovascular risk figures, number of ongoing care visits, hospital emergencies and admissions for angina, heart attack or stroke, and risk factor screenings of the population. DISCUSSION This study is useful, in that clinical governance aims to be a dynamic device to bring professionals into the leadership of health care management and, through monitoring indicators and feeding the findings back to the professionals, to improve health care quality. The study aims to show that management strategy can improve the population s cardiovascular health. The originality of the study lies in the development of a new tool of evaluation based on a novel management strategy for measuring cardiovascular health findings.
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Affiliation(s)
- J Bladé-Creixenti
- Ambit d'Atenció Primària Tarragona-Terres de l'Ebre, Institut Català de la Salut, Spain.
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Pleguezuelos-Cobos E, Guirao-Cano LL, Batlle-Díaz J, Pérez-Mesquida ME, Gual-Coca X. Rehabilitación cardíaca: la gran desconocida. Aten Primaria 2006; 37:179-80. [PMID: 16527146 PMCID: PMC7668810 DOI: 10.1157/13085343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Sala J, Rohlfs I, García MM, Masiá R, Marrugat J. Impacto de la actitud frente a los síntomas en la mortalidad temprana por infarto de miocardio. Rev Esp Cardiol 2005. [DOI: 10.1016/s0300-8932(05)74069-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Colmenero Ruiz M, Reina Toral A, Jiménez Quintana M, Aguayo de Hoyos E, Ruiz Bailén M, García Alcántara A, Álvarez Bueno M, Benítez Parejo J. Variabilidad en el manejo del infarto agudo de miocardio en el registro ARIAM en el año 2002. Med Intensiva 2005. [DOI: 10.1016/s0210-5691(05)74277-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cosín Aguilar J, Rodríguez Padial L, Zamorano Gómez JL, Arístegui Urrestarazu R, Armada Peláez B, Hernándiz Martínez A, Aguilar Llopis A, Masramón Morell X. [Coronary risk differences in hypertensive patients of different autonomous communities. CORONARY study]. Rev Clin Esp 2005; 204:614-25. [PMID: 15710067 DOI: 10.1016/s0014-2565(04)71564-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Various articles describe the existence of differences in cardiovascular morbidity and mortality between different Spanish Autonomous Communities (SACs). We have intended to know if there are coherent differences in hypertensive patients cardiovascular risk. MATERIAL AND METHODS 1,720 family physicians distributed in the 17 SACs as the number of inhabitants of each one selected 5 consecutive patients maximum within a period of 2 months, with blood pressure > or = 140/90 mmHg and at least another coronary risk factor. In 6,775 of 7,469 patients (51% males), the risk of a coronary event (CE) in the next 10 years according to Framingham equation and the risk of fatal cardiovascular event (RCV) according to Score formula were calculated. RESULTS CE calculated in the group of patients in primary prevention (and without diabetes) in northern SACs (Cantábrico) was 18.8%, and 20.5% in south-east SACs (Mediterranean) (p < 0.0001). In addition, CE in secondary prevention was 26.1% in northern SACs and 28.6% in south-east SACs (p < 0.0001). The differences remained upon considering diabetics in primary prevention. There were no significant differences, however, in the risk of cardiovascular death (Score) between both areas, being 8.9% in the north and 8.8% in the south-east. CONCLUSIONS Our study demonstrates that coronary risk is increased in hypertensive populations of south east SACs with respect to SACs of the north and to national average, while the risk of suffering a fatal cardiovascular event is not different.
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Martí H, Pérez-Bárcena J, Fiol M, Marrugat J, Navarro C, Aldasoro E, Cabadés A, Segura A, Masiá R, Turumbay J, Cirera L, Arteagoitia JM, Tomás CA, Vega G, Sala J, de los Arcos E, Tormo MJ, Hurtado-de-Saracho I, Francés-Sempere M, Elosua R. Análisis de la asociación entre un tratamiento y un acontecimiento de interés en estudios observacionales utilizando la probabilidad de recibir el tratamiento (Propensity Score). Un ejemplo con la reperfusión miocárdica. Rev Esp Cardiol 2005. [DOI: 10.1157/13071886] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ahumada M, Cabadés A, Valencia J, Cebrián J, Payá E, Morillas P, Sogorb F, Francés M, Cardona J, Guardiola F. El reinfarto como complicación del infarto agudo de miocardio. Datos del registro PRIMVAC. Rev Esp Cardiol 2005. [DOI: 10.1157/13070503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Marrugat J, García M, Elosua R, Aldasoro E, Tormo MJ, Zurriaga O, Arós F, Masiá R, Sanz G, Valle V, López De Sá E, Sala J, Segura A, Rubert C, Moreno C, Cabadés A, Molina L, López-Sendón JL, Gil M. Short-term (28 days) prognosis between genders according to the type of coronary event (Q-wave versus non-Q-wave acute myocardial infarction versus unstable angina pectoris). Am J Cardiol 2004; 94:1161-5. [PMID: 15518611 DOI: 10.1016/j.amjcard.2004.07.084] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Revised: 07/14/2004] [Accepted: 07/14/2004] [Indexed: 11/29/2022]
Abstract
The type of acute coronary syndrome may account for different prognoses between men and women after myocardial infarction. This study assessed gender differences in 28-day mortality rates for first or recurrent Q-wave and non-Q-wave myocardial infarctions and unstable angina by using data from 5 registries that included 20,836 patients (24.8% women). Mortality rates were higher in women with first Q-wave myocardial infarction but not in the other patients after adjusting for confounding variables.
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Affiliation(s)
- Jaume Marrugat
- Institut Municipal d'Investigació Mèdica, Barcelona, Spain.
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de la Hera JM, Barriales V, Moris C, Alvarez Tamargo JA, Rubín J, Barriales-Villa R, Sanmartín JC, Rodríguez Lambert JL. [Myocardial Infarction Registry in Asturias: the RIMAS project]. Med Clin (Barc) 2004; 123:169-73. [PMID: 15274794 DOI: 10.1016/s0025-7753(04)74450-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Spanish hospital registers of myocardial infarction (MI) are not uniform. The RIMAS project is trying to know the real situation of myocardial infarction in Asturias and to observe possible differences among hospitals and with other registers. PATIENTS AND METHOD It was a cohorts study using a hospital registry of patients with MI. All cases arriving alive to all public and private-public Asturian hospitals during 1998 were included. Demographic data, cardiovascular risk factors, delays, evolution, treatments and techniques used, were all registered. RESULTS 875 cases were registered with a coverage rate of 77%. The average age was 66.5 years (45.6% older than 70 years) and women represented 29.1%. Sixty three per cent of the patients had tobacco consumption, 43% had arterial hypertension, and 22.3% were diabetics. The extrahospital delay was 135 min and thrombolysis delay was 180 min. Thrombolytic therapy was administered to 34.1% of patients and 4% were treated with primary angioplasty. Intrahospital mortality was 14.4%. At discharge, antiagregant therapy was administrated to 94%, betablockers to 43.2%, ACE inhibitors to 33.3% and hypolipemiants to 25% of treated patients. CONCLUSIONS People attended in Asturias with a MI are older and there is a higher percentage of women. There are delays which include the start of thrombolytic therapy. However, there are significant differences with regard to the adhesion to clinical practice guidelines between different hospitals.
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Affiliation(s)
- Jesús M de la Hera
- Servicio de Cardiología, Hospital Carmen y Severo Ochoa, Cangas del Narcea, Asturias, Spain.
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Boix Martínez R, Aragonés Sanz N, Medrano Albero MJ. [Trends in mortality from ischemic heart disease in 50 Spanish provinces]. Rev Esp Cardiol 2004; 56:850-6. [PMID: 14519271 DOI: 10.1016/s0300-8932(03)76972-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES Ischemic heart disease is the leading cause of cardiovascular mortality and the second most frequent cause in women in Spain. It is responsible for 12% and 10%, respectively, of all-cause mortality. Our aim was to identify those provinces where recent trends differ significantly from the overall national pattern of decreasing rates in recent years, and where intervention is probably needed. PATIENTS AND METHOD We report mortality trends due to ischemic heart disease for the periods 1988-1991 and 1994-1997 for each province in persons aged 35 to 64 years, and mortality trends in Spain in the last 19 years for all age groups. Data for ischemic heart disease mortality were obtained from files supplied by the Spanish National Institute for Statistics. Mortality rates in the two 4-year periods were compared with log-linear Poisson regression models to estimate trends. Age-adjusted and mortality hazard-rates are presented with 95% CI, and time trends and geographical variations are also reported. RESULTS The highest rates were seen at Andalucia (south), Levante (east) and the oversea provinces (Balearic [Mediterranean] and Canary Islands [Atlantic]). There were considerable geographical differences in mortality rates. Time trends showed a decrease in men in 27 provinces and a decrease in women in 12 provinces. Overall mortality trends decreased in the last 19 years in Spain. CONCLUSIONS Although the general trend is toward a decrease, there are differences between provinces in Spain. The previously reported North-South gradient and regional discrepancies were confirmed.
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Affiliation(s)
- Raquel Boix Martínez
- Centro Nacional de Epidemiología. Instituto de Salud Carlos III. Madrid. España.
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García J, Elosua R, Tormo Díaz MJ, Audicana Uriarte C, Zurriaga O, Segura A, Fiol M, Moreno-Iribas C, Alonso E, Bosch S, Vega G, Sala J, Marrugat J. [Myocardial infarction. Population case-fatality in seven Spanish autonomous communities: the IBERICA Study]. Med Clin (Barc) 2004; 121:606-12. [PMID: 14636534 DOI: 10.1016/s0025-7753(03)74031-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE The magnitude of the problem of myocardial infarction (MI) is better understood by assessing the population case-fatality than by analyzing only the number of patients attending hospitals. PATIENTS AND METHOD Our data come from the IBERICA Study (Investigation, Specific Search and Registry of Acute Myocardial Ischemic Syndrome). Twenty eight-day MI population case-fatality is described in the population aged 25 to 74 years during 1997 and 1998 in the following Spanish autonomous communities: Castilla-La Mancha (Toledo and Albacete), Catalonia (Girona), Valencia Community (Valencia), Balearic Islands (Majorca), Murcia, Navarra and Basque Country. The relationship between case-fatality and other variables such as sex, age and geographic area is also analyzed. RESULTS A total of 10,660 MI cases were registered, 4,106 of whom died within the period of 28 days following the onset of symptoms (38.5%; CI 95%, 37.6-39.4%). The overall case-fatality was 37.0% (CI 95%, 35.9-38.0%) in men and 44.3% (CI 95%, 42.3-46.4%) in women. Death occurred out of hospitals in 2,869 (69.9%) cases. An increased case-fatality in women was associated with a higher in-hospital case-fatality (45% higher than men). The proportion of patients who died before reaching a hospital was similar in both genders. Classical symptoms of MI were more common among men than women (82.7% vs. 77.6%, p < 0,001). The interval between symptoms' onset and hospitalization was 30 minute longer among hospitalized women as compared with men (p < 0,001). CONCLUSIONS Population MI case-fatality is high in the seven Spanish autonomous communities studied. Approximately 2 out of 3 deaths occur without patients being able to reach a hospital. These results emphasize the importance of primary and secondary prevention measures and the necessity to design ready-access systems to defibrillation and resuscitation manoeuvres for patients with cardiopulmonary arrest.
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Affiliation(s)
- José García
- Servicio de Epidemiología. Consejería de Sanidad y Consumo. Murcia. España.
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Álvarez-León EE, Elosua R, Zamora A, Aldasoro E, Galcerá J, Vanaclocha H, Segura A, Fiol M, Turumbay J, Pérez G, Arteagoitia JM, Tormo MJ, Cabadés A, Vega G, Ayestarán JI, García V, Hurtado-de-Saracho I, Navarro C, Zurriaga O, Muñiz J, Sala J, Marrugat J. Recursos hospitalarios y letalidad por infarto de miocardio. Estudio IBERICA. Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77142-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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de Velasco JA, Cosín J, de Oya M, de Teresa E. Programa de intervención para mejorar la prevención secundaria del infarto de miocardio. Resultados del estudio PRESENTE (PREvención SEcuNdaria TEmprana). Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77077-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Efecto de un programa sencillo de educación de los profesionales en el cumplimiento de medidas de prevención secundaria en el momento del alta hospitalaria tras un síndrome coronario agudo. Proyecto CAM. Rev Esp Cardiol (Engl Ed) 2004. [DOI: 10.1016/s0300-8932(04)77237-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Valencia J, Cabadés A, Ahumada M, Gómez L, Cebrián J, Payá E, Echanove I, Sanjuán R, Antón C, González E. Mortalidad del infarto de miocardio en el registro PRIMVAC. Factores pronósticos. Med Clin (Barc) 2004; 122:561-5. [PMID: 15144742 DOI: 10.1016/s0025-7753(04)74309-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to determine the mortality due to acute myocardial infarction in the coronary units from Comunidad Valenciana (Spain) and the prognostic factors associated with a higher mortality. PATIENTS AND METHOD Demographic characteristics, coronary risk factors, electrocardiographic ischemic signs, complications and mortality of patients with acute myocardial infarction admitted in the coronary units were collected. The study period comprised January 1995-December 1999. Death incidence was measured during coronary unit's stay. Factors associated with poor prognosis were analyzed. RESULTS 10.213 patients entered into the study. Mean age at admission was 65 12 years. 23.8% were females (76.2% males). Global mortality in coronary units was 13.3%. Independent variables associated with higher mortality were (p < 0.05): advanced age (OR=1.06 [1.05-1.06]), female sex (OR=1.45 [1.26-1.66]), diabetes mellitus (OR=1.53 [1.35-1.74]), previous myocardial infarction (OR=1.46 [1.23-1.70]), previous angor pectoris (OR=1.29 [1.13-1.49]) and Q-wave infarction (OR=1.23 [1.03-1.43]). Factors associated with lower mortality were: hypercholesterolemia (OR=0.76 [0.66-0.78]), smoking (OR=0.65 [0.57-0.74]) and thrombolysis (OR=0.85 [0.78-0.92]). CONCLUSIONS At present, in the reperfusion therapy era, acute myocardial infarction has a high mortality after coronary unit admission. Several clinical factors are associated with a worse prognosis.
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Santaló M, Benito S, Vázquez G. [Myocardial infarction: fibrinolytic treatment in the emergency room]. Med Clin (Barc) 2003; 121:221-7. [PMID: 12882734 DOI: 10.1016/s0025-7753(03)73912-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Miguel Santaló
- Departamento de Medicina Interna y Urgencias. Hospital de Sant Pau. Universitat Autònoma de Barcelona. Barcelona. España.
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Bosch X, López De Sá E, López Sendón J, Aboal J, Miranda-Guardiola F, Bethencourt A, Rubio R, Moreno R, Martín Jadraque L, Roldán I, Calviño R, Valle V, Malpartida F. [Clinical characteristics, prognosis, and variability in the management of non-ST-segment elevation acute coronary syndromes. Data from the PEPA registry]. Rev Esp Cardiol 2003; 56:346-53. [PMID: 12689568 DOI: 10.1016/s0300-8932(03)76877-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess the clinical characteristics and inter-hospital variability in the treatment and prognosis of patients with non-ST-segment elevation acute coronary syndromes. PATIENTS AND METHOD Data from the PEPA study, a prospective registry that enrolled 4,115 patients in 18 Spanish hospitals, were analyzed. RESULTS The mean age of the patients enrolled was 65 years, 33% were women, and 26% had diabetes. Large differences were observed in the clinical profile of patients admitted to different centers, especially relative the history of previous disease, prior coronary revascularization, and co-morbidity. Antiplatelet treatment was used in 93% of patients, heparin in 45%, beta-blockers in 42%, nitrates in 67%, and calcium antagonists in 46%. During hospitalization, exercise stress testing was performed in 37% of patients, coronary angiography in 32%, coronary angioplasty in 9%, and coronary surgery in 4%. Inter-hospital variability was minimal for the use of antiplatelet agents, wide for the use of heparin and beta-blockers, and huge for the use of revascularization procedures. Mortality and the incidence of death or myocardial infarction were 2.6% and 4.4% during hospitalization, and 4.6% and 8% at 3 months, with wide inter-hospital variability. These differences were not significant once adjusted for clinical characteristics and the treatment received at admission. CONCLUSIONS Patients with non-ST-segment elevation acute coronary syndromes represent an heterogeneous group with a high incidence of complications. Pharmacologic and, especially, invasive treatment varies widely in different hospitals. These results underline the importance of correct initial risk stratification and uniform treatment following the recommendations of clinical guidelines.
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Affiliation(s)
- Xavier Bosch
- Servicio de Cardiología. Institut de Malalties Cardiovasculars. Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Barcelona. España.
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Bosch X, Pérez J, Ferrer E, Ortiz J, Pérez-Alba JC, Heras M, Sanz G, Betriu A. [Clinical characteristics, management, and prognosis of patients with acute myocardial infarction not admitted to the coronary care unit. Usefulness of an intermediate care unit as the initial admission site]. Rev Esp Cardiol 2003; 56:262-70. [PMID: 12622956 DOI: 10.1016/s0300-8932(03)76862-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES There is little information about the management and prognosis of patients with acute myocardial infarction (AMI) who are not admitted to coronary care units (CCU) because of the lack of available beds. The aim of this study was to evaluate the characteristics and prognosis of the patients who were admitted to the intermediate care unit (INTCU) of a cardiology department. METHODS We compared the clinical profile, management, and 12-month prognosis of the patients admitted to the INTCU or general ward (Ward) instead of the CCU. RESULTS Out of 242 patients with AMI, 62 (23%) were not admitted to the CCU due to the lack of available beds. Of these, 29 (12%) were admitted to the INTCU and 26 (11%) to the Ward after being monitored for at least 24 h in the emergency room. Patients admitted to the CCU arrived at the hospital early, were younger, less frequently female, and had a lower prevalence of diabetes. ST-segment elevation AMI was more frequent in patients admitted to the CCU than in patients admitted to the INTCU or Ward (67 vs 17 and 23%, respectively; p < 0.0001), and non-Q wave AMI was less frequent (30 vs 76 and 81%; p < 0.0001). No differences were found between groups in the number of stress tests or revascularization procedures performed after the first 24 h, the duration of the hospital stay (median 8 days), or in-hospital mortality. The 12-month survival was 82, 80, and 64% in the patients admitted to the CCU, INTCU, or Ward (p < 0.05), respectively. These differences ceased to be significant after adjusting for the patients' baseline clinical profile and treatment received at admission. CONCLUSION Compared to patients with AMI admitted to the CCU, patients admitted to the INTCU or Ward after being monitored at least 24 h had non-ST elevation and non-Q wave AMI more frequently, but a less favorable risk profile for long-term mortality. The different types of AMI were managed similarly and had a similar 12-month prognosis. Intermediate care units may be useful for palliating the lack of CCU beds and care for some patients with AMI.
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Affiliation(s)
- Xavier Bosch
- Institut de Malalties Cardiovasculars. Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Departament de Medicina. Universitat de Barcelona. Barcelona. España.
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