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Fabbian F, Bhatia S, De Giorgi A, Maietti E, Bhatia S, Shanbhag A, Deshmukh A. Circadian Periodicity of Ischemic Heart Disease: A Systematic Review of the Literature. Heart Fail Clin 2017; 13:673-680. [PMID: 28865776 DOI: 10.1016/j.hfc.2017.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The authors performed a MEDLINE search to identify reports, published during the last 20 years, focused on circadian variation of acute myocardial infarction (AMI), and prevalence and the ratios between the number of events per hour during the morning and the other hours of the day were calculated. Despite the optimization of interventional and medical therapy of AMI since the first reports of circadian patterns in AMI occurrence, it was found that such a pattern still exists and that AMI happens most frequently in the morning hours.
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Affiliation(s)
- Fabio Fabbian
- Department of Medical Sciences, University of Ferrara, University Hospital St. Anna, Via Aldo Moro 8, I-44124, Cona, Ferrara, Italy.
| | - Subir Bhatia
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Afredo De Giorgi
- Department of Medical Sciences, University of Ferrara, University Hospital St. Anna, Via Aldo Moro 8, I-44124, Cona, Ferrara, Italy
| | - Elisa Maietti
- Department of Medical Sciences, University of Ferrara, Center for Clinical Epidemiology, 44121 Ferrara, Italy
| | - Sravya Bhatia
- School of Medicine, Duke University, 8 Duke University Medical Center Greenspace, Durham, NC 27703, USA
| | - Anusha Shanbhag
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA
| | - Abhishek Deshmukh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, 200 First Street Southwest, Rochester, Minnesota 55905, USA
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Manfredini R, Eagle KA, Bossone E. Acute myocardial infarction and tako-tsubo cardiomyopathy: could time of onset help to diagnose? Expert Rev Cardiovasc Ther 2014; 9:123-6. [DOI: 10.1586/erc.10.183] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jiddou MR, Pica M, Boura J, Qu L, Franklin BA. Incidence of myocardial infarction with shifts to and from daylight savings time. Am J Cardiol 2013; 111:631-5. [PMID: 23228926 DOI: 10.1016/j.amjcard.2012.11.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 11/14/2012] [Accepted: 11/14/2012] [Indexed: 12/11/2022]
Abstract
Modulators of normal bodily functions such as the duration and quality of sleep might transiently influence cardiovascular risk. The transition to daylight savings time (DST) has been associated with a short-term increased incidence ratio (IR) of acute myocardial infarction (AMI). The present retrospective study examined the IR of AMIs that presented to our hospitals the week after DST and after the autumn switch to standard time, October 2006 to April 2012, with specific reference to the AMI type. Our study population (n = 935 patients; 59% men, 41% women) was obtained from the electronic medical records of the Royal Oak and Troy campuses of the Beaumont Hospitals in Michigan. Overall, the frequency of AMI was similar in the spring and autumn, 463 (49.5%) and 472 (50.5%), respectively. The IR for the first week after the spring shift was 1.17 (95% confidence interval 1.00 to 1.36). After the transition from DST in the autumn, the IR for the same period was lower, but not significantly different, 0.99 (95% confidence interval 0.85 to 1.16). Nevertheless, the greatest increase in AMI occurred on the first day (Sunday) after the spring shift to DST (1.71, 95% confidence interval 1.09 to 2.02; p <0.05). Also, a significantly greater incidence was found of non-ST-segment myocardial infarction after the transition to DST in the study group compared with that in the control group (p = 0.022). In conclusion, these data suggest that shifts to and from DST might transiently affect the incidence and type of acute cardiac events, albeit modestly.
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Christensen AL, Lundbye-Christensen S, Overvad K, Rasmussen LH, Dethlefsen C. Modeling gradually changing seasonal variation in count data using state space models: a cohort study of hospitalization rates of stroke in atrial fibrillation patients in Denmark from 1977 to 2011. BMC Med Res Methodol 2012; 12:174. [PMID: 23167658 PMCID: PMC3573905 DOI: 10.1186/1471-2288-12-174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 11/14/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Seasonal variation in the occurrence of cardiovascular diseases has been recognized for decades. In particular, incidence rates of hospitalization with atrial fibrillation (AF) and stroke have shown to exhibit a seasonal variation. Stroke in AF patients is common and often severe. Obtaining a description of a possible seasonal variation in the occurrence of stroke in AF patients is crucial in clarifying risk factors for developing stroke and initiating prophylaxis treatment. METHODS Using a dynamic generalized linear model we were able to model gradually changing seasonal variation in hospitalization rates of stroke in AF patients from 1977 to 2011. The study population consisted of all Danes registered with a diagnosis of AF comprising 270,017 subjects. During follow-up, 39,632 subjects were hospitalized with stroke. Incidence rates of stroke in AF patients were analyzed assuming the seasonal variation being a sum of two sinusoids and a local linear trend. RESULTS The results showed that the peak-to-trough ratio decreased from 1.25 to 1.16 during the study period, and that the times of year for peak and trough changed slightly. CONCLUSION The present study indicates that using dynamic generalized linear models provides a flexible modeling approach for studying changes in seasonal variation of stroke in AF patients and yields plausible results.
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Affiliation(s)
- Anette L Christensen
- Department of Cardiology, Aalborg AF Study Group, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Søren Lundbye-Christensen
- Department of Cardiology, Aalborg AF Study Group, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Kim Overvad
- Department of Cardiology, Aalborg AF Study Group, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
- Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark
| | - Lars H Rasmussen
- Department of Cardiology, Aalborg AF Study Group, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
- Thrombosis Research Unit, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Claus Dethlefsen
- Department of Cardiology, Aalborg AF Study Group, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
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Manfredini R, Boari B, Salmi R, Fabbian F, Pala M, Tiseo R, Portaluppi F. Twenty-four-hour patterns in occurrence and pathophysiology of acute cardiovascular events and ischemic heart disease. Chronobiol Int 2012; 30:6-16. [PMID: 23002808 DOI: 10.3109/07420528.2012.715843] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The scientific literature clearly establishes the occurrence of cardiovascular (CV) accidents and myocardial ischemic episodes is unevenly distributed during the 24 h. Such temporal patterns result from corresponding temporal variation in pathophysiologic mechanisms and cyclic environmental triggers that elicit the onset of clinical events. Moreover, both the pharmacokinetics and pharmacodynamics of many, though not all, CV medications have been shown to be influenced by the circadian time of their administration, even though further studies are necessary to better clarify the mechanisms of such influence on different drug classes, drug molecules, and pharmaceutical preparations. Twenty-four-hour rhythmic organization of CV functions is such that defense mechanisms against acute events are incapable of providing the same degree of protection during the day and night. Instead, temporal gates of excessive susceptibility exist, particularly in the morning and to a lesser extent evening (in diurnally active persons), to aggressive mechanisms through which overt clinical manifestations may be triggered. When peak levels of critical physiologic variables, such as blood pressure (BP), heart rate (HR), rate pressure product (systolic BP × HR, surrogate measure of myocardial oxygen demand), sympathetic activation, and plasma levels of endogenous vasoconstricting substances, are aligned together at the same circadian time, the risk of acute events becomes significantly elevated such that even relatively minor and usually harmless physical and mental stress and environmental phenomena can precipitate dramatic life-threatening clinical manifestations. Hence, the delivery of CV medications needs to be synchronized in time, i.e., circadian time, in proportion to need as determined by established temporal patterns in risk of CV events, and in a manner that averts or minimizes undesired side effects.
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Affiliation(s)
- Roberto Manfredini
- Section of Clinica Medica, Department of Clinical and Experimental Medicine, University of Ferrara, Via Savonarola 9, Ferrara, Italy
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Holmes DR, Aguirre FV, Aplin R, Lennon RJ, Nestler DM, Bell MR, Rihal CS, Ting HH. Circadian rhythms in patients with ST-elevation myocardial infarction. Circ Cardiovasc Qual Outcomes 2010; 3:382-9. [PMID: 20570918 DOI: 10.1161/circoutcomes.109.913343] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Circadian rhythms with regard to time of symptom onset for patients with acute myocardial infarction have been observed, although their relationship to outcomes has been debated. We evaluated these rhythms in patients with ST-elevation myocardial infarction as a function of the 24-hour circadian cycle. METHODS AND RESULTS The relationship between onset of symptoms during the 24-hour circadian cycle and prehospital delays from symptom onset to hospital arrival, timeliness of reperfusion, and in-hospital death was assessed in 2143 patients with ST-elevation myocardial infarction presenting from 2004-2008 at 1 of 3 tertiary-care healthcare ST-elevation myocardial infarction systems. There was a significant association between time of onset and the circadian cycle, with the greatest percentage (39%) of patients experiencing onset between 8 AM and 3 PM (P<0.001). Time of onset was associated with prehospital delay and timeliness of reperfusion. Patients with onset from 12 AM to 5:59 AM had median prehospital delays of 121 minutes versus 70 minutes from 12 PM to 5:59 PM (P<0.001). Patients with onset time from 12 AM to 5:59 AM had median door-to-balloon times of 75 minutes versus 60 minutes from 6 AM to 11:59 AM (P<0.001). Using multivariable modeling to control for baseline patient characteristics, prehospital delay, and timeliness of reperfusion, there was no significant association between time of symptom onset with in-hospital death. CONCLUSIONS Patients with ST-elevation myocardial infarction exhibit significant circadian patterns in symptom onset, prehospital delay, and timeliness of reperfusion. Patients who develop symptoms from 12 AM to 5:59 AM present with longer prehospital delays and have longer door-to-balloon times. After multivariable adjustment, there was no significant association between circadian patterns of time of onset and in-hospital death.
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Manfredini R, Manfredini F, Boari B, Bergami E, Mari E, Gamberini S, Salmi R, Gallerani M. Seasonal and weekly patterns of hospital admissions for nonfatal and fatal myocardial infarction. Am J Emerg Med 2010; 27:1097-103. [PMID: 19931757 DOI: 10.1016/j.ajem.2008.08.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 08/11/2008] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This retrospective study, based on the database of hospital admissions of the region Emilia-Romagna [RER], Italy, was aimed to confirm the existence of a seasonal or weekly pattern of hospital admission of acute myocardial infarction (AMI) and to verify possible differences between nonfatal or fatal cases. METHODS The study included all cases of patients with AMI hospitalized between 1998 and 2006. Day of admission was categorized, respectively, into four 3-month intervals, into twelve 1-month intervals, and into seven 1-day intervals for statistical analysis, performed by chi(2) test goodness of fit and partial Fourier series on total cases, males, females, and nonfatal and fatal cases. RESULTS The database included 64 191 cases of AMI (62.9% males, 12.3% fatal). Acute myocardial infarction was most frequent in winter and least in summer (P < .0001). The highest number of cases was recorded in January and the lowest in July (P < .0001). Chronobiologic analysis showed winter peaks for total cases (January, P = .035), females (December, P = .009), and fatal cases (January, P < .001). Acute myocardial infarction was most frequent on Monday and least on Sunday (P < .0001). Comparing observed vs expected events, there was a significantly higher frequency of cases on weekdays and reduced on weekends, for total (P < .0001), nonfatal (P < .0001), and fatal cases (P = .0001). CONCLUSIONS This study confirms a significantly higher frequency of AMI admissions in winter and on a Monday. No difference in the frequency of nonfatal vs fatal events, depending of patients' admissions on weekdays or weekends, was found.
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Affiliation(s)
- Roberto Manfredini
- Department of Clinical and Experimental Medicine, Section Clinica Medica and Vascular Diseases Center, University of Ferrara, 44100 Ferrara, Italy.
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Citro R, Previtali M, Bovelli D, Vriz O, Astarita C, Patella MM, Provenza G, Armentano C, Ciampi Q, Gregorio G, Piepoli M, Bossone E, Manfredini R. Chronobiological patterns of onset of Tako-Tsubo cardiomyopathy: a multicenter Italian study. J Am Coll Cardiol 2009; 28:715-9. [PMID: 19573739 DOI: 10.1016/j.ajem.2009.04.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 03/30/2009] [Accepted: 04/16/2009] [Indexed: 12/15/2022]
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Manfredini R, Manfredini F, Boari B, Malagoni AM, Gamberini S, Salmi R, Gallerani M. Temporal Patterns of Hospital Admissions for Transient Ischemic Attack: A Retrospective Population-based Study in the Emilia-Romagna Region of Italy. Clin Appl Thromb Hemost 2009; 16:153-60. [DOI: 10.1177/1076029609332111] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acute cerebrovascular events are not randomly distributed over time but show specific temporal patterns of occurrence. However, most studies focused stroke and little is known about transient ischemic attack. This study aimed to explore the existence of a temporal pattern of transient ischemic attack and the possible influence by the most common risk factors. The analysis included all hospital admissions with the ICD9-CM code for TIA, recorded in the database of the Emilia Romagna region of Italy (1998-2006; n = 43642, mean age 76.8 ± 11.5 years, 45.5% males). Transient ischemic attack was most frequent in autumn and winter and less common in spring and summer (P < 0.0001), with the highest number of cases in October and the lowest in February, and also most frequent on Monday (P < 0.0001). This study shows a seasonal and weekly pattern in occurrence of transient ischemic attack, independent of sex and the presence of the most common risk factors.
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Affiliation(s)
- Roberto Manfredini
- Department of Clinical and Experimental Medicine, Clinica Medica and Vascular Diseases Center,
| | - Fabio Manfredini
- Department of Vascular Rehabilitation and Vascular Diseases Center, University of Ferrara, Italy
| | | | - Anna Maria Malagoni
- Department of Vascular Rehabilitation and Vascular Diseases Center, University of Ferrara, Italy
| | - Susanna Gamberini
- Department of Internal Medicine, Hospital of the Delta, Lagosanto, Azienda U. S. L, Ferrara, Italy
| | | | - Massimo Gallerani
- Department of Clinical and Experimental Medicine, Clinica Medica and Vascular Diseases Center
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