1
|
Gaidai O, Sheng J, Cao Y, Zhang F, Zhu Y, Loginov S. Public health system sustainability assessment by Gaidai hypersurface approach. Curr Probl Cardiol 2024; 49:102391. [PMID: 38244882 DOI: 10.1016/j.cpcardiol.2024.102391] [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: 01/04/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND to determine extreme cardiovascular and cancer diseases deathrate risks at any time in any region of interest. DESIGN Apply modern novel statistical methods to raw clinical surveillance data. METHODS multi-centre, population-based, medical survey data-based bio statistical approach. For this study, cardiovascular and cancer diseases annual recorded deaths numbers in all 195 world countries have been selected, constituting 390D (390-dimensional) biosystem. It is challenging to model such phenomena. RESULTS this paper describes a novel bio-system reliability approach, particularly suitable for multi-regional environmental and health systems, observed over a sufficient timelapse. Traditional statistical methods dealing with temporal observations of multi-regional processes do not have the advantage of dealing efficiently with extensive regional dimensionality. The suggested methodology coped with this challenge well. CONCLUSIONS the suggested methodology may be used in various public health applications, based on raw clinical survey data.
Collapse
Affiliation(s)
| | - Jinlu Sheng
- Chongqing JiaoTong University, Chongqing, China
| | - Yu Cao
- Shanghai Ocean University, Shanghai, China
| | - Fuxi Zhang
- Shanghai Ocean University, Shanghai, China
| | - Yan Zhu
- Jiangsu University of Science and Technology, Zhenjiang, China
| | | |
Collapse
|
2
|
Grave C, Gabet A, Cinaud A, Tuppin P, Blacher J, Olié V. Nationwide time trends in patients hospitalized for acute coronary syndrome: a worrying generational and social effect among women. Eur J Prev Cardiol 2024; 31:116-127. [PMID: 37794752 DOI: 10.1093/eurjpc/zwad288] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 10/06/2023]
Abstract
AIMS To estimate the time trends in the annual incidence of patients hospitalized for acute coronary syndrome (ACS) in France from 2009 to 2021 and to analyse the current sex and social differences in ACS, management, and prognosis. METHODS AND RESULTS All patients hospitalized for ACS in France were selected from the comprehensive National Health Insurance database. Age-standardized rates were computed overall and according to age group (over or under 65 years), sex, proxy of socioeconomic status, and ACS subtype [ST-segment elevation (STSE) and non-ST-segment elevation]. Patient characteristics and outcomes were described for patients hospitalized in 2019. Differences in management (coronarography, revascularization), and prognosis were analysed by sex, adjusting for cofonders. In 2019, 143,670 patients were hospitalized for ACS, including 53,227 STSE-ACS (mean age = 68.8 years; 32% women). Higher standardized incidence rates among the most socially deprived people were observed. Women were less likely to receive coronarography and revascularization but had a higher excess in-hospital mortality. In 2019, the age-standardized rate for hospitalized ACS patients reached 210 per 100 000 person-year. Between 2009 and 2019, these rates decreased by 11.4% (men: -11.2%; women: -14.0%). Differences in trends of age-standardized incidence rate have been observed according to sex, age, and social status. Middle aged women (45-64 years) showing more unfavourable trends than in other age classes or in men. In addition, among women the temporal trends were more unfavourable as social deprivation increased. CONCLUSION Despite encouraging overall trends in patients hospitalized for ACS rates, the increasing trends observed among middle-aged women, especially socially deprived women, is worrying. Targeted cardiovascular prevention and close surveillance of this population should be encouraged.
Collapse
Affiliation(s)
- Clémence Grave
- Surveillance des maladies cardio-neuro-vasculaires, Direction des maladies non transmissibles, Santé publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France
| | - Amélie Gabet
- Surveillance des maladies cardio-neuro-vasculaires, Direction des maladies non transmissibles, Santé publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France
| | - Alexandre Cinaud
- Centre de diagnostic et de thérapeutique, Hôpital Hôtel-Dieu AP-HP, Université Paris Cité, Paris, France
| | - Philippe Tuppin
- Direction de la stratégie, des études et des statistiques, Caisse Nationale de l'Assurance Maladie, Paris, France
| | - Jacques Blacher
- Centre de diagnostic et de thérapeutique, Hôpital Hôtel-Dieu AP-HP, Université Paris Cité, Paris, France
| | - Valérie Olié
- Surveillance des maladies cardio-neuro-vasculaires, Direction des maladies non transmissibles, Santé publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France
| |
Collapse
|
3
|
Ravn PB, Falkentoft AC, Garred CAH, Bruhn J, Christensen DM, Sehested TSG, Gislason GH, Køber L, Olsen NT, Torp-Petersen C, Fosbøl E, Bruun NE, Schou M, Ruwald AC. Temporal trends in major cardiovascular events following first-time myocardial infarction in the reperfusion era - a Danish nationwide cohort study from 2000 to 2017. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:268-280. [PMID: 36036480 DOI: 10.1093/ehjqcco/qcac033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 05/17/2023]
Abstract
AIM We investigated temporal trends in major cardiovascular events following first-time myocardial infarction (MI) and trends in revascularization and pharmacotherapy from 2000 to 2017. METHODS AND RESULTS Using nationwide registries, we identified 120 833 Danish patients with a first-time MI between 2000 and 2017. We investigated 30-day and 1-year mortality and the 1-year risk of first-time admission for heart failure (HF) and recurrent MI. Patients were younger with a higher prevalence of hypertension and diabetes in 2015-2017 compared with 2000-2002. The patients were predominantly male (65.6%), and the median age declined by 3 years through the periods. Percutaneous coronary interventions within 7 days after first-time MI increased significantly (2000: 11.4% vs. 2017: 68.6%; Ptrend < 0.001). Cardiovascular medication after first-time MI changed significantly in the same period. Absolute risks and adjusted rates of outcomes were significantly lower in 2015-2017 compared with 2000-2002: 30-day mortality: 6.5% vs. 14.1% [hazard ratio (HR) 0.52, 95% confidence interval (CI): 0.48-0.55); 1-year mortality 10.7% vs. 21.8% (HR 0.52, 95% CI: 0.50-0.55); recurrent MI: 4.0% vs. 7.8% (HR 0.56, 95% CI: 0.51-0.62); and first-time admission for HF: 2.9% vs. 3.7% (HR 0.82, 95% CI: 0.73-0.92). The rates of 30-day/1-year mortality and recurrent MI showed significantly decreasing trends (Ptrend < 0.001). The rates of first-time admission for HF were borderline significant (Ptrend = 0.045). CONCLUSION From 2000 to 2017, we observed a decreasing risk of recurrent MI, first-time admission for HF, and all-cause mortality in patients with a first-time MI. In the same period, we observed a high rate of guideline-recommended pharmacological treatment after first-time MI as well as increasing rate of early revascularization in Denmark. TRANSLATIONAL PERSPECTIVES The results from the current study portrait the risk of all-cause mortality, recurrent MI, and first-time admission for HF in a real-life setting with a very high utilization of early revascularization and guideline-recommended pharmacological therapy. We observed a temporal trend of improved survival, reduced risk of recurrent MI, as well as reduced risk of first-time admission for HF after first-time MI from 2000 through 2017. We observed an increase in the overall use of revascularization, as well as early revascularization and use of guideline-recommended pharmacotherapy. Our study reveals important results from real-life, nationwide data, showing a reduced risk of cardiovascular outcomes after first-time MI during the past 20 years. Current guidelines are based on results from clinical trials. Our real-life results add additionally important knowledge on patients' prognosis after first-time MI and underline the importance of treating MI according to guideline recommendations.
Collapse
Affiliation(s)
- Pauline Bohsen Ravn
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
| | | | - Caroline A H Garred
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Jonas Bruhn
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | | | - Thomas S G Sehested
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
- The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Niels Thue Olsen
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Christian Torp-Petersen
- Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Cardiology, Nordsjællands Hospital, 3400 Hillerød, Denmark
- Department of Biostatistics, University of Copenhagen, 1165 København, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Anne-Christine Ruwald
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
| |
Collapse
|
4
|
Gaidai O, Xing Y, Balakrishna R, Sun J, Bai X. Prediction of death rates for cardiovascular diseases and cancers. CANCER INNOVATION 2023; 2:140-147. [PMID: 38090058 PMCID: PMC10686159 DOI: 10.1002/cai2.47] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/21/2022] [Accepted: 12/20/2022] [Indexed: 01/03/2024]
Abstract
BACKGROUND To estimate cardiovascular and cancer death rates by regions and time periods. DESIGN Novel statistical methods were used to analyze clinical surveillance data. METHODS A multicenter, population-based medical survey was performed. Annual recorded deaths from cardiovascular diseases were analyzed for all 195 countries of the world. It is challenging to model such data; few mathematical models can be applied because cardiovascular disease and cancer data are generally not normally distributed. RESULTS A novel approach to assessing the biosystem reliability is introduced and has been found to be particularly suitable for analyzing multiregion environmental and healthcare systems. While traditional methods for analyzing temporal observations of multiregion processes do not deal with dimensionality efficiently, our methodology has been shown to be able to cope with this challenge. CONCLUSIONS Our novel methodology can be applied to public health and clinical survey data.
Collapse
Affiliation(s)
- Oleg Gaidai
- Shanghai Engineering Research Center of Marine Renewable Energy, College of Engineering Science and TechnologyShanghai Ocean UniversityShanghaiChina
| | - Yihan Xing
- Department of Mechanical and Structural Engineering and Materials ScienceUniversity of StavangerStavangerNorway
| | - Rajiv Balakrishna
- Department of Mechanical and Structural Engineering and Materials ScienceUniversity of StavangerStavangerNorway
| | - Jiayao Sun
- School of Naval Architecture & Ocean EngineeringJiangsu University of Science and TechnologyZhenjiangChina
| | - Xiaolong Bai
- School of Naval Architecture & Ocean EngineeringJiangsu University of Science and TechnologyZhenjiangChina
| |
Collapse
|
5
|
Gaidai O, Cao Y, Loginov S. Global Cardiovascular Diseases Death Rate Prediction. Curr Probl Cardiol 2023; 48:101622. [PMID: 36724816 DOI: 10.1016/j.cpcardiol.2023.101622] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 01/30/2023]
Abstract
Cardiovascular diseases (CVD) are heart and blood vessels diseases with considerable morbidity and mortality and presenting worldwide public health burden, moreover CVDs are the leading cause of death globally. This paper describes a novel bio-system reliability approach, particularly suitable for multi-regional environmental and health systems, observed over a sufficient period of time, resulting in a reliable long-term forecast of cardiovascular diseases mortality probability. Objective has been to determine extreme cardiovascular diseases death rate probability at any time in any region of interest. Traditional statistical methods dealing with temporal observations of multi-regional processes do not have the advantage of dealing efficiently with extensive regional dimensionality and cross-correlation between different regional observations. Design of this analysis was based on applying novel statistical methods directly to a raw clinical data, with subsequent data analysis using multicenter, population-based, medical survey data based bio-statistical approach. For this study, cardiovascular diseases annual numbers of recorded deaths in all 195 world countries were chosen. The suggested methodology can be used in various public health applications, based on their clinical survey data.
Collapse
Affiliation(s)
| | - Yu Cao
- Shanghai Ocean University, Shanghai, China.
| | | |
Collapse
|
6
|
Alsing CL, Nystad TW, Igland J, Gjesdal CG, Midtbø H, Tell GS, Fevang BT. Trends in the occurrence of ischaemic heart disease over time in rheumatoid arthritis: 1821 patients from 1972 to 2017. Scand J Rheumatol 2022; 52:233-242. [PMID: 35272584 DOI: 10.1080/03009742.2022.2040116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate trends of acute myocardial infarction (AMI) and ischaemic heart disease (IHD) in rheumatoid arthritis (RA) patients compared with the general population over time. METHOD We performed a retrospective cohort study of 1821 RA patients diagnosed from 1972 to 2013. Aggregated counts of the total population of the same county (Hordaland, Norway) and period were used for comparison. Information on AMI and IHD events was obtained from hospital patient administrative systems or cardiovascular registries. We estimated incidence rates and excess of events [standardized event ratio (SER) with 95% confidence interval (CI)] compared with the general population by Poisson regression. RESULTS There was an average annual decline of 1.6% in age- and gender-adjusted AMI incidence rates from 1972 to 2017 (p < 0.035). The difference in events (excess events) in RA patients compared with the general population declined on average by 1.3% per year for AMI and by 2.3% for IHD from 1972 to 2014. There were no significant excess AMI (SER 1.05, 95% CI 0.82-1.35) or IHD events (SER 1.02, 95% CI 0.89-1.16) for RA patients diagnosed after 1998 compared with the general population. CONCLUSION Incidence rates and excess events of AMI and IHD in RA patients declined from 1972 to 2017. There were no excess AMI or IHD events in RA patients diagnosed after 1998 compared with the general population.
Collapse
Affiliation(s)
- C L Alsing
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - T W Nystad
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - J Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Science, Bergen, Norway
| | - C G Gjesdal
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - H Midtbø
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - G S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - B T Fevang
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
7
|
Song PS, Kim MJ, Seong SW, Choi SW, Gwon HC, Hur SH, Rha SW, Yoon CH, Jeong MH, Jeong JO. Gender Differences in All-Cause Mortality after Acute Myocardial Infarction: Evidence for a Gender-Age Interaction. J Clin Med 2022; 11:jcm11030541. [PMID: 35159993 PMCID: PMC8837133 DOI: 10.3390/jcm11030541] [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: 12/15/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 12/19/2022] Open
Abstract
Gender difference studies in mortality after acute myocardial infarction (AMI) have shown inconsistent results. A total of 13,104 patients from the KAMIR-NIH between November 2011 and December 2015 were classified into young (n = 3837 [29.3%]) and elderly (n = 9267 [70.7%]) patients. For the study, women <65 and men <55 years of age were considered “young”. In the adjusted model of the entire cohort, there was no significant difference in three-year all-cause mortality between women and men (17.8% vs. 10.3%; adjusted hazard ratio [HR], 0.953; 95% confidence interval [CI], 0.799–1.137). However, when the entire cohort was subdivided into two age groups, young women showed an 84.3% higher mortality rate than young men (adjusted HR, 1.843; 95% CI, 1.098–3.095). Contrariwise, elderly women patients had a 20.4% lower hazard of mortality compared with elderly men (adjusted HR, 0.796; 95% CI, 0.682–0.929). The interaction of gender with age was significant, even after multiple adjustments (adjusted p for interaction = 0.003). The purpose of this study was to assess whether gender differences depend on the patients’ age. Based on our analysis, higher mortality of young women remains even in the contemporary era of AMI. A better understanding of the mechanisms underlying these differences is warranted.
Collapse
Affiliation(s)
- Pil Sang Song
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 305764, Korea; (M.J.K.); (S.-W.S.); (S.W.C.)
- Correspondence: (P.S.S.); (J.-O.J.); Tel./Fax: +82-42-280-8796 (P.S.S. & J.-O.J.)
| | - Mi Joo Kim
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 305764, Korea; (M.J.K.); (S.-W.S.); (S.W.C.)
| | - Seok-Woo Seong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 305764, Korea; (M.J.K.); (S.-W.S.); (S.W.C.)
| | - Si Wan Choi
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 305764, Korea; (M.J.K.); (S.-W.S.); (S.W.C.)
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Seung-Ho Hur
- Cardiovascular Medicine, Keimyung University Dongsan Medical Center, Deagu 41932, Korea;
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Korea;
| | - Chang-Hwan Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
| | - Myung Ho Jeong
- Chonnam National University Hospital, Gwangju 61469, Korea;
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 305764, Korea; (M.J.K.); (S.-W.S.); (S.W.C.)
- Correspondence: (P.S.S.); (J.-O.J.); Tel./Fax: +82-42-280-8796 (P.S.S. & J.-O.J.)
| | | |
Collapse
|
8
|
Krämer C, Meisinger C, Kirchberger I, Heier M, Kuch B, Thilo C, Linseisen J, Amann U. Epidemiological trends in mortality, event rates and case fatality of acute myocardial infarction from 2004 to 2015: results from the KORA MI registry. Ann Med 2021; 53:2142-2152. [PMID: 34779325 PMCID: PMC8604473 DOI: 10.1080/07853890.2021.2002926] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022] Open
Abstract
AIM This study examines epidemiological trends of acute myocardial infarction (AMI) in Germany from 2004-2015 across different age groups, using data of the population-based KORA myocardial infarction registry. METHODS Annual age-standardised, age-group- and sex-specific mortality and event rates (incident and recurrent) per 100,000 population as well as 28-day case fatality were calculated from all registered cases of AMI and coronary heart disease deaths in 25-74-year-olds from 2004-2015 and 75-84-year-olds from 2009-2015. Average annual percentage changes (AAPC) were calculated by joinpoint regression. RESULTS Mortality rates declined considerably among the elderly (75-84 years), in men by -6.0% annually, due to declines of case fatality by -3.0% and incidence rate by 3.4% and in women by -10.0%, driven by declines in incidence (-9.1%) and recurrence rate (-4.9%). Significant mortality declines also occurred in males, 65-74 years of age (AAPC -3.8%). Among the age groups 25-54 years and 55-64 years, there was no substantial decline in mortality, event rates or case fatality except for a decline of incidence rate in 55-64-year-old men (AAPC -1.8%). CONCLUSION Inhomogeneous AMI trends across age-groups indicate progress in prevention and treatment for the population >64 years, while among <55-year-olds, we found no significant trend in AMI morbidity and mortality.KEY MESSAGESAge standardised AMI mortality continued to decline from 2009 to 2015 in the study region.Declines in AMI mortality were driven by declines in event rates (both incidence and recurrence rates) and case fatality.AMI trends were inconsistent across different age groups with the strongest declines in mortality and event rates among the elderly population (75-84 years of age).
Collapse
Affiliation(s)
- Christina Krämer
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Internal Medicine I – Gastroenterology, Oncology and Endocrinology, Hospital of Friedrichshafen, Friedrichshafen, Germany
| | - Christa Meisinger
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Chair of Epidemiology, University of Augsburg at University Hospital Augsburg, Augsburg, Germany
| | - Inge Kirchberger
- Chair of Epidemiology, University of Augsburg at University Hospital Augsburg, Augsburg, Germany
| | - Margit Heier
- KORA Study Centre, University Hospital of Augsburg, Augsburg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Bernhard Kuch
- Department of Internal Medicine I – Cardiology, University Hospital of Augsburg, Augsburg, Germany
- Department of Internal Medicine – Cardiology, Hospital of Nördlingen, Nördlingen, Germany
| | - Christian Thilo
- Department of Medical Clinic I – Cardiology, Hospital of Rosenheim, Rosenheim, Germany
| | - Jakob Linseisen
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- Chair of Epidemiology, University of Augsburg at University Hospital Augsburg, Augsburg, Germany
| | - Ute Amann
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| |
Collapse
|
9
|
Raunsø J, Song RJ, Vasan RS, Bourdillon MT, Nørager B, Torp-Pedersen C, Gislason GH, Xanthakis V, Andersson C. Familial Clustering of Aortic Size, Aneurysms, and Dissections in the Community. Circulation 2020; 142:920-928. [DOI: 10.1161/circulationaha.120.045990] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background:
Ruptured aortic aneurysm and aortic dissections are potentially preventable disorders associated with high mortality. Screening of individuals at risk may translate into elective surgical interventions and lowered mortality. It is uncertain if the risk of aortic dilation of varying degrees aggregates within families.
Methods:
We investigated the risk of having thoracic and abdominal aortic sizes in the highest quartile (measured by computed tomography scans and indexed for body size) if at least 1 parent did so in the Framingham Heart Study cohorts, and estimated the incidence rates and hazard ratios of developing aortic aneurysm or dissection among first-degree relatives of those with aortic aneurysm or dissection, in comparison with age- and sex-matched controls (1:10 for aortic aneurysm and 1:100 for aortic dissection) using the Danish nationwide administrative registries.
Results:
In the Framingham Heart Study, offspring (n=235) whose parent(s) had a sex- and age-standardized aortic size in the upper quartile had a multivariable-adjusted ≈3-fold increased odds ratio of belonging to the upper quartile themselves. In Denmark, a total of 68 939 individuals (mean age, 42 years) had a first-degree relative with aortic aneurysm and 7209 persons (mean age, 39 years) had a first-degree relative with aortic dissection. During an average follow-up of 7 years, first-degree relatives of patients with aortic aneurysm and dissection had a hazard ratio of 6.70 (95% CI, 5.96–7.52) for developing aortic aneurysm and a hazard ratio of 9.24 (95% CI, 5.53–15.44) for dissection in comparison with matched controls. These estimates remained unchanged on adjusting for several comorbidities, including prevalent hypertension, bicuspid aortic valve, and the Marfan syndrome. For both aortic aneurysm and dissections, the absolute event rates approached 1 per 1000 person-years for first-degree relatives versus 11 to 13 (aortic aneurysm) and 2 to 3 (aortic dissections) per 100 000 person-years among controls.
Conclusions:
Increased aortic size, a precursor of aortic aneurysm and a risk factor for dissection, clusters in families. The incidence rates of aortic aneurysm and dissections approach the incidence rates of other common cardiovascular conditions in first-degree relatives, supporting the use of systematic screening for these conditions.
Collapse
Affiliation(s)
- Jakob Raunsø
- Department of Cardiology, Herlev and Gentofte Hospital, Denmark (J.R., B.N.)
| | - Rebecca J. Song
- Department of Epidemiology (R.J.S, R.S.V.), Boston University School of Public Health, MA
| | - Ramachandran S. Vasan
- Department of Epidemiology (R.J.S, R.S.V.), Boston University School of Public Health, MA
- Department of Medicine, Section of Cardiovascular Medicine (R.S.V., C.A.), Boston University Schools of Public Health and Medicine, MA
- Boston University’s and National Heart Lung and Blood Institute’s Framingham Heart Study, MA (R.S.V., V.X., C.A.)
| | | | - Betina Nørager
- Department of Cardiology, Herlev and Gentofte Hospital, Denmark (J.R., B.N.)
| | - Christian Torp-Pedersen
- Department of Clinical Investigation and Cardiology, Nordsjaellands Hospital, Hillerød, Denmark (C.T.-P.)
- Department of Cardiology, Aalborg University Hospital, Denmark (C.T.-P.)
| | - Gunnar H. Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Denmark (G..H.G., C.A.)
- The Danish Heart Foundation, Copenhagen, Denmark (G.H.G.)
| | - Vanessa Xanthakis
- Department of Biostatistics (V.X.), Boston University School of Public Health, MA
- Boston University’s and National Heart Lung and Blood Institute’s Framingham Heart Study, MA (R.S.V., V.X., C.A.)
| | - Charlotte Andersson
- Department of Medicine, Section of Cardiovascular Medicine (R.S.V., C.A.), Boston University Schools of Public Health and Medicine, MA
- Boston University’s and National Heart Lung and Blood Institute’s Framingham Heart Study, MA (R.S.V., V.X., C.A.)
- Department of Cardiology, Herlev and Gentofte Hospital, Denmark (G..H.G., C.A.)
| |
Collapse
|
10
|
Yao J, Xie Y, Liu Y, Tang Y, Xu J. Prediction Factors of 6-Month Poor Prognosis in Acute Myocardial Infarction Patients. Front Cardiovasc Med 2020; 7:130. [PMID: 32903533 PMCID: PMC7438543 DOI: 10.3389/fcvm.2020.00130] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/25/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Acute myocardial infarction (AMI) is among the leading causes of death worldwide. Patients with AMI may have the risk of developing recurrent cardiovascular events leading to rehospitalization or even death. The present study aimed to investigate the prediction factors of poor prognosis (mortality and/or readmission) after AMI during a 6-month follow-up. Methods: A total of 206 consecutive patients hospitalized for the first visit with AMI were enrolled. Data collection included demographic characteristics, medical history, clinical information, laboratory results, and oral medications within 24 h of admission. At 1, 3, and 6 months after discharge, AMI patients were followed up to assess the occurrence of composite endpoint events including in-hospital and out-of-hospital death and/or readmission due to recurrent myocardial infarction (MI) or exacerbated symptoms of heart failure following MI. Results: After 6-month follow-up, a total of 197 AMI patients were available and divided in two groups according to good prognosis (n = 144) and poor prognosis (n = 53). Our data identified serum myoglobin ≥651 ng/mL, serum creatinine ≥96 μM, Killip classification 2–4, and female gender as independent predictors of 6-month mortality and/or readmission after AMI. Moreover, we demonstrated that Killip classification 2–4 combined with either myoglobin (AUCKillip class 2−4+myoglobin = 0.784, sensitivity = 69.8%, specificity = 79.9%) or creatinine (AUCKillip class 2−4+creatinine = 0.805, sensitivity = 75.5%, specificity = 77.1%) could further enhance the predictive capacity of poor 6-month prognosis among AMI patients. Conclusions: Patients with AMI ranked in the higher Killip class need to be evaluated and monitored with attention. Multibiomarker approach using Killip classification 2–4 and myoglobin or creatinine may be an effective way for 6-month prognosis prediction in AMI patients.
Collapse
Affiliation(s)
- Jianhua Yao
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuan Xie
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Liu
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu Tang
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiahong Xu
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
11
|
Zeitouni M, Sabouret P, Kerneis M, Silvain J, Collet JP, Bruckert E, Montalescot G. 2019 ESC/EAS Guidelines for management of dyslipidaemia: strengths and limitations. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:324-333. [PMID: 32652000 DOI: 10.1093/ehjcvp/pvaa077] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/18/2020] [Accepted: 07/03/2020] [Indexed: 01/28/2023]
Abstract
In 2019, the European Society of Cardiology and European Atherosclerosis Society released a new guideline document with substantial changes regarding the assessment of cardiovascular risk and treatments. The update of high-risk criteria and categories led to a better detection and primary prevention of patients at risk of a first cardiovascular event. Nonetheless, additional efforts are needed for a better inclusion of risk modifiers, especially specific to women, to improve risk stratification and direct primary prevention. Eventually, we discuss how these new guidelines implement PCSK9 inhibitors for very high-risk individuals and the evidence supporting new low-density lipoprotein cholesterol goals below, such as 55 and 40 mg/dL.
Collapse
Affiliation(s)
- Michel Zeitouni
- Department of Cardiology, Institut de cardiologie (AP-HP), Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Pierre Sabouret
- Department of Cardiology, Institut de cardiologie (AP-HP), Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Mathieu Kerneis
- Department of Cardiology, Institut de cardiologie (AP-HP), Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Johanne Silvain
- Department of Cardiology, Institut de cardiologie (AP-HP), Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Jean-Philippe Collet
- Department of Cardiology, Institut de cardiologie (AP-HP), Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Eric Bruckert
- Department of Endocrinology, Pitié-Salpêtrière Hospital and Sorbonne University, Cardio Metabolic Institute, 83 bld de l'Hôpital, 75013 Paris, France
| | - Gilles Montalescot
- Department of Cardiology, Institut de cardiologie (AP-HP), Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, 47-83 bld de l'Hôpital, 75013 Paris, France
| |
Collapse
|
12
|
Pedersen PB, Henriksen DP, Brabrand M, Lassen AT. Prevalence of organ failure and mortality among patients in the emergency department: a population-based cohort study. BMJ Open 2019; 9:e032692. [PMID: 31666275 PMCID: PMC6830583 DOI: 10.1136/bmjopen-2019-032692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The aim was to describe population-based incidence and emergency department-based prevalence and 1-year all-cause mortality of patients with new organ failure present at arrival. DESIGN This was a population-based cohort study of all citizens in four municipalities (population of 230 000 adults). SETTING Emergency department at Odense University Hospital, Denmark. PARTICIPANTS We included all adult patients who arrived from 1 April 2012 to 31 March 2015. PRIMARY AND SECONDARY OUTCOME MEASURES Organ failure was defined as a modified Sequential Organ Failure Assessment score≥2 within six possible organ systems: cerebral, circulatory, renal, respiratory, hepatic and coagulation.The primary outcome was prevalence of organ failure, and secondary outcomes were 0-7 days, 8-30 days and 31-365 days all-cause mortality. RESULTS We identified in total 175 278 contacts, of which 70 399 contacts were further evaluated for organ failure. Fifty-two per cent of these were women, median age 62 (IQR 42-77) years. The incidence of new organ failure was 1342/100 000 person-years, corresponding to 5.2% of all emergency department contacts.The 0-7-day, 8-30-day and 31-365-day mortality was 11.0% (95% CI: 10.2% to 11.8%), 5.6% (95% CI: 5.1% to 6.2%) and 13.2% (95% CI: 12.3% to 14.1%), respectively, if the patient had one or more new organ failures at first contact in the observation period, compared with 1.4% (95% CI: 1.3% to 1.6%), 1.2% (95% CI: 1.1% to 1.3%) and 5.2% (95% CI: 5.0% to 5.4%) for patients without. Seven-day mortality ranged from hepatic failure, 6.5% (95% CI: 4.9% to 8.6%), to cerebral failure, 33.8% (95% CI: 31.0% to 36.8%), the 8-30-day mortality ranged from cerebral failure, 3.9% (95% CI: 2.8% to 5.3%), to hepatic failure, 8.6% (95% CI: 6.6% to 10.8%) and 31-365-day mortality ranged from cerebral failure, 9.3% (95% CI: 7.6% to 11.2%), to renal failure, 18.2% (95% CI: 15.5% to 21.1%). CONCLUSIONS The study revealed an incidence of new organ failure at 1342/100 000 person-years and a prevalence of 5.2% of all emergency department contacts. One-year all-cause mortality was 29.8% among organ failure patients.
Collapse
Affiliation(s)
- Peter Bank Pedersen
- Department of Emergency Medicine, Institute of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | | | - Mikkel Brabrand
- Department of Emergency Medicine, Odense University Hospital & Hospital of South West Jutland, Odense & Esbjerg, Denmark
| | - Annmarie Touborg Lassen
- Department of Emergency Medicine, Institute of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| |
Collapse
|
13
|
Jons C, Sogaard P, Behrens S, Schrader J, Mrosk S, Bloch Thomsen PE. The clinical effect of arrhythmia monitoring after myocardial infarction (BIO-GUARD|MI):study protocol for a randomized controlled trial. Trials 2019; 20:563. [PMID: 31511057 PMCID: PMC6737710 DOI: 10.1186/s13063-019-3644-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 08/09/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The increasing use of implantable cardiac monitors (ICMs) allows early documentation of asymptomatic cardiac arrhythmias that would previously have gone unnoticed. The addition of remote monitoring to cardiac devices means that physicians receive an early warning in cases of new-onset arrhythmias. While remote monitoring has been suggested to increase survival in heart failure patients with implantable defibrillators, trials using ICMs for continuous electrocardiographic monitoring of cardiac arrhythmias in the postmyocardial infarction setting have shown that patients who experienced cardiac arrhythmias such as atrial fibrillation, bradycardia, and ventricular tachyarrhythmia have an increased risk of major adverse cardiac events. METHODS The Biomonitoring in patients with preserved left ventricular function after diagnosed myocardial infarction (BIO-GUARD-MI) study is designed to investigate and clarify whether the incidence of major adverse cardiac events can be decreased by early detection and treatment of cardiac arrhythmias using an ICM in patients after myocardial infarction. In addition, the study will allow us to describe the interplay between baseline characteristics, arrhythmias, and clinical events to improve the treatment of this high-risk patient population. The study will enroll and randomize a cohort of high-risk postmyocardial infarction patients with CHA2DS2-VASc score ≥ 4 and left ventricular ejection fraction > 35% to an ICM or conventional treatment. Physicians are provided with suggestions on how to respond to ICM-documented arrhythmias. An estimated 1400 patients will be enrolled and followed until 372 primary endpoints have occurred. In this paper, we describe the literature and rationale behind the design and interventions towards new-onset arrhythmias, as well as future perspectives and limitations for the use of ICMs. DISCUSSION Remote monitoring may improve clinical outcome if it uncovers conditions with low symptom burden which cause or indicate an increased risk. A simple and easily implementable response to the information is important. Cardiac arrhythmias frequently start as asymptomatic, shorter lasting, and nightly events. The BIO-GUARD-MI trial represents the first attempt to simplify the response to the rather complex nature of heart arrhythmias. TRIAL REGISTRATION Clinical Trials, NCT02341534 . Registered on 19 January 2015.
Collapse
Affiliation(s)
- Christian Jons
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Peter Sogaard
- Department of Cardiology, Aalborg University Hospital, Søndre Skovvej 15, DK-9000 Aalborg, Denmark
| | - Steffen Behrens
- Vivantes Humboldt Klinikum, Abteilung für Kardiologie und konservative Intensivmedizin, Am Nordgraben 2, 13509 Berlin, Germany
| | - Jürgen Schrader
- Biotronik SE & Co. KG, Woermannkehre 1, 12359 Berlin, Germany
| | - Sascha Mrosk
- Biotronik SE & Co. KG, Woermannkehre 1, 12359 Berlin, Germany
| | - Poul Erik Bloch Thomsen
- Department of Cardiology, Aalborg University Hospital, Søndre Skovvej 15, DK-9000 Aalborg, Denmark
| |
Collapse
|
14
|
Keller K, Hobohm L, Münzel T, Ostad MA. Sex-specific differences regarding seasonal variations of incidence and mortality in patients with myocardial infarction in Germany. Int J Cardiol 2019; 287:132-138. [PMID: 31005418 DOI: 10.1016/j.ijcard.2019.04.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/27/2019] [Accepted: 04/10/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Seasonal variation regarding the incidence and the short-term mortality of acute myocardial infarction (MI) was frequently reported, but data about sex-specific differences are sparse. METHODS We analysed the impact of seasons and temperature on incidence and in-hospital mortality of patients with acute MI in Germany between 2005 and 2015. RESULTS The nationwide sample comprised 3,008,188 hospitalizations of MI patients (2005-2015). The incidence was 334.7/100,000 citizens/year. Incidence inclined from 316.3 to 341.6/100,000 citizens/year (β 0.17 [0.10 to 0.24], P < 0.001), while in-hospital mortality rate decreased from 14.1% to 11.3% (β -0.29 [-0.30 to -0.28], P < 0.001). Overall, 377,028 (12.5%) patients died in-hospital. Seasonal variation of both incidence and in-hospital mortality was of substantial magnitude. Seasonal incidence (86.1 vs. 79.0/100,000 citizens/year, P < 0.001) and in-hospital mortality (13.2% vs. 12.1%, P < 0.001) were higher in winter than in summer. Risk to die in winter was elevated (OR 1.080 (95% CI 1.069-1.091), P < 0.001) compared to summer season independently of sex, age and comorbidities. Reperfusion treatment with drug eluting stents and coronary artery bypass graft were more often used in summer. We observed sex-specific differences regarding the seasonal variation of in-hospital mortality: males showed lowest mortality in summer, while females during fall. Low temperature dependency of mortality seems more pronounced in males. CONCLUSION Incidence of acute MI increased 2005-2015, while in-hospital mortality rate decreased. Seasonal variation of incidence and in-hospital mortality were of substantial magnitude with lowest incidence and lowest mortality in the summer season. Additionally, we observed sex-specific differences regarding the seasonal variation of the in-hospital mortality.
Collapse
Affiliation(s)
- Karsten Keller
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Mir Abolfazl Ostad
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| |
Collapse
|
15
|
Shih JY, Chen ZC, Chang HY, Liu YW, Ho CH, Chang WT. Risks of age and sex on clinical outcomes post myocardial infarction. IJC HEART & VASCULATURE 2019; 23:100350. [PMID: 30976655 PMCID: PMC6441739 DOI: 10.1016/j.ijcha.2019.100350] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 03/17/2019] [Accepted: 03/18/2019] [Indexed: 11/29/2022]
Abstract
Background How sex and age influence post-myocardial infarction (post-MI) outcomes remains unclear. This study evaluated the influence of sex and age on drug therapy, echocardiographic parameters, and outcomes in post-MI patients undergoing percutaneous coronary intervention (PCI). Methods We retrospectively enrolled 643 patients with first acute MI who underwent successful PCI and two echocardiographic examinations within 1 year after MI. Clinical characteristics and 4-year follow-up outcomes were compared between sexes and age groups. Primary endpoints were cardiovascular mortality and hospitalization for heart failure (HF). Results Compared with males, female patients with MI, particularly older females, had more systemic diseases. Younger females received fewer guideline-directed therapies. Older patients presented with higher left ventricular volume and mass index but no significant differences in left ventricular ejection fraction. The Kaplan–Meier analysis revealed increased mortality in both younger and older females. Elderly patients, particularly older females, exhibited significantly higher post-MI HF incidence but no difference in recurrent MI, ventricular arrhythmia, or revascularization. Conclusions In MI patients receiving PCI, outcome differences between sexes are age-dependent. Age influences outcome more heavily in females than in males. Females are likely to exhibit worse overall survival, and older females are at higher risk of post-MI HF.
Collapse
Affiliation(s)
- Jhih-Yuan Shih
- Department of Cardiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Zhih-Cherng Chen
- Department of Cardiology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Pharmacy, Chia Nan University of Pharmacy & Science, Tainan, Taiwan
| | - Hsien-Yuan Chang
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital Dou-Liou Branch, Yun-Lin, Taiwan.,Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | - Yen-Wen Liu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Wei-Ting Chang
- Department of Cardiology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| |
Collapse
|
16
|
The FAST-MI 2005-2010-2015 registries in the light of the COMPASS trial: The COMPASS criteria applied to a post-MI population. Int J Cardiol 2019; 278:7-13. [DOI: 10.1016/j.ijcard.2018.11.138] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/20/2018] [Accepted: 11/30/2018] [Indexed: 12/22/2022]
|
17
|
Adamski P, Adamska U, Ostrowska M, Navarese EP, Kubica J. Evaluating current and emerging antithrombotic therapy currently available for the treatment of acute coronary syndrome in geriatric populations. Expert Opin Pharmacother 2018; 19:1415-1425. [PMID: 30132731 DOI: 10.1080/14656566.2018.1510487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Acute coronary syndromes (ACS) represent one of the most perilous presentations of ischemic heart disease. Temporal trends clearly demonstrate that ACS occur later and later in life. Elderly patients with ACS comprise a populous and growing group, with more than half of individuals presenting with myocardial infarction being 75 years or older. Nevertheless, geriatric patients are greatly underrepresented in the landmark ACS trials evaluating innovative pharmacological strategies. AREAS COVERED The authors critically summarize recently published research on contemporary and emerging antithrombotic therapy for the treatment of ACS in geriatric patients. EXPERT OPINION Elderly ACS patients are characterized by simultaneously increased risk of cardiovascular events and bleeding. Very few studies assessing the efficacy and safety of novel ACS pharmacotherapy in geriatric patients are currently available. Guidelines on the treatment of ACS are based on the overall results of major randomized clinical trials (RCTs), and data supporting the recommended therapy in elderly mainly derive from subanalyses of these RCTs. Properly designed and powered RCTs are necessary to properly evaluate the net effect of current and emerging pharmacotherapy in geriatric patients. Until such data are available, elderly ACS patients should receive treatment according to the general recommendations.
Collapse
Affiliation(s)
- Piotr Adamski
- a Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland
| | - Urszula Adamska
- a Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland
| | | | - Eliano Pio Navarese
- a Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland.,b Interventional Cardiology and Cardiovascular Medicine Research, Inova Center for Thrombosis Research and Drug Development , Inova Heart and Vascular Institute , Falls Church , VA , USA.,c SIRIO MEDICINE Research Network, Inova Heart and Vascular Institute, Inova Center for Thrombosis Research and Drug Development , Fairfax , VA , USA
| | - Jacek Kubica
- a Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland
| |
Collapse
|
18
|
Hall M, Dondo TB, Yan AT, Mamas MA, Timmis AD, Deanfield JE, Jernberg T, Hemingway H, Fox KAA, Gale CP. Multimorbidity and survival for patients with acute myocardial infarction in England and Wales: Latent class analysis of a nationwide population-based cohort. PLoS Med 2018; 15:e1002501. [PMID: 29509764 PMCID: PMC5839532 DOI: 10.1371/journal.pmed.1002501] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/08/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is limited knowledge of the scale and impact of multimorbidity for patients who have had an acute myocardial infarction (AMI). Therefore, this study aimed to determine the extent to which multimorbidity is associated with long-term survival following AMI. METHODS AND FINDINGS This national observational study included 693,388 patients (median age 70.7 years, 452,896 [65.5%] male) from the Myocardial Ischaemia National Audit Project (England and Wales) who were admitted with AMI between 1 January 2003 and 30 June 2013. There were 412,809 (59.5%) patients with multimorbidity at the time of admission with AMI, i.e., having at least 1 of the following long-term health conditions: diabetes, chronic obstructive pulmonary disease or asthma, heart failure, renal failure, cerebrovascular disease, peripheral vascular disease, or hypertension. Those with heart failure, renal failure, or cerebrovascular disease had the worst outcomes (39.5 [95% CI 39.0-40.0], 38.2 [27.7-26.8], and 26.6 [25.2-26.4] deaths per 100 person-years, respectively). Latent class analysis revealed 3 multimorbidity phenotype clusters: (1) a high multimorbidity class, with concomitant heart failure, peripheral vascular disease, and hypertension, (2) a medium multimorbidity class, with peripheral vascular disease and hypertension, and (3) a low multimorbidity class. Patients in class 1 were less likely to receive pharmacological therapies compared with class 2 and 3 patients (including aspirin, 83.8% versus 87.3% and 87.2%, respectively; β-blockers, 74.0% versus 80.9% and 81.4%; and statins, 80.6% versus 85.9% and 85.2%). Flexible parametric survival modelling indicated that patients in class 1 and class 2 had a 2.4-fold (95% CI 2.3-2.5) and 1.5-fold (95% CI 1.4-1.5) increased risk of death and a loss in life expectancy of 2.89 and 1.52 years, respectively, compared with those in class 3 over the 8.4-year follow-up period. The study was limited to all-cause mortality due to the lack of available cause-specific mortality data. However, we isolated the disease-specific association with mortality by providing the loss in life expectancy following AMI according to multimorbidity phenotype cluster compared with the general age-, sex-, and year-matched population. CONCLUSIONS Multimorbidity among patients with AMI was common, and conferred an accumulative increased risk of death. Three multimorbidity phenotype clusters that were significantly associated with loss in life expectancy were identified and should be a concomitant treatment target to improve cardiovascular outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT03037255.
Collapse
Affiliation(s)
- Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
- * E-mail:
| | - Tatendashe B. Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Andrew T. Yan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - Adam D. Timmis
- NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, London, United Kingdom
| | - John E. Deanfield
- National Institute for Cardiovascular Outcomes Research, University College London, London, United Kingdom
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Harry Hemingway
- Farr Institute of Health Informatics Research, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, University College London, London, United Kingdom
| | - Keith A. A. Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Chris P. Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
- York Teaching Hospital NHS Foundation Trust, York, United Kingdom
| |
Collapse
|
19
|
Timmis A, Townsend N, Gale C, Grobbee R, Maniadakis N, Flather M, Wilkins E, Wright L, Vos R, Bax J, Blum M, Pinto F, Vardas P. European Society of Cardiology: Cardiovascular Disease Statistics 2017. Eur Heart J 2017; 39:508-579. [PMID: 29190377 DOI: 10.1093/eurheartj/ehx628] [Citation(s) in RCA: 507] [Impact Index Per Article: 72.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/26/2017] [Indexed: 12/26/2022] Open
Abstract
Aims The European Society of Cardiology (ESC) Atlas has been compiled by the European Heart Agency to document cardiovascular disease (CVD) statistics of the 56 ESC member countries. A major aim of this 2017 data presentation has been to compare high-income and middle-income ESC member countries to identify inequalities in disease burden, outcomes, and service provision. Methods and results The Atlas utilizes a variety of data sources, including the World Health Organization, the Institute for Health Metrics and Evaluation, and the World Bank to document risk factors, prevalence, and mortality of cardiovascular disease and national economic indicators. It also includes novel ESC-sponsored survey data of health infrastructure and cardiovascular service provision provided by the national societies of the ESC member countries. Data presentation is descriptive with no attempt to attach statistical significance to differences observed in stratified analyses. Important differences were identified between the high-income and middle-income member countries of the ESC with regard to CVD risk factors, disease incidence, and mortality. For both women and men, the age-standardized prevalence of hypertension was lower in high-income countries (18% and 27%) compared with middle-income countries (24% and 30%). Smoking prevalence in men (not women) was also lower (26% vs. 41%) and together these inequalities are likely to have contributed to the higher CVD mortality in middle-income countries. Declines in CVD mortality have seen cancer becoming a more common cause of death in a number of high-income member countries, but in middle-income countries declines in CVD mortality have been less consistent where CVD remains the leading cause of death. Inequalities in CVD mortality are emphasized by the smaller contribution they make to potential years of life lost in high-income countries compared with middle-income countries both for women (13% vs. 23%) and men (20% vs. 27%). The downward mortality trends for CVD may, however, be threatened by the emerging obesity epidemic that is seeing rates of diabetes increasing across all the ESC member countries. Survey data from the National Cardiac Societies showed that rates of cardiac catheterization and coronary artery bypass surgery, as well as the number of specialist centres required to deliver them, were greatest in the high-income member countries of the ESC. The Atlas confirmed that these ESC member countries, where the facilities for the contemporary treatment of coronary disease were best developed, were often those in which declines in coronary mortality have been most pronounced. Economic resources were not the only driver for delivery of equitable cardiovascular health care, as some middle-income ESC member countries reported rates for interventional procedures and device implantations that matched or exceeded the rates in wealthier member countries. Conclusion In documenting national CVD statistics, the Atlas provides valuable insights into the inequalities in risk factors, health care delivery, and outcomes of CVD across the ESC member countries. The availability of these data will underpin the ESC's ambitious mission 'to reduce the burden of cardiovascular disease' not only in its member countries but also in nation states around the world.
Collapse
Affiliation(s)
- Adam Timmis
- Department of Cardiology, Barts Heart Centre, Queen Mary University, West Smithfield, London, UK
| | - Nick Townsend
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, UK
| | - Chris Gale
- Division of Epidemiology, Medical Research Council Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, Worsley Building, Level 11, Clarendon Way, University of Leeds, Leeds, UK
| | - Rick Grobbee
- Department of Clinical Epidemiology, University Medical Center, Heidelberglaan 100, CX Utrecht, Netherlands
| | - Nikos Maniadakis
- European Society of Cardiology Health Policy Unit, European Heart Health Institute, 29 Square de Meeus, 4th Floor, Brussels, Belgium
| | - Marcus Flather
- Department of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Elizabeth Wilkins
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, UK
| | - Lucy Wright
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, UK
| | - Rimke Vos
- Department of Clinical Epidemiology, University Medical Center, Heidelberglaan 100, CX Utrecht, Netherlands
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, Netherlands
| | - Maxim Blum
- European Society of Cardiology Health Policy Unit, European Heart Health Institute, 29 Square de Meeus, 4th Floor, Brussels, Belgium
| | - Fausto Pinto
- Department of Cardiology, University Hospital Santa Maria, University of Lisbon, Avenida Professor Egas Moniz, Lisbon, Portugal
| | - Panos Vardas
- European Society of Cardiology Health Policy Unit, European Heart Health Institute, 29 Square de Meeus, 4th Floor, Brussels, Belgium
| | | |
Collapse
|
20
|
Rapsomaniki E, Thuresson M, Yang E, Blin P, Hunt P, Chung SC, Stogiannis D, Pujades-Rodriguez M, Timmis A, Denaxas SC, Danchin N, Stokes M, Thomas-Delecourt F, Emmas C, Hasvold P, Jennings E, Johansson S, Cohen DJ, Jernberg T, Moore N, Janzon M, Hemingway H. Using big data from health records from four countries to evaluate chronic disease outcomes: a study in 114 364 survivors of myocardial infarction. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:172-183. [PMID: 29474617 PMCID: PMC5815620 DOI: 10.1093/ehjqcco/qcw004] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/18/2016] [Indexed: 01/16/2023]
Abstract
AIMS To assess the international validity of using hospital record data to compare long-term outcomes in heart attack survivors. METHODS AND RESULTS We used samples of national, ongoing, unselected record sources to assess three outcomes: cause death; a composite of myocardial infarction (MI), stroke, and all-cause death; and hospitalized bleeding. Patients aged 65 years and older entered the study 1 year following the most recent discharge for acute MI in 2002-11 [n = 54 841 (Sweden), 53 909 (USA), 4653 (England), and 961 (France)]. Across each of the four countries, we found consistent associations with 12 baseline prognostic factors and each of the three outcomes. In each country, we observed high 3-year crude cumulative risks of all-cause death (from 19.6% [England] to 30.2% [USA]); the composite of MI, stroke, or death [from 26.0% (France) to 36.2% (USA)]; and hospitalized bleeding [from 3.1% (France) to 5.3% (USA)]. After adjustments for baseline risk factors, risks were similar across all countries [relative risks (RRs) compared with Sweden not statistically significant], but higher in the USA for all-cause death [RR USA vs. Sweden, 1.14 (95% confidence interval 1.04-1.26)] and hospitalized bleeding [RR USA vs. Sweden, 1.54 (1.21-1.96)]. CONCLUSION The validity of using hospital record data is supported by the consistency of estimates across four countries of a high adjusted risk of death, further MI, and stroke in the chronic phase after MI. The possibility that adjusted risks of mortality and bleeding are higher in the USA warrants further study.
Collapse
Affiliation(s)
- Eleni Rapsomaniki
- Farr Institute of Health Informatics Research, University College London, London, UK
| | | | - Erru Yang
- Retrospective Observational Studies, Evidera, Lexington, MA, USA
| | - Patrick Blin
- Department of Pharmacology, CIC Bordeaux CIC1401 INSERM, University of Bordeaux, Bordeaux, France
| | - Phillip Hunt
- Retrospective Observational Studies, Evidera, Lexington, MA, USA
| | - Sheng-Chia Chung
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Dimitris Stogiannis
- Department of Mathematics, National and Kapodistrian University of Athens, Athens, Greece
| | - Mar Pujades-Rodriguez
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Adam Timmis
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Spiros C. Denaxas
- Farr Institute of Health Informatics Research, University College London, London, UK
| | | | - Michael Stokes
- Retrospective Observational Studies, Evidera, Lexington, MA, USA
| | | | - Cathy Emmas
- Real World Evidence, AstraZeneca Luton, Luton, UK
| | - Pål Hasvold
- Medical Department, AstraZeneca Nordic-Baltic, Oslo, Norway
| | - Em Jennings
- Global Payer Evidence and Pricing, AstraZeneca R&D, Cambridge, UK
| | - Saga Johansson
- Global Medicines Development, AstraZeneca Gothenburg, Mölndal, Sweden
| | - David J. Cohen
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Tomas Jernberg
- Department of Medicine, Karolinska Institutet, Huddinge, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Nicholas Moore
- Department of Pharmacology, CIC Bordeaux CIC1401 INSERM, University of Bordeaux, Bordeaux, France
| | - Magnus Janzon
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Harry Hemingway
- Farr Institute of Health Informatics Research, University College London, London, UK
| |
Collapse
|
21
|
Shah ASV, Mills NL. Assessing risk following ST-segment elevation myocardial infarction: cardiac troponin or cardiac magnetic resonance imaging? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:141-143. [PMID: 29474618 DOI: 10.1093/ehjqcco/qcw012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Anoop S V Shah
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Nicholas L Mills
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
22
|
Banerjee A. Stable coronary disease: Cinderella must go to the ball. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:151-152. [PMID: 29474614 DOI: 10.1093/ehjqcco/qcw022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Amitava Banerjee
- Farr Institute of Health Informatics Research, University College London, 222 Euston Road, London NW1 2DA, UK
| |
Collapse
|
23
|
Timmis A, Rapsomaniki E, Chung SC, Pujades-Rodriguez M, Moayyeri A, Stogiannis D, Shah AD, Pasea L, Denaxas S, Emmas C, Hemingway H. Prolonged dual antiplatelet therapy in stable coronary disease: comparative observational study of benefits and harms in unselected versus trial populations. BMJ 2016; 353:i3163. [PMID: 27334486 PMCID: PMC4916922 DOI: 10.1136/bmj.i3163] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To estimate the potential magnitude in unselected patients of the benefits and harms of prolonged dual antiplatelet therapy after acute myocardial infarction seen in selected patients with high risk characteristics in trials. DESIGN Observational population based cohort study. SETTING PEGASUS-TIMI-54 trial population and CALIBER (ClinicAl research using LInked Bespoke studies and Electronic health Records). PARTICIPANTS 7238 patients who survived a year or more after acute myocardial infarction. INTERVENTIONS Prolonged dual antiplatelet therapy after acute myocardial infarction. MAIN OUTCOME MEASURES Recurrent acute myocardial infarction, stroke, or fatal cardiovascular disease. Fatal, severe, or intracranial bleeding. RESULTS 1676/7238 (23.1%) patients met trial inclusion and exclusion criteria ("target" population). Compared with the placebo arm in the trial population, in the target population the median age was 12 years higher, there were more women (48.6% v 24.3%), and there was a substantially higher cumulative three year risk of both the primary (benefit) trial endpoint of recurrent acute myocardial infarction, stroke, or fatal cardiovascular disease (18.8% (95% confidence interval 16.3% to 21.8%) v 9.04%) and the primary (harm) endpoint of fatal, severe, or intracranial bleeding (3.0% (2.0% to 4.4%) v 1.26% (TIMI major bleeding)). Application of intention to treat relative risks from the trial (ticagrelor 60 mg daily arm) to CALIBER's target population showed an estimated 101 (95% confidence interval 87 to 117) ischaemic events prevented per 10 000 treated per year and an estimated 75 (50 to 110) excess fatal, severe, or intracranial bleeds caused per 10 000 patients treated per year. Generalisation from CALIBER's target subgroup to all 7238 real world patients who were stable at least one year after acute myocardial infarction showed similar three year risks of ischaemic events (17.2%, 16.0% to 18.5%), with an estimated 92 (86 to 99) events prevented per 10 000 patients treated per year, and similar three year risks of bleeding events (2.3%, 1.8% to 2.9%), with an estimated 58 (45 to 73) events caused per 10 000 patients treated per year. CONCLUSIONS This novel use of primary-secondary care linked electronic health records allows characterisation of "healthy trial participant" effects and confirms the potential absolute benefits and harms of dual antiplatelet therapy in representative patients a year or more after acute myocardial infarction.
Collapse
Affiliation(s)
- A Timmis
- The Farr Institute of Health Informatics Research, University College London, London, UK Barts and The London National Institute for Health Research, Cardiovascular Biomedical Research Unit, Bart's Heart Centre, London, UK
| | - E Rapsomaniki
- The Farr Institute of Health Informatics Research, University College London, London, UK
| | - S C Chung
- The Farr Institute of Health Informatics Research, University College London, London, UK
| | - M Pujades-Rodriguez
- The Farr Institute of Health Informatics Research, University College London, London, UK
| | - A Moayyeri
- The Farr Institute of Health Informatics Research, University College London, London, UK
| | - D Stogiannis
- Department of Mathematics, University of Athens, Athens, Greece
| | - A D Shah
- The Farr Institute of Health Informatics Research, University College London, London, UK
| | - L Pasea
- The Farr Institute of Health Informatics Research, University College London, London, UK
| | - S Denaxas
- The Farr Institute of Health Informatics Research, University College London, London, UK
| | - C Emmas
- AstraZeneca, Luton, Bedfordshire, UK
| | - H Hemingway
- The Farr Institute of Health Informatics Research, University College London, London, UK
| |
Collapse
|
24
|
Rothnie KJ, Quint JK. Chronic obstructive pulmonary disease and acute myocardial infarction: effects on presentation, management, and outcomes. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:81-90. [PMID: 29474627 PMCID: PMC5862020 DOI: 10.1093/ehjqcco/qcw005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Indexed: 01/09/2023]
Abstract
Cardiovascular disease is a common cause of death in patients with chronic obstructive pulmonary disease (COPD) and is a key target for improving outcomes. However, there are concerns that patients with COPD may not have enjoyed the same mortality reductions from acute myocardial infarction (AMI) in recent decades as the general population. This has raised questions about differences in presentation, management and outcomes in COPD patients compared to non-COPD patients. The evidence points to an increased risk of death after AMI in patients with COPD, but it is unclear to what extent this is attributable to COPD itself or to modifiable factors including under-treatment with guideline-recommended interventions and drugs. We review the evidence for differences between COPD and non-COPD patients in terms of the presentation of AMI, its treatment, and outcomes both in hospital and in the longer term.
Collapse
Affiliation(s)
- Kieran J. Rothnie
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, London SW3 6LR, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer K. Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, London SW3 6LR, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
25
|
Zaman MJ, Kwok CS, Bachmann MO, Mamas MA, Myint PK. Explaining inequalities in receipt of care in the older patient with acute coronary syndrome. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:59-61. [PMID: 29474631 DOI: 10.1093/ehjqcco/qcw011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- M Justin Zaman
- Norwich Medical School, University of East Anglia, Norfolk, UK.,Department of Medicine, James Paget University Hospital, Gorleston-on-Sea, Norfolk, UK
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, Staffordshire, UK.,Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, Staffordshire, UK
| | - Max O Bachmann
- Norwich Medical School, University of East Anglia, Norfolk, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, Staffordshire, UK
| | - Phyo Kyaw Myint
- Epidemiology Group, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Foresterhill, Aberdeen, UK
| |
Collapse
|