1
|
Chin KL, Tacey M, Reid CM, Tonkin A, Hopper I, Brennan A, Andrianopoulos N, Duffy SJ, Clark D, Ajani AE, Liew D. Temporal Changes in Characteristics, Treatment and Outcomes of Heart Failure Patients Undergoing Percutaneous Coronary Intervention Findings From Melbourne Interventional Group Registry. Heart Lung Circ 2018; 28:1018-1026. [PMID: 29960835 DOI: 10.1016/j.hlc.2018.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/24/2018] [Accepted: 03/25/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Limited data exist on whether outcomes of patients with heart failure (HF) undergoing percutaneous coronary intervention (PCI) have improved over time. The purpose of this study was to assess temporal trends in patient characteristics, treatment and outcomes of patients with HF undergoing PCI. METHODS Using data from the Melbourne Interventional Group (MIG), we evaluated temporal trends of procedure volume, major adverse cardiac events (MACE; a composite of all-cause mortality, myocardial infarction and target vessel revascularisation) and rates of cardiovascular readmission, all-cause death and cardiovascular death in consecutive patients with HF undergoing PCI. Change over time was assessed by Box-Jenkins autoregressive integrated moving average (ARIMA) models. RESULTS Data from 1,604 patients were analysed. In our cohort, there were no significant changes in the number of procedures performed annually and patient characteristics between January 2005 and December 2014. Optimal use of HF therapy has improved over the study period. Planned clopidogrel therapy of more than 12 months increased in tandem with increasing use of drug-eluting stents (DES). Procedural success was high (≥90%). However, the rates of MACE, cardiovascular readmission, all-cause death and cardiovascular death remained unchanged throughout the study period. CONCLUSIONS Clinical outcomes in HF patients undergoing PCI have remained unchanged despite improvement in medical technology and contemporary therapeutic measures.
Collapse
Affiliation(s)
- Ken Lee Chin
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Mark Tacey
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Christopher M Reid
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Andrew Tonkin
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Ingrid Hopper
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Vic, Australia
| | - Angela Brennan
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Nick Andrianopoulos
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Stephen J Duffy
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Vic, Australia
| | - David Clark
- Department of Cardiology, Austin Hospital, Melbourne, Vic, Australia
| | - Andrew E Ajani
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Danny Liew
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
| | | |
Collapse
|
2
|
Myftiu S, Sulo E, Burazeri G, Daka B, Sharka I, Shkoza A, Sulo G. Clinical Profile and Management of Patients with Incident and Recurrent Acute Myocardial Infarction in Albania - a Call for More Focus on Prevention Strategies. Zdr Varst 2017; 56:236-243. [PMID: 29062398 PMCID: PMC5639813 DOI: 10.1515/sjph-2017-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 08/07/2017] [Indexed: 11/15/2022] Open
Abstract
Background The clinical profile of acute myocardial infarction (AMI) patients reflects the burden of risk factors in the general population. Differences between incident (first) and recurrent (repeated) events and their impact on treatment are poorly described. We studied potential differences in the clinical profile and in-hospital treatment between patients hospitalised with an incident and recurrent AMI. Methods A total of 324 patients admitted in the Coronary Care Unit of ‘Mother Teresa’ hospital, Tirana, Albania (2013-2014), were included in the study. Information on AMI type, complications and risk factors was obtained from patient’s medical file. Logistic regression analyses were used to explore differences between the incident and recurrent AMIs regarding clinical profile and in-hospital treatment. Results Of all patients, 50 (15.4%) had a prior AMI. Compared to incident cases, recurrent cases were older (P=0.01), more often women (P=0.01), less educated (P=0.01), and smoked less (P=0.03). Recurrent cases experienced more often heart failure (HF) (OR=2.48; 95% CI: 1.31–4.70), impaired left ventricular ejection fraction (OR=1.97; 95% CI:1.05–3.71), and multivessel disease (OR=6.32; 95% CI: 1.43–28.03) than incident cases. In-hospital use of beta-blockers was less frequent among recurrent compared to incident cases (OR=0.45; 95% CI: 0.24–0.85), while no statistically significant differences between groups were observed regarding angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, statin, aspirin or invasive procedures. Conclusion A more severe clinical expression of the disease and underutilisation of treatment among recurrent AMIs are likely to explain their poorer prognosis compared to incident AMIs.
Collapse
Affiliation(s)
- Sokol Myftiu
- Department of Cardiology, University Hospital "Mother Teresa", Tirana, Albania
| | - Enxhela Sulo
- University of Bergen, Faculty of Medicine and Dentistry, Department of Global Public Health and Primary Care, Kalfarveien31, Bergen 5018, Norway
| | - Genc Burazeri
- Maastricht University, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care, Department of International Health, MaastrichtThe Netherlands
| | - Bledar Daka
- University of Gothenburg, Department of Public Health and Community Medicine, Gothenburg, Sweden
| | - Ilir Sharka
- Department of Cardiology, University Hospital "Mother Teresa", Tirana, Albania
| | - Artan Shkoza
- University of Medicine, Faculty of Medicine, Tirana, Albania
| | - Gerhard Sulo
- University of Bergen, Faculty of Medicine and Dentistry, Department of Global Public Health and Primary Care, Kalfarveien31, Bergen 5018, Norway
| |
Collapse
|
3
|
Lavoie L, Khoury H, Welner S, Briere JB. Burden and Prevention of Adverse Cardiac Events in Patients with Concomitant Chronic Heart Failure and Coronary Artery Disease: A Literature Review. Cardiovasc Ther 2017; 34:152-60. [PMID: 26915344 PMCID: PMC5084727 DOI: 10.1111/1755-5922.12180] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Chronic heart failure (HF) or coronary artery disease (CAD) confers risk for thromboembolism and secondary adverse cardiac events (ACEs) (e.g., mortality, myocardial infarction, and stroke). When HF and CAD occur concomitantly, ACE risk is reported to be elevated. We investigated ACEs, their epidemiology, and the resulting burden among patients with concomitant HF and CAD through a structured review of recent literature. Antithrombotic treatment for ACE prevention was assessed. Methods Pertinent databases (PubMed, other) were searched for relevant articles published from January 2004 to March 2015. Data collected included ACE incidence, healthcare resource use, costs, change in quality of life attributed to ACEs, and treatment practice for prevention of ACEs in patients with concomitant HF and CAD. Results Mortality rates for patients with both HF and CAD ranged from 4.9–12.3% at 30 days to 13.7–86% for periods between 9.9 months and 10 years. Incidence of ACEs among HF patients with CAD is, respectively, at least 82% and 15% higher than for patients without HF or without CAD, except for stroke investigated in two studies. All‐cause and HF‐related hospitalization is the main driver of the economic burden in patients with HF, the majority of whom had CAD origin. Despite high prevalence of ischemic complications, there is limited evidence to support the use of warfarin‐type antithrombotics among HF patients. Conclusion This study confirms that patients with concomitant HF and CAD are at elevated risk for ACEs and suggests the need for effective new antithrombotic treatments to further decrease ischemic complication rates in this population.
Collapse
Affiliation(s)
| | | | | | - Jean-Baptiste Briere
- Bayer Pharma AG, Global Health Economics & Outcomes Research General Medicine, Berlin, Germany
| |
Collapse
|
4
|
Iyngkaran P, Liew D, McDonald P, Thomas MC, Reid C, Chew D, Hare DL. Phase 4 Studies in Heart Failure - What is Done and What is Needed? Curr Cardiol Rev 2016; 12:216-30. [PMID: 27280303 PMCID: PMC5011189 DOI: 10.2174/1573403x12666160606121458] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/18/2015] [Accepted: 01/11/2016] [Indexed: 02/07/2023] Open
Abstract
Congestive heart failure (CHF) therapeutics is generated through a well-described evidence generating process. Phases 1 - 3 of this process are required prior to approval and widespread clinical use. Phase 3 in almost all cases is a methodologically sound randomized controlled trial (RCT). After this phase it is generally accepted that the treatment has a significant, independent and prognostically beneficial effect on the pathophysiological process. A major criticism of RCTs is the population to whom the result is applicable. When this population is significantly different from the trial cohort the external validity comes into question. Should the continuation of the evidence generating process continue these problems might be identified. Post marketing surveillance through phase 4 and comparative effectiveness studies through phase 5 trials are often underperformed in comparison to the RCT. These processes can help identify remote adverse events and define new hypotheses for community level benefits. This review is aimed at exploring the post-marketing scene for CHF therapeutics from an Australian health system perspective. We explore the phases of clinical trials, the level of evidence currently available and options for ensuring greater accountability for community level CHF clinical outcomes.
Collapse
Affiliation(s)
- Pupalan Iyngkaran
- Cardiologist & Senior Lecturer NT Medical School, Flinders University, Australia.
| | | | | | | | | | | | | |
Collapse
|
5
|
Lee MH, Park JJ, Yoon CH, Cha MJ, Park SD, Oh IY, Suh JW, Cho YS, Youn TJ, Rha SW, Yu CW, Gwon HC, Jang Y, Kim HS, Chae IH, Choi DJ. Impact of smoking status on clinical outcomes after successful chronic total occlusion intervention: Korean national registry of CTO intervention. Catheter Cardiovasc Interv 2015; 87:1050-62. [DOI: 10.1002/ccd.26167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 07/22/2015] [Accepted: 07/27/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Min-Ho Lee
- Cardiovascular Center; Soonchunhyang University Hospital; Seoul Korea
| | - Jin Joo Park
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
| | - Chang-Hwan Yoon
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
| | - Myung-Jin Cha
- Cardiovascular Center; Seoul National University Hospital; Seoul Korea
| | - Sang-Don Park
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
| | - Il-Young Oh
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
| | - Jung-Won Suh
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
| | - Young-Seok Cho
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
| | - Tae-Jin Youn
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
| | | | | | | | - Yangsoo Jang
- Yonsei University Severance Hospital; Seoul Korea
| | - Hyo-Soo Kim
- Cardiovascular Center; Seoul National University Hospital; Seoul Korea
| | - In-Ho Chae
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
| | - Dong-Ju Choi
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
| |
Collapse
|
6
|
Cleland JG, Freemantle N. Revascularization for patients with heart failure. Inconsistencies between theory and practice. Eur J Heart Fail 2014; 13:694-7. [DOI: 10.1093/eurjhf/hfr075] [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: 11/14/2022] Open
Affiliation(s)
- John G.F. Cleland
- Department of Cardiology; Hull York Medical School, Castle Hill Hospital, University of Hull; Daisy Building Cottingham Kingston-upon-Hull HU16 5JQ UK
| | - Nick Freemantle
- Department of Primary Care and Population Health; UCL Medical School; Rowland Hill Street London NW3 2PF UK
| |
Collapse
|
7
|
Lu KJ, Kearney LG, Ord M, Jones E, Burrell LM, Srivastava PM. Age adjusted Charlson Co-morbidity Index is an independent predictor of mortality over long-term follow-up in infective endocarditis. Int J Cardiol 2013; 168:5243-8. [PMID: 23978361 DOI: 10.1016/j.ijcard.2013.08.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/03/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is associated with high morbidity and mortality. The epidemiology of IE is changing, affecting more elderly patients with increased medical comorbidities. We aimed to assess the ability of the age adjusted Charlson Co-morbidity Index (ACCI) to predict early and late outcomes. METHODS Between 1998 and 2010, adult patients with definite IE according to the modified Duke criteria were identified. The primary outcome was in-hospital and all-cause mortality. The secondary outcome was predictors of the primary outcome incorporating ACCI. RESULTS 148 patients with IE were followed up for a mean of 3.8 ± 3 years. The mean age was 57 ± 17 years and 66% were male. In-hospital mortality and all-cause mortality were 24 and 47% respectively. Comorbid conditions included diabetes mellitus (DM) (21%); ischaemic heart disease (16%); heart failure (HF) (14%); renal failure (eGFR <60 ml/min/1.73 m(2)) (19%); and anaemia (64%). The most common causative organism was Staphylococcus aureus (53%). ACCI was >3 in 59% of patients. Cardiac surgery was performed in 45% of patients. On Cox regression analysis, ACCI >3 (HR=3.0 [1.5-6.0], p<0.002), new onset HF (HR=2.2 [1.3-3.6], p<0.003), anaemia (HR=1.8 [1.1-3.2], p=0.04) and age-per decade (HR=1.4 [1.1-1.7]. p=0.004) were independently associated with all-cause mortality. ACCI >3 was the strongest predictor of in-hospital mortality (OR=8.4 [2.8-24], p<0.001). Of the individual ACCI components, prior HF, DM with complications and metastatic disease were independent predictors of all-cause mortality. CONCLUSION In-hospital and all-cause mortality of IE remain high. An ACCI >3 was a strong predictor of mortality, in addition to age, new HF and anaemia.
Collapse
Affiliation(s)
- K J Lu
- Department of Medicine, University of Melbourne and Austin Health, Victoria, Australia; Department of Cardiology, Austin Health, Victoria, Australia.
| | | | | | | | | | | |
Collapse
|
8
|
Ranasinghe I, Naoum C, Aliprandi-Costa B, Sindone AP, Steg PG, Elliott J, McGarity B, Lefkovits J, Brieger D. Management and outcomes following an acute coronary event in patients with chronic heart failure 1999-2007. Eur J Heart Fail 2012; 14:464-72. [PMID: 22499543 DOI: 10.1093/eurjhf/hfs041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIM The outcome of patients with chronic heart failure (CHF) following an ischaemic event is poorly understood. We evaluated the management and outcomes of CHF patients presenting with an acute coronary syndrome (ACS) and explored changes in outcomes over time. METHOD AND RESULTS A total of 5556 patients enrolled in the Australia-New Zealand population of the Global Registry of Acute Coronary Events (GRACE) between 1999 and 2007 were included. Patients with CHF (n = 609) were compared with those without CHF (n = 4947). Patients with CHF were on average 10 years older, were more likely to be female, had more co-morbidities and cardiac risk factors, and were more likely to have a prior history of angina, myocardial infarction, and revascularization by coronary artery bypass graft (CABG) when compared with those without CHF. CHF was associated with a substantial increase in in-hospital renal failure [odds ratio (OR) 1.76, 95% confidence interval (CI) 1.15-2.71], readmission post-discharge (OR 1.47, 95% CI 1.17-1.90), and 6-month mortality (OR 2.25, 95% CI 1.55-3.27). Over the 9 year study period, in-hospital and 6 month mortality in those with CHF declined by absolute rates of 7.5% and 14%, respectively. This was temporally associated with an increase in prescription of thienopyridines, beta-blockers, statins, and angiotensin II receptor blockers, increased rates of coronary angiography, and 31.8% absolute increase in referral rates for cardiac rehabilitation. CONCLUSIONS Acute coronary syndrome patients with pre-existing CHF are a very high risk group and carry a disproportionate mortality burden. Encouragingly, there was a marked temporal improvement in outcomes over a 9 year period with an increase in evidence-based treatments and secondary preventative measures.
Collapse
Affiliation(s)
- Isuru Ranasinghe
- Concord Repatriation General Hospital and The University of Sydney, Sydney, NSW, Australia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Vlaar PJ, de Smet BJGL. Impact of heart failure on outcome after percutaneous coronary intervention: is it the patient or the intervention? Eur J Heart Fail 2011; 13:364-5. [PMID: 21436362 DOI: 10.1093/eurjhf/hfr027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|