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Sikora M, Skrzydlewski P, Perła-Kaján J, Jakubowski H. Homocysteine thiolactone contributes to the prognostic value of fibrin clot structure/function in coronary artery disease. PLoS One 2022; 17:e0275956. [PMID: 36301961 PMCID: PMC9612472 DOI: 10.1371/journal.pone.0275956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/11/2022] [Indexed: 11/04/2022] Open
Abstract
Fibrin clot structure/function contributes to cardiovascular disease. We examined sulfur-containing metabolites as determinants of fibrin clot lysis time (CLT) and maximum absorbance (Absmax) in relation to outcomes in coronary artery disease (CAD) patients. Effects of B-vitamin/folate therapy on CLT and Absmax were studied. Plasma samples were collected from 1,952 CAD patients randomized in a 2 x 2 factorial design to (i) folic acid, vitamins B12, B6; (ii) folic acid, vitamin B12; (iii) vitamin B6; (iv) placebo for 3.8 years in the Western Norway B-Vitamin Intervention Trial. Clot lysis time (CLT) and maximum absorbance (Absmax) were determined using a validated turbidimetric assay. Acute myocardial infarction (AMI) and mortality were assessed during a 7-year follow-up. Data were analyzed using bivariate and multiple regression. Survival free of events was studied using Kaplan Mayer plots. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards models. Baseline urinary homocysteine (uHcy)-thiolactone and plasma cysteine (Cys) were significantly associated with CLT while plasma total Hcy was significantly associated with Absmax, independently of fibrinogen, triglycerides, vitamin E, glomerular filtration rate, body mass index, age, sex plasma creatinine, CRP, HDL-C, ApoA1, and previous diseases. B-vitamins/folate did not affect CLT and Absmax. Kaplan-Meier analysis showed associations of increased baseline CLT and Absmax with worse outcomes. In Cox regression analysis, baseline CLT and Absmax (>cutoff) predicted AMI (CLT: HR 1.58, 95% CI 1.10-2.28; P = 0.013. Absmax: HR 3.22, CI 1.19-8.69; P = 0.021) and mortality (CLT: HR 2.54, 95% CI 1.40-4.63; P = 0.002. Absmax: 2.39, 95% CI 1.17-4.92; P = 0.017). After adjustments for other prognostic biomarkers these associations remained significant. Cys and uHcy-thiolactone, but not tHcy, were significant predictors of AMI in Cox regression models that included CLT. Conclusions uHcy-thiolactone and plasma Cys are novel determinants of CLT, an important predictor of adverse CAD outcomes. CLT and Absmax were not affected by B-vitamin/folate therapy, which could account for the lack of efficacy of such therapy in CAD. Trial registration: URL: http://clinicaltrials.gov. Identifier: NCT00354081.
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Affiliation(s)
- Marta Sikora
- European Center for Bioinformatics and Genomics, Institute of Bioorganic Chemistry, Poznań, Poland
| | - Paweł Skrzydlewski
- Department of Biochemistry and Biotechnology, University of Life Sciences, Poznań, Poland
| | - Joanna Perła-Kaján
- Department of Biochemistry and Biotechnology, University of Life Sciences, Poznań, Poland
| | - Hieronim Jakubowski
- Department of Biochemistry and Biotechnology, University of Life Sciences, Poznań, Poland
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers-New Jersey Medical School, International Center for Public Health, Newark, NJ, United States of America
- * E-mail:
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Jortveit J, Pripp AH, Langørgen J, Halvorsen S. Time trends in incidence, treatment, and outcome in acute myocardial infarction in Norway 2013–19. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac052. [PMID: 36071696 PMCID: PMC9442850 DOI: 10.1093/ehjopen/oeac052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/26/2022] [Indexed: 11/18/2022]
Abstract
Aims Acute myocardial infarction (AMI) is a common cause of morbidity and mortality. The aim of the present study was to assess time trends in the incidence, treatment, and outcome of AMI in a nationwide registry–based cohort of patients. Methods and results All patients with a first AMI registered in the Norwegian Myocardial Infarction Registry between 2013 and 2019 were included in this cohort study. The number of patients admitted to Norwegian hospitals with a first AMI decreased from 8933 in 2013 to 8383 in 2019. The proportion of patients with ST-elevation myocardial infarction (STEMI) was stable at 30% throughout the period, and the percentage of STEMI undergoing coronary angiography was stable at 87%. The proportion of patients with non-STEMI undergoing coronary angiography increased by 2.4% per year (95% confidence interval 1.6–3.3) from 58% in 2013 to 68% in 2019. More patients were discharged with secondary preventive medication at the end of study period. Age-adjusted 1-year mortality was reduced from 16.4% in 2013 to 15.1% in 2018. The changes over time were primarily seen in the oldest patient groups. Conclusion In the period 2013–19 in Norway, we found a reduction in hospitalizations due to a first AMI. Both the percentage of patients undergoing coronary angiography as well as the percentage discharged with recommended secondary preventive therapy increased during the period, and the age-adjusted 1-year mortality after AMI decreased. A national AMI register provides important information about trends in incidence, treatment, and outcome, and may improve adherence to guideline recommendations.
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Affiliation(s)
- Jarle Jortveit
- Sørlandet Hospital , Arendal, Box 416, Lundsiden, 4604 Kristiansand , Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital , Oslo , Norway
| | | | - Sigrun Halvorsen
- Oslo University Hospital Ullevaal and University of Oslo , Oslo , Norway
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Escobar-Cervantes C, Villa G, Campos-Tapias I, Sorio-Vilela F, Lozano J, Kahangire DA, Fernandez-Delgado M, Sicras-Navarro A, Sicras-Mainar A. Achieving Lower LDL-C Levels After a Recent Myocardial Infarction Might Be Associated with Lower Healthcare Resource Use and Costs in Spain. Adv Ther 2022; 39:3578-3588. [PMID: 35689725 PMCID: PMC9309133 DOI: 10.1007/s12325-022-02187-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There is little evidence on the relationship between achieved low-density lipoprotein cholesterol (LDL-C) levels and costs in patients on lipid-lowering therapy (LLT). We described healthcare resource use and costs (direct and indirect) by achieved LDL-C in patients receiving LLT after a recent myocardial infarction (MI) in Spain. METHODS This was a retrospective observational study of anonymized electronic medical records from seven regions in Spain (BIG-PAC® database; n = 1.9 million). Eligible patients were adults (≥ 18 years) hospitalized for an MI between January 2015 and December 2017, treated with a statin and/or ezetimibe, and having recorded LDL-C values at baseline and during follow-up. Healthcare resource use and direct and indirect costs (in 2018, €) were described by achieved LDL-C levels during a follow-up of 18 months. RESULTS Of 6025 patients (mean age, 69.7 years; 77% male), only 11% achieved LDL-C goals as defined in the 2016 ESC/EAS guidelines (< 70 mg/dL), and just 1% reached the lower target (< 55 mg/dL) in the current 2019 guidelines. Achieving lower LDL-C levels translated to lower healthcare resource use and costs. Mean total (direct and indirect) costs ranged from €5044 for patients with LDL-C < 55 mg/dL to €7567 for patients with LDL-C ≥ 130 mg/dL. CONCLUSION Very few patients achieved recommended LDL-C goals despite using LLT. Achieving lower LDL-C levels after an MI might be associated with lower healthcare resource use and costs. Use of more intensive LLT, leading to greater reductions in LDL-C, could therefore be beneficial both from a clinical and an economic perspective.
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Affiliation(s)
- Carlos Escobar-Cervantes
- Cardiology Department, University Hospital La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain.
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Xie J, Zhang B, Ma J, Zeng D, Lo-Ciganic J. Readmission Prediction for Patients with Heterogeneous Medical History: A Trajectory-Based Deep Learning Approach. ACM TRANSACTIONS ON MANAGEMENT INFORMATION SYSTEMS 2022. [DOI: 10.1145/3468780] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hospital readmission refers to the situation where a patient is re-hospitalized with the same primary diagnosis within a specific time interval after discharge. Hospital readmission causes $26 billion preventable expenses to the U.S. health systems annually and often indicates suboptimal patient care. To alleviate those severe financial and health consequences, it is crucial to proactively predict patients’ readmission risk. Such prediction is challenging because the evolution of patients’ medical history is dynamic and complex. The state-of-the-art studies apply statistical models which use static predictors in a period, failing to consider patients’ heterogeneous medical history. Our approach –
Trajectory-BAsed DEep Learning (TADEL)
– is motivated to tackle the deficiencies of the existing approaches by capturing dynamic medical history. We evaluate TADEL on a five-year national Medicare claims dataset including 3.6 million patients per year over all hospitals in the United States, reaching an F1 score of 87.3% and an AUC of 88.4%. Our approach significantly outperforms all the state-of-the-art methods. Our findings suggest that health status factors and insurance coverage are important predictors for readmission. This study contributes to IS literature and analytical methodology by formulating the trajectory-based readmission prediction problem and developing a novel deep-learning-based readmission risk prediction framework. From a health IT perspective, this research delivers implementable methods to assess patients’ readmission risk and take early interventions to avoid potential negative consequences.
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Affiliation(s)
- Jiaheng Xie
- Lerner College of Business & Economics, University of Delaware, Newark, DE, USA
| | - Bin Zhang
- Eller College of Management, University of Arizona, Tucson, AZ, USA
| | - Jian Ma
- University of Colorado, Colorado Springs, Colorado Springs CO, USA
| | - Daniel Zeng
- Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Jenny Lo-Ciganic
- Department of Pharmaceutical Outcomes & Policy, University of Florida, FL
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Ma S, Bai L, Liu P, She G, Deng XL, Song AQ, Du XJ, Lu Q. Pathogenetic Link of Cardiac Rupture and Left Ventricular Thrombus Following Acute Myocardial Infarction: A Joint Preclinical and Clinical Study. Front Cardiovasc Med 2022; 9:858720. [PMID: 35757352 PMCID: PMC9218188 DOI: 10.3389/fcvm.2022.858720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/25/2022] [Indexed: 12/01/2022] Open
Abstract
Background Cardiac rupture (CR) and left ventricular thrombus (LVT) remain important complications of acute myocardial infarction (MI), and they are currently regarded as independent events. We explored the pathogenetic link between CR and LVT by investigating a murine model of MI with a high frequency of CR and in patients with acute MI. Methods MI was induced in mice, the onset of CR was monitored, and the hearts of mice with or without fatal CR were histologically examined. Between 2015 and 2022, from patients admitted due to acute MI, the data of patients with CR or LVT were retrospectively collected and compared to uncomplicated patients (control). Results A total of 75% of mice (n = 65) with MI developed CR 2–4 days after MI. A histological examination of CR hearts revealed the existence of platelet-rich intramural thrombi in the rupture tunnel, which was connected at the endocardial site to platelet-fibrin thrombi within an LVT. In CR or non-CR mouse hearts, LV blood clots often contained a portion of platelet-fibrin thrombi that adhered to the infarct wall. In non-CR hearts, sites of incomplete CR or erosion of the infarct wall were typically coated with platelet thrombi and dense inflammatory cells. Of 8,936 patients with acute MI, CR and LVT occurred in 102 (1.14%) and 130 (1.45%) patients, respectively, with three cases having both complications. CR accounted for 32.8% of in-hospital deaths. The majority of CR (95%) or LVT (63%, early LVT) occurred within 7 days. In comparison to the control or LVT-late groups, patients with CR or early LVT reported increased levels of cellular and biochemical markers for inflammation or cardiac injury. Conclusion CR and LVT after MI are potentially linked in their pathogenesis. LVT occurring early after MI may be triggered by a thrombo-inflammatory response following wall rupture or endocardial erosion.
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Affiliation(s)
- Shan Ma
- Department of Internal Medicine-Cardiovascular, Cardiovascular Hospital, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Ling Bai
- Department of Internal Medicine-Cardiovascular, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Ping Liu
- Department of Internal Medicine-Cardiovascular, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Gang She
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi’an Jiaotong University, Xi’an, China
| | - Xiu-Ling Deng
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi’an Jiaotong University, Xi’an, China
| | - An-Qi Song
- Department of Internal Medicine-Cardiovascular, Cardiovascular Hospital, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xiao-Jun Du
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi’an Jiaotong University, Xi’an, China
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- *Correspondence: Xiao-Jun Du,
| | - Qun Lu
- Department of Internal Medicine-Cardiovascular, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Qun Lu,
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Bai Z, Hu S, Wang Y, Deng W, Gu N, Zhao R, Zhang W, Ma Y, Wang Z, Liu Z, Shen C, Shi B. Development of a machine learning model to predict the risk of late cardiogenic shock in patients with ST-segment elevation myocardial infarction. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1162. [PMID: 34430603 PMCID: PMC8350690 DOI: 10.21037/atm-21-2905] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/02/2021] [Indexed: 12/23/2022]
Abstract
Background The in-hospital mortality of patients with ST-segment elevation myocardial infarction (STEMI) increases to more than 50% following a cardiogenic shock (CS) event. This study highlights the need to consider the risk of delayed calculation in developing in-hospital CS risk models. This report compared the performances of multiple machine learning models and established a late-CS risk nomogram for STEMI patients. Methods This study used logistic regression (LR) models, least absolute shrinkage and selection operator (LASSO), support vector regression (SVM), and tree-based ensemble machine learning models [light gradient boosting machine (LightGBM) and extreme gradient boosting (XGBoost)] to predict CS risk in STEMI patients. The models were developed based on 1,598 and 684 STEMI patients in the training and test datasets, respectively. The models were compared based on accuracy, the area under the curve (AUC), recall, precision, and Gini score, and the optimal model was used to develop a late CS risk nomogram. Discrimination, calibration, and the clinical usefulness of the predictive model were assessed using C-index, calibration plotd, and decision curve analyses. Results A total of 2282 STEMI patients recruited between January 1, 2016 and May 31, 2020, were included in the complete dataset. The linear models built using LASSO and LR showed the highest overall predictive power, with an average accuracy over 0.93 and an AUC above 0.82. With a C-index of 0.811 [95% confidence interval (CI): 0.769-0.853], the LASSO nomogram showed good differentiation and proper calibration. In internal validation tests, a high C-index value of 0.821 was achieved. Decision curve analysis (DCA) and clinical impact curve (CIC) examination showed that compared with the previous score-based models, the LASSO model showed superior clinical relevance. Conclusions In this study, five machine learning methods were developed for in-hospital CS prediction. The LASSO model showed the best predictive performance. This nomogram could provide an accurate prognostic prediction for CS risk in patients with STEMI.
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Affiliation(s)
- Zhixun Bai
- College of Medicine, Soochow University, Suzhou, China.,Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Internal Medicine, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Shan Hu
- College of Medicine, Soochow University, Suzhou, China.,Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yan Wang
- College of Medicine, Soochow University, Suzhou, China.,Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Wenwen Deng
- College of Medicine, Soochow University, Suzhou, China.,Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ning Gu
- College of Medicine, Soochow University, Suzhou, China.,Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ranzun Zhao
- College of Medicine, Soochow University, Suzhou, China.,Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Wei Zhang
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yi Ma
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhenglong Wang
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhijiang Liu
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Changyin Shen
- Department of Internal Medicine, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Bei Shi
- College of Medicine, Soochow University, Suzhou, China.,Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Mortality following first-time hospitalization with acute myocardial infarction in Norway, 2001-2014: Time trends, underlying causes and place of death. Int J Cardiol 2019; 294:6-12. [PMID: 31387821 DOI: 10.1016/j.ijcard.2019.07.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/19/2019] [Accepted: 07/28/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Trends on cause-specific mortality following acute myocardial infarction (AMI) are poorly described and no studies have analyzed where do AMI patients die. We analyzed trends in 28-day and one-year mortality following an incident AMI with focus on changes over time in the underlying cause and place of death. METHODS We identified in the 'Cardiovascular Disease in Norway' Project all patients 25+ years, hospitalized with an incident AMI in Norway, 2001-2014. Information on date, underlying cause and place of death was obtained from the Cause of Death Registry. RESULTS Of 144,473 patients included in the study, 11.4% died within first 28 days. The adjusted 28-day mortality declined by 5.2% per year (ptrend < 0.001). Of 118,881 patients surviving first 28 days, 10.1% died within one year. The adjusted one-year CVD mortality declined by 6.2% per year (ptrend < 0.001) while non-CVD mortality increased by 1.4% per year (ptrend < 0.001), mainly influenced by increased risk of dying from neoplasms. We observed a shift over time in the underlying cause of death toward more non-CVD deaths, and in the place of death toward more deaths occurring in nursing homes. CONCLUSIONS We observed a decline in 28-day mortality following an incident AMI hospitalization. One-year CVD mortality declined while one-year risk of dying from non-CVD conditions increased. The resulting shift toward more non-CVD deaths and deaths occurring outside a hospital need to be considered when formulating priorities in treating and preventing adverse events among AMI survivors.
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Borowczyk K, Piechocka J, Głowacki R, Dhar I, Midtun Ø, Tell GS, Ueland PM, Nygård O, Jakubowski H. Urinary excretion of homocysteine thiolactone and the risk of acute myocardial infarction in coronary artery disease patients: the WENBIT trial. J Intern Med 2019; 285:232-244. [PMID: 30193001 PMCID: PMC6378604 DOI: 10.1111/joim.12834] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES No individual homocysteine (Hcy) metabolite has been studied as a risk marker for coronary artery disease (CAD). Our objective was to examine Hcy-thiolactone, a chemically reactive metabolite generated by methionyl-tRNA synthetase and cleared by the kidney, as a risk predictor of incident acute myocardial infarction (AMI) in the Western Norway B-Vitamin Intervention Trial. DESIGN Single centre, prospective double-blind clinical intervention study, randomized in a 2 × 2 factorial design. SUBJECTS AND METHODS Patients with suspected CAD (n = 2049, 69.8% men; 61.2-year-old) were randomized to groups receiving daily (i) folic acid (0.8 mg)/vitamin B12 (0.4 mg)/vitamin B6 (40 mg); (ii) folic acid/vitamin B12 ; (iii) vitamin B6 or (iv) placebo. Urinary Hcy-thiolactone was quantified at baseline, 12 and 38 months. RESULTS Baseline urinary Hcy-thiolactone/creatinine was significantly associated with plasma tHcy, ApoA1, glomerular filtration rate, potassium and pyridoxal 5'-phosphate (positively) and with age, hypertension, smoking, urinary creatinine, plasma bilirubin and kynurenine (negatively). During median 4.7-years, 183 patients (8.9%) suffered an AMI. In Cox regression analysis, Hcy-thiolactone/creatinine was associated with AMI risk (hazard ratio = 1.58, 95% confidence interval = 1.10-2.26, P = 0.012 for trend; adjusted for age, gender, tHcy). This association was confined to patients with pyridoxic acid below median (adjusted HR = 2.72, 95% CI = 1.47-5.03, P = 0.0001; Pinteraction = 0.020). B-vitamin/folate treatments did not affect Hcy-thiolactone/creatinine and its AMI risk association. CONCLUSIONS Hcy-thiolactone/creatinine ratio is a novel AMI risk predictor in patients with suspected CAD, independent of traditional risk factors and tHcy, but modified by vitamin B6 catabolism. These findings lend a support to the hypothesis that Hcy-thiolactone is mechanistically involved in cardiovascular disease.
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Affiliation(s)
- K Borowczyk
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers-New Jersey Medical School, International Center for Public Health, Newark, NJ, USA.,Department of Environmental Chemistry, Faculty of Chemistry, University of Łódź, Łódź, Poland
| | - J Piechocka
- Department of Environmental Chemistry, Faculty of Chemistry, University of Łódź, Łódź, Poland
| | - R Głowacki
- Department of Environmental Chemistry, Faculty of Chemistry, University of Łódź, Łódź, Poland
| | - I Dhar
- Department of Clinical Science, University of Bergen, 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
| | - P M Ueland
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - O Nygård
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Institute of Medicine, University of Bergen, Bergen, Norway
| | - H Jakubowski
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers-New Jersey Medical School, International Center for Public Health, Newark, NJ, USA.,Department of Biochemistry and Biotechnology, Poznań University of Life Sciences, Poznań, Poland
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Alonso F, Nazzal C, Cerecera F, Ojeda JI. Reducing Health Inequalities: Comparison of Survival After Acute Myocardial Infarction According to Health Provider in Chile. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2018; 49:127-141. [PMID: 30428269 DOI: 10.1177/0020731418809851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health inequalities are marked in Chile. To address this situation, a health reform was implemented in 2005 that guarantees acute myocardial infarction (AMI) health care for the entire population. We evaluated if the health reform changed AMI early and long-term survival rates by hospital provider (public/private) using a longitudinal population-based study of patients ≥15 years with a first AMI in Chile between 2002 and 2011. Time trends and early (within 28 days) and long-term (29-365 days) survival by age were assessed. We identified 59,557 patients: median age of 64 years; 68.9% men; 83.2% treated at public hospitals; 74.4% with public insurance. Early and long-term case-fatality was higher at public hospitals (14.6% vs 9.3%; P < .001 and 5.8% vs 3.3%; P < .001, respectively). There was a higher annual increase for early and long-term survival in public hospitals, 0.008 percentage points (95% CI: 0.006, 0.009; P < .0001) and 0.03 (0.002, 0.003; P < .0001), than in private hospitals, 0.0002 (95% CI: -0.0001, 0.005; P = .10) and 0.002 (95% CI: 0.0007, 0.003; P = .004), respectively. Being served at public hospitals affected early and long-term survival, especially in patients <70 years: hazard ratio was 2.01 (95% CI: 1.77, 2.28) and 3.11 (2.41, 4.01), respectively. Therefore, even if inequalities persist, there was a higher increase in early and long-term survival in public versus private hospitals.
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Affiliation(s)
- Faustino Alonso
- 1 School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Carolina Nazzal
- 1 School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile
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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.
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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
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11
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Sulo G, Igland J, Nygård O, Vollset SE, Ebbing M, Poulter N, Egeland GM, Cerqueira C, Jørgensen T, Tell GS. Prognostic Impact of In-Hospital and Postdischarge Heart Failure in Patients With Acute Myocardial Infarction: A Nationwide Analysis Using Data From the Cardiovascular Disease in Norway (CVDNOR) Project. J Am Heart Assoc 2017; 6:JAHA.116.005277. [PMID: 28298373 PMCID: PMC5524033 DOI: 10.1161/jaha.116.005277] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Heart failure (HF) is a serious complication of acute myocardial infarction (AMI). We explored the excess mortality associated with HF as an early or late complication of AMI and describe changes over time in such excess mortality. METHODS AND RESULTS All patients hospitalized with an incident AMI and without history of prior HF hospitalization were followed up to 1 year after AMI discharge for episodes of HF. New HF episodes were classified as in-hospital HF if diagnosed during the AMI hospitalization or postdischarge HF if diagnosed within 1 year after discharge from the incident AMI. Logistic and Cox regression models were used to explore the excess mortality associated with HF categories. Changes over time in the excess mortality were assessed by testing the interaction between HF status and study year. In-hospital HF increased in-hospital mortality 1.79 times (odds ratio [OR], 1.79; 95% CI: 1.68-1.91). The excess mortality associated with HF increased by 4.3 times from 2001 to 2009 (P interaction<0.001) as a consequence of a greater decline of in-hospital mortality among AMI patients without (9% per year) compared to those with in-hospital HF (3% per year). Postdischarge HF increased all-cause and CVD mortality 5.98 times (hazard ratio, 5.98; 95% CI: 5.39-6.64) and 7.93 times (subhazard ratio, 7.93; 95% CI: 6.84 -9.19), respectively. The relative excess 1-year mortality associated with HF did not change significantly over time. CONCLUSIONS Development of HF-either as an early or late complication of AMI-has a negative impact on patients' survival. Changes in the excess mortality associated with HF are driven by modest improvements in survival among AMI patients with HF as compared to those without HF.
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Affiliation(s)
- Gerhard Sulo
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Ottar Nygård
- Department of Clinical Science, University of Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Stein Emil Vollset
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Centre for Burden of Disease, Norwegian Institute of Public Health, Bergen, Norway
| | - Marta Ebbing
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Domain for Health Data and Digitalization, Department of Health Registry Research, Norwegian Institute of Public Health, Bergen, Norway
| | - Neil Poulter
- International Centre for Circulatory Health and Imperial Clinical Trials Unit, National Heart and Lung Institute and School of Public Health, Imperial College, London, United Kingdom
| | - Grace M Egeland
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Domain for Health Data and Digitalization, Department of Health Registry Research, Norwegian Institute of Public Health, Bergen, Norway
| | - Charlotte Cerqueira
- Research Centre for Prevention and Health, Capital Region, Copenhagen, Denmark
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Capital Region, Copenhagen, Denmark.,Department of Public Health, Institute of Clinical Science, University of Copenhagen, Denmark.,Faculty of Medicine, University of Aalborg, Denmark
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Domain for Health Data and Digitalization, Department of Health Registry Research, Norwegian Institute of Public Health, Bergen, Norway
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12
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Trends in the risk of early and late-onset heart failure as an adverse outcome of acute myocardial infarction: A Cardiovascular Disease in Norway project. Eur J Prev Cardiol 2017; 24:971-980. [DOI: 10.1177/2047487317698568] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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13
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Sulo E, Nygård O, Vollset SE, Igland J, Ebbing M, Østbye T, Jørgensen T, Sulo G, Tell GS. Time Trends and Educational Inequalities in Out-of-Hospital Coronary Deaths in Norway 1995-2009: A Cardiovascular Disease in Norway (CVDNOR) Project. J Am Heart Assoc 2017; 6:JAHA.116.005236. [PMID: 28219924 PMCID: PMC5523789 DOI: 10.1161/jaha.116.005236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent time trends and educational gradients characterizing out-of-hospital coronary deaths (OHCD) are poorly described. METHODS AND RESULTS We identified all deaths from coronary heart disease occurring outside the hospital in Norway during 1995 to 2009. Time trends were explored using Poisson regression analysis with year as the independent, continuous variable. Information on the highest achieved education was obtained from The National Education Database and classified as primary (up to 10 years of compulsory education), secondary (high school or vocational school), or tertiary (college/university). Educational gradients in OHCD were explored using Poisson regression, stratified by sex and age (<70 and ≥70 years), and results were expressed as incidence rate ratios (IRRs) and 95%CIs. Of 100 783 coronary heart disease deaths, 58.8% were OHCDs. From 1995 to 2009, age-adjusted OHCD rates declined across all education categories (primary, secondary, and tertiary) in younger men (IRR=0.35; 95%CI 0.32-0.38; IRR=0.38; 95%CI 0.35-0.42; IRR=0.33; 95%CI 0.28-0.40), younger women (IRR=0.47; 95% CI 0.40-0.56; IRR=0.55; 95%CI 0.45-0.67; IRR=0.28; 95% CI 0.16-0.47), older men (IRR=0.20; 95%CI 0.19-0.22; IRR=0.20; 95%CI 0.18-0.22; IRR=0.20; 95%CI 0.17-0.23), and older women (IRR=0.26; 95%CI 0.24-0.28; IRR=0.25; 95%CI 0.23-0.28; IRR=0.28; 95%CI 0.22-0.34). Tertiary education was associated with lower risk of OHCD compared to primary education (IRR=0.37; 95%CI 0.35-0.40 in younger men, IRR=0.26; 95%CI 0.22-0.30 in younger women, IRR=0.52; 95%CI 0.49-0.55 in older men, and IRR=0.61; 95%CI 0.57-0.66 in older women). These gradients did not change over time (P interaction=0.25). CONCLUSIONS Although OHCD rates declined substantially during 1995 to 2009, they displayed educational gradients that remained constant over time.
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Affiliation(s)
- Enxhela Sulo
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Ottar Nygård
- Department of Clinical Science, University of Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Stein Emil Vollset
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Centre for Burden of Disease, Norwegian Institute of Public Health, Bergen, Norway
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Marta Ebbing
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Domain for Health Data and Digitalisation, Norwegian Institute of Public Health, Bergen, Norway
| | - Truls Østbye
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Duke Global Health Institute, Duke University, Durham, NC
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Capital Region, Denmark.,Department of Public Health, Institute of Clinical Science, University of Copenhagen, Denmark.,Faculty of Medicine, University of Aalborg, Denmark
| | - Gerhard Sulo
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Domain for Health Data and Digitalisation, Norwegian Institute of Public Health, Bergen, Norway
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14
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Exchanging a few commercial, regularly consumed food items with improved fat quality reduces total cholesterol and LDL-cholesterol: a double-blind, randomised controlled trial. Br J Nutr 2016; 116:1383-1393. [PMID: 27737722 DOI: 10.1017/s0007114516003445] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The healthy Nordic diet has been previously shown to have health beneficial effects among subjects at risk of CVD. However, the extent of food changes needed to achieve these effects is less explored. The aim of the present study was to investigate the effects of exchanging a few commercially available, regularly consumed key food items (e.g. spread on bread, fat for cooking, cheese, bread and cereals) with improved fat quality on total cholesterol, LDL-cholesterol and inflammatory markers in a double-blind randomised, controlled trial. In total, 115 moderately hypercholesterolaemic, non-statin-treated adults (25-70 years) were randomly assigned to an experimental diet group (Ex-diet group) or control diet group (C-diet group) for 8 weeks with commercially available food items with different fatty acid composition (replacing SFA with mostly n-6 PUFA). In the Ex-diet group, serum total cholesterol (P<0·001) and LDL-cholesterol (P<0·001) were reduced after 8 weeks, compared with the C-diet group. The difference in change between the two groups at the end of the study was -9 and -11 % in total cholesterol and LDL-cholesterol, respectively. No difference in change in plasma levels of inflammatory markers (high-sensitive C-reactive protein, IL-6, soluble TNF receptor 1 and interferon-γ) was observed between the groups. In conclusion, exchanging a few regularly consumed food items with improved fat quality reduces total cholesterol, with no negative effect on levels of inflammatory markers. This shows that an exchange of a few commercially available food items was easy and manageable and led to clinically relevant cholesterol reduction, potentially affecting future CVD risk.
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15
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Mundal L, Veierød MB, Halvorsen T, Holven KB, Ose L, Iversen PO, Tell GS, Leren TP, Retterstøl K. Cardiovascular disease in patients with genotyped familial hypercholesterolemia in Norway during 1994–2009, a registry study. Eur J Prev Cardiol 2016; 23:1962-1969. [DOI: 10.1177/2047487316666371] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Liv Mundal
- The Lipid Clinic, Oslo University Hospital Rikshospitalet, Norway
| | - Marit B Veierød
- Department of Nutrition, University of Oslo, Norway
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Norway
| | - Thomas Halvorsen
- Department of Health Research, SINTEF Technology and Society, Norway
| | - Kirsten B Holven
- Department of Nutrition, University of Oslo, Norway
- National Advisory Unit for Familial Hypercholesterolemia, Oslo University Hospital, Norway
| | - Leiv Ose
- Department of Nutrition, University of Oslo, Norway
| | - Per Ole Iversen
- Department of Nutrition, University of Oslo, Norway
- Department of Hematology, Oslo University Hospital Rikshospitalet, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Department of Health Registries, Norwegian Institute of Public Health, Norway
| | - Trond P Leren
- Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital Ullevaal, Norway
| | - Kjetil Retterstøl
- The Lipid Clinic, Oslo University Hospital Rikshospitalet, Norway
- Department of Nutrition, University of Oslo, Norway
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16
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Myftiu S, Bara P, Sharka I, Shkoza A, Belshi X, Rruci E, Vyshka G. Heart Failure Predictors in a Group of Patients with Myocardial Infarction. Open Access Maced J Med Sci 2016; 4:435-438. [PMID: 27703569 PMCID: PMC5042629 DOI: 10.3889/oamjms.2016.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/11/2016] [Accepted: 08/27/2016] [Indexed: 02/05/2023] Open
Abstract
AIM The present study considers of the prevalence of heart failure (HF) in patients suffering from acute myocardial infarction (AMI) in the University Hospital Centre of Tirana (UHCT) "Mother Theresa"; the demographic and clinical characteristics of the sample during hospitalization; and the main predictors of heart failure occurrence inside the group of patients suffering an AMI. MATERIAL AND METHODS During a period of study from 2013-2015 we studied demographic and clinical data from 587 consecutive patients presenting with AMI; Framingham criteria were adopted for classifying patients with HF upon admission. RESULTS A Killip class ≥ 2 was the main diagnostic criterion of HF during hospitalisation. HF was identified in 156 patients (26.6%). The subgroup with HF had significant differences when compared with the other patients with regard to age, sex (male), heart rate upon admission, systolic blood pressure on admission, previous episodes of AMI, glycemia on admission, previous antihypertensive treatment, previous revascularization procedures, peripheral vascular disease, chronic renal disease, ejection fraction (EF), anemia, and atrial fibrillation presence. Independent predictors for HF occurrence in the logistic regression model were EF, previous revascularization, peripheral vascular disease, age, sex, previous AMI, systolic blood pressure upon admission, and anaemia. CONCLUSION As a conclusion, HF seems to be a common occurrence after AMI, in spite of changes in the epidemiological profile of the acute coronary syndrome. An increase in the incidence is registered as well, parallel to a decrease in the mortality following AMI. Attention must be shown for highly risked subpopulations, aged persons, patients with the previous coronary disease, and concomitant conditions.
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Affiliation(s)
- Sokol Myftiu
- Service of Cardiology, University Hospital Centre “Mother Theresa”, Tirana, Albania
| | - Petrit Bara
- Service of Cardiology, University Hospital Centre “Mother Theresa”, Tirana, Albania
| | - Ilir Sharka
- Service of Cardiology, University Hospital Centre “Mother Theresa”, Tirana, Albania
| | - Artan Shkoza
- Biomedical and Experimental Department, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Xhina Belshi
- Service of Cardiology, University Hospital Centre “Mother Theresa”, Tirana, Albania
| | - Edlira Rruci
- Biomedical and Experimental Department, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Gentian Vyshka
- Biomedical and Experimental Department, Faculty of Medicine, University of Medicine, Tirana, Albania
- Correspondence: Gentian Vyshka. Biomedical and Experimental Department, Faculty of Medicine, University of Medicine, Tirana, Albania. Tel: +355 69 7566130. E-mail:
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17
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Jortveit J, Govatsmark RES, Langørgen J, Hole T, Mannsverk J, Olsen S, Risøe C, Halvorsen S. Gender differences in the assessment and treatment of myocardial infarction. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:1215-22. [PMID: 27554562 DOI: 10.4045/tidsskr.16.0224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Previous studies have shown that there are gender-related differences in the assessment and treatment of myocardial infarction, despite international guidelines that prescribe identical treatment for women and men. We investigated whether these differences occurred in Norway. MATERIAL AND METHOD All patients admitted to Norwegian hospitals with myocardial infarction from 1 January 2013 to 31 December 2014 and registered in the Norwegian Myocardial Infarction Registry were included. Data from the registry were used to analyse differences in the assessment, treatment, complications and survival of women and men in different age groups. RESULTS A total of 26 447 myocardial infarctions were registered in the Norwegian Myocardial Infarction Registry in the period 2013 – 2014. Fewer women than men were assessed by means of coronary angiography. Percutaneous coronary intervention (PCI) was used to virtually the same extent for both genders if coronary stenosis was found. Women were recommended secondary prophylactic medication to a lesser extent than men. There were no major differences between men and women in the incidence of complications in the course following myocardial infarction or in survival. INTERPRETATION Fewer women than men suffering acute myocardial infarction were assessed by means of coronary angiography, and women were recommended secondary prophylactic medication less often than men. The reason for the gender differences is not known, but comorbidity and a potentially greater risk of adverse reactions in women may be contributory factors. The different views of doctors providing treatment may also play a part.
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Affiliation(s)
| | | | | | | | - Jan Mannsverk
- Hjertemedisinsk avdeling Universitetssykehuset Nord-Norge
| | - Siv Olsen
- Medisinsk klinikk Universitetssykehuset Nord-Norge, Harstad
| | - Cecilie Risøe
- Kardiologisk avdeling Oslo universitetssykehus, Rikshospitalet
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18
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Myftiu S, Sulo E, Burazeri G, Sharka I, Shkoza A, Sulo G. A higher burden of metabolic risk factors and underutilization of therapy among women compared to men might influence a poorer prognosis: a study among acute myocardial patients in Albania, a transitional country in Southeastern Europe. Croat Med J 2016; 56:542-9. [PMID: 26718760 PMCID: PMC4707925 DOI: 10.3325/cmj.2015.56.542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To determine the clinical profile, burden of risk factors, and quality of care among patients hospitalized for an acute myocardial infarction (AMI) with special focus on gender differences. Methods The study included 256 AMI patients admitted to the Coronary Care Unit of “Mother Teresa” hospital in Tirana during 2013-2014. We obtained information on patients’ demographic data, AMI characteristics, complications (heart failure [HF] and ventricular fibrillation [VF]), risk factors and medication use prior and during the AMI hospitalization. Age-adjusted Poisson regression analyses were applied to explore gender differences (women vs men) with regard to clinical profile and quality of care and results are expressed as incidence rate ratios (IRR). Results 55.4% of patients had ≥3 risk factors, 44.5% developed HF, and 5.7% developed VF. Only 40.4% of patients received all 4 medication classes (beta-blockers, angiotensin-converting-enzyme inhibitor/angiotensin receptor blockers, statins, and aspirin) and 46.4% had revascularization. Significantly more women than men were obese, (P = 0.042) had diabetes, (P = 0.001) developed HF (P < 0.001) or experienced a VF episode (P < 0.001). After adjusting for age, differences with regard to obesity (IRR = 2.17; 95% confidence interval [CI] 1.15-4.09), diabetes (IRR = 1.35; 95% CI 1.07-1.71), HF (IRR = 1.32; 95% CI 1.02-1.74) and VF (IRR = 2.82; 95% CI 1.07-7.43) remained significant. There were no differences with regard to individual drug classes taken. However, women had fewer revascularization procedures than men (IRR = 0.65; 95% CI 0.43-0.98). Conclusion Women were found to have more unfavorable clinical profile, higher complication rates, and underutilization of therapy, which may be influenced by socioeconomic differences between genders and lead to a differential prognosis.
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Affiliation(s)
| | | | | | | | | | - Gerhard Sulo
- Gerhard Sulo, Department of Global Public Health and Primary Care, Kalfarveien 31, N-5018 Bergen, Norway,
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19
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Coronary angiography and myocardial revascularization following the first acute myocardial infarction in Norway during 2001–2009: Analyzing time trends and educational inequalities using data from the CVDNOR project. Int J Cardiol 2016; 212:122-8. [DOI: 10.1016/j.ijcard.2016.03.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 03/13/2016] [Accepted: 03/15/2016] [Indexed: 01/31/2023]
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20
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Nedkoff L, Knuiman M, Hung J, Briffa TG. Improving 30-day case fatality after incident myocardial infarction in people with diabetes between 1998 and 2010. Heart 2015; 101:1318-24. [PMID: 26076939 DOI: 10.1136/heartjnl-2015-307627] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/25/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To compare population-level trends in 30-day case fatality following incident myocardial infarction (MI) in people with diabetes and those without diabetes. METHODS We identified all hospitalised incident MIs in 35-84 year olds from the Western Australian Data Linkage System for 1998-2010, stratified by diabetes status. Crude and age- and sex-standardised 30-day case fatality were estimated, and age- and sex-adjusted trends were calculated from logistic regression. We calculated the trend in risk of 30-day death associated with diabetes from multivariable logistic regression, adjusting for demographics, comorbidities and MI type. RESULTS 26 610 hospitalised incident MI cases were identified, 24.8% of whom had diabetes. The prevalence of heart failure fell in people with diabetes, concurrent with increasing chronic kidney disease and prior coronary heart disease and increasing levels of evidence-based therapies. Case fatality in people with diabetes fell from 11.65%, in 1998-2001, to 3.96% by 2008-2010. Age- and sex-standardised case fatality declined at a greater rate in those with diabetes (-10.6%/year, 95% CI -12.8% to -8.2%) compared to non-diabetics (-6.9%/year, 95% CI -8.3% to -5.3%; interaction p=0.005). The adjusted risk of 30-day death after incident MI was 1.23 times higher in diabetics than non-diabetics in 1998-2001 (95% CI 1.01 to 1.50), but was lower by 2008-2010 (OR 0.64, 95% CI 0.46 to 0.88). CONCLUSIONS Greater improvements in 30-day case fatality following incident MI in people with diabetes during the 13-year study period has led to diabetes no longer being an independent predictor of early death following incident MI by 2008-2010.
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Affiliation(s)
- Lee Nedkoff
- School of Population Health (M431), The University of Western Australia, Crawley, Western Australia, Australia
| | - Matthew Knuiman
- School of Population Health (M431), The University of Western Australia, Crawley, Western Australia, Australia
| | - Joseph Hung
- School of Population Health (M431), The University of Western Australia, Crawley, Western Australia, Australia School of Medicine and Pharmacology (M503), Sir Charles Gairdner Hospital Unit, The University of Western Australia, Crawley, Western Australia, Australia
| | - Tom G Briffa
- School of Population Health (M431), The University of Western Australia, Crawley, Western Australia, Australia
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21
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Sulo G, Igland J, Vollset SE, Nygård O, Egeland GM, Ebbing M, Sulo E, Tell GS. Effect of the Lookback Period's Length Used to Identify Incident Acute Myocardial Infarction on the Observed Trends on Incidence Rates and Survival: Cardiovascular Disease in Norway Project. Circ Cardiovasc Qual Outcomes 2015; 8:376-82. [PMID: 26058719 DOI: 10.1161/circoutcomes.114.001703] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 05/11/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND In studies using patient administrative data, the identification of the first (incident) acute myocardial infarction (AMI) in an individual is based on retrospectively excluding previous hospitalizations for the same condition during a fixed time period (lookback period [LP]). Our aim was to investigate whether the length of the LP used to identify the first AMI had an effect on trends in AMI incidence and subsequent survival in a nationwide study. METHODS AND RESULTS All AMI events during 1994 to 2009 were retrieved from the Cardiovascular Disease in Norway project. Incident AMIs during 2004 to 2009 were identified using LPs of 10, 8, 7, 5, and 3 years. For each LP, we calculated time trends in incident AMI and subsequent 28-day and 1-year mortality rates. Results obtained from analyses using the LP of 10 years were compared with those obtained using shorter LPs. In men, AMI incidence rates declined by 4.2% during 2004 to 2009 (incidence rate ratio, 0.958; 95% confidence interval, 0.935-0.982). The use of other LPs produced similar results, not significantly different from the LP of 10 years. In women, AMI incidence rates declined by 7.3% (incidence rate ratio, 0.927; 95% confidence interval, 0.901-0.955) when an LP of 10 years was used. The decline was statistically significantly smaller for the LP of 5 years (6.2% versus 7.3%; P=0.02) and 3 years (5.9% versus 7.3%; P=0.03). The choice of LP did not influence trends in 28-day and 1-year mortality rates. CONCLUSIONS The length of LP may influence the observed time trends in incident AMIs. This effect is more evident in older women.
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Affiliation(s)
- Gerhard Sulo
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.).
| | - Jannicke Igland
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Stein Emil Vollset
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Ottar Nygård
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Grace M Egeland
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Marta Ebbing
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Enxhela Sulo
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Grethe S Tell
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
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