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Kurucz VC, Schenk J, Veelo DP, Geerts BF, Vlaar APJ, Van Der Ster BJP. Prediction of emergency department presentations for acute coronary syndrome using a machine learning approach. Sci Rep 2024; 14:23125. [PMID: 39367080 PMCID: PMC11452569 DOI: 10.1038/s41598-024-73291-1] [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: 04/24/2024] [Accepted: 09/16/2024] [Indexed: 10/06/2024] Open
Abstract
The relationship between weather and acute coronary syndrome (ACS) incidence has been the subject of considerable research, with varying conclusions. Harnessing machine learning techniques, our study explores the relationship between meteorological factors and ACS presentations in the emergency department (ED), offering insights into seasonal variations and inter-day fluctuations to optimize patient care and resource allocation. A retrospective cohort analysis was conducted, encompassing ACS presentations to Dutch EDs from 2010 to 2017. Temporal patterns were analyzed using heat-maps and time series plots. Multivariable linear regression (MLR) and Random Forest (RF) regression models were employed to forecast daily ACS presentations with prediction horizons of one, three, seven, and thirty days. Model performance was assessed using the coefficient of determination (R²), Mean Absolute Error (MAE), and Mean Absolute Percentage Error (MAPE). The study included 214,953 ACS presentations, predominantly unstable angina (UA) (94,272; 44%), non-ST-elevated myocardial infarction (NSTEMI) (78,963; 37%), and ST-elevated myocardial infarction (STEMI) (41,718; 19%). A decline in daily ACS admissions over time was observed, with notable inter-day (estimated median difference: 41 (95%CI = 37-43, p = < 0.001) and seasonal variations (estimated median difference: 9 (95%CI 6-12, p = < 0.001). Both MLR and RF models demonstrated similar predictive capabilities, with MLR slightly outperforming RF. The models showed moderate explanatory power for ACS incidence (adjusted R² = 0.66; MAE (MAPE): 7.8 (11%)), with varying performance across subdiagnoses. Prediction of UA incidence resulted in the best-explained variability (adjusted R² = 0.80; MAE (MAPE): 5.3 (19.1%)), followed by NSTEMI and STEMI diagnoses. All models maintained consistent performance over extended prediction horizons. Our findings indicate that ACS presentation exhibits distinctive seasonal changes and inter-day differences, with marked reductions in incidence during the summer months and a distinct peak prevalence on Mondays. The predictive performance of our model was moderate. Nonetheless, we obtained good explanatory power for UA presentations. Our model emerges as a potentially valuable supplementary tool to enhance ED resource allocation or future predictive models predicting ACS incidence in the ED.
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Affiliation(s)
- Vincent C Kurucz
- Department of Anesthesiology, Amsterdam UMC, location Academic Medical Centre, University of Amsterdam, Meibergdreef 9, PO Box 22660, Amsterdam, 1105 AZ, The Netherlands.
| | - Jimmy Schenk
- Department of Anesthesiology, Amsterdam UMC, location Academic Medical Centre, University of Amsterdam, Meibergdreef 9, PO Box 22660, Amsterdam, 1105 AZ, The Netherlands
- Department of Intensive Care, Amsterdam UMC, location Academic Medical Centre, University of Amsterdam, Meibergdreef 9, PO Box 22660, Amsterdam, 1105 AZ, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, location Academic Medical Centre, University of Amsterdam, Meibergdreef 9, PO Box 22660, Amsterdam, 1105 AZ, The Netherlands
| | - Denise P Veelo
- Department of Anesthesiology, Amsterdam UMC, location Academic Medical Centre, University of Amsterdam, Meibergdreef 9, PO Box 22660, Amsterdam, 1105 AZ, The Netherlands
| | | | - Alexander P J Vlaar
- Department of Intensive Care, Amsterdam UMC, location Academic Medical Centre, University of Amsterdam, Meibergdreef 9, PO Box 22660, Amsterdam, 1105 AZ, The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, location Academic Medical Centre, University of Amsterdam, Meibergdreef 9, PO Box 22660, Amsterdam, 1105 AZ, The Netherlands
| | - Björn J P Van Der Ster
- Department of Anesthesiology, Amsterdam UMC, location Academic Medical Centre, University of Amsterdam, Meibergdreef 9, PO Box 22660, Amsterdam, 1105 AZ, The Netherlands
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Tian H, Zhao X, Zhang Y, Xia Z. Research progress of circadian rhythm in cardiovascular disease: A bibliometric study from 2002 to 2022. Heliyon 2024; 10:e28738. [PMID: 38560247 PMCID: PMC10979111 DOI: 10.1016/j.heliyon.2024.e28738] [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: 05/05/2023] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
Background Given that the circadian rhythm is intricately linked to cardiovascular physiological functions, the objective of this investigation was to employ bibliometric visualization analysis in order to scrutinize the trends, hotspots, and prospects of the circadian rhythm and cardiovascular disease (CVD) over the past two decades. Methods A thorough exploration of the literature related to the circadian rhythm and CVD was conducted via the Web of Science Core Collection database spanning the years 2002-2022. Advanced software tools, including citespace and VOSviewer, were employed to carry out a comprehensive analysis of the co-occurrence and collaborative relationships among countries, institutions, journals, references, and keywords found in this literature. Furthermore, correlation mapping was executed to provide a visual representation of the data. Results The present study encompassed a total of 3399 published works, comprising of 2691 articles and 708 reviews. The publications under scrutiny were primarily derived from countries such as the United States, Japan, and China. The most prominent research institutions were found to be the University of Vigo, University of Minnesota, and Harvard University. Notably, the journal Chronobiology International, alongside its co-cited publications, had the most substantial contribution to the research in this field. Following an exhaustive analysis, the most frequently observed keywords were identified as circadian rhythm, blood pressure, hypertension, heart rate, heart rate variability, and melatonin. Furthermore, a nascent analysis indicated that future research might gravitate towards topics such as inflammation, metabolism, oxidative stress, and autophagy, thereby indicating new directions for investigation. Conclusion This analysis represents the first instance of bibliometric scrutiny pertaining to circadian rhythm and its correlation with cardiovascular disease (CVD) through the use of visualization software. Notably, this study has succeeded in highlighting the recent research frontiers and prominent trajectories in this field, thereby providing a valuable contribution to the literature.
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Affiliation(s)
- Hao Tian
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Xiaoshuai Zhao
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yuxi Zhang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Zhongyuan Xia
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
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Jiang Q, Zhang N, Zhang H, Xiao Y, Zhang X, Gao J, Liu Y. Impact of off-hour admission on the MACEs of patients with acute myocardial infarction. Clin Exp Hypertens 2023; 45:2186317. [PMID: 36890705 DOI: 10.1080/10641963.2023.2186317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
BACKGROUND In China, on more than 100 weekends or holidays, only on-duty cardiologists are available during admissions. This study aimed to analyze the impact of admission time on major adverse cardiovascular events (MACEs) in patients with acute myocardial infarction (AMI). METHODS This prospective observational study enrolled patients with AMI between October 2018 and July 2019. The patients were assorted into off-hour (admitted on weekends or national holidays) and on-hour groups. The outcome was MACEs at admission and 1 year after discharge. RESULTS A total of 485 patients with AMI were enrolled in this study. The occurrence of MACEs was significantly higher in the off-hour group compared with the on-hour group (P < .05). Multivariate regression analysis showed that age (HR = 1.047, 95% CI: 1.021-1.073), blood glucose level (HR = 1.029, 95% CI: 1.009-1.050), multivessel disease (HR = 1.904, 95% CI: 1.074-3.375), and off-hour hospital admission (HR = 1.849, 95% CI: 1.125-3.039) were all independent risk factors for in-hospital MACEs, while percutaneous coronary intervention (HR = 0.210, 95% CI: 0.147-0.300) and on-hour admission (HR = 0.723, 95% CI: 0.532-0.984) were protective factors for MACEs 1 year after discharge. CONCLUSION The "off-hour effect" still existed in patients with AMI, and the risk of MACEs in the hospital and 1 year after discharge was higher for off-hour admission.
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Affiliation(s)
- Qiuhong Jiang
- Department of Cardiology, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Nan Zhang
- Department of Cardiovascular Medicine CCU, Tianjin Chest Hospital, Tianjin, China
| | - Hongyu Zhang
- Department of Cardiology, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Yongjian Xiao
- Department of Cardiovascular Medicine CCU, Tianjin Chest Hospital, Tianjin, China
| | - Xia Zhang
- Department of Cardiology, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Jing Gao
- Department of cardiovascular medicine institute, Tianjin Chest Hospital, Tianjin, China
| | - Yin Liu
- Department of Cardiovascular Medicine CCU, Tianjin Chest Hospital, Tianjin, China
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Yang W, Zeng L, Yang H, Guo F, Zhou D, Cui W, Wu S, Chen C, Zhao J, Wang W, Yang N, Lin H, Li L. Effect of national holidays on health outcomes of patients receiving peritoneal dialysis in a single center over a ten-year period. Ren Fail 2023; 45:2153697. [PMID: 36645059 PMCID: PMC9848312 DOI: 10.1080/0886022x.2022.2153697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND National holidays are associated with high mortality in some diseases, but little is known about patients undergoing peritoneal dialysis (PD). The research aimed to investigate the impact of national holidays on the health outcomes of PD patients. METHODS Over ten years, all episodes of unplanned hospitalization, death, and peritonitis in PD patients were collected in our center. Seven national holidays in China were chosen, and non-holiday days were selected as the control period. The effect of national holidays was observed by comparing the hospitalization, death, and peritonitis rates between holiday and non-holiday groups. RESULTS There were 297 events in all holiday periods and 1247 in non-holiday periods. There is no significant difference in hospitalization rate between holiday and non-holiday groups (32.4% ± 6.4% vs. 29.2% ± 3.4%, p = 0.175). So is the death rate [6.3% (4.8-12.3%) vs.5.0% (4.2-8.9%), p = 0.324] and peritonitis rate [0.19 (0.13-0.53) vs. 0.22 (0.18-0.27), p = 0.445] between the two groups. Significant differences were observed in the distribution of peritonitis causes between the two groups (p = 0.017). The rate of secondary to other infections in the holiday group was significantly higher than in the non-holiday group (25.0 vs. 10.3%, p = 0.015). CONCLUSION Our study suggested no national holiday effect on health outcomes of PD patients based on ten-year data in our center.
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Affiliation(s)
- Wei Yang
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Li Zeng
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Huibin Yang
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Fujia Guo
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Dan Zhou
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China,College of Integrative Medicine, Dalian Medical University, Dalian, China
| | - Wenting Cui
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuran Wu
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Cong Chen
- Graduate School, Dalian Medical University, Dalian, China
| | - Jiayao Zhao
- Graduate School, Dalian Medical University, Dalian, China
| | - Weidong Wang
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ning Yang
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hongli Lin
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China,Hongli Lin Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, 116011, Liaoning Province, China
| | - Longkai Li
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China,CONTACT Longkai Li
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Hlavaty A, Roustit M, Manceau M, Cracowski JL, Khouri C. The Christmas adverse event syndrome: An analysis of the WHO pharmacovigilance database. Therapie 2023:S0040-5957(23)00187-7. [PMID: 38057212 DOI: 10.1016/j.therap.2023.11.004] [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: 09/19/2023] [Revised: 10/23/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES We hypothesized that during the Christmas season the safety profile and the toxicity of some drugs may be exacerbated. We therefore assessed and characterized changes in drug safety profiles over the Christmas period. DESIGN We performed a retrospective longitudinal analysis of adverse events reported in the World Health Organization (WHO) pharmacovigilance database between April 1st 2017 to March 31th 2023. SETTING We extracted cases reported by the 5 main contributors' countries of the WHO pharmacovigilance database with a Christmas tradition: USA, France, Germany, Italy and UK. PARTICIPANTS We analyzed 4,999,459 individual case safety reports from USA (n=3,498,961), France (n=419,018), Germany (n=398,763), Italy (n=251,641) and UK (n=431,076), reported between April 1st 2017 to March 31th 2023. MAIN OUTCOME MEASURES Monthly reports of adverse events were analyzed. Time trend, seasonal effect a Christmas effect (December-January) were explored. RESULTS We found 91 adverse events significantly more frequently reported during the Christmas period, independently after controlling for winter effect and general tendency. The main type of adverse events were psychiatric disorders, infections and skin and subcutaneous disorders. The highest numbers of attributable cases to Christmas were found for drug dependence, emotional distress, and drug withdrawal syndrome. The most involved drugs were oxycodone in psychiatric disorders (n=47,527), docetaxel in skin disorders (n=9440) and social circumstances (n=1940), olmesartan in gastrointestinal disorders (n=1263), fentanyl in cardiac disorders (n=929), adalimumab in infections (n=11,316) and immune system disorders (n=3781), and collagenase clostridium histolyticum in reproductive system disorders (n=318). CONCLUSIONS Our study shows that a range of drugs adverse events are more frequently reported at Christmas compared to other periods of the year, notably psychiatric disorders, infections, and skin disorders.
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Affiliation(s)
- Alex Hlavaty
- University Grenoble-Alpes, Pharmacovigilance Unit, Grenoble-Alpes University Hospital, 38000 Grenoble, France
| | - Matthieu Roustit
- University Grenoble-Alpes, Inserm CIC1406, CHU de Grenoble, 38000 Grenoble, France; University Grenoble-Alpes, Inserm U1300, HP2, 38000 Grenoble, France
| | - Marc Manceau
- University Grenoble-Alpes, Inserm CIC1406, CHU de Grenoble, 38000 Grenoble, France
| | - Jean-Luc Cracowski
- University Grenoble-Alpes, Pharmacovigilance Unit, Grenoble-Alpes University Hospital, 38000 Grenoble, France; University Grenoble-Alpes, Inserm U1300, HP2, 38000 Grenoble, France
| | - Charles Khouri
- University Grenoble-Alpes, Pharmacovigilance Unit, Grenoble-Alpes University Hospital, 38000 Grenoble, France; University Grenoble-Alpes, Inserm CIC1406, CHU de Grenoble, 38000 Grenoble, France; University Grenoble-Alpes, Inserm U1300, HP2, 38000 Grenoble, France.
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Luo ZR, Bin-Yao, Huang ZY. Chronobiology discrepancies between patients with acute type a aortic dissection complicated with and without sleep apnea syndrome: a single-center seven-year retrospective study. BMC Cardiovasc Disord 2023; 23:508. [PMID: 37828436 PMCID: PMC10571263 DOI: 10.1186/s12872-023-03548-6] [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: 02/04/2023] [Accepted: 10/05/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND The present study aimed to investigate the differences in chronobiology and prevention between patients with acute type-A aortic dissection (ATAAD) complicated with sleep apnea syndrome (SAS) and without sleep apnea syndrome (non-SAS). METHODS We retrospectively analyzed the clinical information of ATAAD patients using hospital medical records and regional meteorological and chronological information between January 2013 and December 2019. RESULTS An early mortality rate of 16.9% (196 out of 1160 cases) was observed, comprising 95 cases of aortic rupture before surgery and 101 surgery-related deaths. Eighty-one of the 964 survivors were screened for SAS using complete morphological characteristics. Of these patients, 291 (33.0%) suffered from SAS, while 590 (67.0%) had no SAS. Based on a Circular Von Mises distribution analysis, the non-SAS patients experienced a significant morning peak in the occurrence of ATAAD at 10:04 (r1 = 0.148, p < 0.01). In contrast, the SAS patients experienced a significantly different (non-SAS vs. SAS, U2 = 0.947, p < 0.001) nighttime peak at 23:48 (r2 = 0.489, p < 0.01). Moreover, both non-SAS (Z = 39.770, P < 0.001) and SAS (Z = 55.663, P < 0.001) patients showed a comparable peak during January (non-SAS vs. SAS, U2 = 0.173, p > 0.05). Furthermore, SAS patients experienced a peak on Fridays (χ2 = 36.419, p < 0.001), whereas there was no significant difference in the weekly distribution in non-SAS patients (χ2 = 11.315, p = 0.079). CONCLUSIONS The analyses showed that both SAS and non-SAS patients showed distinct rhythmicity in ATAAD onset. These findings highlight the chronobiological triggers within different ATAAD subpopulations and may contribute to the prevention of this potentially fatal occurrence.
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Affiliation(s)
- Zeng-Rong Luo
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001 P. R. China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, P. R. China
| | - Bin-Yao
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001 P. R. China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, P. R. China
| | - Zhong-Yao Huang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001 P. R. China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, P. R. China
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Britton PC, Bohnert KM, Denneson LM, Ganoczy D, Ilgen MA. Analysis of veterans crisis line data: Temporal factors associated with the initiation of emergency dispatches. Suicide Life Threat Behav 2023; 53:538-545. [PMID: 37032606 DOI: 10.1111/sltb.12962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE To identify temporal patterns of emergency dispatches as initiated by Veteran Crisis Line (VCL) responders and among moderate- and high-risk contacts. METHODS Incidence rate ratios (IRRs) were used to examine the incidence of emergency dispatches among all 1,437,543 VCL contacts across 2019-2020. RESULTS Emergency dispatches were initiated in 57,077 (4.0%) contacts. IRRs were elevated during Labor Day, IRR (95% CI) = 1.33 (1.15-1.54), and Independence Day, IRR (95% CI) = 1.22 (1.05-1.43), weekends, Saturdays, IRR (95% CI) = 1.04 (1.01-1.08), Sunday (reference), and 6 pm to 11:59 pm, IRR (95% CI) = 1.06 (1.04-1.09). IRRs for moderate- and high-risk contacts were higher on Memorial Day, IRR (95% CI) = 1.16 (1.00-1.33), Sunday (reference), and 6 pm to 11:59 pm (reference). CONCLUSIONS The initiation of emergency dispatches fluctuates over time and were highest during Labor Day and Independence Day, weekends, and evenings. Moderate- and high-risk contact also fluctuate over time and were highest on Memorial Day, Sundays, and midnight to 5:59 am. VCL policy makers can use knowledge of temporal fluctuations to allocate public health resources for increased efficiency and greatest impact; however, additional research on temporal stability and generalizability is needed.
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Affiliation(s)
- Peter C Britton
- Department of Veteran Affairs, VISN 2 Center of Excellence for Suicide Prevention, Finger Lakes Healthcare System, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical School, Rochester, New York, USA
| | - Kipling M Bohnert
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Department of Veteran Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Lauren M Denneson
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Dara Ganoczy
- Department of Veteran Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Mark A Ilgen
- Department of Veteran Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Cheng J, Zheng H, Wei J, Huang C, Ho HC, Sun S, Phung D, Kim H, Wang X, Bai Z, Hossain MZ, Tong S, Su H, Xu Z. Short-term residential exposure to air pollution and risk of acute myocardial infarction deaths at home in China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:76881-76890. [PMID: 37247141 PMCID: PMC10300167 DOI: 10.1007/s11356-023-27813-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/17/2023] [Indexed: 05/30/2023]
Abstract
Air pollution remains a major threat to cardiovascular health and most acute myocardial infarction (AMI) deaths occur at home. However, currently established knowledge on the deleterious effect of air pollution on AMI has been limited to routinely monitored air pollutants and overlooked the place of death. In this study, we examined the association between short-term residential exposure to China's routinely monitored and unmonitored air pollutants and the risk of AMI deaths at home. A time-stratified case-crossover analysis was undertaken to associate short-term residential exposure to air pollution with 0.1 million AMI deaths at home in Jiangsu Province (China) during 2016-2019. Individual-level residential exposure to five unmonitored and monitored air pollutants including PM1 (particulate matter with an aerodynamic diameter ≤ 1 μm) and PM2.5 (particulate matter with an aerodynamic diameter ≤ 2.5 μm), SO2 (sulfur dioxide), NO2 (nitrogen dioxide), and O3 (ozone) was estimated from satellite remote sensing and machine learning technique. We found that exposure to five air pollutants, even below the recently released stricter air quality standards of the World Health Organization (WHO), was all associated with increased odds of AMI deaths at home. The odds of AMI deaths increased by 20% (95% confidence interval: 8 to 33%), 22% (12 to 33%), 14% (2 to 27%), 13% (3 to 25%), and 7% (3 to 12%) for an interquartile range increase in PM1, PM2.5, SO2, NO2, and O3, respectively. A greater magnitude of association between NO2 or O3 and AMI deaths was observed in females and in the warm season. The greatest association between PM1 and AMI deaths was found in individuals aged ≤ 64 years. This study for the first time suggests that residential exposure to routinely monitored and unmonitored air pollutants, even below the newest WHO air quality standards, is still associated with higher odds of AMI deaths at home. Future studies are warranted to understand the biological mechanisms behind the triggering of AMI deaths by air pollution exposure, to develop intervention strategies to reduce AMI deaths triggered by air pollution exposure, and to evaluate the cost-effectiveness, accessibility, and sustainability of these intervention strategies.
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Affiliation(s)
- Jian Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Hao Zheng
- Department of Environmental Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, USA
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Hung Chak Ho
- Department of Public and International Affairs, City University of Hong Kong , Hong Kong, China
| | - Shengzhi Sun
- School of Public Health, Capital Medical University, Beijing, China
| | - Dung Phung
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Ho Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment and Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Xiling Wang
- School of Public Health, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China
| | - Zhongliang Bai
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Mohammad Zahid Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shilu Tong
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
- School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China
- Center for Global Health, Nanjing Medical University, Nanjing, China
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Hong Su
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Zhiwei Xu
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, 4222, Australia.
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Olsson A, Mohammad MA, Rylance R, Platonov PG, Sparv D, Erlinge D. Sex differences in potential triggers of myocardial infarction. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead011. [PMID: 37006409 PMCID: PMC10063195 DOI: 10.1093/ehjopen/oead011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/05/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
Aims Internal and external triggers affect seasonal and circadian variations of myocardial infarction (MI). We aimed to assess sex differences in the common triggers of MI. Methods and results A nationwide, retrospective, cross-sectional postal survey study was conducted. Individuals who experienced a MI during holidays and weekdays were identified through the SWEDEHEART registry. Twenty-seven potential MI triggers were rated in regards to occurring more or less than usual during the last 24 h before the MI. Three areas were covered: activities, emotions, and food or alcohol consumption. A logistic regression model was used to identify sex differences for each trigger and odds ratios (ORs) were reported. Four hundred and fifty-one patients, of whom 317 were men, responded. The most commonly reported triggers were stress (35.3%), worry (26.2%), depression (21.1%), and insomnia (20.0%). Women reported emotional triggers including sadness [OR 3.52, 95% confidence interval (CI) 1.92-6.45], stress (OR 2.38, 95% CI 1.52-3.71), insomnia (OR 2.31, 95% CI 1.39-3.81), and upset (OR 2.69, 95% CI 1.47-4.95) to a greater extent than men. Outdoor activity was less reported by women (OR 0.35, 95% CI 0.14-0.87). No significant sex differences were found in other activities or food and alcohol consumption. Conclusion Self-experienced stress and distress were higher among women prior to MI compared with men. Understanding sex perspectives in acute triggers may help us find preventive strategies and reduce the excess numbers of MI.
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Affiliation(s)
- Anneli Olsson
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, EA-blocket, Lund 221 85, Sweden
| | - Moman A Mohammad
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, EA-blocket, Lund 221 85, Sweden
| | - Rebecca Rylance
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, EA-blocket, Lund 221 85, Sweden
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, EA-blocket, Lund 221 85, Sweden
| | - David Sparv
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, EA-blocket, Lund 221 85, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, EA-blocket, Lund 221 85, Sweden
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Ryu R, Bahjri K, Tran H. Potential Association of Holidays on Internationalized Normalized Ratio in Warfarin-Users at a Multidisciplinary Clinic. Cardiol Res 2023; 14:38-44. [PMID: 36896230 PMCID: PMC9990547 DOI: 10.14740/cr1448] [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: 11/08/2022] [Accepted: 01/06/2023] [Indexed: 02/27/2023] Open
Abstract
Background Warfarin is approved by the United States Food and Drug Administration for numerous clinical indications. The effectiveness of warfarin is highly dependent on the time-in-therapeutic range based on the international normalized ratio (INR) goal, which may be altered by changes in diet, alcohol intake, concomitant drugs, and travel, all of which are prevalent during the holidays. At this time, there are no published studies assessing the impact of holidays on INR in warfarin-users. Methods A retrospective chart review was conducted on all adult patients taking warfarin and managed at a multidisciplinary clinic. Patients were included if they were taking warfarin at home regardless of indication for anticoagulation. The INR pre- and post-holiday was assessed. Results Of a total of 92 patients, the mean age was 71.5 ± 14.3 years, and most patients were on warfarin with an INR goal of 2 - 3 (89%). There were significant differences in INR before and after Independence Day (2.55 vs. 2.81, P = 0.043) and Columbus Day (2.39 vs. 2.82, P < 0.001). The remaining holidays showed no significant differences in INR before and after each respective holiday. Conclusions There may be factors related to Independence and Columbus Day that are increasing the level of anticoagulation in warfarin-users. Although the mean post-holiday INR values, in essence, maintained within the typical target of 2 - 3, our study underscores the specialized care that is warranted in higher risk patients to prevent a continued increase in INR and subsequent toxicities. We hope our results would be hypothesis-generating and aid in the development of larger, prospective evaluations to validate the findings of our present study.
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Affiliation(s)
- Rachel Ryu
- Western University of Health Sciences College of Pharmacy, Pomona, CA 91766, USA
| | - Khaled Bahjri
- Loma Linda University School of Pharmacy, Loma Linda, CA 92350, USA
| | - Huyentran Tran
- Loma Linda University School of Pharmacy, Loma Linda, CA 92350, USA
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11
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Yu Y, Li W, Xu L, Wang Y. Circadian rhythm of plasminogen activator inhibitor-1 and cardiovascular complications in type 2 diabetes. Front Endocrinol (Lausanne) 2023; 14:1124353. [PMID: 37020596 PMCID: PMC10067678 DOI: 10.3389/fendo.2023.1124353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/27/2023] [Indexed: 03/22/2023] Open
Abstract
Cardiovascular complications are a common death cause in type 2 diabetes patients, as they are often combined. Plasminogen-activator Inhibitor 1 (PAI-1) participates in the development and progression of cardiovascular complications in diabetes. Insulin resistance increases PAI-1 production, and high PAI-1 levels lead to an environment conducive to thrombosis and earlier and more severe vascular disease. Current evidence also suggests that PAI-1 has a rhythmic profile of circadian fluctuations and acrophase in the morning within a single day, which might explain the high morning incidence of cardiovascular events. Thus, PAI-1 is a possible drug target. Although several PAI-1 inhibitors have been developed, none have yet been allowed for clinical use. Research on rhythm has also led to the concept of "chronotherapy", a rhythm-based drug regimen expected to improve the treatment of cardiovascular complications in diabetic patients. Herein, we searched several databases and reviewed relevant articles to describe the circadian rhythm characteristics and endogenous molecular mechanisms of PAI-1, its relationship with insulin resistance, the causes of cardiovascular complications caused by PAI-1, and the current development of PAI-1 inhibitors. We also summarized the possibility of using the circadian rhythm of PAI-1 to treat cardiovascular complications in diabetic patients.
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12
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Fernandes BF, Kock KDS. Acute coronary syndrome in a hospital in southern Brazil: peak of hospitalizations on Mondays and severe cases on weekends and at night. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2022; 12:307-314. [PMID: 36743513 PMCID: PMC9890198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/07/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Ischemic heart disease is the leading cause of death in Brazil and worldwide. The term acute coronary syndrome (ACS) generically represents the acute myocardial ischemic events. These events are clinically divided into three types: acute myocardial infarction (AMI) with ST-segment elevation, AMI without ST-segment elevation, and unstable angina. Although cardiovascular ischemic events occur acutely, studies describe cyclic patterns of ACS, mainly on circadian and weekly variation. OBJECTIVE The aim of this study was to analyze the circadian and weekly variation of hospitalizations for ACS in a hospital in southern Brazil in 2019. METHODS Observational, cross-sectional type study. The population was the patients hospitalized at the Nossa Senhora da Conceição Hospital (NSCH) in Tubarão (SC, Brazil) with the international classification of diseases (ICD) code referring to ACS in the year 2019, corresponding to 579 patients. RESULTS After applying the exclusion criteria, 512 patients hospitalized for ACS were analyzed, 55.1% were male with a median (p25-p75) age of 62.0 (56.0-69.0) years. The main ICDs of hospitalization were: I20.0 (76.2%), I21.9 (16.6%), I21.3 (3.1%) and the most prevalent comorbidities were high blood pressure (82.6%), diabetes (30.1%) and previous AMI (23.6%). The median (p25-p75) time of admission was 14 h (10-18) h and length of stay was 5 (3-9) days. Death occurred in 18 hospitalizations (3.5%) of cases. CONCLUSION We conclude that in the present study there was a peak of hospitalizations for ACS on Mondays, proportionally reducing throughout the week and with a significant decrease on the weekend.
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The Peripandemic Impact of the First Wave of the COVID-19 Pandemic on Management and Prognosis of ST-Segment Elevation Myocardial Infarction in China. J Clin Med 2022; 11:jcm11247290. [PMID: 36555907 PMCID: PMC9784305 DOI: 10.3390/jcm11247290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Rapid reperfusion of ST-segment elevation myocardial infarction (STEMI) has been challenging during the coronavirus disease 2019 (COVID-19) outbreak. Whether and to what degree there will be a residual impact when the COVID-19 pandemic has passed is unclear. METHODS This nationwide retrospective study was based on electronic records of STEMI patients registered in the Chinese Cardiovascular Association Database. RESULTS We analyzed 141,375 STEMI patients (including 4871 patients in Hubei province, where 80% of COVID-19 cases in China occurred in 2019-2020) during the pre-outbreak (23 October 2019-22 January 2020), outbreak (23 January 2020-22 April 2020), and post-outbreak (23 April 2020-22 July 2020) periods. In the post-outbreak period in Hubei province, the increased in-hospital mortality dropped to become insignificant (adjusted odds ratio compared to the pre-outbreak level (aOR) 1.40, [95% confidential interval (CI): 0.97-2.03]) and was lower than that in the outbreak period (1.62 [1.09-2.41]). The decreased odds of primary percutaneous coronary intervention (PCI) (0.73 [0.55-0.96]) and timely reperfusion (0.74 [0.62-0.88]) persisted, although they were substantially improved compared to the outbreak period (aOR of primary PCI: 0.23 [0.18-0.30] and timely reperfusion: 0.43 [0.35-0.53]). The residual impact of COVID-19 on STEMI in the post-outbreak period in non-Hubei provinces was insignificant. CONCLUSIONS Residual pandemic impacts on STEMI management persisted after the first wave of the COVID-19 outbreak in Hubei province, the earliest and hardest hit area in China.
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Oudin A, Bjursten H, Oudin Åström D, Nozohoor S, Ahmad K, Tang M, Bjurbom M, Hansson EC, Jeppsson A, Moeller CH, Jormalainen M, Juvonen T, Mennander A, Olsen PS, Olsson C, Ahlsson A, Pan E, Raivio P, Wickbom A, Sjögren J, Geirsson A, Gudbjartsson T, Zindovic I. Impact of national holidays and weekends on incidence of acute type A aortic dissection repair. Sci Rep 2022; 12:20552. [PMID: 36446905 PMCID: PMC9708832 DOI: 10.1038/s41598-022-25076-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
Previous studies have demonstrated that environmental and temporal factors may affect the incidence of acute type A aortic dissection (ATAAD). Here, we aimed to investigate the hypothesis that national holidays and weekends influence the incidence of surgery for ATAAD. For the period 1st of January 2005 until 31st of December 2019, we investigated a hypothesised effect of (country-specific) national holidays and weekends on the frequency of 2995 surgical repairs for ATAAD at 10 Nordic cities included in the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) collaboration. Compared to other days, the number of ATAAD repairs were 29% (RR 0.71; 95% CI 0.54-0.94) lower on national holidays and 26% (RR 0.74; 95% CI 0.68-0.82) lower on weekends. As day of week patterns of symptom duration were assessed and the primary analyses were adjusted for period of year, our findings suggest that the reduced surgical incidence on national holidays and weekends does not seem to correspond to seasonal effects or surgery being delayed and performed on regular working days.
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Affiliation(s)
- Anna Oudin
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Division of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Henrik Bjursten
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Daniel Oudin Åström
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Division of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Shahab Nozohoor
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Khalil Ahmad
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark
| | - Mariann Tang
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark
| | - Markus Bjurbom
- Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Emma C Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian H Moeller
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mikko Jormalainen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Ari Mennander
- Heart Centre, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Peter S Olsen
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Olsson
- Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Ahlsson
- Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Emily Pan
- Heart Center, Turku University Hospital, Turku, Finland
- Brigham and Women's Hopistal and Harvard Medical School, Boston, MA, USA
| | - Peter Raivio
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Anders Wickbom
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Johan Sjögren
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Igor Zindovic
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
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15
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Liu WP, Li P, Zhan X, Qu LH, Xiong T, Hou FX, Wang JK, Wei N, Liu FQ. Identification of molecular subtypes of coronary artery disease based on ferroptosis- and necroptosis-related genes. Front Genet 2022; 13:870222. [PMID: 36204316 PMCID: PMC9531137 DOI: 10.3389/fgene.2022.870222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Aim: Coronary artery disease (CAD) is a heterogeneous disorder with high morbidity, mortality, and healthcare costs, representing a major burden on public health. Here, we aimed to improve our understanding of the genetic drivers of ferroptosis and necroptosis and the clustering of gene expression in CAD in order to develop novel personalized therapies to slow disease progression.Methods: CAD datasets were obtained from the Gene Expression Omnibus. The identification of ferroptosis- and necroptosis-related differentially expressed genes (DEGs) and the consensus clustering method including the classification algorithm used km and distance used spearman were performed to differentiate individuals with CAD into two clusters (cluster A and cluster B) based expression matrix of DEGs. Next, we identified four subgroup-specific genes of significant difference between cluster A and B and again divided individuals with CAD into gene cluster A and gene cluster B with same methods. Additionally, we compared differences in clinical information between the subtypes separately. Finally, principal component analysis algorithms were constructed to calculate the cluster-specific gene score for each sample for quantification of the two clusters.Results: In total, 25 ferroptosis- and necroptosis-related DEGs were screened. The genes in cluster A were mostly related to the neutrophil pathway, whereas those in cluster B were mostly related to the B-cell receptor signaling pathway. Moreover, the subgroup-specific gene scores and CAD indices were higher in cluster A and gene cluster A than in cluster B and gene cluster B. We also identified and validated two genes showing upregulation between clusters A and B in a validation dataset.Conclusion: High expression of CBS and TLR4 was related to more severe disease in patients with CAD, whereas LONP1 and HSPB1 expression was associated with delayed CAD progression. The identification of genetic subgroups of patients with CAD may improve clinician knowledge of disease pathogenesis and facilitate the development of methods for disease diagnosis, classification, and prognosis.
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Affiliation(s)
- Wen-Pan Liu
- Cardiovascular Department, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
- Department of Cardiothoracic Surgery, The First People’s Hospital of Kunming City and Ganmei Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Peng Li
- Department of Surgery, Nanzhao County People’s Hospital, Nanyang, Henan, China
| | - Xu Zhan
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lai-Hao Qu
- Department of Cardiothoracic Surgery, Yan’an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Tao Xiong
- Department of Cardiothoracic Surgery, Yan’an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Fang-Xia Hou
- Cardiovascular Department, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Jun-Kui Wang
- Cardiovascular Department, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Na Wei
- Cardiovascular Department, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
- *Correspondence: Na Wei, ; Fu-Qiang Liu,
| | - Fu-Qiang Liu
- Cardiovascular Department, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
- *Correspondence: Na Wei, ; Fu-Qiang Liu,
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16
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After-hours consultations and antibiotic prescribing for self-limiting upper respiratory tract infections in primary-care practices. Infect Control Hosp Epidemiol 2022; 44:755-761. [DOI: 10.1017/ice.2022.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Objectives:
To determine the association between after-hours consultations and the likelihood of antibiotic prescribing for self-limiting upper respiratory tract infections (URTIs) in primary care practices.
Design:
A cross-sectional analysis using Australian national primary-care practice data (MedicineInsight) between February 1, 2016 and January 31, 2019.
Setting:
Nationwide primary-care practices across Australia.
Participants:
Adult and pediatric patients who visited primary care practices for first-time URTIs.
Methods:
We estimated the proportion of first-time URTI episodes for which antibiotic prescribing occurred on the same day (immediate prescribing) using diagnoses and prescription records in the electronic primary-care database. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the likelihood of antibiotic prescribing by the time of primary care visits were calculated using generalized estimating equations.
Results:
Among 357,287 URTI episodes, antibiotics were prescribed in 172,605 episodes (48.3%). After adjusting for patients’ demographics, practice characteristics, and seasons, we detected a higher likelihood of antibiotic prescribing on weekends compared to weekdays (OR, 1.42; 95% CI, 1.39–1.45) and on national public holidays compared to nonholidays (OR, 1.23; 95% CI, 1.17–1.29). When we controlled for patient presentation and diagnosis, the association between antibiotic prescribing and after-hours consultations remained significant: weekend versus weekdays (OR, 1.37; 95% CI, 1.33–1.41) and holidays versus nonholidays (OR, 1.10; 95% CI, 1.03–1.18).
Conclusions:
Primary-care consultations on weekends and public holidays were associated with a higher likelihood of immediate antibiotic prescribing for self-limiting URTIs in primary care. This finding might be attributed to lower resourcing in after-hours health care.
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Mental Stress and Cardiovascular Health-Part I. J Clin Med 2022; 11:jcm11123353. [PMID: 35743423 PMCID: PMC9225328 DOI: 10.3390/jcm11123353] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/05/2022] [Accepted: 06/09/2022] [Indexed: 12/30/2022] Open
Abstract
Epidemiological studies have shown that a substantial proportion of acute coronary events occur in individuals who lack the traditional high-risk cardiovascular (CV) profile. Mental stress is an emerging risk and prognostic factor for coronary artery disease and stroke, independently of conventional risk factors. It is associated with an increased rate of CV events. Acute mental stress may develop as a result of anger, fear, or job strain, as well as consequence of earthquakes or hurricanes. Chronic stress may develop as a result of long-term or repetitive stress exposure, such as job-related stress, low socioeconomic status, financial problems, depression, and type A and type D personality. While the response to acute mental stress may result in acute coronary events, the relationship of chronic stress with increased risk of coronary artery disease (CAD) is mainly due to acceleration of atherosclerosis. Emotionally stressful stimuli are processed by a network of cortical and subcortical brain regions, including the prefrontal cortex, insula, amygdala, hypothalamus, and hippocampus. This system is involved in the interpretation of relevance of environmental stimuli, according to individual’s memory, past experience, and current context. The brain transduces the cognitive process of emotional stimuli into hemodynamic, neuroendocrine, and immune changes, called fight or flight response, through the autonomic nervous system and the hypothalamic–pituitary–adrenal axis. These changes may induce transient myocardial ischemia, defined as mental stress-induced myocardial ischemia (MSIMI) in patients with and without significant coronary obstruction. The clinical consequences may be angina, myocardial infarction, arrhythmias, and left ventricular dysfunction. Although MSIMI is associated with a substantial increase in CV mortality, it is usually underestimated because it arises without pain in most cases. MSIMI occurs at lower levels of cardiac work than exercise-induced ischemia, suggesting that the impairment of myocardial blood flow is mainly due to paradoxical coronary vasoconstriction and microvascular dysfunction.
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Lavie G, Battat E, Saliba W, Flugelman MY. Change in Hospitalizations and 30-Day Mortality of Patients With Acute Myocardial Infarction During the First COVID-19 Lockdown - A Pure Social Isolation Effect? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 38:38-42. [PMID: 34483076 PMCID: PMC8413659 DOI: 10.1016/j.carrev.2021.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/22/2021] [Accepted: 08/27/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic has had diverse effects on population health and psychology in relation to non-COVID-19 diseases, as well as on COVID-19 infection. Fewer patients with acute myocardial infarction (AMI) sought medical attention during the first lockdown of the pandemic. METHODS AND RESULTS We conducted a retrospective cohort study of Clalit Health Services patients treated in multiple hospitals for AMI. We examined the numbers and characteristics of the patients and 30-day mortality during three 5-week phases of the first wave of the COVID-19 pandemic in Israel: pre-lockdown (N = 702), lockdown (N = 584), and lockdown-lift (N = 669). We compared data for the same period in 2018 and 2019. We stratified the data by ST-elevation myocardial infarction (STEMI) and non-STEMI. AMI hospitalizations during the lockdown were 17% lower than in the pre-lockdown period (rate ratio-0.83, 95% CI 0.74-0.93), and 22% and 31% lower than in the corresponding periods in 2018 and 2019, respectively. The reduction was mainly attributed to non-STEMI hospitalizations (26% lower than the pre-lockdown period in 2020). Hospitalizations due to both STEMI and non-STEMI were moderately reduced during the post-lockdown period compared to the corresponding periods in 2018 and 2019. Thirty-day mortality rate was similar for all the periods assessed. CONCLUSIONS The number of hospitalized patients with AMI during the first COVID-19 lockdown and post-lockdown periods was significantly reduced, without significant changes in 30-day mortality rates.
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Affiliation(s)
- Gil Lavie
- Division of Planning and Strategy, Clalit Heath Services, Tel Aviv, Israel,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Erez Battat
- Division of Planning and Strategy, Clalit Heath Services, Tel Aviv, Israel
| | - Walid Saliba
- Division of Planning and Strategy, Clalit Heath Services, Tel Aviv, Israel,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Moshe Y. Flugelman
- The Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel,Corresponding author at: Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 34632, Israel
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Auger N, Bilodeau-Bertrand M, Potter BJ. Halloween and myocardial infarction: A case-crossover study. Arch Cardiovasc Dis 2021; 115:57-59. [PMID: 34955438 DOI: 10.1016/j.acvd.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, H2X 0A9, Montreal, QC, Canada; Institut national de santé publique du Québec, H2P 1E2, Montreal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, H3N 1X9, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, H3A 1A2, Montreal, QC, Canada.
| | | | - Brian J Potter
- University of Montreal Hospital Research Centre, H2X 0A9, Montreal, QC, Canada; Division of Cardiology, Department of Medicine, University of Montreal, H3T 1J4, Montreal, QC, Canada
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Olsson A, Thorén I, Mohammad MA, Rylance R, Platonov PG, Sparv D, Erlinge D. Christmas holiday triggers of myocardial infarction. SCAND CARDIOVASC J 2021; 55:340-344. [PMID: 34585998 DOI: 10.1080/14017431.2021.1983638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives: Christmas holidays have been associated with the highest incidence of myocardial infarction (MI). We wanted to assess possible triggers of MI during Christmas. Design: A nationwide, retrospective postal survey with case-control design. All individuals suffering an MI during the Christmas holidays 2018 and 2019 in Sweden were identified through the SWEDEHEART registry and a control group matched in age and gender with chronic coronary syndrome who did not seek medical attention during Christmas were asked for participation. Subjects completed a questionnaire asking them to rate 27 potential MI-triggers as having occurred more or less than usual. Results: A total of 189 patients suffering an MI on Christmas Eve, Christmas Day, or Boxing Day, and 157 patients in the control group responded to the questionnaire, representing response rates of 66% and 62%, respectively. Patients with MI on Christmas experienced more stress (37% vs. 21%, p = .002), depression (21% vs. 11%, p = .024), and worry (26% vs. 10%, p < .001) compared to the control group. The food and sweets consumption was increased in both groups, but to a greater extent in the control group (33% vs. 50%, p = .002 and 32% vs. 43%, p = .031). There were no increases in quarrels, anger, economic worries, or reduced compliance with medication. Conclusions: Patients suffering MI on Christmas holiday experienced higher levels of stress and emotional distress compared to patients with chronic coronary syndrome, possibly contributing to the phenomenon of holiday heart attack. Understanding what factors increase the number of MI on Christmas may help reduce the excess number of MIs and cardiovascular burden.
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Affiliation(s)
- Anneli Olsson
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - Ida Thorén
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - Moman A Mohammad
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - Rebecca Rylance
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - David Sparv
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
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Weather Trumps Festivity? More Cardiovascular Disease Events Occur in Winter than in December Holidays in Queensland, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910158. [PMID: 34639460 PMCID: PMC8508171 DOI: 10.3390/ijerph181910158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022]
Abstract
Objective: Cardiovascular disease (CVD) is the leading cause of hospitalisations and deaths in Australia. This study estimates the excess CVD hospitalisations and deaths across seasons and during the December holidays in Queensland, Australia. Methods: The study uses retrospective, longitudinal, population-based cohort data from Queensland, Australia from January 2010 to December 2015. The outcomes were hospitalisations and deaths categorised as CVD-related. CVD events were grouped according to when they occurred in the calendar year. Excess hospitalisations and deaths were estimated using the multivariate ordinary least squares method after adjusting for confounding effects. Results: More CVD hospitalisations and deaths occurred in winter than in summer, with 7811 (CI: 1353, 14,270; p < 0.01) excess hospitalisations and 774 (CI: 35, 1513; p < 0.01) deaths compared to summer. During the coldest month (July), there was an excess of 42 hospitalisations and 7 deaths per 1000 patients. Fewer CVD hospitalisations (-20 (CI: -29, -9; p < 0.01)) occurred during the December holidays than any other period during the calendar year. Non-CVD events were mostly not statistically significant different between periods. Conclusion: Most CVD events in Queensland occurred in winter rather than during the December holidays. Potentially cost-effective initiatives should be explored such as encouraging patients with CVD conditions to wear warmer clothes during cold temperatures and/or insulating the homes of CVD patients who cannot otherwise afford to.
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Matters of the Heart: Case-Crossover Analysis of Myocardial Infarction on Valentine's Day. CJC Open 2021; 3:1075-1078. [PMID: 34505046 PMCID: PMC8413234 DOI: 10.1016/j.cjco.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/14/2021] [Indexed: 11/23/2022] Open
Abstract
We studied the risk of myocardial infarction on Valentine's Day. We conducted a case-crossover study of 51,450 adults with myocardial infarctions in February, 1989-2019. The exposure was Valentine's Day, and the 2 days before and after Valentine's Day. We estimated odds ratios (OR) to compare days when myocardial infarction occurred with neighboring control days. Compared with other days, Valentine's Day was associated with lower odds of myocardial infarction the following day for men (OR 0.91, 95% confidence interval 0.85-0.98), but not for men and women combined (OR 0.95, 95% confidence interval 0.91-1.01). Risk of myocardial infarction in men is lower the day after Valentine's Day.
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23
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Boytsov SA, Shakhnovich RM, Erlikh AD, Tereschenko SN, Kukava NG, Rytova YK, Pevsner DV, Reitblat OM, Konstantinov SL, Kletkina AS, Shirikova GA, Nedbaikin AM, Borisova TV, Makarov SA, Chesnokova LY, Bykov AN, Shilko YV, Nikolaev DS, Istomina TA, Eremin SA, Romakh IV, Platonov DY, Rabinovich RM, Veselova NA, Urvantseva IA, Zalototskaya YI, Kostina GV, Potapova AN, Dubrovina YA, Shedrova YA, Sodnomova LB, Donirova YS, Hkludeeva EA, Khegya DV, Ivanov KI, Stepanova NV, Philippov EV, Moseychuk KA, Devyatova LS, Kolcheva YG, Rachkova SA, Nazarova OA, Menshikova IG, Pogorelova NA, Sanabasova GK, Azarin OG, Sviridova AV, Zyazina VO, Ilyamakova NA, Kuklina YA, Pronin AA, Vajnshtejn IV, Ustyugov SA, Anohina AR, Gindler AI, Shchepinova LV, Grigoreva TV, Melnik II, Sotnikova MI, Kalashnikova MV, Khramtsova NA, Medvedeva NA, Vahrakova MV, Belousov OV, Doronkina OA, Reprinceva NV, Komarov AV, Lebedev SV, Belskaya EV. Registry of Acute Myocardial Infarction. REGION-MI - Russian Registry of Acute Myocardial Infarction. ACTA ACUST UNITED AC 2021; 61:41-51. [PMID: 34311687 DOI: 10.18087/cardio.2021.6.n1595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/12/2021] [Indexed: 11/18/2022]
Abstract
Aim To study features of diagnosis and treatment of acute myocardial infarction (AMI) in Russian hospitals, results of the treatment, and early and late outcomes (6 and 12 months after AMI diagnosis); to evaluate the consistence of the treatment with clinical guidelines; and to evaluate patients' compliance with the treatment.Material and methods The program was designed for 3 years, including 24 months for recruitment of patients to the study. The study will include 10, 000 patients hospitalized with a confirmed diagnosis (I21 according to ICD-10) of ST segment elevation acute myocardial infarction (MI) (STEMI) or non-ST segment elevation MI (NSTEMI) based on criteria of the European Society of Cardiology Guidelines on Forth Universal Definition of Myocardial Infarction (2018). The follow-up period was divided into three stages: observation during the stay in the hospital and at 6 and 12 months following inclusion into the registry. The primary endpoint included cardiac death, nonfatal MI during the hospitalization and after one-year follow-up. Secondary endpoints were 6-months and one-year incidence of repeated MI, heart failure, ischemic stroke, clinically significant hemorrhage, unscheduled revascularization after discharge from the hospital, and the proportion of patients who continue on statins, antiplatelet drugs, and drugs of other groups for 6 months and 1 year.Results The inclusion of patients into the registry started in 2020 and will continue for 24 months. By the time of the article publication (June, 2021), more than 2,000 patients will be included.Conclusion REGION-MI (Russian rEGIstry Of acute myocardial iNfarction) is a multicenter, retrospective and prospective observational cohort study that excludes any interference with the clinical practice. Results of the registry will help to analyze a real picture of medical care provided to patients with myocardial infarction and to schedule ways to improve the situation.
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Affiliation(s)
- S A Boytsov
- National Medical Scientific Center for Cardiology, Moscow
| | | | - A D Erlikh
- City Clinical Hospital №29 Named. N.E. Bauman" Department of Health of the City of Moscow, Moscow
| | | | - N G Kukava
- National Medical Scientific Center for Cardiology, Moscow
| | - Y K Rytova
- National Medical Scientific Center for Cardiology, Moscow
| | - D V Pevsner
- National Medical Scientific Center for Cardiology, Moscow
| | | | - S L Konstantinov
- Belgorod Regional Clinical Hospital Named after Svyatitelya Iosafa, Belgorod
| | - A S Kletkina
- Belgorod Regional Clinical Hospital Named after Svyatitelya Iosafa, Belgorod
| | | | | | - T V Borisova
- Bryansk Regional Cardiologic Dispensary, Bryansk
| | - S A Makarov
- Kuzbass Clinical Cardiology Dispensary Named after Academician L.S.Barbarash, Kemerovo
| | - L Yu Chesnokova
- Kuzbass Clinical Cardiology Dispensary Named after Academician L.S.Barbarash, Kemerovo
| | - A N Bykov
- Sverdlovsk Regional Clinical Hospital № 1, Ekaterinburg
| | - Yu V Shilko
- Sverdlovsk Regional Clinical Hospital № 1, Ekaterinburg
| | - D S Nikolaev
- Krasnoufimsk Regional Hospital № 1, Krasnoufimsk
| | - T A Istomina
- Tambov Regional Clinical Hospital im. V. D. Babenko, Tambov
| | - S A Eremin
- Tambov Regional Clinical Hospital im. V. D. Babenko, Tambov
| | - I V Romakh
- Morshansk Central Regional Hospital, Morshansk
| | | | | | | | - I A Urvantseva
- The Khanty-Mansi Autonomous Okrug - Yugra Diagnostics and Cardiovascular Surgery Center (cardiology clinic), a public-sector entity, Surgut
| | - Yu I Zalototskaya
- The Khanty-Mansi Autonomous Okrug - Yugra Diagnostics and Cardiovascular Surgery Center (cardiology clinic), a public-sector entity, Surgut
| | - G V Kostina
- Yaroslavl Regional Clinical Hospital, Yaroslavl
| | | | | | | | - L B Sodnomova
- Ulan-Ude Republican Clinical Hospital Named After N.A. Semashko, Ulan-Ude
| | - Yo S Donirova
- Ulan-Ude Republican Clinical Hospital Named After N.A. Semashko, Ulan-Ude
| | - E A Hkludeeva
- Primorsaya regional clinical hospital № 1, Vladivostok
| | - D V Khegya
- Primorsaya regional clinical hospital № 1, Vladivostok
| | - K I Ivanov
- The Republican Hospital №1 - The National Center of the Medicine, Yakutsk
| | - N V Stepanova
- The Republican Hospital №1 - The National Center of the Medicine, Yakutsk
| | | | | | | | | | | | - O A Nazarova
- Ivanovo Regional Clinical Hospital, Regional Vascular Center, Ivanovo
| | | | | | | | - O G Azarin
- Voronezh Regional Clinical Hospital № 1, Voronezh
| | | | - Vi O Zyazina
- Voronezh Regional Clinical Hospital № 1, Voronezh
| | | | | | | | | | | | | | | | | | | | | | | | | | - N A Khramtsova
- Irkutsk Regional Clinical Hospital, Winner of the "Mark of the Honor", Irkutsk
| | - N A Medvedeva
- Irkutsk Regional Clinical Hospital, Winner of the "Mark of the Honor", Irkutsk
| | | | | | | | | | | | | | - E V Belskaya
- Novomoskovsk City Clinical Hospital, Novomoskovsk
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24
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Liu X, Xiao W, Jiang Y, Zou L, Chen F, Xiao W, Zhang X, Cao Y, Xu L, Zhu Y. Bmal1 Regulates the Redox Rhythm of HSPB1, and Homooxidized HSPB1 Attenuates the Oxidative Stress Injury of Cardiomyocytes. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:5542815. [PMID: 34239687 PMCID: PMC8238613 DOI: 10.1155/2021/5542815] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/05/2021] [Accepted: 05/07/2021] [Indexed: 12/20/2022]
Abstract
Oxidative stress is the main cause of acute myocardial infarction (AMI), which is related to the disorder of the regulation of Bmal1 on the redox state. HSPB1 form homologous-oxidized HSPB1 (homooxidized HSPB1) to resist oxidative damage via S-thiolated modification. However, it is still unclarified whether there is an interaction between the circadian clock and HSPB1 in myocardial injury. A total of 118 AMI patients admitted and treated in our hospital from Sep. 2019 to Sep. 2020 were selected to detect the plasma HSPB1 expression and the redox state. We divided the AMI patients into three subgroups: morning-onset AMI (5 : 00 am to 8 : 00 am; Am-subgroup, n = 38), noon-onset AMI (12 : 00 pm to 15 : 00; Pm-subgroup, n = 45), and night-onset AMI (20 : 00 pm to 23 : 00 pm; Eve-subgroup, n = 35) according to the circadian rhythm of onset. The Am-subgroup had remarkably higher cardiac troponin I (cTnI), creatine kinase MB (CK-MB), and B-type natriuretic peptide (BNP) but lower left ventricular ejection fraction (LVEF) than the Pm-subgroup and Eve-subgroup. Patients complicated with cardiogenic shock were significantly higher in the Am-subgroup than in the other two groups. The homooxidized HSPB1 in plasma markedly decreased in the Am-subgroup. The HSPB1C141S mutant accelerated H9c2 cell apoptosis, increased reactive oxygen species (ROS), and decreased reduced-glutathione (GSH) and the ratio of reduced-GSH and GSSG during oxidative stress. Importantly, we found that the redox state of HSPB1 was consistent with the oscillatory rhythm of Bmal1 expression in normal C57B/L mice. The circadian rhythm disorder contributed to decrease Bmal1 and homooxidized HSPB1 in cardiomyocytes of C57BL/6 mice. In addition, Bmal1 and homooxidized HSPB1 decreased in neonatal rat cardiomyocytes exposed to H2O2. Knockdown of Bmal1 led to significant attenuation in homooxidized HSPB1 expression, whereas overexpression of Bmal1 increased homooxidized HSPB1 expression in response to H2O2. Our findings indicated that the homooxidized HSPB1 reduced probably the AMI patients' risk of shock and target organ damage, which was associated with Bmal1 regulating the redox state of HSPB1.
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Affiliation(s)
- Xiehong Liu
- Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics, Institute of Emergency Medicine, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, Hunan, China
| | - Wen Xiao
- Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics, Institute of Emergency Medicine, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, Hunan, China
- Emergency Department, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Yu Jiang
- Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics, Institute of Emergency Medicine, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, Hunan, China
| | - Lianhong Zou
- Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics, Institute of Emergency Medicine, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, Hunan, China
| | - Fang Chen
- Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics, Institute of Emergency Medicine, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, Hunan, China
- Emergency Department, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Weiwei Xiao
- Emergency Department, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Xingwen Zhang
- Emergency Department, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Yan Cao
- Emergency Department, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Lei Xu
- Public Health Clinical Center, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Yimin Zhu
- Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics, Institute of Emergency Medicine, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, Hunan, China
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Meng H, Ruan J, Tian X, Li L, Chen W, Meng F. High retinoic acid receptor-related orphan receptor A gene expression in peripheral blood leukocytes may be related to acute myocardial infarction. J Int Med Res 2021; 49:3000605211019663. [PMID: 34101510 PMCID: PMC8191083 DOI: 10.1177/03000605211019663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to investigate whether differential expression of the retinoic acid receptor-related orphan receptor A (RORA) gene is related to occurrence of acute myocardial infarction (AMI). METHODS This was a retrospective study. White blood cells of 93 patients with acute myocardial infarction and 74 patients with stable coronary artery disease were collected. Reverse transcription quantitative polymerase chain reaction and western blotting were used to measure RORA mRNA and protein expression, respectively. RESULTS RORA mRNA expression levels in peripheral blood leukocytes in patients with AMI were 1.57 times higher than those in patients with stable coronary artery disease. Protein RORA levels in peripheral blood of patients with AMI were increased. Binary logistic regression analysis showed that high expression of RORA was an independent risk factor for AMI, and it increased the risk of AMI by 2.990 times. CONCLUSION RORA expression levels in patients with AMI is significantly higher than that in patients with stable coronary artery disease. High expression of RORA is related to AMI and it may be an independent risk factor for AMI.
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Affiliation(s)
- Heyu Meng
- Department of Cardiology, Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin, China
| | - Jianjun Ruan
- Department of Cardiology, Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin, China
| | - Xiaomin Tian
- Department of Cardiology, Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin, China
| | - Lihong Li
- Department of Cardiology, Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin, China
| | - Weiwei Chen
- Department of Cardiology, Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin, China
| | - Fanbo Meng
- Department of Cardiology, Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin, China
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Coronary deaths during Midsummer festival in Finland: miseries of long, light nights. Eur J Epidemiol 2021; 36:539-543. [PMID: 33884545 PMCID: PMC8159801 DOI: 10.1007/s10654-021-00744-6] [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: 03/27/2020] [Accepted: 03/26/2021] [Indexed: 10/26/2022]
Abstract
This paper examines whether the anomalous summer peak in deaths from coronary heart disease (CHD) in Finland could be attributed to adverse effects of the Midsummer festival and alcohol consumption during the festival. Daily deaths from CHD and alcohol poisoning in Finland, 1961-2014, that occurred during the 7 days centering on Midsummer Day were analysed in relation to deaths during 14 to 4 days before and 4 to 14 after Midsummer Day. Daily counts of deaths from CHD among persons aged 35-64 years were regressed on days around the Midsummer period by negative binomial regression. Mortality from CHD was highest on Midsummer Day (RR 1.25 (95% confidence interval 1.12-1.31), one day after the peak in deaths from alcohol poisonings. RR for CHD on Midsummer Day was particulary high (RR = 1.43; 1.09-1.86) in the 2000s, 30% of deaths being attributable to that day. In conclusion, the anomalous and prominent summer peak in deaths from CHD in Finland is an adverse consequence of the Midsummer festival. The most likely underlying reason is heavy alcohol consumption during the festival period, especially on Midsummer Eve. In the 2000s, one third of deaths from CHD on Midsummer Day are preventable.
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27
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Derks L, Houterman S, Geuzebroek GSC, van der Harst P, Smits PC. Daylight saving time does not seem to be associated with number of percutaneous coronary interventions for acute myocardial infarction in the Netherlands. Neth Heart J 2021; 29:427-432. [PMID: 33765223 PMCID: PMC8397810 DOI: 10.1007/s12471-021-01566-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background In multiple studies, the potential relationship between daylight saving time (DST) and the occurrence of acute myocardial infarction (MI) has been investigated, with mixed results. Using the Dutch Percutaneous Coronary Intervention (PCI) registry facilitated by the Netherlands Heart Registration, we investigated whether the transitions to and from DST interact with the incidence rate of PCI for acute MI. Methods We assessed changes in hospital admissions for patients with ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) undergoing PCI between 1 January 2015 and 31 December 2018. We compared the incidence rate of PCI procedures during the first 3 or 7 days after the transition with that during a control period (2 weeks before transition plus second week after transition). Incidence rate ratio (IRR) was calculated using Poisson regression. Potential gender differences were also investigated. Results A total of 80,970 PCI procedures for STEMI or NSTEMI were performed. No difference in incidence rate a week after the transition to DST in spring was observed for STEMI (IRR 0.95, 95% confidence interval (CI) 0.87–1.03) or NSTEMI (IRR 1.04, 95% CI 0.96–1.12). After the transition from DST in autumn, the IRR was also comparable with the control period (STEMI: 1.03, 95% CI 0.95–1.12, and NSTEMI: 0.98, 95% CI 0.91–1.06). Observing the first 3 days after each transition yielded similar results. Gender-specific results were comparable. Conclusion Based on data from a large, nationwide registry, there was no correlation between the transition to or from DST and a change in the incidence rate of PCI for acute MI.
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Affiliation(s)
- L Derks
- Netherlands Heart Registration, Utrecht, The Netherlands.
| | - S Houterman
- Netherlands Heart Registration, Utrecht, The Netherlands
| | - G S C Geuzebroek
- Department of Cardiothoracic Surgery, Radboudumc, Nijmegen, The Netherlands
| | - P van der Harst
- Department of Cardiology, Division of Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - P C Smits
- Netherlands Heart Registration, Utrecht, The Netherlands.,Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
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28
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Moholdt T, Afoakwah C, Scuffham P, McDonald CF, Burrell LM, Stewart S. Excess mortality at Christmas due to cardiovascular disease in the HUNT study prospective population-based cohort in Norway. BMC Public Health 2021; 21:549. [PMID: 33743642 PMCID: PMC7980726 DOI: 10.1186/s12889-021-10503-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/12/2021] [Indexed: 01/08/2023] Open
Abstract
Background Although it is known that winter inclusive of the Christmas holiday period is associated with an increased risk of dying compared to other times of the year, very few studies have specifically examined this phenomenon within a population cohort subject to baseline profiling and prospective follow-up. In such a cohort, we sought to determine the specific characteristics of mortality occuring during the Christmas holidays. Methods Baseline profiling and outcome data were derived from a prospective population-based cohort with longitudinal follow-up in Central Norway - the Trøndelag Health (HUNT) Study. From 1984 to 1986, 88% of the target population comprising 39,273 men and 40,353 women aged 48 ± 18 and 50 ± 18 years, respectively, were profiled. We examined the long-term pattern of mortality to determine the number of excess (all-cause and cause-specific) deaths that occurred during winter overall and, more specifically, the Christmas holidays. Results During 33.5 (IQR 17.1–34.4) years follow-up, 19,879 (50.7%) men and 19,316 (49.3%) women died at age-adjusted rate of 5.3 and 4.6 deaths per 1000/annum, respectively. Overall, 1540 (95% CI 43–45 deaths/season) more all-cause deaths occurred in winter (December to February) versus summer (June to August), with 735 (95% CI 20–22 deaths per season) of these cardiovascular-related. December 25th–27th was the deadliest 3-day period of the year; being associated with 138 (95% CI 96–147) and 102 (95% CI 72–132) excess all-cause and cardiovascular-related deaths, respectively. Accordingly, compared to 1st–21st December (equivalent winter conditions), the incidence rate ratio of all-cause mortality increased to 1.22 (95% CI 1.16–1.27) and 1.17 (95% 1.11–1.22) in men and women, respectively, during the next 21 days (Christmas/New Year holidays). All observed differences were highly significant (P < 0.001). A less pronounced pattern of mortality due to respiratory illnesses (but not cancer) was also observed. Conclusion Beyond a broader pattern of seasonally-linked mortality characterised by excess winter deaths, the deadliest time of year in Central Norway coincides with the Christmas holidays. During this time, the pattern and frequency of cardiovascular-related mortality changes markedly; contrasting with a more stable pattern of cancer-related mortality. Pending confirmation in other populations and climates, further research to determine if these excess deaths are preventable is warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10503-7.
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Affiliation(s)
- Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,The Women's Clinic, St.Olav Hospital, Trondheim, Norway
| | - Clifford Afoakwah
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Paul Scuffham
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Institute for Breathing and Sleep, University of Melbourne, Melbourne, Australia
| | - Louise M Burrell
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia
| | - Simon Stewart
- Torrens University Australia, South Australia, Wakefield Campus, Adelaide, SA, 5000, Australia. .,University of Glasgow, Glasgow, Scotland, UK.
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Allison MC, Doyle NA, Greene G, Mahmood A, Glickman M, Jones AK, Mizen PE. Lockdown Britain: Evidence for reduced incidence and severity of some non-COVID acute medical illnesses. Clin Med (Lond) 2021; 21:e171-e178. [PMID: 33762383 PMCID: PMC8002805 DOI: 10.7861/clinmed.2020-0586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Large reductions in emergency department attendances and hospitalisations with non-COVID acute medical illness early during the pandemic were attributed to reluctance to seek medical help and higher referral thresholds. Here, we compare acute medical admissions with a comparison cohort from 2017. Deaths in the same geographic area were examined, and Wales-wide deaths during these 4 weeks in 2020 were compared with a seasonally matched period in 2019. There were 528 patients admitted with non-COVID illness in 2020, versus 924 in 2017 (a reduction of 43%). Deaths from non-COVID causes increased by 10.9% compared with 2017, over half this rise being from neurological causes including stroke and dementia. While far fewer patients required hospitalisation as medical emergencies, rises in local non-COVID deaths proved small. Wales-wide non-COVID deaths rose by just 1% compared with 2019. The findings suggest that changes in population behaviour and lifestyle during lockdown brought about unforeseen health benefits.
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Affiliation(s)
| | | | | | - Arif Mahmood
- Aneurin Bevan University Health Board Headquarters, Newport, UK
| | - Myer Glickman
- methods and international, Office for National Statistics, Newport, UK
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30
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Mohammad MA, Koul S, Gale CP, Alfredsson J, James S, Fröbert O, Omerovic E, Erlinge D. The association of mode of location activity and mobility with acute coronary syndrome: a nationwide ecological study. J Intern Med 2021; 289:247-254. [PMID: 33259680 PMCID: PMC7898898 DOI: 10.1111/joim.13206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND We aimed to study the effect of social containment mandates on ACS presentation during COVID-19 pandemic using location activity and mobility data from mobile phone map services. METHODS We conducted a cross-sectional study using data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) including all ACS presentations during the pandemic until 7 May 2020. Using a count regression model, we adjusted for day of the week, daily weather and incidence of COVID-19. RESULTS A 10% increase in activity around areas of residence was associated with 38% lower rates of ACS hospitalizations, whereas increased activity relating to retail and recreation, grocery stores and pharmacies, workplaces and mode of mobility was associated with 10-20% higher rates of ACS hospitalizations. CONCLUSION Government policy regarding social containment mandates has important public health implications for medical emergencies such as ACS and may explain the decline in ACS presentations observed during COVID-19 pandemic.
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Affiliation(s)
- M A Mohammad
- From the, Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - S Koul
- From the, Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - C P Gale
- Leeds Institute of Cardiovascular and Medicine, University of Leeds, Leeds, UK
| | - J Alfredsson
- Department of Cardiology, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - S James
- Department of Medical Sciences and Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
| | - O Fröbert
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | - E Omerovic
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - D Erlinge
- From the, Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
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31
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Daios S, Savopoulos C, Kanellos I, Goudis CA, Nakou I, Petalloti S, Hadjidimitriou N, Pilalas D, Ziakas A, Kaiafa G. Circadian Pattern of Acute Myocardial Infarction and Atrial Fibrillation in a Mediterranean Country: A study in Diabetic Patients. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57010041. [PMID: 33418926 PMCID: PMC7825022 DOI: 10.3390/medicina57010041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 05/13/2023]
Abstract
Background and objectives: The circadian pattern seems to play a crucial role in cardiovascular events and arrhythmias. Diabetes mellitus is a complex metabolic disorder associated with autonomic nervous system alterations and increased risk of microvascular and macrovascular disease. We sought to determine whether acute myocardial infarction (AMI) and atrial fibrillation (AF) follow a circadian pattern in diabetic patients in a Mediterranean country. Materials and Methods: This retrospective study included 178 diabetic patients (mean age: 67.7) with AMI or AF who were admitted to the coronary care unit. The circadian pattern of AMI and AF was identified in the 24-h period (divided in 3-h and 1-h intervals). Patients were also divided in 3 groups according to age; 40-65 years, 66-79 years and patients older than 80 years. A chi-square goodness-of-fit test was used for the statistical analysis. Results: AMI seems to occur more often in the midnight hours (21:00-23:59) (p < 0.001). Regarding age distribution, patients between 40 and 65 years were more likely to experience an AMI compared to other age groups (p < 0.001). Autonomic alterations, working habits, and social reasons might contribute to this phenomenon. AF in diabetic patients occurs more frequently at noon (12:00-14:59) (p = 0.019). Conclusions: Diabetic patients with AMI and AF seem to follow a specific circadian pattern in a Mediterranean country, with AMI occurring most often at midnight hours and AF mostly at noon. Autonomic dysfunction, glycemic fluctuations, intense anti-diabetic treatment before lunch, and patterns of insulin secretion and resistance may explain this pattern. More studies are needed to elucidate the circadian pattern of AMI and AF in diabetic patients to contribute to the development of new therapeutic approaches in this setting.
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Affiliation(s)
- Stylianos Daios
- First Propedeutic Department of Internal Medicine, Department of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi Street, 54636 Thessaloniki, Greece; (S.D.); (I.K.); (S.P.); (N.H.); (D.P.); (G.K.)
- Cardiology Department, Serres General Hospital, 62120 Serres, Greece; (C.A.G.); (I.N.)
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Department of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi Street, 54636 Thessaloniki, Greece; (S.D.); (I.K.); (S.P.); (N.H.); (D.P.); (G.K.)
- Correspondence: ; Tel.: +30-2310994783; Fax: +30-2310285128
| | - Ilias Kanellos
- First Propedeutic Department of Internal Medicine, Department of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi Street, 54636 Thessaloniki, Greece; (S.D.); (I.K.); (S.P.); (N.H.); (D.P.); (G.K.)
| | | | - Ifigeneia Nakou
- Cardiology Department, Serres General Hospital, 62120 Serres, Greece; (C.A.G.); (I.N.)
| | - Stergiani Petalloti
- First Propedeutic Department of Internal Medicine, Department of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi Street, 54636 Thessaloniki, Greece; (S.D.); (I.K.); (S.P.); (N.H.); (D.P.); (G.K.)
- Cardiology Department, Serres General Hospital, 62120 Serres, Greece; (C.A.G.); (I.N.)
| | - Nicolas Hadjidimitriou
- First Propedeutic Department of Internal Medicine, Department of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi Street, 54636 Thessaloniki, Greece; (S.D.); (I.K.); (S.P.); (N.H.); (D.P.); (G.K.)
| | - Dimitrios Pilalas
- First Propedeutic Department of Internal Medicine, Department of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi Street, 54636 Thessaloniki, Greece; (S.D.); (I.K.); (S.P.); (N.H.); (D.P.); (G.K.)
| | - Antonios Ziakas
- First Department of Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece;
| | - Georgia Kaiafa
- First Propedeutic Department of Internal Medicine, Department of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi Street, 54636 Thessaloniki, Greece; (S.D.); (I.K.); (S.P.); (N.H.); (D.P.); (G.K.)
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Schwarz V, Mahfoud F, Lauder L, Reith W, Behnke S, Smola S, Rissland J, Pfuhl T, Scheller B, Böhm M, Ewen S. Decline of emergency admissions for cardiovascular and cerebrovascular events after the outbreak of COVID-19. Clin Res Cardiol 2020; 109:1500-1506. [PMID: 32749557 PMCID: PMC7399595 DOI: 10.1007/s00392-020-01688-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/07/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The spread of the novel coronavirus SARS-CoV-2 and the guidance from authorities for social distancing and media reporting lead to significant uncertainty in Germany. Concerns have been expressed regarding the underdiagnosing of harmful diseases. We explored the rates of emergency presentations for acute coronary syndrome (ACS) and acute cerebrovascular events (ACVE) before and after spread of SARS-CoV-2. METHODS We analyzed all-cause visits at a tertiary university emergency department and admissions for ACS and ACVE before (calendar weeks 1-9, 2020) and after (calendar weeks 10-16, 2020) the first coronavirus disease (COVID-19) case in the region of the Saarland, Germany. The data were compared with the same period of the previous year. RESULTS In 2020 an average of 346 patients per week presented at the emergency department whereas in 2019 an average of 400 patients presented up to calendar week 16 (p = 0.018; whole year 2019 = 395 patients per week). After the first COVID-19 diagnosis in the region, emergency department visit volume decreased by 30% compared with the same period in 2019 (p = 0.0012). Admissions due to ACS decreased by 41% (p = 0.0023 for all; Δ - 71% (p = 0.007) for unstable angina, Δ - 25% (p = 0.42) for myocardial infarction with ST-elevation and Δ - 17% (p = 0.28) without ST-elevation) compared with the same period in 2019 and decreased from 142 patients in calendar weeks 1-9 to 62 patients in calendar weeks 10-16. ACVE decreased numerically by 20% [p = 0.25 for all; transient ischemic attack: Δ - 32% (p = 0.18), ischemic stroke: Δ - 23% (p = 0.48), intracerebral haemorrhage: Δ + 57% (p = 0.4)]. There was no significant change in ACVE per week (p = 0.7) comparing calendar weeks 1-9 (213 patients) and weeks 10-16 (147 patients). Testing of 3756 samples was performed to detect 58 SARS-CoV-2 positive patients (prevalence 1,54%, thereof one patient with myocardial and two with cerebral ischemia) up to calendar week 16 in 2020. CONCLUSIONS The COVID-19 pandemic was associated with a significant decrease in all-cause admission and admissions due to cardiovascular events in the emergency department. Regarding acute cerebrovascular events there was a numerical decrease but no significant difference.
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Affiliation(s)
- Viktoria Schwarz
- Emergency Department, Saarland University Medical Center, Homburg, Germany.
- Clinic of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), Saarland University Medical Center, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 100, Geb. 41, 66421, Homburg, Saar, Germany.
| | - Felix Mahfoud
- Clinic of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), Saarland University Medical Center, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 100, Geb. 41, 66421, Homburg, Saar, Germany
| | - Lucas Lauder
- Clinic of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), Saarland University Medical Center, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 100, Geb. 41, 66421, Homburg, Saar, Germany
| | - Wolfgang Reith
- Department of Neuroradiology, Saarland University Medical Center, Homburg, Germany
| | - Stefanie Behnke
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Sigrun Smola
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
| | - Jürgen Rissland
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
| | - Thorsten Pfuhl
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
| | - Bruno Scheller
- Clinic of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), Saarland University Medical Center, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 100, Geb. 41, 66421, Homburg, Saar, Germany
| | - Michael Böhm
- Clinic of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), Saarland University Medical Center, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 100, Geb. 41, 66421, Homburg, Saar, Germany
| | - Sebastian Ewen
- Emergency Department, Saarland University Medical Center, Homburg, Germany.
- Clinic of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), Saarland University Medical Center, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 100, Geb. 41, 66421, Homburg, Saar, Germany.
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33
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Chan DZ, Stewart RA, Kerr AJ, Dicker B, Kyle CV, Adamson PD, Devlin G, Edmond J, El-Jack S, Elliott JM, Fisher N, Flynn C, Lee M, Liao YWB, Rhodes M, Scott T, Smith T, Stiles MK, Swain AH, Todd VF, Webster MW, Williams MJ, White HD, Somaratne JB. The impact of a national COVID-19 lockdown on acute coronary syndrome hospitalisations in New Zealand (ANZACS-QI 55). LANCET REGIONAL HEALTH-WESTERN PACIFIC 2020; 5:100056. [PMID: 34173604 PMCID: PMC7677076 DOI: 10.1016/j.lanwpc.2020.100056] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/16/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023]
Abstract
Background Countries with a high incidence of coronavirus 2019 (COVID-19) reported reduced hospitalisations for acute coronary syndromes (ACS) during the pandemic. This study describes the impact of a nationwide lockdown on ACS hospitalisations in New Zealand (NZ), a country with a low incidence of COVID-19. Methods All patients admitted to a NZ Hospital with ACS who underwent coronary angiography in the All NZ ACS Quality Improvement registry during the lockdown (23 March – 26 April 2020) were compared with equivalent weeks in 2015–2019. Ambulance attendances and regional community troponin-I testing were compared for lockdown and non-lockdown (1 July 2019 to 16 February 2020) periods. Findings Hospitalisation for ACS was lower during the 5-week lockdown (105 vs. 146 per-week, rate ratio 0•72 [95% CI 0•61–0•83], p = 0.003). This was explained by fewer admissions for non-ST-segment elevation ACS (NSTE-ACS; p = 0•002) but not ST-segment elevation myocardial infarction (STEMI; p = 0•31). Patient characteristics and in-hospital mortality were similar. For STEMI, door-to-balloon times were similar (70 vs. 72 min, p = 0•52). For NSTE-ACS, there was an increase in percutaneous revascularisation (59% vs. 49%, p<0•001) and reduction in surgical revascularisation (9% vs. 15%, p = 0•005). There were fewer ambulance attendances for cardiac arrests (98 vs. 110 per-week, p = 0•04) but no difference for suspected ACS (408 vs. 420 per-week, p = 0•44). Community troponin testing was lower throughout the lockdown (182 vs. 394 per-week, p<0•001). Interpretation Despite the low incidence of COVID-19, there was a nationwide decrease in ACS hospitalisations during the lockdown. These findings have important implications for future pandemic planning. Funding The ANZACS-QI registry receives funding from the New Zealand Ministry of Health.
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Affiliation(s)
- Daniel Zl Chan
- Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.,Department of Cardiology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand
| | - Ralph Ah Stewart
- Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Andrew J Kerr
- Department of Cardiology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand.,School of Population Health, University of Auckland, Auckland, New Zealand
| | - Bridget Dicker
- Clinical Audit and Research, St John New Zealand, Auckland, New Zealand.,Department of Paramedicine, Auckland University of Technology, Auckland, New Zealand
| | - Campbell V Kyle
- Department of Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand.,Department of Biochemistry, Labtests New Zealand, Auckland, New Zealand
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.,British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | | | - John Edmond
- Department of Cardiology, Southern District Health Board, Dunedin, New Zealand
| | - Seif El-Jack
- Department of Cardiology, Waitemata District Health Board, Auckland, New Zealand
| | - John M Elliott
- Department of Medicine, University of Otago, Christchurch, New Zealand.,Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Nick Fisher
- Department of Cardiology, Nelson Hospital, Nelson, New Zealand
| | - Charmaine Flynn
- The National Institute for Health Innovation, University of Auckland, Auckland New Zealand.,Tauranga Hospital, Tauranga, New Zealand
| | - Mildred Lee
- Department of Cardiology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand
| | - Yi-Wen Becky Liao
- Department of Cardiology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand
| | - Maxine Rhodes
- The National Institute for Health Innovation, University of Auckland, Auckland New Zealand
| | - Tony Scott
- Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Tony Smith
- Clinical Audit and Research, St John New Zealand, Auckland, New Zealand
| | - Martin K Stiles
- Waikato Clinical School, Faculty of Medicine and Health Sciences, University of Auckland, New Zealand
| | - Andrew H Swain
- Department of Paramedicine, Auckland University of Technology, Auckland, New Zealand.,Wellington Free Ambulance, Wellington, New Zealand
| | - Verity F Todd
- Clinical Audit and Research, St John New Zealand, Auckland, New Zealand.,Department of Paramedicine, Auckland University of Technology, Auckland, New Zealand
| | - Mark Wi Webster
- Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Michael Ja Williams
- Department of Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Harvey D White
- Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
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Mohammad MA, Koul S, Olivecrona GK, Gӧtberg M, Tydén P, Rydberg E, Scherstén F, Alfredsson J, Vasko P, Omerovic E, Angerås O, Fröbert O, Calais F, Völz S, Ulvenstam A, Venetsanos D, Yndigegn T, Oldgren J, Sarno G, Grimfjärd P, Persson J, Witt N, Ostenfeld E, Lindahl B, James SK, Erlinge D. Incidence and outcome of myocardial infarction treated with percutaneous coronary intervention during COVID-19 pandemic. Heart 2020; 106:1812-1818. [PMID: 33023905 PMCID: PMC7677488 DOI: 10.1136/heartjnl-2020-317685] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022] Open
Abstract
Objective Most reports on the declining incidence of myocardial infarction (MI) during the COVID-19 have either been anecdotal, survey results or geographically limited to areas with lockdowns. We examined the incidence of MI during the COVID-19 pandemic in Sweden, which has remained an open society with a different public health approach fighting COVID-19. Methods We assessed the incidence rate (IR) as well as the incidence rate ratios (IRRs) of all MI referred for coronary angiography in Sweden using the nationwide Swedish Coronary Angiography and Angioplasty Registry (SCAAR), during the COVID-19 pandemic in Sweden (1 March 2020–7 May 2020) in relation to the same days 2015–2019. Results A total of 2443 MIs were referred for coronary angiography during the COVID-19 pandemic resulting in an IR 36 MIs/day (204 MIs/100 000 per year) compared with 15 213 MIs during the reference period with an IR of 45 MIs/day (254 MIs/100 000 per year) resulting in IRR of 0.80, 95% CI (0.74 to 0.86), p<0.001. Results were consistent in all investigated patient subgroups, indicating no change in patient category seeking cardiac care. Kaplan-Meier event rates for 7-day case fatality were 439 (2.3%) compared with 37 (2.9%) (HR: 0.81, 95% CI (0.58 to 1.13), p=0.21). Time to percutaneous coronary intervention (PCI) was shorter during the pandemic and PCI was equally performed, indicating no change in quality of care during the pandemic. Conclusion The COVID-19 pandemic has significantly reduced the incidence of MI referred for invasive treatment strategy. No differences in overall short-term case fatality or quality of care indicators were observed.
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Affiliation(s)
- Moman A Mohammad
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Göran K Olivecrona
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Matthias Gӧtberg
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Patrik Tydén
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Rydberg
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Fredrik Scherstén
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | | | - Peter Vasko
- Department of Medicine, Växjö Hospital, Växjö, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Department of Molecular and Clinical Medicine, Department of Cardiology, Sahlgrenska University Hospital, Institute of Medicine, Department of Molecular and Clinical Medicine,Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Department of Molecular and Clinical Medicine, Department of Cardiology, Sahlgrenska University Hospital, Institute of Medicine, Department of Molecular and Clinical Medicine,Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ole Fröbert
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | - Fredrik Calais
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | - Sebastian Völz
- Department of Cardiology, Department of Molecular and Clinical Medicine, Department of Cardiology, Sahlgrenska University Hospital, Institute of Medicine, Department of Molecular and Clinical Medicine,Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | | | - Troels Yndigegn
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jonas Oldgren
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Giovanna Sarno
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Per Grimfjärd
- Department of Internal Medicine, Västmanlands Sjuk, Lund, Sweden
| | - Jonas Persson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockolm, Sweden
| | - Nils Witt
- Dvision of Cardiology, Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Physiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Stefan K James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
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35
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Mohammad MA, Tham J, Koul S, Rylance R, Bergh C, Erlinge D, Fröbert O. Association of acute myocardial infarction with influenza: A nationwide observational study. PLoS One 2020; 15:e0236866. [PMID: 32760080 PMCID: PMC7410234 DOI: 10.1371/journal.pone.0236866] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/15/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Influenza may precipitate cardiovascular disease, but influenza typically peaks in winter, coinciding with other triggers of myocardial infarction (MI) such as low air temperature, high wind velocity, low atmospheric pressure, and short sunshine duration. Objective We aimed to determine the relationship of week-to-week variation in influenza cases and acute MI, controlling for meteorological factors in a nationwide population. Methods Weekly laboratory-confirmed influenza case reports were obtained from the Public Health Agency of Sweden from 2009 to 2016 and merged with the nationwide SWEDEHEART MI registry. Weekly incidence of MI was studied with regard to number of influenza cases stratified into tertiles of 0–16, 17–164, and >164 cases/week. Incidence rate ratios (IRR) were calculated using a count regression model for each category and compared to a non-influenza period as reference, controlling for air temperature, atmospheric pressure, wind velocity, and sunshine duration. Results A total of 133562 MI events was reported to the registry during the study period. Weeks with influenza cases were associated with higher incidence of MI than those without in unadjusted analysis for overall MI, ST-elevation MI and non ST-elevation MI independently. During the influenza season, weeks with 0–16 reported cases/week were not associated with MI incidence after adjusting for weather parameters, adjusted IRR for MI was 1.03 (95% CI 1.00–1.06, P = 0.09). However, weeks with more cases reported were associated with MI incidence: 17–163 reported cases/week, adjusted IRR = 1.05 (95% CI 1.02–1.08, P = 0.003); and for ≥164 cases/week, the IRR = 1.06 (95% CI 1.02–1.09, P = 0.002). Results were consistent across a large range of subgroups. Conclusions In this nationwide observational study, we found an association of incidence of MI with incidence of influenza cases beyond what could be explained by meteorological factors.
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Affiliation(s)
- Moman A. Mohammad
- Department of Cardiology, Clinical Sciences Lund University, Lund, Sweden
- * E-mail:
| | - Johan Tham
- Infectious Diseases Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences Lund University, Lund, Sweden
| | - Rebecca Rylance
- Department of Cardiology, Clinical Sciences Lund University, Lund, Sweden
| | - Cecilia Bergh
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences Lund University, Lund, Sweden
| | - Ole Fröbert
- Department of Cardiology, Faculty of Medicine and Health; Örebro University, Örebro, Sweden
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Circadian variations in pathogenesis of ST-segment elevation myocardial infarction: an optical coherence tomography study. J Thromb Thrombolysis 2020; 51:379-387. [PMID: 32651890 DOI: 10.1007/s11239-020-02220-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Previous studies have reported a circadian variation in the onset of ST-segment elevation myocardial infarction (STEMI). However, underlying mechanisms for the circadian variation have not been fully elucidated. We investigated the relationship between onset of STEMI and the underlying pathology using optical coherence tomography (OCT). Patients with a diagnosis of STEMI were selected from a multicenter OCT registry. Patients were divided into 4 groups based on the estimated time of onset (00:00-05:59, 06:00-11:59, 12:00-17:59, or 18:00-23:59). Underlying pathologies of MI (plaque rupture, plaque erosion, and calcified plaque) were compared among the 4 groups. Among 648 patients, plaque rupture was diagnosed in 386 patients (59.6%), plaque erosion in 197 patients (30.4%), and calcified plaque in 65 patients (10.0%). A marked circadian variation was detected in the incidence of plaque rupture with a peak at 09:00, whereas it was not evident in plaque erosion or calcified plaque. The probability of plaque rupture significantly increased in the periods of 06:00-11:59 [odds ratio (OR) 2.13, 95% confidence interval (CI) 1.30-3.49, p = 0.002] and 12:00-17:59 (OR 2.10, 95% CI 1.23-3.58, p = 0.005), compared to the period of 00:00-05:59. This circadian pattern was observed only during weekdays (p = 0.010) and it was not evident during the weekend (p = 0.742). Plaque rupture occurred most frequently in the morning and this circadian variation was evident only during weekdays. Acute MI caused by plaque rupture may be related to catecholamine surge.
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Lee JM. Are Traditional Holidays (Seollal and Chuseok) Harmful for Cardiac Arrest? Korean Circ J 2019; 49:957-959. [PMID: 31347315 PMCID: PMC6753027 DOI: 10.4070/kcj.2019.0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ju Mi Lee
- Department of Preventive Medicine, Eulji College of Medicine, Daejeon, Korea.
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Seasonal and Monthly Patterns, Weekly Variations, and the Holiday Effect of Outpatient Visits for Type 2 Diabetes Mellitus Patients in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152653. [PMID: 31349563 PMCID: PMC6695902 DOI: 10.3390/ijerph16152653] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the seasonal and monthly patterns, weekly variations, and the holiday effect of outpatient visits for type 2 diabetes mellitus patients, as well as the influence of gender, age, and insurance type on variations. METHODS Data were obtained from the Shandong medical insurance database, including all outpatients in 12 cities of Shandong province in China from 2015 to 2017. The seasonal index (St) was calculated in terms of seasons, months, and weeks by the moving average method. RESULTS A total of 904,488 patients received outpatient services during the study period. The seasonal indices of outpatient visits by type 2 diabetes patients were higher in autumn (108.36%) and spring (102.67%), while lower in winter (89.92%) and summer (99.04%), exhibiting an obvious seasonality. Gender and age had no effect on seasonal patterns. The month impacted the seasons patterns: January to February were the lowest and December the highest months of outpatient visits, complicating the seasonal patterns. We also identified a weekly pattern of outpatient visits. In addition, the outpatient visits for type 2 diabetes mellitus patients was also strongly affected by the Spring Festival, Lantern Festival, and National Day holiday periods. The type of medical insurance had a significant impact on outpatient visits. CONCLUSIONS The outpatient visits for type 2 diabetes mellitus patients displayed seasonal patterns that were contradictory to the variations in blood glucose fluctuations found in previous studies and was also strongly affected by the holiday effect. The type of medical insurance impacted the pattern of outpatient visits.
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Circadian onset and prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA). PLoS One 2019; 14:e0216073. [PMID: 31022242 PMCID: PMC6483255 DOI: 10.1371/journal.pone.0216073] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/12/2019] [Indexed: 01/07/2023] Open
Abstract
Background Many acute cardiovascular events such as myocardial infarction (MI) follow circadian rhythms. Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a newly noticed entity with limited data on onset pattern and its impact on prognosis. Material and methods In this observational study of Swedish MINOCA patients registered in the SWEDEHEART registry between 2003–2013 and followed until December 2013 we identified 9,092 unique patients with MINOCA out of 199,163 MI admissions in total. Incidence rate ratios (IRR) were calculated for whole hours, parts of the day, weekdays, months, seasons and major holidays. Results The mean age was 65.5 years, 62.0% were women and 16.6% presented with STEMI. The risk for MINOCA proved to be most common in the morning (IRR = 1.70, 95% CI [1.63–1.84]) with a peak at 08.00 AM (IRR = 2.25, 95% CI [1.96–2.59]) and on Mondays (IRR = 1.28, 95% CI [1.18–1.38]). No altered risk was detected during the different seasons, the Christmas and New Year holidays or the Swedish Midsummer festivities. There was no association between time of onset of MINOCA and short- or long-term prognosis. Conclusion The onset of MINOCA shows a circadian and circaseptan variation with increased risk at early mornings and Mondays, similar to previous studies on all MI, suggesting stress related triggering. However, during holidays were traditional MI increase, we did not see any increase for MINOCA. No association was detected between time of onset and prognosis, indicating that the underlying pathological mechanisms of MINOCA and the quality of care are similar at different times of onset but triggering mechanism may be more active early mornings and Mondays.
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Flaherty GT. Getting to the heart of influenza vaccination in winter travellers. J Travel Med 2019; 26:5259068. [PMID: 30590731 DOI: 10.1093/jtm/tay158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Gerard T Flaherty
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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