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Earle NJ, Doughty RN, Devlin G, White H, Riddell C, Choi Y, Kerr AJ, Poppe KK. Sex differences in outcomes after acute coronary syndrome vary with age: a New Zealand national study. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:284-292. [PMID: 38085048 PMCID: PMC10927026 DOI: 10.1093/ehjacc/zuad151] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 03/13/2024]
Abstract
AIMS This study investigated age-specific sex differences in short- and long-term clinical outcomes following hospitalization for a first-time acute coronary syndrome (ACS) in New Zealand (NZ). METHODS AND RESULTS Using linked national health datasets, people admitted to hospital for a first-time ACS between January 2010 and December 2016 were included. Analyses were stratified by sex and 10-year age groups. Logistic and Cox regression were used to assess in-hospital death and from discharge the primary outcome of time to first cardiovascular (CV) readmission or death and other secondary outcomes at 30 days and 2 years. Among 63 245 people (mean age 69 years, 40% women), women were older than men at the time of the ACS admission (mean age 73 vs. 66 years), with a higher comorbidity burden. Overall compared with men, women experienced higher rates of unadjusted in-hospital death (10% vs. 7%), 30-day (16% vs. 12%) and 2-year (44% vs. 34%) death, or CV readmission (all P < 0.001). Age group-specific analyses showed sex differences in outcomes varied with age, with younger women (<65 years) at higher risk than men and older women (≥85 years) at lower risk than men: unadjusted hazard ratio of 2-year death or CV readmission for women aged 18-44 years = 1.51 [95% confidence interval (CI) 1.21-1.84] and aged ≥85 years = 0.88 (95% CI 0.83-0.93). The increased risk for younger women was no longer significant after multivariable adjustment whereas the increased risk for older men remained. CONCLUSION Men and women admitted with first-time ACS have differing age and comorbidity profiles, resulting in contrasting age-specific sex differences in the risk of adverse outcomes between the youngest and oldest age groups.
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Affiliation(s)
- Nikki J Earle
- Department of Medicine, University of Auckland, Park Avenue, Graton, Auckland 1023, New Zealand
| | - Robert N Doughty
- Department of Medicine, University of Auckland, Park Avenue, Graton, Auckland 1023, New Zealand
- Cardiology, Te Toka Tumai Auckland Hospital, Auckland, New Zealand
| | - Gerry Devlin
- Cardiology, Gisborne Hospital, Gisborne, New Zealand
| | - Harvey White
- Cardiology, Te Toka Tumai Auckland Hospital, Auckland, New Zealand
| | - Craig Riddell
- Department of Medicine, University of Auckland, Park Avenue, Graton, Auckland 1023, New Zealand
| | - Yeunhyang Choi
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Andrew J Kerr
- Department of Medicine, University of Auckland, Park Avenue, Graton, Auckland 1023, New Zealand
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
- Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Katrina K Poppe
- Department of Medicine, University of Auckland, Park Avenue, Graton, Auckland 1023, New Zealand
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Korsgaard S, Christiansen CF, Pedersen L, Sørensen HT, Schmidt M. Breaking Point Toward Decreasing Prevalence of Myocardial Infarction Owing to Relative Stronger Decrease in Incidence Than Increase in Survival Rate (A Danish Cohort Study [1994-2016]). Am J Cardiol 2021; 160:8-13. [PMID: 34593217 DOI: 10.1016/j.amjcard.2021.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/01/2022]
Abstract
The aim of this study was to examine whether myocardial infarction (MI) incidence rate continues to decrease and to determine whether the relative magnitude of a potentially decreasing incidence rate has surpassed increasing survival, demasking a breaking point in trends of MI prevalence proportion. This was a nationwide population-based cohort study using medical registries covering all hospitals in Denmark (1994 to 2016). We identified 193,870 persons with a first-time hospitalization for MI. Age-standardized incidence rates (per 100,000 persons) decreased from 154 (95% confidence interval [CI] 149 to 159) in 1994 to 90 (95% CI 86 to 93) in 2016 for females, and from 335 (95% CI 326 to 344) in 1994 to 205 (95% CI 199 to 211) in 2016 for males. Age-standardized prevalence proportion increased overall from 1994 to 2004 with a subsequent plateau. From 2006 to 2016, age-standardized prevalence proportion decreased by 0.09% (95% CI 0.07% to 0.11%) for females (from 1.07% to 0.98%) and by 0.20% (95% CI 0.17% to 0.23%) for males (from 2.85% to 2.65%). The age-standardized prevalence proportion decreased solely among persons aged 55 to 84 years. It remained stable among persons aged <55 years and increased among persons aged ≥85 years until 2012 with subsequent stable trends. We conclude that the continuous decreasing age-standardized incidence rate of MI over decades has, although with increasing survival, led to an overall breaking point toward a decreasing age-standardized prevalence proportion of MI since 2006.
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Affiliation(s)
- Søren Korsgaard
- Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Medicine, Aarhus University.
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Medicine, Aarhus University
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Medicine, Aarhus University
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Medicine, Aarhus University
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Medicine, Aarhus University; Department of Cardiology, Aarhus University Hospital
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Pylypchuk R, Wells S, Kerr A, Poppe K, Harwood M, Mehta S, Grey C, Wu BP, Selak V, Drury PL, Chan WC, Orr-Walker B, Murphy R, Mann J, Krebs JD, Zhao J, Jackson R. Cardiovascular risk prediction in type 2 diabetes before and after widespread screening: a derivation and validation study. Lancet 2021; 397:2264-2274. [PMID: 34089656 DOI: 10.1016/s0140-6736(21)00572-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Until recently, most patients with diabetes worldwide have been diagnosed when symptomatic and have high cardiovascular risk, meaning most should be prescribed cardiovascular preventive medications. However, in New Zealand, a world-first national programme led to approximately 90% of eligible adults being screened for diabetes by 2016, up from 50% in 2012, identifying many asymptomatic patients with recent-onset diabetes. We hypothesised that cardiovascular risk prediction equations derived before widespread screening would now significantly overestimate risk in screen-detected patients. METHODS New Zealanders aged 30-74 years with type 2 diabetes and without known cardiovascular disease, heart failure, or substantial renal impairment were identified from the 400 000-person PREDICT primary care cohort study between Oct 27, 2004, and Dec 30, 2016, covering the period before and after widespread screening. Sex-specific equations estimating 5-year risk of cardiovascular disease were developed using Cox regression models, with 18 prespecified predictors, including diabetes-related and renal function measures. Equation performance was compared with an equivalent equation derived in the New Zealand Diabetes Cohort Study (NZDCS), which recruited between 2000 and 2006, before widespread screening. FINDINGS 46 652 participants were included in the PREDICT-1° Diabetes subcohort, of whom 4114 experienced first cardiovascular events during follow-up (median 5·2 years, IQR 3·3-7·4). 14 829 (31·8%) were not taking oral hypoglycaemic medications or insulin at baseline. Median 5-year cardiovascular risk estimated by the new equations was 4·0% (IQR 2·3-6·8) in women and 7·1% (4·5-11·2) in men. The older NZDCS equation overestimated median cardiovascular risk by three times in women (median 14·2% [9·7-20·0]) and two times in men (17·1% [4·5-20·0]). Model and discrimination performance measures for PREDICT-1° Diabetse equations were also significantly better than for the NZDCS equation (eg, for women: R2=32% [95% CI 29-34], Harrell's C=0·73 [0·72-0·74], Royston's D=1·410 [1·330-1·490] vs R2=24% [21-26], C=0·69 [0·67-0·70], and D=1·147 [1·107-1·187]). INTERPRETATION International treatment guidelines still consider most people with diabetes to be at high cardiovascular risk; however, we show that recent widespread diabetes screening has radically changed the cardiovascular risk profile of people with diabetes in New Zealand. Many of these patients have normal renal function, are not dispensed glucose-lowering medications, and have low cardiovascular risk. These findings have clear international implications as increased diabetes screening is inevitable due to increasing obesity, simpler screening tests, and the introduction of new-generation glucose-lowering medications that prevent cardiovascular events. Cardiovascular risk prediction equations derived from contemporary diabetes populations, with multiple diabetes-related and renal function predictors, will be required to better differentiate between low-risk and high-risk patients in this increasingly heterogeneous population and to inform appropriate non-pharmacological management and cost-effective targeting of expensive new medications. FUNDING Health Research Council of New Zealand, Heart Foundation of New Zealand, and Healthier Lives National Science Challenge.
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Affiliation(s)
- Romana Pylypchuk
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sue Wells
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andrew Kerr
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Cardiology, Middlemore Hospital, Auckland, New Zealand
| | - Katrina Poppe
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Matire Harwood
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Suneela Mehta
- Planning, Funding and Outcome Teams, Waitemata District Health Board, Auckland, New Zealand
| | - Corina Grey
- Strategy and Performance Improvement Teams, Auckland District Health Board, Auckland, New Zealand
| | - Billy P Wu
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Vanessa Selak
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Wing Cheuk Chan
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Population Health, Counties Manukau District Health Board, Auckland, New Zealand
| | | | - Rinki Murphy
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jim Mann
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Jeremy D Krebs
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jinfeng Zhao
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rod Jackson
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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Tan EJ, Hayen A, Clarke P, Jackson R, Knight J, Hayes AJ. Trends in Ischaemic Heart Disease in Australia, 2001-2015: A Comparison of Urban and Rural Populations. Heart Lung Circ 2021; 30:971-977. [PMID: 33454212 DOI: 10.1016/j.hlc.2020.11.009] [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: 08/12/2020] [Revised: 10/24/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Ischaemic heart disease (IHD) is a major source of disease burden worldwide. Recent trends show incidence is declining but it is unclear whether the trends are similar in urban and rural populations. This study examines the trends of IHD events (i.e. hospitalisations and deaths) in New South Wales, Australia by rurality. METHODS This was a retrospective analysis of linked administrative data for hospitalisation and death records across NSW between 2001 and 2015. Participants were NSW residents aged 15-105 years who died or were hospitalised with a principal diagnosis of IHD. The main outcome measures were annual age-standardised mortality and hospitalisations for IHD by calendar year and rurality. RESULTS Between 2001 and 2015, age-standardised annual IHD hospitalisations declined in urban areas from 587 to 260 and in rural areas from 766 to 395 per 100,000 people. The annual decline in hospitalisations was greater in urban than rural areas, with Annual Percentage Change (APC) of -5.6% (95% CI, -6.1%, -5.0%) and -4.5% (95% CI, -5.0%, -4.0%), respectively (p=0.012). Ischaemic heart disease mortality declined at a similar rate in urban and rural regions (APC -7.6% and -6.7% per annum, p=0.28). Absolute inequalities in IHD deaths persisted until 2015 when there were 49 (urban) and 70 (rural) IHD deaths per 100,000 people. CONCLUSIONS Ischaemic heart disease hospitalisations and mortality have declined considerably between 2001 and 2015 in both rural and urban areas, yet inequalities persist, suggesting more intensive preventive efforts are required to further reduce the burden of IHD in rural populations.
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Affiliation(s)
- Eng Joo Tan
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, NSW, Australia
| | - Andrew Hayen
- Discipline of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Philip Clarke
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rod Jackson
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Josh Knight
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic, Australia
| | - Alison J Hayes
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, NSW, Australia.
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Grey C, Jackson R, Wells S, Wu B, Pujades-Rodriguez M, Schmidt M, Selak V, Kerr AJ. Both incidence and prevalence of ischaemic heart disease are declining in parallel: a national data-linkage study in New Zealand (ANZACS-QI 52). Eur J Prev Cardiol 2020; 29:321-327. [PMID: 33623988 DOI: 10.1093/eurjpc/zwaa120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/18/2020] [Accepted: 10/30/2020] [Indexed: 01/19/2023]
Abstract
AIMS To examine trends in ischaemic heart disease (IHD) incidence and prevalence in New Zealand from 2005 to 2016, using comprehensive linked national hospitalization and mortality data as proxy measures of all significant events. METHODS AND RESULTS Incident and prevalent cases of IHD in people aged ≥25 years were identified using individual patient-linkage of routinely collected ICD-10-coded hospitalization and mortality data. Incidence rates and prevalence proportions were calculated by sex and age group and then age-standardized to the 2016 New Zealand population. Ischaemic heart disease incidence and prevalence declined in men and women in all age groups. The average annual rate of decline in age-standardized IHD incidence was 3.3% for women and 2.7% for men, and the rate of decline in age-standardized IHD prevalence was 3.2% for women and 2.2% for men. Despite a 17% increase in the New Zealand population aged 25 years and over during the study period, the total number of people living with IHD also decreased, particularly in those aged 65 years and older. CONCLUSION In contrast to observations from other countries, where IHD incidence but not IHD prevalence has been falling, declining IHD incidence in New Zealand in recent decades is now mirrored by declining IHD prevalence.
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Affiliation(s)
- Corina Grey
- Performance Improvement, Auckland District Health Board, Auckland, New Zealand
| | - Rod Jackson
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Sue Wells
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Billy Wu
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | | | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
| | - Vanessa Selak
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Andrew J Kerr
- Department of Medicine and Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.,Department of Cardiology, Middlemore Hospital, Auckland, New Zealand
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Jackson R, Wells S, Rodgers A. Cardiovascular preventive strategies are not conflicting. Lancet 2020; 396:1879-1880. [PMID: 33308462 DOI: 10.1016/s0140-6736(20)32587-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Rod Jackson
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland 92019, New Zealand.
| | - Sue Wells
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland 92019, New Zealand
| | - Anthony Rodgers
- The George Instititue for Global Health, Sydney, NSW, Australia
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Wang TKM, Grey C, Jiang Y, Selak V, Bullen C, Jackson RT, Kerr AJ. Trends in cardiovascular outcomes after acute coronary syndrome in New Zealand 2006-2016. Heart 2020; 107:heartjnl-2020-316891. [PMID: 32826288 DOI: 10.1136/heartjnl-2020-316891] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/05/2020] [Accepted: 07/14/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Characterisation of trends in acute coronary syndrome (ACS) outcomes are critical to informing clinical practice and quality improvement, but there are few recent population studies for ACS. We reviewed the recent trends in the outcomes of ACS in New Zealand (NZ). METHODS All patients with ACS admitted to NZ public hospitals in 2006-2016 were identified from hospital discharge records, and their first ACS hospitalisations per year extracted for analysis. Thirty-day and 1-year death, myocardial infarction, stroke, heart failure and bleeding rates were calculated for each calendar year. Trends in outcome rates were assessed using generalised linear mixed models. RESULTS Total annual ACS hospitalisations decreased from 685 to 424 per 100 000. Using first patient hospitalisations per year (n=1 55 060), we found significant annual declines in all major outcomes except for non-cardiovascular deaths. All-cause mortality fell from 10.5% to 9.1% at 30 days (adjusted OR 0.985 per year change, p<0.001) and from 21.8% to 18.7% at 1 year (OR=0.994, p=0.016). This was related to significant decreases in cardiovascular death at both time points (OR=0.982 and 0.987, respectively, p<0.001), outweighing a slight increase in non-cardiovascular death at 1 year (OR=1.009, p=0.014). One-year rates of myocardial infarction, heart failure, stroke and bleeding rates all decreased significantly over time. CONCLUSION ACS outcomes including all-cause mortality, cardiovascular death, myocardial infarction, stroke, heart failure and bleeding at 30 days and 1 year improved over the last decade in NZ, reflecting successful implementation and advances in prevention, medical and invasive management in ACS over time.
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Affiliation(s)
- Tom Kai Ming Wang
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand
| | - Corina Grey
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Vanessa Selak
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rodney T Jackson
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Andrew J Kerr
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
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Kasargod C, Devlin G, Lee M, White HD, Kerr AJ. Prescribing Performance Post-Acute Coronary Syndrome Using a Composite Medication Indicator: ANZACS-QI 24. Heart Lung Circ 2020; 29:824-834. [DOI: 10.1016/j.hlc.2019.05.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/05/2018] [Accepted: 05/17/2019] [Indexed: 11/26/2022]
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Bruthans J, Mayer O, Jarkovsky J, Zvolsky M, Bruthans J. Long-term trends in the incidence, treatment, hospital fatality and subsequent mortality from acute myocardial infarction in the Czech Republic. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:283-290. [PMID: 32285848 DOI: 10.5507/bp.2020.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/16/2020] [Indexed: 11/23/2022] Open
Abstract
AIMS Studies on the incidence, acute and subsequent mortality from myocardial infarction are limited mostly to selected clinical cohorts and populations and cover relatively short periods. Our aim was to describe and analyse long-term trends on a national scale. METHODS Acute myocardial infarction (AMI) was defined by the International Classification of Diseases (ICD)10; codes I21 and I22. Our natiowide 1994-2016 data on AMI mortality were obtained from the official mortality statistics (Czech Bureau of Statistics), data on morbidity (hospitalizations) from the National Register of Hospitalizations (Institute for Health Information and Statistics). For further analyses, data from the Czech EUROASPIRE I-V and Czech IMPACT studies were used. RESULTS Over the 1994-2016 period the total number of AMI cases per year decreased from 34,084 to 19,015, that of patients hospitalized for AMI from 22,373 to 15,419, the total number of deaths due to AMI from 14,834 to 4,673, in those treated because of AMI from 3,794 to 1,137, and hospital fatality in patients treated for AMI decreased from 17% to 7.5%. Over the years 1997-2016, the one-year all-cause mortality rate after AMI declined from 25.1 to 17.9%, cardiovascular (CV) mortality from 22.3 to 14.2%, five-year all-cause mortality from 41.7 to 34%, and CV mortality from 34.1 to 23.6%. CONCLUSION The Czech Republic has witnessed a pronounced decrease in AMI incidence and fatality and, consequently, long-term mortality. The decreasing incidence and improving course of AMI are due to progress in primary prevention, in acute coronary care and interventional cardiology, and in secondary coronary heart disease (CHD) prevention.
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Affiliation(s)
- Jan Bruthans
- Centre for Cardiovascular Prevention, 1st Faculty of Medicine, Charles University in Prague and Thomayer Hospital, Prague, Czech Republic.,2nd Department of Medicine, Faculty of Medicine Pilsen, Charles University and Faculty Hospital, Pilsen, Pilsen, Czech Republic
| | - Otto Mayer
- 2nd Department of Medicine, Faculty of Medicine Pilsen, Charles University and Faculty Hospital, Pilsen, Pilsen, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Miroslav Zvolsky
- Institute of Medical Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Jan Bruthans
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University, Prague, Czech Republic
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Pilmore HL, Xiong F, Choi Y, Poppe K, Lee M, Legget M, Kerr A. Impact of chronic kidney disease on mortality and cardiovascular outcomes after acute coronary syndrome: A nationwide data linkage study (ANZACS‐QI 44). Nephrology (Carlton) 2020; 25:535-543. [DOI: 10.1111/nep.13703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/09/2020] [Accepted: 01/11/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Helen L. Pilmore
- Department of Renal MedicineAuckland City Hospital Auckland New Zealand
- Department of MedicineAuckland University Auckland New Zealand
| | - Fei Xiong
- Department of Renal MedicineAuckland City Hospital Auckland New Zealand
| | - Yeunhyang Choi
- Section of Epidemiology and Biostatistics, School of Population HealthUniversity of Auckland Auckland New Zealand
| | - Katrina Poppe
- Section of Epidemiology and Biostatistics, School of Population HealthUniversity of Auckland Auckland New Zealand
| | - Mildred Lee
- Section of Epidemiology and Biostatistics, School of Population HealthUniversity of Auckland Auckland New Zealand
| | - Malcolm Legget
- Department of MedicineAuckland University Auckland New Zealand
- Department of CardiologyAuckland City Hospital Auckland New Zealand
| | - Andrew Kerr
- Department of MedicineAuckland University Auckland New Zealand
- Section of Epidemiology and Biostatistics, School of Population HealthUniversity of Auckland Auckland New Zealand
- Department of CardiologyMiddlemore Hospital Auckland New Zealand
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11
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Wang TKM, Grey C, Jiang Y, Jackson R, Kerr A. Contrasting Trends in Acute Coronary Syndrome Hospitalisation and Coronary Revascularisation in New Zealand 2006-2016: A National Data Linkage Study (ANZACS-QI 27). Heart Lung Circ 2020; 29:1375-1385. [PMID: 31974025 DOI: 10.1016/j.hlc.2019.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/28/2019] [Accepted: 11/18/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Evaluating trends in acute coronary syndrome (ACS) and invasive coronary procedures, including coronary angiography, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) can identify areas for improvement in clinical care and inform future health planning. This national data-linkage study reports trends in ACS hospitalisations and procedure rates in New Zealand between 2006 and 2016. METHODS All adult ACS hospitalisations and associated angiography and revascularisation procedures were identified from hospital discharge codes. Crude and age-standardised ACS incidence and procedure rates were calculated for each calendar year. RESULTS Between 2006 and 2016 there were 188,264 ACS admissions. During this time, there was a steady decline in hospitalisation rates, from 685 to 424 per 100,000 per year. This decline was observed in both sexes and in all age groups. There were also significant increases in coronary angiography and revascularisation rates, from 29.8% to 54.3% and 20.6% to 37.3%, respectively, between 2006 and 2016. The rate of revascularisation by PCI increased from 16.0% to 31.0%, a greater increase than revascularisation by CABG, which increased from 4.6% to 6.5%. Increases in procedures were observed in all age groups and both sexes. The proportions of coronary angiograms that resulted in revascularisation each year consistently ranged from 67 to 70% throughout the period. CONCLUSIONS Acute coronary syndrome hospitalisation rates in New Zealand decreased by nearly 40% between 2006 and 2016, while the use of coronary angiography and revascularisation after ACS nearly doubled. The similar proportions of angiograms that resulted in revascularisation each year suggests that, despite the doubling of angiograms over the 10-year study period, they are not over-utilised.
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Affiliation(s)
- Tom Kai Ming Wang
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand; Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Corina Grey
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rod Jackson
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Andrew Kerr
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand; School of Population Health, University of Auckland, Auckland, New Zealand.
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Kaptoge S, Pennells L, De Bacquer D, Cooney MT, Kavousi M, Stevens G, Riley LM, Savin S, Khan T, Altay S, Amouyel P, Assmann G, Bell S, Ben-Shlomo Y, Berkman L, Beulens JW, Björkelund C, Blaha M, Blazer DG, Bolton T, Bonita Beaglehole R, Brenner H, Brunner EJ, Casiglia E, Chamnan P, Choi YH, Chowdry R, Coady S, Crespo CJ, Cushman M, Dagenais GR, D'Agostino Sr RB, Daimon M, Davidson KW, Engström G, Ford I, Gallacher J, Gansevoort RT, Gaziano TA, Giampaoli S, Grandits G, Grimsgaard S, Grobbee DE, Gudnason V, Guo Q, Tolonen H, Humphries S, Iso H, Jukema JW, Kauhanen J, Kengne AP, Khalili D, Koenig W, Kromhout D, Krumholz H, Lam TH, Laughlin G, Marín Ibañez A, Meade TW, Moons KGM, Nietert PJ, Ninomiya T, Nordestgaard BG, O'Donnell C, Palmieri L, Patel A, Perel P, Price JF, Providencia R, Ridker PM, Rodriguez B, Rosengren A, Roussel R, Sakurai M, Salomaa V, Sato S, Schöttker B, Shara N, Shaw JE, Shin HC, Simons LA, Sofianopoulou E, Sundström J, Völzke H, Wallace RB, Wareham NJ, Willeit P, Wood D, Wood A, Zhao D, Woodward M, Danaei G, Roth G, Mendis S, Onuma O, Varghese C, Ezzati M, Graham I, Jackson R, Danesh J, Di Angelantonio E. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. Lancet Glob Health 2019; 7:e1332-e1345. [PMID: 31488387 PMCID: PMC7025029 DOI: 10.1016/s2214-109x(19)30318-3] [Citation(s) in RCA: 488] [Impact Index Per Article: 97.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/16/2019] [Accepted: 07/10/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND To help adapt cardiovascular disease risk prediction approaches to low-income and middle-income countries, WHO has convened an effort to develop, evaluate, and illustrate revised risk models. Here, we report the derivation, validation, and illustration of the revised WHO cardiovascular disease risk prediction charts that have been adapted to the circumstances of 21 global regions. METHODS In this model revision initiative, we derived 10-year risk prediction models for fatal and non-fatal cardiovascular disease (ie, myocardial infarction and stroke) using individual participant data from the Emerging Risk Factors Collaboration. Models included information on age, smoking status, systolic blood pressure, history of diabetes, and total cholesterol. For derivation, we included participants aged 40-80 years without a known baseline history of cardiovascular disease, who were followed up until the first myocardial infarction, fatal coronary heart disease, or stroke event. We recalibrated models using age-specific and sex-specific incidences and risk factor values available from 21 global regions. For external validation, we analysed individual participant data from studies distinct from those used in model derivation. We illustrated models by analysing data on a further 123 743 individuals from surveys in 79 countries collected with the WHO STEPwise Approach to Surveillance. FINDINGS Our risk model derivation involved 376 177 individuals from 85 cohorts, and 19 333 incident cardiovascular events recorded during 10 years of follow-up. The derived risk prediction models discriminated well in external validation cohorts (19 cohorts, 1 096 061 individuals, 25 950 cardiovascular disease events), with Harrell's C indices ranging from 0·685 (95% CI 0·629-0·741) to 0·833 (0·783-0·882). For a given risk factor profile, we found substantial variation across global regions in the estimated 10-year predicted risk. For example, estimated cardiovascular disease risk for a 60-year-old male smoker without diabetes and with systolic blood pressure of 140 mm Hg and total cholesterol of 5 mmol/L ranged from 11% in Andean Latin America to 30% in central Asia. When applied to data from 79 countries (mostly low-income and middle-income countries), the proportion of individuals aged 40-64 years estimated to be at greater than 20% risk ranged from less than 1% in Uganda to more than 16% in Egypt. INTERPRETATION We have derived, calibrated, and validated new WHO risk prediction models to estimate cardiovascular disease risk in 21 Global Burden of Disease regions. The widespread use of these models could enhance the accuracy, practicability, and sustainability of efforts to reduce the burden of cardiovascular disease worldwide. FUNDING World Health Organization, British Heart Foundation (BHF), BHF Cambridge Centre for Research Excellence, UK Medical Research Council, and National Institute for Health Research.
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Brown L, Swan A, Whalley GA. The 21st Century Echocardiography Laboratory in Australia and New Zealand: Rapid Evolution of Training and Workforce, Practice and Technology. Heart Lung Circ 2019; 28:1421-1426. [PMID: 31010637 DOI: 10.1016/j.hlc.2019.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/08/2019] [Accepted: 03/21/2019] [Indexed: 01/09/2023]
Abstract
Echocardiography is a common and increasingly used noninvasive imaging tool in medicine. In this paper, we imagine the echocardiography laboratory of the future and consider the challenges we face currently, and may face in the future, and how these might be overcome; challenges such as training enough sonographers to meet the increasing demands of the ageing population living with chronic cardiovascular disease and the need for surveillance in other clinical scenarios. We consider the changing qualification framework and the requirements for accreditation and registration in Australia and New Zealand and the potential for migrant sonographers to meet some of the increasing demand. Advanced scopes of practice are likely to be a feature of the future workforce and we consider some of the ways these may evolve. Lastly, we consider how the evolving clinical landscape and technology may change the way echocardiography is delivered.
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Affiliation(s)
- Lynn Brown
- Cardiology Department, Flinders Medical Centre, Adelaide, SA, Australia
| | - Amy Swan
- Cardiology Department, Flinders Medical Centre, Adelaide, SA, Australia
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14
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Nedkoff L, Goldacre R, Greenland M, Goldacre MJ, Lopez D, Hall N, Knuiman M, Hobbs M, Sanfilippo FM, Wright FL. Comparative trends in coronary heart disease subgroup hospitalisation rates in England and Australia. Heart 2019; 105:1343-1350. [PMID: 30948515 PMCID: PMC6711344 DOI: 10.1136/heartjnl-2018-314512] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/20/2019] [Accepted: 02/12/2019] [Indexed: 12/21/2022] Open
Abstract
Background Population-based coronary heart disease (CHD) studies have focused on myocardial infarction (MI) with limited data on trends across the spectrum of CHD. We investigated trends in hospitalisation rates for acute and chronic CHD subgroups in England and Australia from 1996 to 2013. Methods CHD hospitalisations for individuals aged 35–84 years were identified from electronic hospital data from 1996 to 2013 for England and Australia and from the Oxford Region and Western Australia. CHD subgroups identified were acute coronary syndromes (ACS) (MI and unstable angina) and chronic CHD (stable angina and ‘other CHD’). We calculated age-standardised and age-specific rates and estimated annual changes (95% CI) from age-adjusted Poisson regression. Results From 1996 to 2013, there were 4.9 million CHD hospitalisations in England and 2.6 million in Australia (67% men). From 1996 to 2003, there was between-country variation in the direction of trends in ACS and chronic CHD hospitalisation rates (p<0.001). During 2004–2013, reductions in ACS hospitalisation rates were greater than for chronic CHD hospitalisation rates in both countries, with the largest subgroup declines in unstable angina (England: men: −7.1 %/year, 95% CI −7.2 to –7.0; women: −7.5 %/year, 95% CI −7.7 to –7.3; Australia: men: −8.5 %/year, 95% CI −8.6 to –8.4; women: −8.6 %/year, 95% CI −8.8 to –8.4). Other CHD rates increased in individuals aged 75–84 years in both countries. Chronic CHD comprised half of all CHD admissions, with the majority involving angiography or percutaneous coronary intervention. Conclusions Since 2004, rates of all CHD subgroups have fallen, with greater declines in acute than chronic presentations. The slower declines and high proportion of chronic CHD admissions undergoing coronary procedures requires greater focus.
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Affiliation(s)
- Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Raphael Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, England
| | - Melanie Greenland
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Michael J Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, England
| | - Derrick Lopez
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Nick Hall
- Unit of Health-Care Epidemiology, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, England
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Michael Hobbs
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - F Lucy Wright
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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15
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Rabanal KS, Meyer HE, Pylypchuk R, Mehta S, Selmer RM, Jackson RT. Performance of a Framingham cardiovascular risk model among Indians and Europeans in New Zealand and the role of body mass index and social deprivation. Open Heart 2018; 5:e000821. [PMID: 30018780 PMCID: PMC6045758 DOI: 10.1136/openhrt-2018-000821] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/15/2018] [Accepted: 06/13/2018] [Indexed: 12/18/2022] Open
Abstract
Objectives To evaluate a Framingham 5-year cardiovascular disease (CVD) risk score in Indians and Europeans in New Zealand, and determine whether body mass index (BMI) and socioeconomic deprivation were independent predictors of CVD risk. Methods We included Indians and Europeans, aged 30–74 years without prior CVD undergoing risk assessment in New Zealand primary care during 2002–2015 (n=256 446). Risk profiles included standard Framingham predictors (age, sex, systolic blood pressure, total cholesterol/high-density lipoprotein ratio, smoking and diabetes) and were linked with national CVD hospitalisations and mortality datasets. Discrimination was measured by the area under the receiver operating characteristics curve (AUC) and calibration examined graphically. We used Cox regression to study the impact of BMI and deprivation on the risk of CVD with and without adjustment for the Framingham score. Results During follow-up, 8105 and 1156 CVD events occurred in Europeans and Indians, respectively. Higher AUCs of 0.76 were found in Indian men (95% CI 0.74 to 0.78) and women (95% CI 0.73 to 0.78) compared with 0.74 (95% CI 0.73 to 0.74) in European men and 0.72 (95% CI 0.71 to 0.73) in European women. Framingham was best calibrated in Indian men, and overestimated risk in Indian women and in Europeans. BMI and deprivation were positively associated with CVD, also after adjustment for the Framingham risk score, although the BMI association was attenuated. Conclusions The Framingham risk model performed reasonably well in Indian men, but overestimated risk in Indian women and in Europeans. BMI and socioeconomic deprivation could be useful predictors in addition to a Framingham score.
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Affiliation(s)
| | - Haakon Eduard Meyer
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Romana Pylypchuk
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Suneela Mehta
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Randi Marie Selmer
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Rodney T Jackson
- School of Population Health, University of Auckland, Auckland, New Zealand
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16
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Szummer K, Wallentin L, Lindhagen L, Alfredsson J, Erlinge D, Held C, James S, Kellerth T, Lindahl B, Ravn-Fischer A, Rydberg E, Yndigegn T, Jernberg T. Improved outcomes in patients with ST-elevation myocardial infarction during the last 20 years are related to implementation of evidence-based treatments: experiences from the SWEDEHEART registry 1995-2014. Eur Heart J 2018; 38:3056-3065. [PMID: 29020314 PMCID: PMC5837507 DOI: 10.1093/eurheartj/ehx515] [Citation(s) in RCA: 286] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/17/2017] [Indexed: 12/15/2022] Open
Abstract
Aims Impact of changes of treatments on outcomes in ST-elevation myocardial infarction (STEMI) patients in real-life health care has not been documented. Methods and results All STEMI cases (n = 105.674) registered in the nation-wide SWEDEHEART registry between 1995 and 2014 were included and followed for fatal and non-fatal outcomes for up to 20 years. Most changes in treatment and outcomes occurred from 1994 to 2008. Evidence-based treatments increased: reperfusion from 66.2 to 81.7%; primary percutaneous coronary intervention: 4.5 to 78.0%; dual antiplatelet therapy from 0 to 89.6%; statin: 14.1 to 93.6%; beta-blocker: 78.2 to 91.0%, and angiotensin-converting-enzyme/angiotensin-2-receptor inhibitors: 40.8 to 85.2% (P-value for-trend <0.001 for all). One-year mortality decreased from 22.1 to 14.1%. Standardized incidence ratio compared with the general population decreased from 5.54 to 3.74 (P < 0.001). Cardiovascular (CV) death decreased from 20.1 to 11.1%, myocardial infarction (MI) from 11.5 to 5.8%; stroke from 2.9 to 2.1%; heart failure from 7.1 to 6.2%. After standardization for differences in demography and baseline characteristics, the change of 1-year CV-death or MI corresponded to a linear trend of 0.915 (95% confidence interval: 0.906–0.923) per 2-year period which no longer was significant, 0.997 (0.984–1.009), after adjustment for changes in treatment. The changes in treatment and outcomes were most pronounced from 1994 to 2008. Conclusion Gradual implementation of new and established evidence-based treatments in STEMI patients during the last 20 years has been associated with prolonged survival and lower risk of recurrent ischaemic events, although a plateauing is seen since around 2008.
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Affiliation(s)
- Karolina Szummer
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Wallentin
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lars Lindhagen
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Joakim Alfredsson
- Department of Cardiology, Linköping University, Linköping, Sweden.,Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - David Erlinge
- Department of Cardiology, Lund University, Skane University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Claes Held
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Stefan James
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Thomas Kellerth
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden
| | - Bertil Lindahl
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Annica Ravn-Fischer
- Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Erik Rydberg
- Department of Cardiology, Lund University, Skane University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Troels Yndigegn
- Department of Cardiology, Lund University, Skane University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
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17
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Milinkovic I, Ašanin M, Simeunovic DS, Seferović PM. In the search for an ideal registry: Does the cloud have a silver lining? Eur J Prev Cardiol 2018; 25:956-959. [DOI: 10.1177/2047487318774420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Milika Ašanin
- Clinical Center of Serbia, Serbia
- University of Belgrade School of Medicine, Serbia
| | - Dejan S Simeunovic
- Clinical Center of Serbia, Serbia
- University of Belgrade School of Medicine, Serbia
| | - Petar M Seferović
- Clinical Center of Serbia, Serbia
- University of Belgrade School of Medicine, Serbia
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18
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Alvarez-Alvarez B, Abou Jokh Casas C, Garcia Acuña JM, Cid Alvarez B, Agra Bermejo RM, Cordero Fort A, Rodríguez Mañero M, Gude Sampedro F, González-Juanatey JR. Temporal trends between association of evidence-based treatment and outcomes in patients with non-ST-elevation myocardial infarction. Int J Cardiol 2018; 260:1-6. [PMID: 29506939 DOI: 10.1016/j.ijcard.2018.02.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 02/12/2018] [Accepted: 02/26/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Belén Alvarez-Alvarez
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Charigan Abou Jokh Casas
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Jose María Garcia Acuña
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Belén Cid Alvarez
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Rosa María Agra Bermejo
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Alberto Cordero Fort
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain
| | - Moisés Rodríguez Mañero
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Francisco Gude Sampedro
- Epidemiology Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - José R González-Juanatey
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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