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Lu Y, Wang Y, Zhou B. Predicting long-term prognosis after percutaneous coronary intervention in patients with acute coronary syndromes: a prospective nested case-control analysis for county-level health services. Front Cardiovasc Med 2023; 10:1297527. [PMID: 38111892 PMCID: PMC10725923 DOI: 10.3389/fcvm.2023.1297527] [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: 09/20/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023] Open
Abstract
Purpose We aimed to establish and authenticate a clinical prognostic nomogram for predicting long-term Major Adverse Cardiovascular Events (MACEs) among high-risk patients who have undergone Percutaneous Coronary Intervention (PCI) in county-level health service. Patients and methods This prospective study included Acute Coronary Syndrome (ACS) patients treated with PCI at six county-level hospitals between September 2018 and August 2019, selected from both the original training set and external validation set. Least Absolute Shrinkage and Selection Operator (LASSO) regression techniques and logistic regression were used to assess potential risk factors and construct a risk predictive nomogram. Additionally, the potential non-linear relationships between continuous variables were tested using Restricted Cubic Splines (RCS). The performance of the nomogram was evaluated based on the Receiver Operating Characteristic (ROC) curve analysis, Calibration Curve, Decision Curve Analysis (DCA), and Clinical Impact Curve (CIC). Results The original training set and external validation set comprised 520 and 1,061 patients, respectively. The final nomogram was developed using nine clinical variables: Age, Killip functional classification III-IV, Hypertension, Hyperhomocysteinemia, Heart failure, Number of stents, Multivessel disease, Low-density Lipoprotein Cholesterol, and Left Ventricular Ejection Fraction. The AUC of the nomogram was 0.79 and 0.75 in the training set and external validation set, respectively. The DCA and CIC validated the clinical value of the constructed prognostic nomogram. Conclusion We developed and validated a prognostic nomogram for predicting the probability of 3-year MACEs in ACS patients who underwent PCI at county-level hospitals. The nomogram could provide a precise risk assessment for secondary prevention in ACS patients receiving PCI.
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Affiliation(s)
| | | | - Bo Zhou
- Department of Clinical Epidemiology and Evidence-Based Medicine, The First Hospital of China Medical University, Shenyang, China
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Liu S, Jiang Z, Zhang Y, Pang S, Hou Y, Liu Y, huang Y, Peng N, Tang Y. A nomogramic model for predicting the left ventricular ejection fraction of STEMI patients after thrombolysis-transfer PCI. Front Cardiovasc Med 2023; 10:1178417. [PMID: 37745105 PMCID: PMC10517723 DOI: 10.3389/fcvm.2023.1178417] [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: 03/21/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Background The prognosis of ST-segment elevation myocardial infarction (STEMI) is closely linked to left ventricular ejection fraction (LVEF). In contrast to primary percutaneous coronary intervention (PPCI), thrombolysis-transfer PCI (TTPCI) is influenced by multiple factors that lead to heterogeneity in cardiac function and prognosis. The aim of this study is to develop a nomogram model for predicting early LVEF in STEMI patients with TTPCI, based on routine indicators at admission. Method We retrospectively reviewed data from patients diagnosed with STEMI at five network hospitals of our PCI center who performed TTPCI as door-to-balloon time (the interval between arrival at the hospital and intracoronary balloon inflation) over 120 min, from February 2018 to April 2022. Categorical variables were analyzed using Pearson χ2 tests or Fisher exact tests, while Student's t-test or Mann-Whitney U-test was used to compare continuous variables. Subsequently, independent risk factors associated with reduced LVEF one week after TTPCI were identified through comprehensive analysis by combining All-Subsets Regression with Logistic Regression. Based on these indicators, a nomogram model was developed, and validated using the area under the receiver operating characteristic (ROC) curve and the Bootstrap method. Results A total of 288 patients were analyzed, including 60 with LVEF < 50% and 228 with LVEF ≥ 50%. The nomogram model based on six independent risk factors including age, heart rate (HR), hypertension, smoking history, Alanine aminotransferase (ALT), and Killip class, demonstrated excellent discrimination with an AUC of 0.84 (95% CI: 0.78-0.89), predicted C-index of 0.84 and curve fit of 0.713. Conclusions The nomogram model incorporating age, HR, hypertension, smoking history, ALT and Killip class could accurately predict the early LVEF ≥ 50% probability of STEMI patients undergoing TTPCI, and enable clinicians' early evaluation of cardiac function in STEMI patients with TTPCI and early optimization of treatment.
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Affiliation(s)
- Shuai Liu
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
- Department of Emergency Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Zhihui Jiang
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Pharmacy, General Hospital of Southern Theater Command, Guangzhou, China
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Yuanyuan Zhang
- Department of Geriatrics, General Hospital of Southern Theater Command, Guangzhou, China
| | - Shuwen Pang
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Emergency Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yan Hou
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yipei Liu
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University Guangzhou, Guangzhou, China
| | - Yuekang huang
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University Guangzhou, Guangzhou, China
| | - Na Peng
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University Guangzhou, Guangzhou, China
| | - Youqing Tang
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
- Department of Emergency Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
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Yu Q, Guo D, Peng J, Wu Q, Yao Y, Ding M, Wang J. Prevalence and adverse outcomes of frailty in older patients with acute myocardial infarction after percutaneous coronary interventions: A systematic review and meta-analysis. Clin Cardiol 2022; 46:5-12. [PMID: 36168782 PMCID: PMC9849439 DOI: 10.1002/clc.23929] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The association between frailty and older patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) is unclear. Therefore, we conducted a systematic review and meta-analysis to investigate the prevalence of frailty in older patients with AMI following PCI, and determine the relationship between frailty and adverse outcomes in these patients. HYPOTHESIS Older patients with AMI have a higher prevalence of frailty after PCI, and the frailty in these patients increases the risk of adverse outcomes. METHODS A comprehensive search of the PubMed, Cochrane, Ovid (Medline), Ovid (Embase), and Web of Science databases was performed for articles published until October 2021. A meta-analysis was performed using stata12.0 software. A random-effects model was used when I2 was greater than 50%; otherwise, a fixed-effects model was used. RESULTS There were a total of 274,976 older patients in the included studies. Nine studies investigated the prevalence of frailty in older patients with AMI after PCI, with an overall prevalence of 39% (95% confidence interval [CI]: 18%-60%, p < .001). Six studies included adverse outcomes of frailty in older patients with AMI after PCI, including all-cause mortality (hazard ratio [HR] = 2.29, 95% CI: 1.65-3.16, p = .285), rehospitalization (HR = 2.53, 95% CI: 1.38-4.63), and in-hospital major bleeding (HR = 1.93, 95% CI: 1.29-2.90, p = .825). CONCLUSION The frailty prevalence is increased in older patients with AMI after PCI, especially in ST-segment elevation myocardial infarction (STEMI). AMI with frailty after PCI is more likely to be associated with worse clinical outcomes, such as death, bleeding, and rehospitalization.
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Affiliation(s)
- Qian Yu
- College of NursingGannan Medical UniversityGanzhouJiangxiChina
| | - Dawei Guo
- Department of MedicineJingGangshan UniversityJi'anJiangxiChina
| | - Jianan Peng
- Department of MedicineJingGangshan UniversityJi'anJiangxiChina
| | - Qifei Wu
- College of NursingGannan Medical UniversityGanzhouJiangxiChina
| | - Yonghuan Yao
- College of NursingGannan Medical UniversityGanzhouJiangxiChina
| | - Mei Ding
- College of NursingGannan Medical UniversityGanzhouJiangxiChina
| | - Jiang Wang
- Department of MedicineJingGangshan UniversityJi'anJiangxiChina
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Sun H, Sun C, Zhang B, Ma K, Wu Z, Visser BC, Han B. Establishment and Application of a Novel Difficulty Scoring System for da Vinci Robotic Pancreatoduodenectomy. Front Surg 2022; 9:916014. [PMID: 35722537 PMCID: PMC9200290 DOI: 10.3389/fsurg.2022.916014] [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: 04/08/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundRobotic pancreatoduodenectomy (RPD) technology is developing rapidly, but there is still a lack of a specific and objective difficulty evaluation system in the field of application and training of RPD surgery.MethodsThe clinical data of patients who underwent RPD in our hospital from November 2014 to October 2020 were analyzed retrospectively. Univariate and multivariate logistic regression analyses were used to determine the predictors of operation difficulty and convert into a scoring system.ResultsA total of 72 patients were enrolled in the group. According to the operation time (25%), intraoperative blood loss (25%), conversion to laparotomy, and major complications, the difficulty of operation was divided into low difficulty (0–2 points) and high difficulty (3–4 points). The multivariate logistic regression model included the thickness of mesenteric tissue (P1) (P = 0.035), the thickness of the abdominal wall (B1) (P = 0.017), and the preoperative albumin (P = 0.032), and the nomogram was established. AUC = 0.773 (0.645–0.901).ConclusionsThe RPD difficulty evaluation system based on the specific anatomical relationship between da Vinci’s laparoscopic robotic arm and tissues/organs in the operation area can be used as a predictive tool to evaluate the surgical difficulty of patients before operation and guide clinical practice.
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Affiliation(s)
- Hongfa Sun
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chuandong Sun
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bingyuan Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Kai Ma
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zehua Wu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Brendan C. Visser
- Hepatobiliary & Pancreatic Surgery, Stanford University School of Medicine, Stanford, CA, United States
- Correspondence: Bing Han Brendan C. Visser
| | - Bing Han
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- Correspondence: Bing Han Brendan C. Visser
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Zhang H, Yi M, Wang Y, Zhang Y, Xiao K, Si J, Shi N, Sun L, Miao Z, Zhao T, Sun X, Liu Z, Gao J, Li J. Air pollution and recurrence of cardiovascular events after ST-segment elevation myocardial infarction. Atherosclerosis 2021; 342:1-8. [PMID: 34974197 DOI: 10.1016/j.atherosclerosis.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/12/2021] [Accepted: 12/17/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND AIMS The effects of air pollution on discharged patients after ST-segment elevation myocardial infarction (STEMI) still remain uncertain. We examined the association between air pollutants and recurrent cardiovascular events in STEMI survivors. METHODS A retrospective cohort of 1641 discharged patients after STEMI was established in 2013 and followed until the end of 2019. Concentrations of air pollutants including fine particles <2.5 μm aerodynamic diameter (PM2.5), inhalable particles <10 μm aerodynamic diameter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and ozone (O3) measured by fixed ambient air monitoring stations were collected for exposure assessment. Multivariate-adjusted Cox proportional hazards models were used to estimate the increased risks of recurrent cardiovascular events. RESULTS Compared with the first exposure quartile, for short-term exposure, hazard ratios (HRs) of recurrent cardiovascular events associated with the fourth exposure quartiles of PM2.5, PM10, NO2, SO2, CO, and O3 were 4.06 (95% CI: 2.62-6.30), 3.79 (95% CI: 2.57-5.58), 2.22 (95% CI: 1.67-2.94), 4.47 (95% CI: 3.08-6.48), 3.73 (95% CI: 2.54-5.48), and 5.35 (95% CI: 3.12-9.20), respectively. For long-term exposure, HRs associated with the fourth exposure quartiles of PM2.5, PM10, NO2, SO2, CO, and O3 were 6.43 (95% CI: 3.60-11.47), 4.77 (95% CI: 2.85-7.99), 3.22 (95% CI: 2.00-5.19), 3.20 (95% CI: 2.05-5.01), 4.44 (95% CI: 2.65-7.45), and 1.07 (95% CI: 0.80-1.42), respectively. The risks of recurrent cardiovascular events brought by air pollutants mostly increased nonlinearly. CONCLUSIONS Short- and long-term exposure to air pollutants except ozone increases the risks of recurrent cardiovascular events in STEMI survivors. Better environmental policies and secondary prevention strategies should be developed to protect STEMI survivors as a susceptible population.
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Affiliation(s)
- Haoyu Zhang
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China; Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Ming Yi
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Yang Wang
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yinghua Zhang
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China; Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Keling Xiao
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China; Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Jin Si
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China; Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Ning Shi
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China; Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Lijie Sun
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China; Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Zupei Miao
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China; Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Ting Zhao
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China; Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Xipeng Sun
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Zhi Liu
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Jing Gao
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Jing Li
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China; Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
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Cheng Y, Zhang Y, Tu B, Qin Y, Cheng X, Qi R, Guo W, Li D, Wu S, Zhu R, Zhao Y, Tang Y, Wu C. Association Between Base Excess and Mortality Among Patients in ICU With Acute Kidney Injury. Front Med (Lausanne) 2021; 8:779627. [PMID: 34926523 PMCID: PMC8674681 DOI: 10.3389/fmed.2021.779627] [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] [Received: 09/19/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to explore the association between base excess (BE) and the risk of 30-day mortality among patients with acute kidney injury (AKI) in the intensive care unit (ICU). Methods: This retrospective study included patients with AKI from the Medical Information Mart for Intensive Care (MIMIC)-IV database. We used a multivariate Cox proportional-hazards model to obtain the hazard ratio (HR) for the risk of 30-day mortality among patients with AKI. Furthermore, we utilized a Cox proportional-hazard model with restricted cubic splines (RCS) to explore the potential non-linear associations. Results: Among the 14,238 ICU patients with AKI, BE showed a U-shaped relationship with risk of 30-day mortality for patients with AKI, and higher or lower BE values could increase the risk. Compared with normal base excess (-3~3 mEq/L), patients in different groups (BE ≤ -9 mEq/L, -9 mEq/L < BE ≤ -3 mEq/L, 3 mEq/L < BE ≤ 9 mEq/L, and BE > 9 mEq/L) had different HRs for mortality: 1.57 (1.40, 1.76), 1.26 (1.14, 1.39), 0.97 (0.83, 1.12), 1.53 (1.17, 2.02), respectively. The RCS analyses also showed a U-shaped curve between BE and the 30-day mortality risk. Conclusion: Our results suggest that higher and lower BE in patients with AKI would increase the risk of 30-day mortality. BE measured at administration could be a critical prognostic indicator for ICU patients with AKI and provide guidance for clinicians.
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Affiliation(s)
- Yi Cheng
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
| | - You Zhang
- Department of Nephrology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Boxiang Tu
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
| | - Yingyi Qin
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
| | - Xin Cheng
- Jinan People's Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Ran Qi
- The Second Children & Women's Healthcare of Jinan City, Shandong, China
| | - Wei Guo
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
| | - Dongdong Li
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
| | - Shengyong Wu
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
| | - Ronghui Zhu
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
| | - Yanfang Zhao
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
| | - Yuanjun Tang
- Department of Clinical Pharmacy, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Cheng Wu
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
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Application Effect of Intelligent Monitoring of Emergency Nursing Process Reengineering in the Thrombolytic Therapy of Acute Myocardial Infarction. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:3043289. [PMID: 34887709 PMCID: PMC8629612 DOI: 10.1155/2021/3043289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
The application of emergency nursing process in intravenous thrombolytic therapy for patients with acute myocardial infarction was discussed. 100 patients with ST segment elevation myocardial infarction who met the inclusion and exclusion criteria were selected for intravenous thrombolysis. 50 patients with ST segment elevation myocardial infarction were treated from December 2018 to June 2019. The first-aid time and treatment effect of the two groups were compared. The results showed that the first aid time in the optimized process group was less than that in the conventional flow group (P < 0.05); the ECG rate was higher within 10 min than that in the conventional flow group (P < 0.05). It indicates that standardized and meticulous nursing procedures can avoid repetition and omissions and improve work efficiency. The application of the emergency care process in the emergency care of patients with acute myocardial infarction can win more rescue time and then improve the success rate of their rescue.
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Tisminetzky M, Mehawej J, Miozzo R, Gurwitz JH, Gore JM, Lessard D, Abu HO, Bamgbade BA, Yarzebski J, Granillo E, Goldberg RJ. Temporal Trends and Patient Characteristics Associated with 30-Day Hospital Readmission Rates after a First Acute Myocardial Infarction. Am J Med 2021; 134:1127-1134. [PMID: 33864760 PMCID: PMC8410623 DOI: 10.1016/j.amjmed.2021.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Limited data exist about relatively recent trends in the magnitude and characteristics of patients who are re-hospitalized after hospital admission for an acute myocardial infarction. This study examined trends in the frequency and sociodemographic and clinical characteristics of patients readmitted to the hospital within 30 days after an initial acute myocardial infarction. METHODS We reviewed the medical records of 3116 individuals who were hospitalized for a validated first acute myocardial infarction in 6 study periods between 2003 and 2015 at the 3 major medical centers in central Massachusetts. RESULTS The median age of our population was 67 years, and 42% were women. The risk of being readmitted to the hospital within 30 days after an initial acute myocardial infarction increased slightly during the most recent study years after controlling for potentially confounding factors. Overall, older adults and patients with previously diagnosed atrial fibrillation, heart failure, diabetes, chronic kidney disease, stroke, and peripheral vascular disease were at higher risk for being readmitted to the hospital than respective comparison groups. For those hospitalized in the most recent study years of 2011/2015, a higher risk of rehospitalization was associated with a previous diagnosis of chronic kidney disease, peripheral vascular disease, the presence of 3 or more chronic conditions, and having developed atrial fibrillation or heart failure during the patient's hospitalization for a first acute myocardial infarction. CONCLUSIONS We identified several groups at higher risk for hospital readmission in whom enhanced surveillance efforts as well as tailored educational and treatment approaches remain needed.
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Affiliation(s)
- Mayra Tisminetzky
- Meyers Primary Care Institute, Worcester, Mass; Division of Geriatric Medicine; Department of Population and Quantitative Health Sciences.
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Ruben Miozzo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, Worcester, Mass; Division of Geriatric Medicine; Department of Population and Quantitative Health Sciences
| | - Joel M Gore
- Department of Population and Quantitative Health Sciences; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | | | - Hawa O Abu
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester; Internal Medicine Department, Saint Vincent Hospital, Worcester, Mass
| | - Benita A Bamgbade
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, Mass
| | | | | | - Robert J Goldberg
- Meyers Primary Care Institute, Worcester, Mass; Department of Population and Quantitative Health Sciences
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Tonet E, Campana R, Caglioni S, Gibiino F, Fiorio A, Chiaranda G, Zagnoni S, Casella G, Campo G. Tools for the Assessment of the Malnutrition Status and Possible Interventions in Elderly with Cardiovascular Diseases. J Clin Med 2021; 10:jcm10071508. [PMID: 33916645 PMCID: PMC8038542 DOI: 10.3390/jcm10071508] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/27/2021] [Accepted: 04/01/2021] [Indexed: 12/18/2022] Open
Abstract
Malnutrition represents a common and important feature in elderly people affected by cardiovascular diseases. Several studies have investigated its prevalence and prognostic role in most clinical settings, including cardiovascular disease. However, in daily practice it usually remains unrecognized and consequently untreated. The present review was ideated to answer the main questions about nutritional status assessment in patients with cardiovascular disease: why, when, where, how to evaluate it, and what to do to improve it. The three main cardiovascular diseases, namely aortic stenosis, ischaemic heart disease, and heart failure were considered. First, the main evidence supporting the prognostic role of malnutrition are summarized and analyzed. Second, the main tools for the assessment of malnutrition in the hospital and outpatient setting are reported for each condition. Finally, the possible strategies and interventions to address malnutrition are discussed.
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Affiliation(s)
- Elisabetta Tonet
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (R.C.); (S.C.); (F.G.); (A.F.); (G.C.)
- Correspondence: ; Tel.: +3-905-3223-7227; Fax: +3-905-3223-9531
| | - Roberta Campana
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (R.C.); (S.C.); (F.G.); (A.F.); (G.C.)
| | - Serena Caglioni
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (R.C.); (S.C.); (F.G.); (A.F.); (G.C.)
| | - Federico Gibiino
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (R.C.); (S.C.); (F.G.); (A.F.); (G.C.)
| | - Alessio Fiorio
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (R.C.); (S.C.); (F.G.); (A.F.); (G.C.)
| | - Giorgio Chiaranda
- Department of Public Health, AUSL Piacenza, and Sport Medicine Service, 29121 Piacenza, Italy;
| | - Silvia Zagnoni
- Department of Cardiology, Ospedale Maggiore, 40133 Bologna, Italy; (S.Z.); (G.C.)
| | - Gianni Casella
- Department of Cardiology, Ospedale Maggiore, 40133 Bologna, Italy; (S.Z.); (G.C.)
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (R.C.); (S.C.); (F.G.); (A.F.); (G.C.)
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