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Kahraman F, Yılmaz AS, Ersoy İ, Demir M, Orhan H. Predictive outcomes of APACHE II and expanded SAPS II mortality scoring systems in coronary care unit. Int J Cardiol 2023; 371:427-431. [PMID: 36181949 DOI: 10.1016/j.ijcard.2022.09.065] [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: 03/16/2022] [Revised: 08/27/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We investigated the predictive values of the expanded Simplified Acute Physiology Score (SAPS) II and Acute Physiologic Score and Chronic Health Evaluation (APACHE) II score in predicting in-hospital mortality in coronary care unit (CCU) patients. METHODS In this study, expanded SAPS II and APACHE II scores were calculated in the CCU of a single-center tertiary hospital. Patients admitted to CCU with any cardivascular indication were included in the study. Both scores were calculated according to previously determined criteria. Calibration and discrimination abilities of the scores in predicting in-hospital mortality were tested with Hosmer-Lemeshow goodness-of-fit C chi-square and receiver operating characteristics (ROC) curve analyses. RESULTS A total of 871 patients were included in the analysis. The goodness-of-fit C chi-square test showed that both scores have a good performance in predicting survivors and nonsurvivors in CCU. Expanded SAPS II score has a sensitivity of 80% and a specificity of 91.8% with the cut-off value of 5.55, while APACHE II has a sensitivity of 75.9% and a specificity of 87.4% with the cut-off value of 16.5 in predicting mortality. CONCLUSION Expanded SAPS II and APACHE II scores have good ability to predict in-hospital mortality in CCU patients. Therefore, they can be used as a tool to predict short-term mortality in cardiovascular emergencies.
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Affiliation(s)
- Fatih Kahraman
- Cardiology Clinic, Kutahya Evliya Celebi Research and Training Hospital, Kutahya, Turkey.
| | | | - İbrahim Ersoy
- Department of Cardiology, Afyonkarahisar Health Sciences University, Afyon, Turkey
| | - Mevlüt Demir
- Department of Cardiology, Kutahya Health Sciences University, Kutahya, Turkey
| | - Hikmet Orhan
- Department of Medical Informatics and Biostatistics, Suleyman Demirel University, School of Medicine, Isparta, Turkey
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Iida T, Tanimura F, Takahashi K, Nakamura H, Nakajima S, Nakamura M, Morino Y, Itoh T. Electrocardiographic characteristics associated with in-hospital outcome in patients with left main acute coronary syndrome: For contriving a new risk stratification score. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2017; 7:200-207. [PMID: 29027810 DOI: 10.1177/2048872616683524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIM The aim of this study was to evaluate electrocardiographic characteristics associated with in-hospital prognosis in patients with left main acute coronary syndrome. METHODS AND RESULTS A total of 89 left main acute coronary syndrome subjects were selected from 3357 consecutive acute coronary syndrome patients (2.7%). Patients of this study were divided into two groups; those who survived and those who died. Patients' characteristics and electrocardiogram on admission were then retrospectively analyzed between the two groups. In-hospital mortality was 28.1%. The prevalence and degree of ST-segment elevation at lead aVL were significantly higher in the deceased group than in the survival group ( p<0.001). However, those at lead aVR did not show significant differences between the two groups. Moreover, the width of the QRS-complex was significantly wider (lead V3; p<0.001), and the level of five minus the absolute value of five minus number of ST-segment elevation (5-|5-ST|; due to the highest in-hospital mortality (70%) in the five-lead ST-segment elevation group) was significantly larger in the deceased group than in the survival group ( p<0.001). The odds ratios that predicted in-hospital cardiac death were 1.03 for width of the QRS-complex at lead V3 (95% confidence interval (CI); 1.01-1.06; p=0.003), 1.74 for 5-|5-ST| (95% CI; 1.03-3.00; p=0.040), and 1.44 for ST-segment elevation at lead aVL (95% CI; 0.93-2.23; p=0.100). CONCLUSIONS ST-segment elevation at lead aVL rather than aVR, width of the QRS-complex at lead V3 and number of ST-segment elevation were the prognostic predictors for in-hospital mortality in patients with left main acute coronary syndrome. Electrocardiographic characteristics should be assessed in addition to the established risk score in patients with left main acute coronary syndrome.
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Affiliation(s)
- Takayuki Iida
- 1 School of Medicine, Iwate Medical University, Japan
| | | | | | | | | | - Motoyuki Nakamura
- 3 Division of Cardiovascular Medicine, Nephrology and Endocrinology, Iwate Medical University, Japan
| | | | - Tomonori Itoh
- 2 Division of Cardiology, Iwate Medical University, Japan
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Abstract
Four issues of a methodological nature that are perceived to be recurring problems in research directed at predictors of illness are pointed out. In the first place, sample size affects statistical power (i.e. the probability of obtaining significant results). Methodological literature tends to caution against the use of samples that are too small, but tends to ignore the problems arising from obtaining statistical significance for trivial effects due to samples that are very large. Possible solutions to this problem are mentioned. Secondly, the reduction of criterion variability due to the operationalization of the criterion variable may result in failure to find statistical significance. This problem is of special relevance when patients already suffering from a particular illness are used and survival rates are used in lieu of the degree of that illness. Thirdly, the demand for a more differentiated set of hypotheses is emphasized. This situation arises because of the non-experimental nature of research and the consequent multivariate nature of research problems in this area. Elementary statistical procedures do not allow for theoretically derived hypotheses that are really meaningful, to be investigated adequately. However, using more advanced procedures, such as path analysis and structural equation modelling, not only requires a sound theoretical background (in health psychology) but also a knowledge of these procedures. Finally, the interrelatedness of statistical design, measurement and statistical analyses is emphasized. Because of this interrelatedness, the delegation of research design to statisticians, who cannot be expected to be familiar with theoretical issues and measurement possibilities in the field, is bound to result in impoverished research findings. As a result, a sound grounding in methodology is of great importance to a burgeoning field such as health psychology.
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Affiliation(s)
- G.K. Huysamen
- Department of Psychology, UOFS, P.O. Box 339, Bloemfontein 9300, South Africa
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Impact of oral beta-blocker therapy on mortality after primary percutaneous coronary intervention for Killip class 1 myocardial infarction. Heart Vessels 2015; 31:687-93. [PMID: 25863805 PMCID: PMC4850180 DOI: 10.1007/s00380-015-0673-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 04/01/2015] [Indexed: 11/16/2022]
Abstract
The use of beta-blockers therapy has been recommended to reduce mortality in patients with left ventricular dysfunction after acute myocardial infarction (AMI). Primary percutaneous coronary intervention (PCI), which has become the mainstay of treatment for AMI, is associated with a lower mortality than fibrinolysis. The benefits of beta-blockers after primary PCI in AMI patients without pump failure are unclear. We hypothesized that oral beta-blocker therapy after primary PCI might reduce the mortality in AMI patients without pump failure. The assessment of lipophilic vs. hydrophilic statin therapy in acute myocardial infarction (ALPS-AMI) study was a multi-center study that enrolled 508 AMI patients to compare the efficacy of hydrophilic and lipophilic statins in secondary prevention after myocardial infarction. We prospectively tracked cardiovascular events for 3 years in 444 ALPS-AMI patients (median age 66 years; 18.2 % women) who had Killip class 1 on admission and were discharged alive. The primary endpoint was all-cause mortality. The 3-year follow-up was completed in 413 patients (93.0 %). During this follow-up, 21 patients (4.7 %) died. In Kaplan–Meier analysis, patients on beta-blockers had a significantly lower incidence of all-cause mortality (2.7 vs. 7.3 %, log-rank p = 0.025). After adjusting for the calculated propensity score for using beta-blockers, their use remained an independent predictor of all-cause mortality (hazard ratio 0.309; 95 % confidence interval 0.116–0.824; p = 0.019). In the statin era, the use of beta-blocker therapy after primary PCI is associated with lower mortality in AMI patients with Killip class 1 on admission.
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Locomotor Development Prediction Based on Statistical Model Parameters Identification. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2012; 2012:548208. [PMID: 23365618 PMCID: PMC3529891 DOI: 10.1155/2012/548208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 10/08/2012] [Accepted: 10/23/2012] [Indexed: 11/17/2022]
Abstract
This paper introduces an approach for parameters identification of a
statistical predicting model with the use of the available individual data.
Unknown parameters are separated into two groups: the ones specifying
the average trend over large set of individuals and the ones describing the
details of a concrete person. In order to calculate the vector of unknown
parameters, a multidimensional constrained optimization problem is solved
minimizing the discrepancy between real data and the model prediction over
the set of feasible solutions. Both the individual retrospective data and factors
influencing the individual dynamics are taken into account. The application of
the method for predicting the movement of a patient with congenital motility disorders is considered.
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Chiostri M, Valente S, Crudeli E, Giglioli C, Gensini GF. A new post-PCI scoring system for in-hospital mortality in STEMI patients. J Cardiovasc Med (Hagerstown) 2010; 11:733-8. [DOI: 10.2459/jcm.0b013e328339d910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
A series of 597 consecutive patients with acute myocardial infarction (AMI) have been screened for diabetes mellitus (DM). Six per cent of the series had DM, which is exactly the frequency of DM in an age-matched population. This finding corresponds with results of other investigators, indicating that treated diabetics do not have an increased risk of AMI. Diabetics suffering from AMI do not have an increased mortality, nor do patients treated with oral antidiabetics have a higher mortality than those treated with insulin.
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Löfmark R. Clinical features in patients with recurrent myocardial infarction. ACTA MEDICA SCANDINAVICA 2009; 206:367-70. [PMID: 525436 DOI: 10.1111/j.0954-6820.1979.tb13528.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A retrospective investigation of 420 patients who had survived the acute phase of myocardial infarction revealed 63 reinfarctions (in 57 patients) within three months. Twenty-eight patients died without reinfarction during the same period, and 335 survived three months without reinfarction. The reinfarction patients were significantly more often women, had more frequently a history of previous myocardial infarction and hypertension, and their myocardial infarctions were more often non-transmural and localized to the anterior wall of the heart. The ECG of each patient that was registered nearest prior to the reinfarction during hospitalization or prior to discharge showed more often negative T-waves.
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Maeland JG, Meen K. Predicting long-term mortality after a myocardial infarction from routine hospital data. ACTA MEDICA SCANDINAVICA 2009; 224:539-47. [PMID: 3207066 DOI: 10.1111/j.0954-6820.1988.tb19624.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Among 528 patients under 67 years of age discharged alive after a myocardial infarction (MI), the cumulative survival rates after 3, 5, and 7 years were 84.1%, 75.9% and 68.6%, respectively. Compared with the "normal" population, the relative mortality risk was 4.8 for the first year, 3.1 for the second, and on average 2.1 for the next 5 years. Significant age differences were not observed for relative mortality. A multivariate Cox proportional hazards model showed long-term mortality to be independently related to higher age, a reduced working activity before the MI, previous cardiovascular disease, and a higher inhospital complication score, which was computed by summing eight defined clinical events weighted for severity. The results indicate that a reasonable prediction of long-term survival after a MI can be made from routine hospital data.
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Affiliation(s)
- J G Maeland
- Institute of Hygiene and Social Medicine, University of Bergen, Norway
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Vedin A, Wilhelmsen L, Wedel H, Pettersson B, Wilhelmsson C, Elmfeldt D, Tibblin G. Prediction of cardiovascular deaths and non-fatal reinfarctions after myocardial infarction. ACTA MEDICA SCANDINAVICA 2009; 201:309-16. [PMID: 851039 DOI: 10.1111/j.0954-6820.1977.tb15705.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The present study concerns the development and validation of a logistic multivariate prognostic function in patients followed for two years after myocardial infarction. The patients studied constituted at least 90% of all cases in a total community--the City of Göteborg, Sweden. Using a multivariate logistic function with 7 variables, based on 30 cardiovascular deaths during two years after discharge from hospital among 292 men with first infarction, breathlessness at onset of symptoms of infarction, SGOT quartile, left heart failure, relative heart size, atrial fibrillation, a history of hypertension, and AV block recorded during the hospital phase were the most important variables. The first five of these variables made significant contributions (p less than 0.01) to the predictive power. The predictive capacity was confirmed in an independent series of 195 men with first infarction, among whom 17 cardiovascular deaths occurred. Around 60% of the total cardiovascular mortality was concentrated in the highest risk quintile. Deaths from non-cardiovascular causes were predicted less efficiently. Non-fatal recurrences could not be predicted by the present model. Thus, the function can predict the excess risk of mortality but not the excess risk of reinfarction during two years among men after an initial myocardial infarction.
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Isacsson SO, Johansson BW. Myocardial infarction in Malmö during the 10-year period 1963--1972. ACTA MEDICA SCANDINAVICA 2009; 206:293-8. [PMID: 506800 DOI: 10.1111/j.0954-6820.1979.tb13513.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Myocardial infarctions in Malmö during the 10-year period 1963--1972 have been studied. The mortality from myocardial infarction decreased significantly among men during this period but not among women. The incidence of hospital-treated infarction increased significantly among men, mainly due to an increase in primary infarctions. The one-year survival in this hospital material did not improve during the period. The number of days of sick-leave during 12 months before primary infarction was significantly higher than expected. The duration of sick-leave during the year after primary infarction remained unchanged throughout the period. The mortality figures relate to all age groups, comprising 2 111 men and 1 409 women. The hospital incidence relates to men and women aged 65 years or below and comprises 1 323 men and 279 women during the period concerned. The reduced mortality and increased incidence of hospital-treated infarction are probaby explained by the fact that more men seek hospital treatment, leading to a better prognosis. The long duration of sick-leave after infarction is probably due to causes other than strictly medical factors.
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Nordlander R, Nyquist O. Mortality, arrhythmias and pump failure in acute myocardial infarction in relation to estimated infarct size. ACTA MEDICA SCANDINAVICA 2009; 206:65-71. [PMID: 484259 DOI: 10.1111/j.0954-6820.1979.tb13471.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Serial estimations of total serum creatine kinase (S-CK) were made in 194 consecutive patients with acute myocardial infarction (AMI). By itself, the maximum CK value could not separate patients in terms of high and low mortality but when the maximum CK value was related to age for patients with and without a history of previous AMI, two subgroups became apparent, one with 46% mortality (high-risk group) and another with 6% (low-risk group) during the hospital stay plus the next 90 days. In 114 of the patients, infarct size could be calculated. A good correlation was found between maximum CK and calculated infarct size (r = 0.93). Calculated infarct size alone could not distinguish between high and low mortality but when it was related to age for patients with and without a history of previous AMI, two subgroups emerged, one with 43% mortality and another with 3% during the hospital stay plus the next 90 days. The incidence of ventricular tachycardia during the stay in the Coronary Care Unit did not differ between the two risk groups separated either by maximum CK value or calculated infarct size. However, the incidence of shock and severe left heart failure during the acute phase was higher in the high-risk groups.
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Biörck G, Erhardt LR, Lindberg G. Prediction of survival in patients with acute myocardial infarction. A clinical study on 100 consecutive patients. ACTA MEDICA SCANDINAVICA 2009; 206:165-8. [PMID: 495222 DOI: 10.1111/j.0954-6820.1979.tb13488.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Expected survival after acute myocardial infarction (AMI) in 100 consecutive patients was predicted by three doctors and two nurses at the time of discharge from a CCU. Predictions were compared with various coronary prognostic indices (CPI) and were found to be too optimistic for the first 9 months. Experienced physicians made more reliable predictions than junior physicians and nurses. All patients with a predicted survival of more than 10 years were alive after 1 year and all with predicted death within one month died during the first year. Intermediate predictions were unreliable with reference to the one-year survival. Regardless of which CPI was used, a low index score carried a very low one-year mortality and high index a high mortality. Intermediate index scores were unreliable. A comparison between the predictions and index scores showed that there was no difference in sensitivity and specificity between the methods. Our study thus shows that patients with either a very good or a very poor prognosis will be identified regardless of the method used. The problem of identifying the individual with an intermediate risk remains to be solved.
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Wihelmsson C, Vedin A, Wilhelmsen L, Tibblin G, Werkö L, Wedel H. Deaths and non-fatal reinfarctions during two years' follow-up. ACTA MEDICA SCANDINAVICA. SUPPLEMENTUM 2009; 575:19-24. [PMID: 1098398 DOI: 10.1111/j.0954-6820.1975.tb06481.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Löfmark R, Orinius E. T wave changes after acute myocardial infarction predicting reinfarction. ACTA MEDICA SCANDINAVICA 2009; 209:169-74. [PMID: 7223510 DOI: 10.1111/j.0954-6820.1981.tb11572.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Of 420 consecutive patients with acute myocardial infarction who survived the coronary care unit period, 57 developed 63 reinfarctions with 16 deaths within three months (reinfarction group). Of the remaining 363 patients, 28 died without evidence of reinfarction during the same observation period and 335 survived. The last ECGs before discharge, or prior to a reinfarction in hospital, of the reinfarction patients were studied and compared with time-matched ECGs from the 335 survivors without reinfarction. In ECGs without interfering patterns, the slope of the ascending limb of a negative T wave was measured as the angle to the vertical plane (interobserver variation less than or equal to 5 degrees in 95%). Of the 63 reinfarctions, 40% had a steeply ascending limb of a negative T wave (T wave angle less than or equal to 55 degrees in lead II, less than or equal to 35 degrees in CR4 and/or less than or equal to 40 degrees in CR7) and a QRS complex without signs of infarction in the same lead (abnormal Q waves or abnormal R wave progression). The same criteria were fulfilled by 6% of the 335 survivors without reinfarction (p less than 0.001) and by one of the 28 patients who died without reinfarction. Thus, a steeply ascending limb of a negative T wave in the acute phase of a myocardial infarction heralds a reinfarction if the QRS complex of the same lead does not show signs of infarction (3-month sensitivity 40% and predictive value 53%). A T wave angle less than or equal to 35 degrees in CR4 corresponds to less than or equal to 40 degrees in V4. CR7 is not transferable to V6 but was the least predictive lead.
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Pedersen T. The Norwegian Multicenter Study on timolol after myocardial infarction--design, management and results on mortality. ACTA MEDICA SCANDINAVICA. SUPPLEMENTUM 2009; 651:235-41. [PMID: 7034475 DOI: 10.1111/j.0954-6820.1981.tb03663.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Takkunen J, Oilinki O, Huhti E, Vuopala U, Koivisto O. MEDICAL TREATMENT AND MORTALITY IN CARDIOGENIC SHOCK. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.0954-6820.1972.tb04797.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thoresen CE, Friedman M, Gill JK, Ulmer DK. The recurrent coronary prevention project. Some preliminary findings. ACTA MEDICA SCANDINAVICA. SUPPLEMENTUM 2009; 660:172-92. [PMID: 6958187 DOI: 10.1111/j.0954-6820.1982.tb00373.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The Recurrent Coronary Prevention Project (RCPP) was established as a 5-year clinical trial to examine two basic questions: --1. Can the recurrence rate of post-coronary subjects be substantially reduced over a 5-year period by means of a programme of behavioural change, in comparison with treatment by cardiologists focussing on medication, diet, exercise and cardiovascular issues, and with subjects who only receive regular care from their own physician? 2. Can the Type A behaviour pattern (TABP) be changed and do such changes correspond to reduced recurrences of coronary heart disease (CHD) over a 5 year period? To answer these questions, four major treatment groups are currently being compared: --1. A small group treatment programme (Section I) led by cardiologists emphasizing adherence to medication, diet and exercise, and giving cardiovascular and cardiological information. 2. A behavioural change treatment programme (Section II) based primarily on a cognitive social learning model and attempting to alter TABP. 3. A control group of subjects assessed annually and receiving private medical care from their own physicians. 4. A dropout comparison group composed of subjects voluntarily discontinuing participation in groups led by cardiologists or in behavioural change groups. Results to date show a significantly reduced rate of recurrence for subjects in the behavioural change group, compared to those in the groups led by cardiologists as well as control and dropout groups. These significantly lower recurrence rates are accompanied by data suggesting that subjects in the behavioural change programme are also altering their TABP as measured by both behavioural questionnaires and videotaped Type A structured interviews. Clinical impressions suggest that treatment programmes to alter TABP should consider the primary importance of the personal meaning of the TABP and other behaviours to the individual concerned, particularly how basic underlying beliefs set the stage for the TABP. The central role of hostility as a pervasive orientation towards self and others is emphasized, as are issues of excessive controllability related to extreme competitiveness and hyper-arousal. The multiple roles of group leaders, especially as social models for coping, and the impact of the small groups settings, is also discussed.
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Linko E, Koskinen PJ, Ruosteenoja R, Kauranen O, Hakala T. INTENSIVE CARE OF MYOCARDIAL INFARCTION. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.0954-6820.1970.tb02917.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ivanusa M, Milicic D. 40 years since Killip clinical classification. Int J Cardiol 2008; 134:420-1. [PMID: 18353462 DOI: 10.1016/j.ijcard.2007.12.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 12/29/2007] [Indexed: 11/25/2022]
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Addala S, Grines CL, Dixon SR, Stone GW, Boura JA, Ochoa AB, Pellizzon G, O'Neill WW, Kahn JK. Predicting mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PAMI risk score). Am J Cardiol 2004; 93:629-32. [PMID: 14996596 DOI: 10.1016/j.amjcard.2003.11.036] [Citation(s) in RCA: 158] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2003] [Revised: 11/03/2003] [Accepted: 11/03/2003] [Indexed: 02/07/2023]
Abstract
We performed a pooled analysis of the Primary Angioplasty in Myocardial Infarction (PAMI) trials to examine predictors of death after primary percutaneous coronary intervention. Using these data, we developed a risk score with a range of 0 to 15 points. The PAMI risk score was found to be a strong predictor of late mortality.
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Affiliation(s)
- Eric J Velazquez
- Division of Cardiology, Department of Medicine, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
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Jolly K, Lip GYH, Sandercock J, Greenfield SM, Raftery JP, Mant J, Taylor R, Lane D, Lee KW, Stevens AJ. Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM): a randomised controlled trial [ISRCTN72884263]. BMC Cardiovasc Disord 2003; 3:10. [PMID: 12964946 PMCID: PMC200974 DOI: 10.1186/1471-2261-3-10] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2003] [Accepted: 09/10/2003] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation following myocardial infarction reduces subsequent mortality, but uptake and adherence to rehabilitation programmes remains poor, particularly among women, the elderly and ethnic minority groups. Evidence of the effectiveness of home-based cardiac rehabilitation remains limited. This trial evaluates the effectiveness and cost-effectiveness of home-based compared to hospital-based cardiac rehabilitation. METHODS/DESIGN A pragmatic randomised controlled trial of home-based compared with hospital-based cardiac rehabilitation in four hospitals serving a multi-ethnic inner city population in the United Kingdom was designed. The home programme is nurse-facilitated, manual-based using the Heart Manual. The hospital programmes offer comprehensive cardiac rehabilitation in an out-patient setting. PATIENTS We will randomise 650 adult, English or Punjabi-speaking patients of low-medium risk following myocardial infarction, coronary angioplasty or coronary artery bypass graft who have been referred for cardiac rehabilitation. MAIN OUTCOME MEASURES Serum cholesterol, smoking cessation, blood pressure, Hospital Anxiety and Depression Score, distance walked on Shuttle walk-test measured at 6, 12 and 24 months. Adherence to the programmes will be estimated using patient self-reports of activity.In-depth interviews with non-attendees and non-adherers will ascertain patient views and the acceptability of the programmes and provide insights about non-attendance and aims to generate a theory of attendance at cardiac rehabilitation. The economic analysis will measure National Health Service costs using resource inputs. Patient costs will be established from the qualitative research, in particular how they affect adherence. DISCUSSION More data are needed on the role of home-based versus hospital-based cardiac rehabilitation for patients following myocardial infarction and revascularisation, which would be provided by the Birmingham Rehabilitation Uptake Maximisation Study (BRUM) study and has implications for the clinical management of these patients. A novel feature of this study is the inclusion of non-English Punjabi speakers.
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Affiliation(s)
- Kate Jolly
- Department of Public Health & Epidemiology, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Gregory YH Lip
- University Department of Medicine, City Hospital, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Josie Sandercock
- Department of Public Health & Epidemiology, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Sheila M Greenfield
- Department of Primary Care & General Practice, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - James P Raftery
- Health Services Management Centre, Park House, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Jonathan Mant
- Department of Primary Care & General Practice, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Rod Taylor
- Department of Public Health & Epidemiology, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Deirdre Lane
- University Department of Medicine, City Hospital, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Kaeng Wai Lee
- University Department of Medicine, City Hospital, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - AJ Stevens
- Department of Public Health & Epidemiology, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
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Abstract
Near-death experiences, unusual experiences during a close brush with death, may precipitate pervasive attitudinal and behavior changes. The incidence and psychological correlates of such experiences, and their association with proximity to death, are unclear. We conducted a 30-month survey to identify near-death experiences in a tertiary care center cardiac inpatient service. In a consecutive sample of 1595 patients admitted to the cardiac inpatient service (mean age 63 years, 61% male), of whom 7% were admitted with cardiac arrest, patients who described near-death experiences were matched with comparison patients on diagnosis, gender, and age. Near-death experiences were reported by 10% of patients with cardiac arrest and 1% of other cardiac patients (P<.001). Near-death experiencers were younger than other patients (P=.001), were more likely to have lost consciousness (P<.001) and to report prior purportedly paranormal experiences (P=.009), and had greater approach-oriented death acceptance (P=.01). Near-death experiencers and comparison patients did not differ in sociodemographic variables, social support, quality of life, acceptance of their illness, cognitive function, capacity for physical activities, degree of cardiac dysfunction, objective proximity to death, or coronary prognosis.
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Affiliation(s)
- Bruce Greyson
- Department of Psychiatric Medicine, University of Virginia Health System, Charlottesville, VA, USA.
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Lane D, Carroll D, Ring C, Beevers DG, Lip GYH. In-hospital symptoms of depression do not predict mortality 3 years after myocardial infarction. Int J Epidemiol 2002; 31:1179-82. [PMID: 12540719 DOI: 10.1093/ije/31.6.1179] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The main aim of this study was to examine the relationship between symptoms of depression following myocardial infarction (MI) and 3-year survival status. METHODS The Beck Depression Inventory was completed by 288 patients hospitalized for MI. Patients' cardiological status, including indices of disease severity, were recorded or derived from hospital notes. Three-year survival status was determined using patient information systems and cause of death ascertained from death certificates. RESULTS During the 3 years of follow-up, 38 patients (13%) died, 33 (11%) from cardiac causes. Symptoms of depression did not predict either cardiac-specific or all-cause mortality. Similarly, in-hospital levels of anxiety were not associated with prognosis. In contrast, measures of disease severity and discharge medication status were strong prognostic indicators. Depression was not related to measures of disease severity at entry to the study. CONCLUSIONS Symptoms of depression following MI do not predict longer-term survival, although measures of disease severity and discharge medication status do. Previous positive results for depression and cardiac mortality in MI patients could reflect the occasional confounding of depression with disease severity.
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Affiliation(s)
- Deirdre Lane
- University Department of Medicine, City Hospital NHS Trust, Dudley Road, Birmingham, B18 7QH, UK.
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Brzek A, Nowak Z, Plewa M. Modified programme of in-patient (phase I) cardiac rehabilitation after acute myocardial infarction. Int J Rehabil Res 2002; 25:225-9. [PMID: 12352176 DOI: 10.1097/00004356-200209000-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A group of 61 men who suffered from myocardial infarction (MI) were divided into two groups: group A (31 patients post MI, one day at intensive care unit (ICU), no beta-blockers, physical therapy according to a seven-day programme) and group B (30 patients post MI, two days at ICU, with beta-blockers, physical therapy according to a seven-day programme). Results from both groups were compared with a control group (C) (38 patients post MI, three days at ICU, physical therapy according to a longer ten-day graded programme). The objective of this study was to assess the efficacy of a proposed modified rehabilitation programme in patients after acute MI on the basis of a submaximal stress test performed on a cycle ergometer and to find out which stress test parameters might be used for the selection of an appropriate phase 2 rehabilitation programme. The performed analysis of correlation between exercise and resting parameters showed statistical relevancy with regard to systolic blood pressure in group A. Maximal load (WATs), metabolic cost (METs), maximal heart rate (beats/min), stress-test time (T-test) and time of normalization for the exercise parameters (t(n)) are the parameters of the stress test that should be taken into consideration for appropriate selection of an out-patient (phase 2) rehabilitation programme.
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Affiliation(s)
- Anna Brzek
- First Clinic Hospital, Silesian Medical Academy, Katowice, Poland
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Carroll D, Lane D. Depression and mortality following myocardial infarction: the issue of disease severity. EPIDEMIOLOGIA E PSICHIATRIA SOCIALE 2002; 11:65-8. [PMID: 12212466 DOI: 10.1017/s1121189x00005510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lane D, Carroll D, Ring C, Beevers DG, Lip GY. Predictors of attendance at cardiac rehabilitation after myocardial infarction. J Psychosom Res 2001; 51:497-501. [PMID: 11602219 DOI: 10.1016/s0022-3999(01)00225-2] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to determine predictors of attendance at cardiac rehabilitation after myocardial infarction (MI). METHODS Various demographic, behavioural, and clinical variables were measured during hospitalisation in 288 MI patients. Of these, 263 were available to attend outpatient-based cardiac rehabilitation: 108 actually attended. RESULTS Multiple logistic regression analyses indicated that nonattenders lived in more deprived areas and were less likely to have paid employment. Nonattenders also registered more symptoms of depression and anxiety and exercised less frequently prior to their MI, although only the last of these variables were predicted in a multivariate model. In terms of clinical status, whether patients had been thrombolysed or not was the strongest predictor of attendance. CONCLUSIONS Attendance at cardiac rehabilitation is not an arbitrary matter. Strategies should be developed for encouraging greater attendance among those not in paid employment, those from deprived areas, and those who exercise infrequently.
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Affiliation(s)
- D Lane
- School of Sport and Exercise Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Abstract
A sample of 945 cardiac patients admitted under emergency conditions completed a quality of life questionnaire 4 months post-discharge. Half (471) were randomly allocated to a group used to develop a logistic regression model to predict mortality and cardiovascular morbidity 8 months later. Age 65-85 years, ever having heart failure, experiencing another cardiovascular event since discharge, and low global quality of life (QOL) score were found to be predictive of these outcomes; an interaction between QOL and heart failure was also found. The model was used to formulate a risk index which was validated in the remaining 474 patients. The index defines four levels of increasing risk of adverse outcomes, with rates in the development and validation groups, respectively, of: low risk 4% and 9%; moderate risk 13% and 15%; high risk 31% and 33%; very high risk 52% and 40%. Scores in the emotional, physical and social QOL domains were also found to be predictive of adverse outcomes, suggesting that interventions in any of these areas may prove beneficial. The index may be useful for follow-up evaluation of cardiac patients.
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Affiliation(s)
- T Dixon
- Cardiovascular Disease and Risk Factor Monitoring Unit, Australian Institute of Health and Welfare, 6A Traeger Court, 2617, Bruce ACT, Australia.
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Dimsdale JE, Hackett TP, Hutter AM, Block PC. The association of clinical, psychosocial, and angiographic variables with work status in patients with coronary artery disease. J Psychosom Res 2001; 26:215-21. [PMID: 7077552 DOI: 10.1016/0022-3999(82)90039-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The bearing of clinical history, epidemiological risk factors, psychosocial factors, angiographic findings, and treatment characteristics was studied in relationship to the work status of 182 men who underwent coronary angiography because of presumptive coronary artery disease. Follow-up at one year found 42% of the cohort persistently unemployed or working at a lower level, 40% at the same job, and 19% at a more demanding job. Multiple regression analysis was used to derive the most important variables predictive of work status. Neither number of vessels diseased nor Coronary Artery Bypass Graft surgery entered the multiple regression analysis. Instead, the most important variables, listed in decreasing order of importance, are: age, subsequent cardiac morbid events, past myocardial infarction, and mood during the follow-up year. Together, they account for 24% of the variance in work status outcome (p less than 0.001).
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Lane D, Carroll D, Ring C, Beevers DG, Lip GY. Mortality and quality of life 12 months after myocardial infarction: effects of depression and anxiety. Psychosom Med 2001; 63:221-30. [PMID: 11292269 DOI: 10.1097/00006842-200103000-00005] [Citation(s) in RCA: 262] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the impact of symptoms of depression and anxiety on mortality and quality of life in patients hospitalized for acute myocardial infarction (MI). METHODS The Beck Depression Inventory and the State-Trait Anxiety Inventory were completed by 288 patients hospitalized for MI. Twelve-month survival status was ascertained, and quality of life among survivors was assessed at 12 months using the Dartmouth COOP charts. RESULTS Thirty-one (10.8%) patients died, 27 of cardiac causes, during the 12-month follow-up. Symptoms of depression and anxiety predicted neither cardiac nor all-cause mortality. Severity of infarction and evidence of heart failure predicted both cardiac and all-cause mortality. The same findings emerged from supplementary analyses of data from patients who died after discharge from the hospital. Symptoms of depression and anxiety, measured at entry, predicted 12-month quality of life among survivors, as did gender, partner status, employment status, living alone, previous frequency of exercise, and indices of disease severity (Killip class and Peel Index). In a multiple regression model in which all of these variables were entered, initial depression scores provided the best independent prediction of quality of life, although living alone, severity of infarction, and state anxiety also entered the model. CONCLUSIONS Symptoms of depression and anxiety did not predict either cardiac or all-cause mortality after MI, but they did predict quality of life among those who lived to 12 months.
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Affiliation(s)
- D Lane
- University of Birmingham, Edgbaston, United Kingdom
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Julian D, Furberg C. Are there fundamental deficiencies in the megatrial methodology? CURRENT CONTROLLED TRIALS IN CARDIOVASCULAR MEDICINE 2001; 2:1. [PMID: 11806764 PMCID: PMC59650 DOI: 10.1186/cvm-2-1-001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lane D, Carroll D, Ring C, Beevers DG, Lip GY. Effects of depression and anxiety on mortality and quality-of-life 4 months after myocardial infarction. J Psychosom Res 2000; 49:229-38. [PMID: 11119779 DOI: 10.1016/s0022-3999(00)00170-7] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the impact of depression and anxiety on mortality and quality-of-life in patients hospitalized for an acute myocardial infarction (MI). METHODS Questionnaire measures of depression and anxiety were completed during hospitalization by 288 MI patients. The main outcomes were mortality and quality-of-life, assessed by the Dartmouth COOP charts, at 4 months. RESULTS A total of 25 patients died, 22 from cardiac causes, during the 4-month follow-up. Symptoms of depression and anxiety did not predict either cardiac or all-cause mortality. Severity of infarction, extent of heart failure, and a longer stay in hospital predicted mortality. Symptoms of depression and anxiety predicted 4-month quality-of-life among survivors, as did gender, partner status, occupational status, living alone, previous exercise behaviour, length of hospital admission, and Peel Index scores. In a multiple regression model, depression emerged as the strongest predictor of quality-of-life. State anxiety, severity of infarction, and partner status also entered the model. CONCLUSION Neither depression nor anxiety predicted mortality 4 months after MI. Both depression and anxiety predicted quality-of-life at 4 months among survivors.
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Affiliation(s)
- D Lane
- School of Sport and Exercise Sciences, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK
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Goff DC, Howard G, Wang CH, Folsom AR, Rosamond WD, Cooper LS, Chambless LE. Trends in severity of hospitalized myocardial infarction: the atherosclerosis risk in communities (ARIC) study, 1987-1994. Am Heart J 2000; 139:874-80. [PMID: 10783222 DOI: 10.1016/s0002-8703(00)90020-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Declining mortality rates of coronary heart disease in the United States could be attributable to declining incidence, declining severity, and/or improvements in treatment. METHODS We examined trends in severity of patients hospitalized for myocardial infarction to characterize its contribution to this decline by using data from the Atherosclerosis Risk in Communities (ARIC) study. RESULTS No significant change in the proportion having systolic blood pressure <100 mm Hg or an abnormal pulse at presentation was noted. The proportion with ST-segment elevation on the initial electrocardiogram increased 10% per year (P <.001), and the proportion with a diagnostic or evolving diagnostic electrocardiogram abnormality increased 4% per year (P <.01); the proportion that had a new Q-wave infarction develop remained unchanged. The mean peak creatine kinase level decreased 5% per year (P <.001), the proportion with abnormal enzyme levels decreased 10% per year (P <.001), and the proportion that met criteria for definite myocardial infarction decreased 4% per year (P <.05). The proportion that had cardiogenic shock decreased 10.9% per year (P <. 01), but the proportion that had an acute episode of congestive heart failure was stable. CONCLUSIONS With stable hemodynamic indicators, worsening electrocardiographic indicators, and improving enzymatic indicators, these results provide mixed support for decreases in the severity of myocardial infarction.
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Affiliation(s)
- D C Goff
- Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA.
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Madias JE. Killip and Forrester classifications: should they be abandoned, kept, reevaluated, or modified? Chest 2000; 117:1223-6. [PMID: 10807802 DOI: 10.1378/chest.117.5.1223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Tunstall-Pedoe H, Vanuzzo D, Hobbs M, Mähönen M, Cepaitis Z, Kuulasmaa K, Keil U. Estimation of contribution of changes in coronary care to improving survival, event rates, and coronary heart disease mortality across the WHO MONICA Project populations. Lancet 2000; 355:688-700. [PMID: 10703800 DOI: 10.1016/s0140-6736(99)11181-4] [Citation(s) in RCA: 341] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The revolution in coronary care in the mid-1980s to mid-1990s corresponded with monitoring of coronary heart disease (CHD) in 31 populations of the WHO MONICA Project. We studied the impact of this revolution on coronary endpoints. METHODS Case fatality, coronary-event rates, and CHD mortality were monitored in men and women aged 35-64 years in two separate 3-4-year periods. In each period, we recorded percentage use of eight treatments: coronary-artery reperfusion before, thrombolytics during, and beta-blockers, antiplatelet drugs, and angiotensin-converting-enzyme (ACE) inhibitors before and during non-fatal myocardial infarction. Values were averaged to produce treatment scores. We correlated changes across populations, and regressed changes in coronary endpoints on changes in treatment scores. FINDINGS Treatment changes correlated positively with each other but inversely with change in coronary endpoints. By regression, for the common average treatment change of 20, case fatality fell by 19% (95% CI 12-26) in men and 16% (5-27) in women; coronary-event rates fell by 25% (16-35) and 23% (7-39); and CHD mortality rates fell by 42% (31-53) and 34% (17-50). The regression model explained an estimated 61% and 41% of variance for men and women in trends for case fatality, 52% and 30% for coronary-event rates, and 72% and 56% for CHD mortality. INTERPRETATION Changes in coronary care and secondary prevention were strongly linked with declining coronary endpoints. Scores and benefits followed a geographical east-to-west gradient. The apparent effects of the treatment might be exaggerated by other changes in economically successful populations, so their specificity needs further assessment.
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Affiliation(s)
- H Tunstall-Pedoe
- Cardiovascular Epidemiology Unit, (MONICA Quality Control Centre for Event Registration), University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
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Abstract
OBJECTIVES To describe the clinical profile and hospital outcome of successive unselected patients with pulmonary edema hospitalized in an internal medicine department. DESIGN Prospective, consecutive, unsolicited patients diagnosed with pulmonary edema. SETTING An internal medicine department in a 900 tertiary care center. PATIENTS A total of 150 consecutive unselected patients (90 males, 60 females; median age, 75 yrs). RESULTS Ischemic heart disease, hypertension, various valvular lesions and diabetes mellitus were present in 85%, 70%, 53%, and 52% of patients, respectively. Acute myocardial infarction at admission was observed in 15% of patients. The most common precipitating factors associated with the development of pulmonary edema included: high blood pressure (29%), rapid atrial fibrillation (29%,) unstable angina pectoris (25%), infection (18%), and acute myocardial infarction (15%). Twenty-two patients (15%) were mechanically ventilated. Eighteen patients (12%) died while in the hospital, and the cause of death was cardiac pump failure in 82%. The median hospital stay was 10 days. Predictors for increase rate of in-hospital mortality included: diabetes (p<.05), orthopnea (p<.05), echocardiographic finding of moderate-to-severely depressed global left ventricular systolic function (p<.001), acute myocardial infarction during hospital stay (p<.001), hypotension/shock (p<.05), and the need for mechanical ventilation (p<.001). CONCLUSIONS Most patients with pulmonary edema in the internal medicine department are elderly, having ischemic heart disease, hypertension, diabetes, and a previous history of pulmonary edema. The overall mortality is high (in-hospital, 12%) and the predictors associated with high in-hospital mortality are related to left ventricular myocardial function. The long median hospital stay (10 days) and the need for many cardiovascular drugs, impose a considerable cost in the management and health care of these patients.
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Affiliation(s)
- Y Edoute
- Department of Internal Medicine C, Rambam Medical Center, and The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Fresco C, Carinci F, Maggioni AP, Ciampi A, Nicolucci A, Santoro E, Tavazzi L, Tognonia G. Very early assessment of risk for in-hospital death among 11,483 patients with acute myocardial infarction. GISSI investigators. Am Heart J 1999; 138:1058-64. [PMID: 10577435 DOI: 10.1016/s0002-8703(99)70070-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The efficacy of reperfusion therapy after acute myocardial infarction is time dependent. The risk profile of every patient should be available as soon as possible. Our aim was to determine whether collection of simple clinical markers at hospital admission might allow reliable risk stratification for in-hospital mortality. METHODS The subjects were 11,483 patients with acute myocardial infarction from the GISSI-2 cohort. The GISSI-1 and GISSI-3 populations were selected to validate the classification. To stratify patients, the tree-growing method called recursive partitioning and amalgamation (RECPAM) was used. This method is used to identify homogeneous and distinct subgroups with respect to outcome. RESULTS The RECPAM algorithm provided 6 classes. RECPAM class I included Killip class 3 to class 4 patients (516 deaths/1000). RECPAM class II included Killip 2 patients older than 66 years and with anterior infarction or sites of infarction that could not be evaluated (314 deaths/1000). Killip 1 patients older than 75 years and with anterior or multiple sites or sites that could not be evaluated were included in RECPAM class III with Killip class 2 patients younger than 66 years and with systolic blood pressure less than 120 mm Hg or older than 66 years and with any other infarction site (207 deaths/1000). The other classes showed lower mortality rates (91, 32, and 12 deaths/1000 for RECPAM classes IV, V, and VI). In the GISSI 1 and GISSI 3 samples the 6 classes ranked in the same order in terms of mortality rate. With respect to low-risk strata, patients belonging to RECPAM class VI without serious clinical events in the first 4 days had a very low incidence of in-hospital death (0.9%) or morbidity. Cumulative 6-month mortality for the 6 RECPAM classes was 59.6%, 41.2%, 26.4%, 12.9%, 4. 8%, and 2.2%. CONCLUSIONS Four simple clinical markers readily available at admission of patients with myocardial infarction allow a quick, reliable, and inexpensive prediction of risk for in-hospital and 6-month mortality. The RECPAM classification also helped identify a large subgroup of patients fit for early hospital discharge.
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Affiliation(s)
- C Fresco
- Istituto di Cardiologia, Azienda Ospedaliera Santa Maria della Misericordia, Udine, Italy
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Goff DC, Feldman HA, McGovern PG, Goldberg RJ, Simons-Morton DG, Cornell CE, Osganian SK, Cooper LS, Hedges JR. Prehospital delay in patients hospitalized with heart attack symptoms in the United States: the REACT trial. Rapid Early Action for Coronary Treatment (REACT) Study Group. Am Heart J 1999; 138:1046-1057. [PMID: 10577434 DOI: 10.1016/s0002-8703(99)70069-4] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND The use of thrombolytic therapy for patients with myocardial infarction has been limited by patient delay in seeking care. We sought to characterize prehospital delay in patients hospitalized for evaluation of heart attack symptoms. METHODS AND RESULTS The Rapid Early Action for Coronary Treatment (REACT) is a multicenter, randomized community trial designed to reduce patient delay. At baseline, data were abstracted from the medical records of 3783 patients hospitalized for evaluation of heart attack symptoms in 20 communities. The median prehospital delay was 2.0 hours; 25% of patients delayed longer than 5.2 hours. In a multivariable analysis, delay time was longer among non-Hispanic blacks than among non-Hispanic whites, longer at older ages, longer among Medicaid-only recipients and shorter among Medicare recipients than among privately insured patients, and shorter among patients who used an ambulance. CONCLUSIONS The observed pattern of differences is consistent with the contention that demographic, cultural, and/or socioeconomic barriers exist that impede rapid care seeking.
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Affiliation(s)
- D C Goff
- Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA.
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Jacobs DR, Kroenke C, Crow R, Deshpande M, Gu DF, Gatewood L, Blackburn H. PREDICT: A simple risk score for clinical severity and long-term prognosis after hospitalization for acute myocardial infarction or unstable angina: the Minnesota heart survey. Circulation 1999; 100:599-607. [PMID: 10441096 DOI: 10.1161/01.cir.100.6.599] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We evaluated short- and long-term mortality risks in 30- to 74-year-old patients hospitalized for acute myocardial infarction or unstable angina and developed a new score called PREDICT. METHODS AND RESULTS PREDICT was based on information routinely collected in hospital. Predictors abstracted from hospital record items pertaining to the admission day, including shock, heart failure, ECG findings, cardiovascular disease history, kidney function, and age. Comorbidity was assessed from discharge diagnoses, and mortality was determined from death certificates. For 1985 and 1990 hospitalizations, the 6-year death rate in 6134 patients with 0 to 1 score points was 4%, increasing stepwise to 89% for >/=16 points. Score validity was established by only slightly attenuated mortality prediction in 3570 admissions in 1970 and 1980. When case severity was controlled for, 6-year risk declined 32% between 1970 and 1990. When PREDICT was held constant, 24% of those treated with thrombolysis died in 6 years compared with 31% of those not treated. CONCLUSIONS The simple PREDICT risk score was a powerful prognosticator of 6-year mortality after hospitalization.
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Affiliation(s)
- D R Jacobs
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, USA.
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Valor pronóstico de la ecocardiografía con dobutamina después de un infarto agudo de miocardio no complicado. Rev Esp Cardiol 1999. [DOI: 10.1016/s0300-8932(99)74905-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Nidorf M, Parsons R, Thompson P, Jamrozik K, Hobbs M. Refining the risk-benefit equation for thrombolysis: how to identify the low risk patient before administering thrombolytic therapy. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1998; 28:525-8. [PMID: 9777133 DOI: 10.1111/j.1445-5994.1998.tb02104.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In view of the relative risk of intracranial haemorrhage and major bleeding with thrombolytic therapy, it is important to identify as early as possible the low risk patient who may not have a net clinical benefit from thrombolysis in the setting of acute myocardial infarction. An analysis of 5434 hospital-treated patients with myocardial infarction in the Perth MONICA study showed that age below 60 and absence of previous infarction or diabetes, shock, pulmonary oedema, cardiac arrest and Q-wave or left bundle branch block on the initial ECG identified a large group of patients with a 28 day mortality of only 1%, and one year mortality of only 2%. Identification of baseline risk in this way helps refine the risk-benefit equation for thrombolytic therapy, and may help avoid unnecessary use of thrombolysis in those unlikely to benefit.
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Affiliation(s)
- M Nidorf
- Department of Cardiovascular Medicine, Queen Elizabeth Medical Centre, Perth, WA
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