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Ma W, Timóteo A, Ribeiro V, Mateus C, Perelman J. Contribution of high-technology procedures to public healthcare expenditures: the case of ischemic heart disease in Portugal, 2002-2015. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2024; 24:419-437. [PMID: 38551735 PMCID: PMC11445372 DOI: 10.1007/s10754-024-09372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 03/11/2024] [Indexed: 10/02/2024]
Abstract
The magnitude of the impact of technological innovations on healthcare expenditure is unclear. This paper estimated the impact of high-technology procedures on public healthcare expenditure for patients with ischemic heart disease (IHD) in Portugal. The Blinder-Oaxaca decomposition method was applied to Portuguese NHS administrative data for IHD discharges during two periods, 2008-2015 vs. 2002-2007 (N = 434,870). We modelled per episode healthcare expenditures on the introduction of new technologies, adjusting for GDP, patient age, and comorbidities. The per episode healthcare expenditure was significantly higher in 2008-2015 compared to 2002-2007 for IHD discharges. The increase in the use of high-technology procedures contributed to 28.6% of this growth among all IHD patients, and to 18.4%, 6.8%, 11.1%, and 29.2% for acute myocardial infarction, unstable angina, stable angina, and other IHDs, respectively. Changes in the use of stents and embolic protection and/or coronary brachytherapy devices were the largest contributors to expenditure growth. High-technology procedures were confirmed as a key driver of public healthcare expenditure growth in Portugal, contributing to more than a quarter of this growth.
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Affiliation(s)
- Wenkang Ma
- Department of Economics and Related Studies, University of York, York, England, UK
| | - Ana Timóteo
- Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
- Comprehensive Health Research Center, Nova University of Lisbon, Lisbon, Portugal
| | - Vanessa Ribeiro
- Central Administration of the Health System, Lisbon, Portugal
| | - Céu Mateus
- Lancaster University, Lancaster, England, UK
| | - Julian Perelman
- Comprehensive Health Research Center, Nova University of Lisbon, Lisbon, Portugal.
- Nova National School of Public Health, Lisbon, Portugal.
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Barros H, Baia I, Monjardino T, Pimenta P, Alfredo A, Sorokina A, Domingues R. Fast-track referral for health interventions during pregnancy: study protocol of a randomised pragmatic experimental study to reduce low birth weight in Portugal (STOP LBW). BMJ Open 2022; 12:e052964. [PMID: 35292492 PMCID: PMC8928251 DOI: 10.1136/bmjopen-2021-052964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Low birth weight (LBW) is associated with a wide range of short-term and long-term consequences and is related to maternal psychosocial and behavioural determinants. The objective of this study is to estimate the effect of implementing fast-track referral for early intervention on psychosocial and behavioural risk factors-smoking, alcohol consumption, depression and physical violence-in reducing the incidence of LBW. METHODS AND ANALYSIS Parallel superiority pragmatic clinical trial randomised by clusters. Primary healthcare units (PHCU) located in Portugal will be randomised (1:1) to intervention or control groups. Pregnant women over 18 years of age attending these PHCU will be eligible to the study. Risk factors will be assessed through face-to-face interviews. In the intervention group, women who report at least one risk factor will have immediate access to referral services. The comparison group will be the local standard of care for these risk factors. We will use intention-to-treat analyses to compare intervention and control groups. We estimated a sample size of 2832 pregnant women to detect a 30% reduction in the incidence rate of LBW between the control and intervention groups. Secondary outcomes are the reduction of preterm births, reduction of the four risk factors and acceptance of the intervention. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the Public Health Institute of the University of Porto (no CE20140). The findings will be disseminated to the public, the funders, health professionals, health managers and other researchers. TRIAL REGISTRATION NUMBER NCT04866277.
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Affiliation(s)
- Henrique Barros
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto, Porto, Portugal
| | - Ines Baia
- Instituto de Saúde Pública da Universidade do Porto, Universidade do Porto, Porto, Portugal
| | - Teresa Monjardino
- Instituto de Saúde Pública da Universidade do Porto, Universidade do Porto, Porto, Portugal
| | - Pedro Pimenta
- Instituto de Saúde Pública da Universidade do Porto, Universidade do Porto, Porto, Portugal
| | - Ana Alfredo
- Instituto de Saúde Pública da Universidade do Porto, Universidade do Porto, Porto, Portugal
| | - Anzhela Sorokina
- Instituto de Saúde Pública da Universidade do Porto, Universidade do Porto, Porto, Portugal
| | - Rosa Domingues
- Laboratório de Pesquisa Clínica em DST/Aids, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Ahmadi M, Lanphear B. The impact of clinical and population strategies on coronary heart disease mortality: an assessment of Rose's big idea. BMC Public Health 2022; 22:14. [PMID: 34991551 PMCID: PMC8734316 DOI: 10.1186/s12889-021-12421-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/09/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Coronary heart disease (CHD), the leading cause of death worldwide, has declined in many affluent countries but it continues to rise in industrializing countries. OBJECTIVE To quantify the relative contribution of the clinical and population strategies to the decline in CHD mortality in affluent countries. DESIGN Meta-analysis of cross-sectional and prospective studies. DATA SOURCES PubMed and Web of Science from January 1, 1970 to December 31, 2019. METHOD We combined and analyzed data from 22 cross-sectional and prospective studies, representing 500 million people, to quantify the relative decline in CHD mortality attributable to the clinical strategy and population strategy. RESULT The population strategy accounted for 48% (range = 19 to 73%) of the decline in CHD deaths and the clinical strategy accounted for 42% (range = 25 to 56%), with moderate inconsistency of results across studies. CONCLUSION Since 1970, a larger fraction of the decline in CHD deaths in industrialized countries was attributable to reduction in CHD risk factors than medical care. Population strategies, which are more cost-effective than clinical strategies, are under-utilized.
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Affiliation(s)
- Mohadeseh Ahmadi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Bruce Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
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Suki SZ, Zuhdi ASM, Yahya 'AA, Zaharan NL. Intervention and in-hospital pharmacoterapies in octogenarian with acute coronary syndrome: a 10-year retrospective analysis of the Malaysian National Cardiovascular Database (NCVD) registry. BMC Geriatr 2022; 22:23. [PMID: 34983393 PMCID: PMC8729007 DOI: 10.1186/s12877-021-02724-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Octogenarians and beyond have often been neglected in the populational study of disease despite being at the highest point of non-modifiable disease risk burden and the fastest-growing age group for the past decade. This study examined the characteristics and in-hospital management of octogenarian patients with acute coronary syndrome (ACS) in a multi-ethnic, middle-income country in South East Asia. METHOD This retrospective study utilised the Malaysian National Cardiovascular Disease- ACS (NCVD-ACS) registry. Consecutive patient data of those ≥80 years old admitted with ACS at 24 participating hospitals from 2008 to 2017 (n = 3162) were identified. Demographics, in-hospital intervention, and evidence-based pharmacotherapies over the 10-years were examined and compared across groups of interests using the Chi-square test. Multivariate logistic regression was used to calculate the adjusted odds ratio of receiving individual therapies according to patients' characteristics. RESULTS Octogenarians made up 3.8% of patients with ACS in the NCVD-ACS registry (mean age = 84, SD ± 3.6) from 2008 until 2017. The largest ethnic group was Chinese (44%). Most octogenarians (95%) have multiple cardiovascular risk factors, with hypertension (82%) being the main. Non-ST-elevation myocardial infarction (NSTEMI) predominated (38%, p < 0.001). Within the 10-year, there were positive increments in cardiovascular intervention and pharmacotherapies. Only 10% of octogenarians with ACS underwent percutaneous coronary intervention (PCI), the majority being STEMI patients (17.5%; p < 0.05). More than 80% were prescribed aspirin (91.3%) either alone or combined, dual antiplatelet therapy (DAPT) (83.3%), anticoagulants (89.7%) and statins (89.6%), while less being prescribed angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (47.6%) and beta-blockers (43.0%). Men were more likely to receive PCI than women (adjusted Odds Ratio (aOR): 0.698; 95% CI: 0.490-0.993). NSTEMI (aOR = 0.402, 95% CI: 0.278-0.583) and unstable angina (UA) (aOR = 0.229, 95% CI: 0.143-0.366) were less likely to receive PCI but more likely given anticoagulants (NSTEMI, aOR = 1.543, 95% CI: 1.111-2.142; UA, aOR = 1.610, 95% CI: 1.120-2.314) than STEMI. The presence of cardiovascular risk factors and comorbidities influences management. CONCLUSION Octogenarians with ACS in this country were mainly treated with cardiovascular pharmacotherapies. As the number of octogenarians with ACS will continue to increase, the country needs to embrace the increasing use of PCI in this group of patients.
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Affiliation(s)
- Siti Z Suki
- Department of Pharmacology, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Ahmad S M Zuhdi
- Cardiology Unit, Department of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - ' Abqariyah A Yahya
- Department of Social and Preventive Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nur L Zaharan
- Department of Pharmacology, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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Motamed N, Ajdarkosh H, Perumal D, Ashrafi GH, Maadi M, Safarnezhad Tameshkel F, Farahani B, Rezaie N, Nikkhah M, Faraji AH, Miri SM, Roozafzai F, Khoonsari M, Karbalaie Niya MH, Zamani F. Comparison of risk assessment tools for cardiovascular diseases: results of an Iranian cohort study. Public Health 2021; 200:116-123. [PMID: 34717165 DOI: 10.1016/j.puhe.2021.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 08/27/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Several popular cardiovascular risk assessment tools have been developed in Western countries; however, the predictive abilities of these tools have not been evaluated in Middle Eastern countries. The present study aimed to determine the abilities of cardiovascular risk assessment tools in a population-based study in Northern Iran. STUDY DESIGN Population-based cohort study in Northern Iran. METHODS In total, 2883 individuals (1629 men and 1254 women), aged 40-74 years, were included in the study. We determined the predictive abilities of the American College of Cardiology/American Heart Association (ACC/AHA) risk prediction tool, the Framingham general cardiovascular risk profile in primary care settings, and the Systematic Coronary Risk Evaluation (SCORE) equations for low- and high-risk European countries. Receiver operating characteristic (ROC) analysis was used to determine the predictive abilities of these four risk assessment tools. RESULTS Based on areas under curve (AUC) values and related 95% confidence intervals (95% CIs), the discriminative abilities of the ACC/AHA tool, the Framingham approach, and the SCORE for low- and high-risk European countries to estimate non-fatal cardiovascular disease (CVD) events were 0.6625, 0.6517, 0.6476 and 0.6458, respectively, in men, and 0.7722, 0.7525, 0.7330 and 0.7331, respectively, in women. Moreover, the abilities of these four tools to estimate fatal CVD events were found to be 0.8614, 0.8329, 0.7996 and 0.7988 in men, and 0.8779, 0.8372, 0.8535 and 0.8518 in women, respectively. CONCLUSIONS The cardiovascular risk assessment tools investigated in this study showed acceptable predictive abilities in women. The ACC/AHA approach showed slightly better performance compared with the SCORE tool; however, the SCORE tool benefited from the lowest cost compared with all the other tools.
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Affiliation(s)
- N Motamed
- Department of Social Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - H Ajdarkosh
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - D Perumal
- Faculty of Science, Engineering and Computing, Kingston University, Kingston, United Kingdom
| | - G H Ashrafi
- Cancer Theme SEC Faculty Penrhyn Road, Kingston University London, KT1 2EE, United Kingdom
| | - M Maadi
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - F Safarnezhad Tameshkel
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran; Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - B Farahani
- Department of Cardiology, Iran University of Medical Sciences, Tehran, Iran
| | - N Rezaie
- Department of Pulmonology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - M Nikkhah
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - A H Faraji
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - F Roozafzai
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran; Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - M Khoonsari
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - M H Karbalaie Niya
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - F Zamani
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran.
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6
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Heaven can wait… for lipid control in very high cardiovascular risk patients. Rev Port Cardiol 2021; 40:649-651. [PMID: 34503702 DOI: 10.1016/j.repce.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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7
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Heaven can wait… for lipid control in very high cardiovascular risk patients. Rev Port Cardiol 2021. [PMID: 34092472 DOI: 10.1016/j.repc.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Fonseca AA, Lima TM, Castel-Branco M, Figueiredo IV. Feasibility of cardiovascular risk screening in Portuguese community pharmacies. Pharm Pract (Granada) 2021; 19:2255. [PMID: 34188730 PMCID: PMC8203311 DOI: 10.18549/pharmpract.2021.2.2255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Cardiovascular disease (CVD) remains the leading cause of human mortality. As
highly accessible and qualified health professionals, community pharmacists
can be included in the early detection of patients at risk for CVD by
implementing CVD screening programs. Objective: To assess the feasibility of CVD risk screening services in Portuguese
community pharmacies from the evaluation of customers acceptability. Methods: A cross-sectional study was conducted in a community pharmacy in Portugal.
The purpose of entering the pharmacy was recorded for all customers.
Afterwards, the customers were invited to be interviewed by the pharmacist,
who registered their willingness to participate and collected the
participants’ data and biochemical and physical parameters to assess
their CV risk by applying the Systematic COronary Risk Evaluation (SCORE)
model. For the participants who were not eligible for the SCORE-based risk
assessment, the pharmacist considered the major modifiable CVD risk factors
- hypertension, dyslipidemia, smoking habits, obesity, impaired fasting
glucose and sedentary behavior - according to the ESC guidelines. Results: Picking up medication was the most prevalent reason 69.8% (n=1,600)
for entering the pharmacy, and among the contacted customers, 56.4%
(n=621) agreed to have their CVD risk assessed. Of the 588 participants,
56.6% (n=333) were already on CV pharmacotherapy and were therefore
not eligible for screening. Of the 43.4% (n=255) CV
pharmacotherapy-naïve participants, 94.9% (n=242) were
screened with at least one CVD risk factor; 52.9% (n=135) were not
eligible for the SCORE assessment, of which 92.6% (n=125) presented
CVD risk factors. Of the 120 SCORE eligible participants, 80.0%
(n=96) were at least at moderate risk of CVD. Conclusions: We determined the feasibility of CVD risk screening in Portuguese community
pharmacies, as we found high customer acceptability, noted the reasons for
nonattendance, and found a high prevalence of CVD risk factors in at-risk
patients. This is an opportunity for Portuguese community pharmacists to
take a leading role in the early detection of CVD.
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Affiliation(s)
- Anabela A Fonseca
- Faculty of Pharmacy, Pharmacology and Pharmaceutical Care Laboratory, University Coimbra, Coimbra (Portugal).
| | - Tácio M Lima
- PhD. Professor. Department of Pharmaceutical Sciences, Federal Rural University of Rio de Janeiro. Seropédica, RJ (Brazil).
| | - Margarida Castel-Branco
- PhD. Professor. Coimbra Institute for Biomedical Imaging and Translational Research (iCBR), Faculty of Pharmacy, Pharmacology and Pharmaceutical Care Laboratory, University Coimbra. Coimbra (Portugal).
| | - Isabel V Figueiredo
- PhD. Professor. Coimbra Institute for Biomedical Imaging and Translational Research (iCBR), Faculty of Pharmacy, Pharmacology and Pharmaceutical Care Laboratory, University Coimbra. Coimbra (Portugal).
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Enhos A, Karacop E. Impact of Antecedent Aspirin Use on Infarct Size, Bleeding and Composite Endpoint in Patients with de Novo Acute Myocardial Infarction. Ther Clin Risk Manag 2021; 17:441-452. [PMID: 34054296 PMCID: PMC8149313 DOI: 10.2147/tcrm.s307768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/27/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The study aimed to evaluate the impact of antecedent aspirin use on infarct size, bleeding and composite endpoint in patients with de novo acute myocardial infarction. PATIENTS AND METHODS A total of 562 consecutive patients with de novo acute myocardial infarction were included in this prospective cohort study. Patients were assigned into two groups based on presence (n=212) and absence (n=350) of prior aspirin use. Primary endpoint was myocardial infarct size, as estimated by troponin I peak. In-hospital mortality, bleeding and composite clinical endpoint including cardiogenic shock, stroke, in-hospital mortality and major bleeding were also evaluated. RESULTS Although GRACE and CRUSADE scores were higher, troponin I peak was lower in prior aspirin users. This result was maintained after adjustment for baseline ischemic risk profile and other major confounders including MI type and location. Despite high CRUSADE score, there was no increase in major and minor bleeding. Minimal bleeding was higher in antecedent aspirin users. When it was adjusted for the CRUSADE score, a similar risk was reported. CONCLUSION Patients with de novo acute myocardial infarction using aspirin for primary prevention have an unexpectedly smaller infarct size and similar bleeding rates.
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Affiliation(s)
- Asim Enhos
- Bezmialem Foundation University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Erdem Karacop
- Bezmialem Foundation University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
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Arroyo-Quiroz C, O’Flaherty M, Guzman-Castillo M, Capewell S, Chuquiure-Valenzuela E, Jerjes-Sanchez C, Barrientos-Gutierrez T. Explaining the increment in coronary heart disease mortality in Mexico between 2000 and 2012. PLoS One 2020; 15:e0242930. [PMID: 33270684 PMCID: PMC7714134 DOI: 10.1371/journal.pone.0242930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mexico is still in the growing phase of the epidemic of coronary heart disease (CHD), with mortality increasing by 48% since 1980. However, no studies have analyzed the drivers of these trends. We aimed to model CHD deaths between 2000 and 2012 in Mexico and to quantify the proportion of the mortality change attributable to advances in medical treatments and to changes in population-wide cardiovascular risk factors. METHODS We performed a retrospective analysis using the previously validated IMPACT model to explain observed changes in CHD mortality in Mexican adults. The model integrates nationwide data at two-time points (2000 and 2012) to quantify the effects on CHD mortality attributable to changes in risk factors and therapeutic trends. RESULTS From 2000 to 2012, CHD mortality rates increased by 33.8% in men and by 22.8% in women. The IMPACT model explained 71% of the CHD mortality increase. Most of the mortality increases could be attributed to increases in population risk factors, such as diabetes (43%), physical inactivity (28%) and total cholesterol (24%). Improvements in medical and surgical treatments together prevented or postponed 40.3% of deaths; 10% was attributable to improvements in secondary prevention treatments following MI, while 5.3% to community heart failure treatments. CONCLUSIONS CHD mortality in Mexico is increasing due to adverse trends in major risk factors and suboptimal use of CHD treatments. Population-level interventions to reduce CHD risk factors are urgently needed, along with increased access and equitable distribution of therapies.
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Affiliation(s)
- Carmen Arroyo-Quiroz
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
- Universidad Autonoma Metropolitana- Unidad Lerma, Lerma de Villada, Mexico
| | - Martin O’Flaherty
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Maria Guzman-Castillo
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Simon Capewell
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | | | - Carlos Jerjes-Sanchez
- Escuela de Medicina y Ciencias de la Salud, Instituto Tecnológico de Monterrey, Instituto de Cardiología y Medicina Vascular, TecSalud, Monterrey, Mexico
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Stolpe S, Kowall B, Stang A. Decline of coronary heart disease mortality is strongly effected by changing patterns of underlying causes of death: an analysis of mortality data from 27 countries of the WHO European region 2000 and 2013. Eur J Epidemiol 2020; 36:57-68. [PMID: 33247420 PMCID: PMC7847455 DOI: 10.1007/s10654-020-00699-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/12/2020] [Indexed: 01/09/2023]
Abstract
Mortality rates for coronary heart disease (CHD) experience a longstanding decline, attributed to progress in prevention, diagnostics and therapy. However, CHD mortality rates vary between countries. To estimate whether national patterns of causes of death impact CHD mortality, data from the WHO “European detailed mortality database” for 2000 and 2013 for populations aged ≥ 80 years was analyzed. We extracted mortality rates for total mortality, cardiovascular diseases, neoplasms, dementia and ill-defined causes. We calculated proportions of selected causes of death among all deaths, and proportions of selected cardiovascular causes among cardiovascular deaths. CHD mortality rates were recalculated after re-coding ill-defined causes of death. Association between CHD mortality rates and proportions of CHD deaths was estimated by population-weighted linear regression. National patterns of causes of death were divers. In 2000, CHD was assigned as cause of death in 13–53% of all cardiovascular deaths. Until 2013, this proportion changed between − 65% (Czech Republic) and + 57% (Georgia). Dementia was increasingly assigned as underlying cause of death in Western Europe, but rarely in eastern European countries. Ill-defined causes accounted for between < 1% and 53% of all cardiovascular deaths. CHD mortality rates were closely linked to a countries’ proportion of cardiovascular deaths assigned to CHD (R2 = 0.95 for 2000 and 0.99 for 2013). We show that CHD mortality is considerably influenced by national particularities in certifying death. Changes in CHD mortality rates reflect changes in certifying competing underlying causes of death. This must be accounted for when discussing reasons for the CHD mortality decline.
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Affiliation(s)
- Susanne Stolpe
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany. .,Institute for Technical Chemistry, Leibniz-University Hannover, Hannover, Germany.
| | - Bernd Kowall
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany.,Department of Epidemiology, School of Public Health, Boston University, Boston, USA
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Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Atherosclerosis 2020; 290:140-205. [PMID: 31504418 DOI: 10.1016/j.atherosclerosis.2019.08.014] [Citation(s) in RCA: 585] [Impact Index Per Article: 146.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41:111-188. [PMID: 31504418 DOI: 10.1093/eurheartj/ehz455] [Citation(s) in RCA: 4490] [Impact Index Per Article: 1122.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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14
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Ogata S, Nishimura K, Guzman-Castillo M, Sumita Y, Nakai M, Nakao YM, Nishi N, Noguchi T, Sekikawa A, Saito Y, Watanabe T, Kobayashi Y, Okamura T, Ogawa H, Yasuda S, Miyamoto Y, Capewell S, O'Flaherty M. Explaining the decline in coronary heart disease mortality rates in Japan: Contributions of changes in risk factors and evidence-based treatments between 1980 and 2012. Int J Cardiol 2019; 291:183-188. [DOI: 10.1016/j.ijcard.2019.02.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/14/2018] [Accepted: 02/12/2019] [Indexed: 11/16/2022]
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15
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Statins for the Primary Prevention of Coronary Heart Disease. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4870350. [PMID: 30834266 PMCID: PMC6374814 DOI: 10.1155/2019/4870350] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 11/06/2018] [Accepted: 12/03/2018] [Indexed: 11/17/2022]
Abstract
Object The purpose of this study was to fully assess the role of statins in the primary prevention of coronary heart disease (CHD). Methods We searched six databases (PubMed, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and Chinese Scientific Journal Database) to identify relevant randomized controlled trials (RCTs) from inception to 31 October 2017. Two review authors independently assessed the methodological quality and analysed the data using Rev Man 5.3 software. Risk ratios and 95% confidence intervals (95% CI) were pooled using fixed/random-effects models. Funnel plots and Begg's test were conducted to assess publication bias. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Sixteen RCTs with 69159 participants were included in this review. Statins can effectively decrease the occurrence of angina (RR=0.70, 95% CI: 0.58~0.85, I2 =0%), nonfatal myocardial infarction (MI) (RR=0.60, 95% CI: 0.51~0.69, I2 =14%), fatal MI (RR=0.49, 95% CI: 0.24~0.98, I2 =0%), any MI (RR=0.53, 95% CI: 0.42~0.67, I2 =0%), any coronary heart events (RR=0.73, 95% CI: 0.68~0.78, I2=0%), coronary revascularization (RR=0.66, 95% CI: 0.55~0.78, I2 = 0%), and any cardiovascular events (RR=0.77, 95% CI: 0.72~82, I2 = 0%). However, based on the current evidence, there were no significant differences in CHD deaths (RR=0.82, 95% CI: 0.66~1.02, I2=0%) and all-cause mortality (RR=0.88, 95% CI: 0.76 ~1.01, I2 =58%) between the two groups. Additionally, statins were more likely to result in diabetes (RR=1.21, 95% CI: 1.05~1.39, I2 =0%). There was no evidence of publication biases, and the quality of the evidence was considered moderate. Conclusion Statins seemed to be beneficial for the primary prevention of CHDs but have no effect on CHD death and all-cause mortality.
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Abreu D, Pinto FJ, Matias-Dias C, Sousa P. Trends of case-fatality rate by acute coronary syndrome in Portugal: Impact of a fast track to the coronary unit. JRSM Cardiovasc Dis 2019; 8:2048004019851952. [PMID: 31205687 PMCID: PMC6537501 DOI: 10.1177/2048004019851952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/23/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Efforts were made to improve management of coronary disease as the fast-track system to the Coronary Unit. We aim to analyse case-fatality rates by acute coronary syndrome in Portugal from 2000 to 2016, mainly the impact of the fast-track system and the proportion of patients that activate the fast-track system. METHODS We analysed monthly acute coronary syndrome case-fatality before and after the implementation of the fast-track system in 2007. Impact of the system was assessed through regression models for interrupted time-series. We calculated annual proportion of fast-track system admissions. RESULTS After 2007 case-fatality by acute coronary syndrome decreased (β=-1.27, p-value < 0.01). The estimates obtained for ST Elevation Myocardial Infarction suggest a reduction of nearly 86 monthly deaths prevented after 2007. The highest percentage of patients admitted through the fast-track system was 35%. CONCLUSIONS Our results suggest fast-track system may have contributed to a decline in acute coronary syndrome case-fatality. However, more than half of patients were not admitted through the system. This should encourage health authorities to make efforts to ensure compliance.
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Affiliation(s)
- D Abreu
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - FJ Pinto
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte – EPE, Centro, Académico Medicina de Lisboa, Lisboa, Portugal
- Centro Cardiovascular da Universidade de Lisboa, Lisboa, Portugal
| | - C Matias-Dias
- Department of Epidemiology of the Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | - P Sousa
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
- Centro de Investigação em Saúde Pública – ENSP-UNL, Lisboa, Portugal
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Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, Bart van der Worp H, van Dis I, Verschuren WMM. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis 2018; 252:207-274. [PMID: 27664503 DOI: 10.1016/j.atherosclerosis.2016.05.037] [Citation(s) in RCA: 348] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Ugo Corrà
- Societie: European Society of Cardiology (ESC)
| | | | | | - Ian Graham
- Societie: European Society of Cardiology (ESC)
| | | | | | | | | | | | - Joep Perk
- Societie: European Society of Cardiology (ESC)
| | | | - Josep Redon
- Societie: European Society of Hypertension (ESH)
| | | | - Naveed Sattar
- Societie: European Association for the Study of Diabetes (EASD)
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Andrade N, Alves E, Costa AR, Moura-Ferreira P, Azevedo A, Lunet N. Knowledge about cardiovascular disease in Portugal. Rev Port Cardiol 2018; 37:669-677. [DOI: 10.1016/j.repc.2017.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/08/2017] [Indexed: 10/28/2022] Open
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Alves E, Costa AR, Moura-Ferreira P, Azevedo A, Lunet N. Health-related knowledge on hypertension among the Portuguese population: results from a population-based survey. Blood Press 2018; 27:194-199. [PMID: 29366359 DOI: 10.1080/08037051.2018.1430503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Adequate knowledge on hypertension has been shown to improve awareness, adherence to treatment and control of the disease. We aimed to estimate the health-related knowledge about hypertension among the Portuguese population. MATERIALS AND METHODS A representative sample of Portuguese-speaking dwellers in mainland Portugal (n = 1624), aged 16 to 79 years, was evaluated through face-to-face interviews conducted using a structured questionnaire. Health literacy was evaluated using the instrument Newest Vital Sign. RESULTS The mean prevalence of hypertension in the Portuguese population estimated by the participants in this study was 45.4%. Salt intake and poor diet were reported as main causes of hypertension by 27.5% and 21.5% of the participants, respectively, whereas more than 85% acknowledged myocardial infarction and stroke as its main consequences. However, 31.2% of the participants were not able to identify a cause for high blood pressure, especially the older and those with worse scores for health literacy. The accurate interpretation of blood pressure values diminished with the increase of systolic and diastolic blood pressure figures provided as examples for interpretation, from approximately 80% for 95/60 mmHg to 50% for 180/100 mmHg. Women and participants with greater levels of education or a previous diagnosis of hypertension tended to interpret blood pressure values correctly more often. CONCLUSIONS This study provided a quantitative estimate of the gaps in health-related knowledge about hypertension among the general population. Understanding the barriers that hinder the achievement of health-related knowledge on hypertension is expected to contribute for the global improvement of prevention and management of hypertension.
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Affiliation(s)
- Elisabete Alves
- a EPIUnit - Instituto de Saúde Pública , Universidade do Porto , Porto , Portugal
- b Departamento de Ciências da Saúde Pública e Forenses e Educação Médica , Faculdade de Medicina, Universidade do Porto , Portugal
| | - Ana Rute Costa
- a EPIUnit - Instituto de Saúde Pública , Universidade do Porto , Porto , Portugal
| | | | - Ana Azevedo
- a EPIUnit - Instituto de Saúde Pública , Universidade do Porto , Porto , Portugal
- b Departamento de Ciências da Saúde Pública e Forenses e Educação Médica , Faculdade de Medicina, Universidade do Porto , Portugal
| | - Nuno Lunet
- a EPIUnit - Instituto de Saúde Pública , Universidade do Porto , Porto , Portugal
- b Departamento de Ciências da Saúde Pública e Forenses e Educação Médica , Faculdade de Medicina, Universidade do Porto , Portugal
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Knowledge about cardiovascular disease in Portugal. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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21
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Yu W, Shi R, Li J, Lan Y, Li Q, Hu S. Need for hyperlipidemia management policy reform in China: learning from the global experience. Curr Med Res Opin 2018; 34:197-207. [PMID: 28696793 DOI: 10.1080/03007995.2017.1354833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the hyperlipidemia prevention programs and policies in different countries and highlight the need of reforming the hyperlipidemia prevention policies in China to lower the growing cardiovascular disease (CVD) risk. RESEARCH DESIGN AND METHODS PubMed, Google Scholar and Cochrane were searched for global hyperlipidemia prevention policies. Government-funded policies pertaining to lipid management were considered for this review. Only those studies that evaluated the success of prevention policies on the basis of: (i) achievement of hyperlipidemia targets; (ii) improvement in Cardiovascular (CV) risk reduction; and (iii) outcomes with reduction in hyperlipidemia after implementation of the policy, were included. RESULTS Several global policies and programs aimed to improve CV health by highlighting lipid profile management. Implementation of the global and national policies led to improvement in cholesterol related outcomes such as availability of diagnostic measures, awareness of the risk factors, decrease in cholesterol levels, achieving healthy lifestyle to prevent CVD and improvement in availability of hypolipidemic medications, etc. Statins have been covered under reimbursement policies in many countries to improve usage and thereby preventing incidence of stroke and CVD. We observed a need for introducing new programs in China as the ongoing hyperlipidemia management policies are inadequate. The World Bank Report 2016 recommended that prevention policies in China be modeled on the US Million Hearts program. CONCLUSIONS New hyperlipidemia prevention policies must set a time-bound target, and need to be patient and clinician centric in terms of applications, and revised periodically for long-term benefits.
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Affiliation(s)
- Wei Yu
- a Department of Medical Affairs , Pfizer , Beijing , China
| | - Ruizhi Shi
- a Department of Medical Affairs , Pfizer , Beijing , China
| | - Jim Li
- b Department of Medical Affairs , Pfizer Inc. , San Diego , CA , USA
| | - Yong Lan
- a Department of Medical Affairs , Pfizer , Beijing , China
| | - Qian Li
- a Department of Medical Affairs , Pfizer , Beijing , China
| | - Shanlian Hu
- c Shanghai Health Development Research Center , Fudan University , Shanghai , China
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Araújo C, Pereira M, Laszczyńska O, Dias P, Azevedo A. Sex-related inequalities in management of patients with acute coronary syndrome-results from the EURHOBOP study. Int J Clin Pract 2018; 72. [PMID: 29271543 DOI: 10.1111/ijcp.13049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 11/29/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Real-world data from different levels of hospital specialisation would help to understand if differences in management between women and men with acute coronary syndrome (ACS) are still a priority target. We aimed to identify sex inequalities in management of patients with different types of ACS. METHODS We analysed 1757 patients with a non-ST-elevation ACS (NSTEACS) and 1184 with ST elevation myocardial infarction (STEMI) or left bundle branch block (non-classifiable (NC) ACS (STEMI/NC ACS group), consecutively discharged from ten Portuguese hospitals with different specialisation levels, between 2008 and 2010. We estimated odds ratios (OR) and 95% confidence intervals (95% CI) for the association between sex and the performance of coronary angiography, reperfusion and revascularisation. RESULTS Among STEMI/NC ACS, men had higher probability of performing coronary angiography than women (adjusted OR = 1.64, 95% CI: 1.11-2.44), while among NSTEACS patients there was no significant difference by sex (adjusted OR = 1.26, 95% CI: 0.99-1.62). In patients who underwent coronary angiography, there was no difference in proportion of women and men submitted to revascularisation, regardless of the ACS type. Although men with STEMI/NC ACS were more likely to undergo reperfusion (crude OR = 2.17, 95% CI: 1.68-2.81), the effect became not significant after multivariable adjustment (adjusted OR = 1.33, 95% CI: 0.96-1.84). CONCLUSION Women diagnosed with STEMI/NC, but not NSTEACS, had lower probability when compared with men to be submitted to coronary angiography. There was no difference in performance of reperfusion and revascularisation by sex.
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Affiliation(s)
- Carla Araújo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Serviço de Cardiologia, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Hospital de São Pedro, Vila Real, Portugal
| | - Marta Pereira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Olga Laszczyńska
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Paula Dias
- Serviço de Cardiologia, Centro Hospitalar São João, EPE, Porto, Portugal
| | - Ana Azevedo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Myftiu S, Sulo E, Burazeri G, Daka B, Sharka I, Shkoza A, Sulo G. Clinical Profile and Management of Patients with Incident and Recurrent Acute Myocardial Infarction in Albania - a Call for More Focus on Prevention Strategies. Zdr Varst 2017; 56:236-243. [PMID: 29062398 PMCID: PMC5639813 DOI: 10.1515/sjph-2017-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 08/07/2017] [Indexed: 11/15/2022] Open
Abstract
Background The clinical profile of acute myocardial infarction (AMI) patients reflects the burden of risk factors in the general population. Differences between incident (first) and recurrent (repeated) events and their impact on treatment are poorly described. We studied potential differences in the clinical profile and in-hospital treatment between patients hospitalised with an incident and recurrent AMI. Methods A total of 324 patients admitted in the Coronary Care Unit of ‘Mother Teresa’ hospital, Tirana, Albania (2013-2014), were included in the study. Information on AMI type, complications and risk factors was obtained from patient’s medical file. Logistic regression analyses were used to explore differences between the incident and recurrent AMIs regarding clinical profile and in-hospital treatment. Results Of all patients, 50 (15.4%) had a prior AMI. Compared to incident cases, recurrent cases were older (P=0.01), more often women (P=0.01), less educated (P=0.01), and smoked less (P=0.03). Recurrent cases experienced more often heart failure (HF) (OR=2.48; 95% CI: 1.31–4.70), impaired left ventricular ejection fraction (OR=1.97; 95% CI:1.05–3.71), and multivessel disease (OR=6.32; 95% CI: 1.43–28.03) than incident cases. In-hospital use of beta-blockers was less frequent among recurrent compared to incident cases (OR=0.45; 95% CI: 0.24–0.85), while no statistically significant differences between groups were observed regarding angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, statin, aspirin or invasive procedures. Conclusion A more severe clinical expression of the disease and underutilisation of treatment among recurrent AMIs are likely to explain their poorer prognosis compared to incident AMIs.
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Affiliation(s)
- Sokol Myftiu
- Department of Cardiology, University Hospital "Mother Teresa", Tirana, Albania
| | - Enxhela Sulo
- University of Bergen, Faculty of Medicine and Dentistry, Department of Global Public Health and Primary Care, Kalfarveien31, Bergen 5018, Norway
| | - Genc Burazeri
- Maastricht University, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care, Department of International Health, MaastrichtThe Netherlands
| | - Bledar Daka
- University of Gothenburg, Department of Public Health and Community Medicine, Gothenburg, Sweden
| | - Ilir Sharka
- Department of Cardiology, University Hospital "Mother Teresa", Tirana, Albania
| | - Artan Shkoza
- University of Medicine, Faculty of Medicine, Tirana, Albania
| | - Gerhard Sulo
- University of Bergen, Faculty of Medicine and Dentistry, Department of Global Public Health and Primary Care, Kalfarveien31, Bergen 5018, Norway
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Lobo MF, Azzone V, Azevedo LF, Melica B, Freitas A, Bacelar-Nicolau L, Rocha-Gonçalves FN, Nisa C, Teixeira-Pinto A, Pereira-Miguel J, Resnic FS, Costa-Pereira A, Normand SL. A comparison of in-hospital acute myocardial infarction management between Portugal and the United States: 2000-2010. Int J Qual Health Care 2017; 29:669-678. [PMID: 28992151 DOI: 10.1093/intqhc/mzx092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 07/04/2017] [Indexed: 12/26/2022] Open
Abstract
Objective To compare healthcare in acute myocardial infarction (AMI) treatment between contrasting health systems using comparable representative data from Europe and USA. Design Repeated cross-sectional retrospective cohort study. Setting Acute care hospitals in Portugal and USA during 2000-2010. Participants Adults discharged with AMI. Interventions Coronary revascularizations procedures (percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery). Main Outcome Measures In-hospital mortality and length of stay. Results We identified 1 566 601 AMI hospitalizations. Relative to the USA, more hospitalizations in Portugal presented with elevated ST-segment, and fewer had documented comorbidities. Age-sex-adjusted AMI hospitalization rates decreased in USA but increased in Portugal. Crude procedure rates were generally lower in Portugal (PCI: 44% vs. 47%; CABG: 2% vs. 9%, 2010) but only CABG rates differed significantly after standardization. PCI use increased annually in both countries but CABG decreased only in the USA (USA: 0.95 [0.94, 0.95], Portugal: 1.04 [1.02, 1.07], odds ratios). Both countries observed annual decreases in risk-adjusted mortality (USA: 0.97 [0.965, 0.969]; Portugal: 0.99 [0.979, 0.991], hazard ratios). While between-hospital variability in procedure use was larger in USA, the risk of dying in a high relative to a low mortality hospital (hospitals in percentiles 95 and 5) was 2.65 in Portugal when in USA was only 1.03. Conclusions Although in-hospital mortality due to an AMI improved in both countries, patient management in USA seems more effective and alarming disparities in quality of care across hospitals are more likely to exist in Portugal.
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Affiliation(s)
- Mariana F Lobo
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal
| | - Vanessa Azzone
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
| | - Luís Filipe Azevedo
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal
| | - Bruno Melica
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal.,Serviço de Cardiologia, Unidade de Diagnóstico e Intervenção Cardiovascular, Centro Hospitalar de Vila Nova de Gaia e Espinho, R. Conceição Fernandes 1079, Vila Nova de Gaia Portugal
| | - Alberto Freitas
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal
| | - Leonor Bacelar-Nicolau
- Institute of Preventive Medicine and Public Health and ISAMB - Institute of Environmental Health, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisbon, Portugal
| | - Francisco N Rocha-Gonçalves
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal.,Portuguese Institute of Oncology Porto, R. Dr. António Bernardino de Almeida 62, 4200-162 Porto, Portugal
| | - Cláudia Nisa
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal
| | - Armando Teixeira-Pinto
- School of Public Health, Faculty of Medicine, Edward Ford Building (A27), The University of Sidney, NSW 2006, Australia
| | - José Pereira-Miguel
- Institute of Preventive Medicine and Public Health and ISAMB - Institute of Environmental Health, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisbon, Portugal
| | - Frederic S Resnic
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA.,Tufts University School of Medicine, Boston, MA 02111, USA
| | - Altamiro Costa-Pereira
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal
| | - Sharon-Lise Normand
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.,Department of Biostatistics, Havard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
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Lobo MF, Azzone V, Resnic FS, Melica B, Teixeira-Pinto A, Azevedo LF, Freitas A, Nisa C, Bacelar-Nicolau L, Rocha-Gonçalves FN, Pereira-Miguel J, Costa-Pereira A, Normand SL. The Atlantic divide in coronary heart disease: Epidemiology and patient care in the US and Portugal. Rev Port Cardiol 2017; 36:583-593. [PMID: 28886892 DOI: 10.1016/j.repc.2016.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/04/2016] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES We aimed to compare access to new health technologies to treat coronary heart disease (CHD) in the health systems of Portugal and the US, characterizing the needs of the populations and the resources available. METHODS We reviewed data for 2000 and 2010 on epidemiologic profiles of CHD and on health care available to patients. Thirty health technologies (16 medical devices and 14 drugs) introduced during the period 1980-2015 were identified by interventional cardiologists. Approval and marketing dates were compared between countries. RESULTS Relative to the US, Portugal has lower risk profiles and less than half the hospitalizations per capita, but fewer centers per capita provide catheterization and cardiothoracic surgery services. More than 70% of drugs were available sooner in the US, whereas 12 out of 16 medical devices were approved earlier in Portugal. Nevertheless, at least five of these devices were adopted first or diffused faster in the US. Mortality due to CHD and myocardial infarction (MI) was lower in Portugal (CHD: 72.8 vs. 168 and MI: 48.7 vs. 54.1 in Portugal and the US, respectively; age- and gender-adjusted deaths per 100000 population, 2010); but only CHD deaths exhibited a statistically significant difference between the countries. CONCLUSIONS Differences in regulatory mechanisms and price regulations have a significant impact on the types of health technologies available in the two countries. However, other factors may influence their adoption and diffusion, and this appears to have a greater impact on mortality, due to acute conditions.
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Affiliation(s)
- Mariana F Lobo
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Vanessa Azzone
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Frederic S Resnic
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington and Tufts University School of Medicine, Boston, MA, United States
| | - Bruno Melica
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Serviço de Cardiologia, Unidade de Diagnóstico e Intervenção Cardiovascular, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Armando Teixeira-Pinto
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Luís Filipe Azevedo
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alberto Freitas
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cláudia Nisa
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Leonor Bacelar-Nicolau
- Institute of Preventive Medicine and Public Health and ISAMB - Institute of Environmental Health, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Francisco Nuno Rocha-Gonçalves
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Portuguese Institute of Oncology Porto (IPO-Porto), Porto, Portugal
| | - José Pereira-Miguel
- Institute of Preventive Medicine and Public Health and ISAMB - Institute of Environmental Health, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Altamiro Costa-Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sharon-Lise Normand
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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The Atlantic divide in coronary heart disease: Epidemiology and patient care in the US and Portugal. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Royo-Bordonada MÁ, Armario P, Lobos Bejarano JM, Pedro-Botet J, Villar Álvarez F, Elosua R, Brotons Cuixart C, Cortés O, Serrano B, Camafort Babkowski M, Gil Núñez A, Pérez A, Maiques A, de Santiago Nocito A, de Castro A, Alegría E, Baeza C, Herranz M, Sans S, Campos P. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. Semergen 2017; 43:295-311. [PMID: 28532894 DOI: 10.1016/j.semerg.2016.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/05/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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Affiliation(s)
| | - Pedro Armario
- Sociedad Española de Hipertensión-Liga Española de la Lucha Contra la HTA
| | | | | | | | | | | | - Olga Cortés
- Asociación Española de Pediatría de Atención Primaria
| | | | | | | | | | | | | | | | | | - Ciro Baeza
- Sociedad Española de Angiología y Cirugía Vascular
| | - María Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria
| | - Susana Sans
- Sociedad Española de Salud Pública y Administración Sanitaria
| | - Pilar Campos
- Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, España
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Disability-adjusted life years lost due to ischemic heart disease in mainland Portugal, 2013. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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29
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Henriques A, Araújo C, Viana M, Laszczynska O, Pereira M, Bennett K, Lunet N, Azevedo A. Disability-adjusted life years lost due to ischemic heart disease in mainland Portugal, 2013. Rev Port Cardiol 2017; 36:273-281. [PMID: 28318855 DOI: 10.1016/j.repc.2016.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/02/2016] [Accepted: 08/05/2016] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Estimates of the burden of ischemic heart disease (IHD), including geographic differences, should support health policy decisions. We set out to estimate the burden of IHD in mainland Portugal in 2013 by calculating disability-adjusted life years (DALYs) and to compare this burden between five regions. METHODS Years of life lost (YLLs) were calculated by multiplying the number of IHD deaths in 2013 (Statistics Portugal) by the life expectancy at the age at which death occurred. Years lived with disability (YLDs) were computed as the number of cases of acute coronary syndrome, stable angina and ischemic heart failure multiplied by an average disability weight. Crude and age-standardized DALYs (direct method, Standard European Population) were calculated for mainland Portugal and for the Northern, Central, Lisbon, Alentejo and Algarve regions. RESULTS In 2013, 95413 DALYs were lost in mainland Portugal due to IHD. YLLs accounted for 88.3% of the disease burden. Age-standardized DALY rates per 1000 population were higher in men than in women, across the entire country (8.9 in men; 3.4 in women) and within each region, ranging from 7.3 in the Northern and Central regions to 11.8 in the Algarve in men, and from 2.6 in the Northern region to 4.6 in Lisbon in women. CONCLUSIONS Nearly 100000 DALYs were lost to IHD in Portugal, mostly through early mortality. This study enables accurate comparisons with other countries and between regions; however, it highlights the need for population-based studies to obtain specific data on morbidity.
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Affiliation(s)
- Ana Henriques
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
| | - Carla Araújo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Department of Cardiology, Centro Hospitalar Trás-os-Montes-e-Alto-Douro, Vila Real, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Marta Viana
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Olga Laszczynska
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Marta Pereira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Kathleen Bennett
- Population Health Sciences Division, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Ana Azevedo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
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30
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2016 European Guidelines on cardiovascular disease prevention in clinical practice. Int J Behav Med 2017; 24:321-419. [DOI: 10.1007/s12529-016-9583-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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31
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Royo-Bordonada MÁ, Armario P, Lobos Bejarano JM, Pedro-Botet J, Villar Álvarez F, Elosua R, Brotons Cuixart C, Cortés O, Serrano B, Camafort Babkowski M, Gil Núñez A, Pérez A, Maiques A, de Santiago Nocito A, de Castro A, Alegría E, Baeza C, Herranz M, Sans S, Campos P. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. GACETA SANITARIA 2017; 31:255-268. [PMID: 28292529 DOI: 10.1016/j.gaceta.2016.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/24/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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Affiliation(s)
| | - Pedro Armario
- Sociedad Española de Hipertensión-Liga Española de la Lucha Contra la HTA
| | | | | | | | | | | | - Olga Cortés
- Asociación Española de Pediatría de Atención Primaria
| | | | | | | | | | | | | | | | | | - Ciro Baeza
- Sociedad Española de Angiología y Cirugía Vascular
| | - María Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria
| | - Susana Sans
- Sociedad Española de Salud Pública y Administración Sanitaria
| | - Pilar Campos
- Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, España
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32
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Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2017; 29:69-85. [PMID: 28173956 DOI: 10.1016/j.arteri.2016.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/18/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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33
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Mensah GA, Wei GS, Sorlie PD, Fine LJ, Rosenberg Y, Kaufmann PG, Mussolino ME, Hsu LL, Addou E, Engelgau MM, Gordon D. Decline in Cardiovascular Mortality: Possible Causes and Implications. Circ Res 2017; 120:366-380. [PMID: 28104770 PMCID: PMC5268076 DOI: 10.1161/circresaha.116.309115] [Citation(s) in RCA: 504] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/23/2016] [Accepted: 12/23/2016] [Indexed: 02/06/2023]
Abstract
If the control of infectious diseases was the public health success story of the first half of the 20th century, then the decline in mortality from coronary heart disease and stroke has been the success story of the century's past 4 decades. The early phase of this decline in coronary heart disease and stroke was unexpected and controversial when first reported in the mid-1970s, having followed 60 years of gradual increase as the US population aged. However, in 1978, the participants in a conference convened by the National Heart, Lung, and Blood Institute concluded that a significant recent downtick in coronary heart disease and stroke mortality rates had definitely occurred, at least in the US Since 1978, a sharp decline in mortality rates from coronary heart disease and stroke has become unmistakable throughout the industrialized world, with age-adjusted mortality rates having declined to about one third of their 1960s baseline by 2000. Models have shown that this remarkable decline has been fueled by rapid progress in both prevention and treatment, including precipitous declines in cigarette smoking, improvements in hypertension treatment and control, widespread use of statins to lower circulating cholesterol levels, and the development and timely use of thrombolysis and stents in acute coronary syndrome to limit or prevent infarction. However, despite the huge growth in knowledge and advances in prevention and treatment, there remain many questions about this decline. In fact, there is evidence that the rate of decline may have abated and may even be showing early signs of reversal in some population groups. The National Heart, Lung, and Blood Institute, through a request for information, is soliciting input that could inform a follow-up conference on or near the 40th anniversary of the original landmark conference to further explore these trends in cardiovascular mortality in the context of what has come before and what may lie ahead.
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Affiliation(s)
- George A Mensah
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD.
| | - Gina S Wei
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Paul D Sorlie
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Lawrence J Fine
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Yves Rosenberg
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Peter G Kaufmann
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Michael E Mussolino
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Lucy L Hsu
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Ebyan Addou
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Michael M Engelgau
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - David Gordon
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
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Royo-Bordonada MÁ, Armario P, Lobos Bejarano JM, Pedro-Botet J, Villar Alvarez F, Elosua R, Brotons Cuixart C, Cortés O, Serrano B, Cammafort Babkowski M, Gil Núñez A, Pérez A, Maiques A, de Santiago Nocito A, Castro A, Alegría E, Baeza C, Herranz M, Sans S, Campos P. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. HIPERTENSION Y RIESGO VASCULAR 2016; 34:24-40. [PMID: 28017552 DOI: 10.1016/j.hipert.2016.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/21/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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Affiliation(s)
- M Á Royo-Bordonada
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España.
| | - P Armario
- Sociedad Española de Hipertensión-Liga Española de la Lucha Contra la HTA
| | | | | | | | - R Elosua
- Sociedad Española de Epidemiología
| | | | - O Cortés
- Asociación Española de Pediatría de Atención Primaria
| | - B Serrano
- Sociedad Española de Medicina y Seguridad en el Trabajo
| | | | | | - A Pérez
- Sociedad Española de Diabetes
| | - A Maiques
- Sociedad Española de Medicina de Familia y Comunitaria
| | | | - A Castro
- Sociedad Española de Cardiología
| | | | - C Baeza
- Sociedad Española de Angiología y Cirugía Vascular
| | - M Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria
| | - S Sans
- Sociedad Española de Salud Pública y Administración Sanitaria
| | - P Campos
- Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, España
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35
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Regional variation in coronary heart disease mortality trends in Portugal, 1981–2012. Int J Cardiol 2016; 224:279-285. [DOI: 10.1016/j.ijcard.2016.09.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/07/2016] [Accepted: 09/15/2016] [Indexed: 11/19/2022]
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36
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Koopman C, Vaartjes I, van Dis I, Verschuren WMM, Engelfriet P, Heintjes EM, Blokstra A, Deeg DJH, Visser M, Bots ML, O’Flaherty M, Capewell S. Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007. PLoS One 2016; 11:e0166139. [PMID: 27906998 PMCID: PMC5132334 DOI: 10.1371/journal.pone.0166139] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/23/2016] [Indexed: 11/22/2022] Open
Abstract
Objective We set out to determine what proportion of the mortality decline from 1997 to 2007 in coronary heart disease (CHD) in the Netherlands could be attributed to advances in medical treatment and to improvements in population-wide cardiovascular risk factors. Methods We used the IMPACT-SEC model. Nationwide information was obtained on changes between 1997 and 2007 in the use of 42 treatments and in cardiovascular risk factor levels in adults, aged 25 or over. The primary outcome was the number of CHD deaths prevented or postponed. Results The age-standardized CHD mortality fell by 48% from 269 to 141 per 100.000, with remarkably similar relative declines across socioeconomic groups. This resulted in 11,200 fewer CHD deaths in 2007 than expected. The model was able to explain 72% of the mortality decline. Approximately 37% (95% CI: 10%-80%) of the decline was attributable to changes in acute phase and secondary prevention treatments: the largest contributions came from treating patients in the community with heart failure (11%) or chronic angina (9%). Approximately 36% (24%-67%) was attributable to decreases in risk factors: blood pressure (30%), total cholesterol levels (10%), smoking (5%) and physical inactivity (1%). Ten% more deaths could have been prevented if body mass index and diabetes would not have increased. Overall, these findings did not vary across socioeconomic groups, although within socioeconomic groups the contribution of risk factors differed. Conclusion CHD mortality has recently halved in The Netherlands. Equally large contributions have come from the increased use of acute and secondary prevention treatments and from improvements in population risk factors (including primary prevention treatments). Increases in obesity and diabetes represent a major challenge for future prevention policies.
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Affiliation(s)
- Carla Koopman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Dutch Heart Foundation, The Hague, the Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Dutch Heart Foundation, The Hague, the Netherlands
- * E-mail:
| | | | - W. M. Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Peter Engelfriet
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | - Anneke Blokstra
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Dorly J. H. Deeg
- EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - Marjolein Visser
- EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
- Department of Health Sciences, VU University, Amsterdam, The Netherlands
- Department of Dietetics and Nutrition Sciences, Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin O’Flaherty
- Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, Liverpool, United Kingdom
| | - Simon Capewell
- Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, Liverpool, United Kingdom
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Gabet A, Chatignoux E, Ducimetière P, Danchin N, Olié V. Differential trends in myocardial infarction mortality over 1975–2010 in France according to gender: An age-period-cohort analysis. Int J Cardiol 2016; 223:660-664. [PMID: 27567235 DOI: 10.1016/j.ijcard.2016.07.194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/28/2016] [Indexed: 11/15/2022]
Affiliation(s)
- A Gabet
- Department of Chronic Diseases and Injuries, The French Public Health Agency, Saint Maurice, France.
| | - E Chatignoux
- Department of Chronic Diseases and Injuries, The French Public Health Agency, Saint Maurice, France
| | | | - N Danchin
- Department of Cardiology, European Georges-Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Paris-Descartes University, Paris, France
| | - V Olié
- Department of Chronic Diseases and Injuries, The French Public Health Agency, Saint Maurice, France
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Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WMM, Vlachopoulos C, Wood DA, Zamorano JL, Cooney MT. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 2016; 37:2999-3058. [PMID: 27567407 DOI: 10.1093/eurheartj/ehw272] [Citation(s) in RCA: 1912] [Impact Index Per Article: 239.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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39
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Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WM, Vlachopoulos C, Wood DA, Zamorano JL. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Atherosclerosis 2016; 253:281-344. [DOI: 10.1016/j.atherosclerosis.2016.08.018] [Citation(s) in RCA: 558] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WMM. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37:2315-2381. [PMID: 27222591 PMCID: PMC4986030 DOI: 10.1093/eurheartj/ehw106] [Citation(s) in RCA: 4519] [Impact Index Per Article: 564.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Massimo F. Piepoli
- Corresponding authors: Massimo F. Piepoli, Heart Failure Unit, Cardiology Department, Polichirurgico Hospital G. Da Saliceto, Cantone Del Cristo, 29121 Piacenza, Emilia Romagna, Italy, Tel: +39 0523 30 32 17, Fax: +39 0523 30 32 20, E-mail: ,
| | - Arno W. Hoes
- Arno W. Hoes, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500 (HP Str. 6.131), 3508 GA Utrecht, The Netherlands, Tel: +31 88 756 8193, Fax: +31 88 756 8099, E-mail:
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Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WMM, De Backer G, Roffi M, Aboyans V, Bachl N, Bueno H, Carerj S, Cho L, Cox J, De Sutter J, Egidi G, Fisher M, Fitzsimons D, Franco OH, Guenoun M, Jennings C, Jug B, Kirchhof P, Kotseva K, Lip GYH, Mach F, Mancia G, Bermudo FM, Mezzani A, Niessner A, Ponikowski P, Rauch B, Rydén L, Stauder A, Turc G, Wiklund O, Windecker S, Zamorano JL. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prev Cardiol 2016; 23:NP1-NP96. [PMID: 27353126 DOI: 10.1177/2047487316653709] [Citation(s) in RCA: 579] [Impact Index Per Article: 72.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Ugo Corrà
- Societies: European Society of Cardiology (ESC)
| | | | | | - Ian Graham
- Societies: European Society of Cardiology (ESC)
| | | | | | | | | | | | - Joep Perk
- Societies: European Society of Cardiology (ESC)
| | | | | | | | - Naveed Sattar
- European Association for the Study of Diabetes (EASD)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Leslie Cho
- Societies: European Society of Cardiology (ESC)
| | | | | | | | - Miles Fisher
- European Association for the Study of Diabetes (EASD)
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- Societies: European Society of Cardiology (ESC)
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Case management does not decrease mortality of patients with myocardial infarction or unstable angina: Evidence from a systematic review. Int J Nurs Sci 2016. [DOI: 10.1016/j.ijnss.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Jousilahti P, Laatikainen T, Peltonen M, Borodulin K, Männistö S, Jula A, Salomaa V, Harald K, Puska P, Vartiainen E. Primary prevention and risk factor reduction in coronary heart disease mortality among working aged men and women in eastern Finland over 40 years: population based observational study. BMJ 2016; 352:i721. [PMID: 26932978 PMCID: PMC4772739 DOI: 10.1136/bmj.i721] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To estimate how much changes in the main risk factors of cardiovascular disease (smoking prevalence, serum cholesterol, and systolic blood pressure) can explain the reduction in coronary heart disease mortality observed among working aged men and women in eastern Finland. DESIGN Population based observational study. SETTING Eastern Finland. PARTICIPANTS 34,525 men and women aged 30-59 years who participated in the national FINRISK studies between 1972 and 2012. INTERVENTIONS Change in main cardiovascular risk factors through population based primary prevention. MAIN OUTCOME MEASURES Predicted and observed age standardised mortality due to coronary heart disease. Predicted change was estimated with a logistic regression model using risk factor data collected in nine consecutive, population based, risk factor surveys conducted every five years since 1972. Data on observed mortality were obtained from the National Causes of Death Register. RESULTS During the 40 year study period, levels of the three major cardiovascular risk factors decreased except for a small increase in serum cholesterol levels between 2007 and 2012. From years 1969-1972 to 2012, coronary heart disease mortality decreased by 82% (from 643 to 118 deaths per 100,000 people) and 84% (114 to 17) among men and women aged 35-64 years, respectively. During the first 10 years of the study, changes in these three target risk factors contributed to nearly all of the observed mortality reduction. Since the mid-1980s, the observed reduction in mortality has been larger than predicted. In the last 10 years of the study, about two thirds (69% in men and 66% in women) of the reduction could be explained by changes in the three main risk factors, and the remaining third by other factors. CONCLUSION Reductions in disease burden and mortality due to coronary heart disease can be achieved through the use of population based primary prevention programmes. Secondary prevention among high risk individuals and treatment of acute events of coronary heart disease could confer additional benefit.
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Affiliation(s)
- Pekka Jousilahti
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Tiina Laatikainen
- University of Eastern Finland, Institute of Public Health and Clinical Nutrition, Kuopio, Finland
| | - Markku Peltonen
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Katja Borodulin
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Satu Männistö
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Antti Jula
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Veikko Salomaa
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Kennet Harald
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Pekka Puska
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Erkki Vartiainen
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
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Hansen KW, Sorensen R, Madsen M, Madsen JK, Jensen JS, von Kappelgaard LM, Mortensen PE, Lange T, Galatius S. Effectiveness of an early versus a conservative invasive treatment strategy in acute coronary syndromes: a nationwide cohort study. Ann Intern Med 2015; 163:737-46. [PMID: 26502223 DOI: 10.7326/m15-0303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Randomized clinical trials have found that early invasive strategies reduce mortality, myocardial infarction (MI), and rehospitalization compared with a conservative invasive approach in acute coronary syndromes (ACSs), but the effectiveness of such strategies in real-world settings is unknown. OBJECTIVE To investigate adverse cardiovascular outcomes of an early versus a conservative invasive strategy in a national cohort of patients with ACSs. DESIGN Retrospective cohort study. SETTING Administrative health care data on hospitalizations, procedures, and outcomes abstracted from the Danish national registries and covering all acute invasive procedures in patients presenting with an ACS. PATIENTS 19 704 propensity score-matched patients hospitalized with a first ACS between 1 January 2005 and 31 December 2011. MEASUREMENTS Risk for cardiac death or rehospitalization for MI within 60 days of hospitalization. RESULTS Compared with a conservative approach, early invasive strategies were associated with a lower risk for cardiac death (cumulative incidence, 5.9% vs. 7.6%; adjusted hazard ratio [HR], 0.75 [95% CI, 0.66 to 0.84]; P < 0.001). Similar results were found for rehospitalization for MI (cumulative incidence, 3.4% vs. 5.0%; adjusted odds ratio, 0.67 [CI, 0.58 to 0.77]; P < 0.001) and all-cause death (cumulative incidence, 7.3% vs. 10.6%; adjusted HR, 0.65 [CI, 0.59 to 0.72]; P < 0.001). LIMITATION Potential residual confounding due to lack of core clinical variables. CONCLUSION In this real-world cohort of patients with a first hospitalization for an ACS, the use of an early invasive treatment strategy was associated with a lower risk for cardiac death and rehospitalization for MI compared with a conservative invasive approach. PRIMARY FUNDING SOURCE Department of Cardiology, University Hospital Gentofte.
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Affiliation(s)
- Kim Wadt Hansen
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
| | - Rikke Sorensen
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
| | - Mette Madsen
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
| | - Jan Kyst Madsen
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
| | - Jan Skov Jensen
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
| | - Lene Mia von Kappelgaard
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
| | - Poul Erik Mortensen
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
| | - Theis Lange
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
| | - Soren Galatius
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
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